等待全膝关节置换术患者的健康相关生活质量进展情况。
Progression of health-related quality of life of patients waiting for total knee arthroplasty.
作者信息
Ho Ki Wai, Pong Gerald, Poon Wai Chin, Chung Kwong Yin, Kwok Yan-Yan, Chiu Kwok Hing
机构信息
Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong.
Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Shatin, Hong Kong.
出版信息
J Eval Clin Pract. 2021 Feb;27(1):69-74. doi: 10.1111/jep.13388. Epub 2020 Mar 22.
BACKGROUND
Total knee arthroplasty (TKA) remains the surgical gold standard treatment for patients suffering from end-stage osteoarthritis (OA) of the knee. However, due to the high demand and scarce medical resources, the waiting time for surgery is astoundingly lengthy. Controversies are shown in numerous studies, on whether physical functionality and mental status decline or remain stable over the waiting period. This study aims to evaluate the progression in patients suffering from end-stage OA while on the waiting list for TKA.
METHODS
One hundred and twenty-seven patients suffering from end-stage OA who were on the TKA waiting list were prospectively recruited from our orthopaedics specialist clinic. They were assessed once a year for 2 years or until surgery. The Western Ontario and McMaster University Osteoarthritis Index (WOMAC), SF-36 self-rated questionnaire and 15D health-related quality of life (HRQoL) questionnaire were used as outcome measurements for functionality and disability assessment.
RESULTS
Patients on the waiting list for TKA showed a progressive increase in pain and disability level within the first year (P = .035). Those patients waiting for more than 2 years showed worsening HRQoL (P < .05) as time progressed. However, no significant difference was observed between the first and second years.
CONCLUSIONS
A decline in functionality and increase in disability were shown in follow-up assessments conducted every year. However, a plateau effect is observed with end-stage disease. This emphasizes that more active conservative management programmes should be introduced and implemented while patients are enlisted on the TKA waiting list. Moreover, timely surgical intervention can improve patients' overall function.
TRIAL REGISTRATION
This study involved human participants and reports health-related outcomes concerning the HRQoL in patients with end-stage OA of the knee. Thus, it was registered, retrospectively, as a clinical trial under the U.S. National Library of Medicine ClinicalTrials.gov (https://clinicaltrials.gov/) on March 4, 2018.
背景
全膝关节置换术（TKA）仍然是终末期膝骨关节炎（OA）患者外科治疗的金标准。然而，由于需求高且医疗资源稀缺，手术等待时间长得惊人。众多研究对于在等待期内身体功能和精神状态是下降还是保持稳定存在争议。本研究旨在评估终末期OA患者在等待TKA手术期间的病情进展。
方法
从我们的骨科专科诊所前瞻性招募了127名在TKA等待名单上的终末期OA患者。对他们进行为期2年的每年一次评估，或直至手术。采用西安大略和麦克马斯特大学骨关节炎指数（WOMAC）、SF-36自评问卷以及15D健康相关生活质量（HRQoL）问卷作为功能和残疾评估的结果测量指标。
结果
TKA等待名单上的患者在第一年疼痛和残疾水平逐渐增加（P = 0.035）。随着时间推移，那些等待超过2年的患者健康相关生活质量恶化（P < 0.05）。然而，第一年和第二年之间未观察到显著差异。
结论
每年进行的随访评估显示功能下降和残疾增加。然而，终末期疾病存在平台效应。这强调在患者列入TKA等待名单时应引入并实施更积极的保守管理方案。此外，及时的手术干预可改善患者的整体功能。
试验注册
本研究涉及人类受试者，并报告了与终末期膝OA患者健康相关生活质量有关的结果。因此，于2018年3月4日在美国国立医学图书馆ClinicalTrials.gov（https://clinicaltrials.gov/）上进行了回顾性注册，作为一项临床试验。
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