从全新的以患者为中心的角度评估患者的期望可预测膝关节置换手术的结果。
Evaluating Patients' Expectations From a Novel Patient-Centered Perspective Predicts Knee Arthroplasty Outcome.
机构信息
Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford UK.
Department of Translational Health Sciences, Bristol Medical School, University of Bristol, Musculoskeletal Research Unit, University of Bristol, School of Clinical Sciences, Bristol, UK; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK.
出版信息
J Arthroplasty. 2018 Jul;33(7):2146-2152.e4. doi: 10.1016/j.arth.2018.02.026. Epub 2018 Feb 15.
BACKGROUND
One-in-five patients are dissatisfied following knee arthroplasty and <50% have fulfilled expectations. The relationship between knee-arthroplasty expectations and surgical outcome remains unclear.
PURPOSE
Are expectations regarding the impact of pain on postoperative life predictive of one-year outcome? Does the impact of pain on preoperative quality of life (QOL) influence this relationship?
METHODS
Longitudinal cohort of 1044 uni-compartmental (43%) or total knee-arthroplasty (57%) (UKA or TKA) patients, aged mean 69 ± 9 years. Preoperatively, patients reported the impact of pain on QOL and expected impact of pain on life one-year post-arthroplasty. One-year postoperative outcomes: non-return to desired activity, surgical dissatisfaction, not achieving Oxford Knee Score minimal important change (OKS <MIC). Logistic regression including covariates was performed for all patients and subgroups (better vs worse pre-operative pain-related QOL; UKA vs TKA).
RESULTS
Expecting moderate-to-extreme pain (vs no pain) predicted non-return to activity (odds ratio [95% confidence interval], 2.3 [1.3, 4.1]), dissatisfaction (4.0 [1.7, 9.3]), OKS <MIC (3.1 [1.5, 6.3]). Expecting mild pain (vs no pain) predicted worse outcomes for patients with better preoperative pain-related QOL (non-return to activity: 2.7 [1.5, 4.8], OKS <MIC: 2.5 [1.1, 5.5]). Expecting moderate-to-extreme pain (vs. no pain) predicted worse outcomes for patients with worse preoperative pain-related QOL (non-return to activity: 2.4 [1.1, 5.5], dissatisfaction: 5.0 [1.7, 14.8], OKS <MIC: 3.4 [1.4, 8.6]). The odds of a poor outcome in people with worse expectations was higher for UKA patients.
CONCLUSIONS
Expecting a worse outcome predicted surgical dissatisfaction, less clinical improvement and non-return to desired activity. Patients expecting a more optimistic outcome relative to preoperative status achieved better surgical outcomes.
背景
五分之一的膝关节置换术后患者不满意，且<50%的患者达到了预期效果。膝关节置换术的预期效果与手术结果之间的关系尚不清楚。
目的
疼痛对术后生活的影响预期是否可预测一年的结果？疼痛对术前生活质量（QOL）的影响是否会影响这种关系？
方法
对 1044 例单侧（43%）或全膝关节置换术（57%）（UKA 或 TKA）患者的纵向队列进行研究，患者年龄平均为 69±9 岁。术前，患者报告了疼痛对 QOL 的影响以及术后一年生活中疼痛的预期影响。一年后的手术结果：无法恢复至期望的活动水平、手术不满意、未达到牛津膝关节评分最小重要变化（OKS<MIC）。对所有患者和亚组（术前疼痛相关 QOL 更好或更差；UKA 或 TKA）进行包括协变量的逻辑回归。
结果
预期中度至重度疼痛（而非无疼痛）预测无法恢复活动（优势比[95%置信区间]，2.3[1.3，4.1]）、不满意（4.0[1.7，9.3]）、OKS<MIC（3.1[1.5，6.3]）。预期轻度疼痛（而非无疼痛）预测术前疼痛相关 QOL 更好的患者结果更差（无法恢复活动：2.7[1.5，4.8]，OKS<MIC：2.5[1.1，5.5]）。预期中度至重度疼痛（而非无疼痛）预测术前疼痛相关 QOL 更差的患者结果更差（无法恢复活动：2.4[1.1，5.5]，不满意：5.0[1.7，14.8]，OKS<MIC：3.4[1.4，8.6]）。对于 UKA 患者，预期不佳的患者发生不良结局的可能性更高。
结论
预期手术结果不佳预测手术不满意、临床改善程度较低和无法恢复至期望活动水平。与术前状态相比，对手术结果持更乐观预期的患者获得了更好的手术结果。
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