患者报告的透明质酸注射治疗后结果的预测因素：期望和心理压力的影响。

Predictors of Patient-Reported Outcomes After Hyaluronic Acid Injections: Effect of Expectations and Psychological Stress.

机构信息

From the Rothman Orthopaedic Institute, Egg Harbor Township, NJ (Dr. Hall Dr. Lee, Dr. Campbell, Mr. Paul, Dr. Leider, and Dr. Tjoumakaris); the Drexel University College of Medicine, Philadelphia, PA (Mr. Smith); and the Rothman Orthopaedic Institute, Bryn Mawr, PA (Dr. Freedman).

出版信息

J Am Acad Orthop Surg Glob Res Rev. 2024 Aug 2;8(8). doi: 10.5435/JAAOSGlobal-D-23-00152. eCollection 2024 Aug 1.

DOI:10.5435/JAAOSGlobal-D-23-00152

PMID:39106472

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11302948/

Abstract

INTRODUCTION

Hyaluronic acid (HA) injections are a common nonsurgical treatment of knee osteoarthritis (OA). Patient expectations and psychological stress are believed to affect outcomes after orthopaedic procedures.

METHODS

This was a prospective cohort study seeking to identify factors predictive of greater patient-reported outcomes after HA injections, particularly expectations and psychological stress. 250 patients receiving a series of HA injections for knee OA were enrolled, with 196 being included for analysis. Demographics, surgical history, and preoperative Kellgren-Lawrence severity scores were collected, and patients completed the Knee Osteoarthritis Outcome Score (KOOS) questionnaire, a modified KOOS questionnaire assessing their 6-month postinjection expectations, and the Perceived Stress Scale before the first injection. Outcomes were assessed at 3 weeks and 3 and 6 months after the final injection.

RESULTS

KOOS scores improved from preinjection to 6-month follow-up but did not meet patients' expectations or minimal clinically important difference. Expectations correlated with 6-month KOOS pain, activities of daily living, sport, and quality of life subscales (ρ = 0.19 to 0.34), but not the symptom subscale (P = 0.10). Expectations (ρ = 0.31 to 0.37), younger age (ρ = -0.17 to -0.18), and greater perceived stress (ρ = 0.23) correlated with greater improvement from baseline KOOSs. Lower body mass index (ρ = -0.19 to -0.22), male sex (ρ = -0.17), and greater preinjection function (ρ = 0.37 to 0.46) correlated with greater 6-month outcomes. Stress measured on the Perceived Stress Scale did not correlate with 6-month KOOSs (P ≥ 0.27). Lower Kellgren-Lawrence severity score was weakly associated with greater 6-month KOOS activities of daily living and sport scores (ρ = -0.15 to -0.16) and greater improvement in the KOOS symptom score (ρ = -0.15).

DISCUSSION

This study identified that higher expectations, lower body mass index, younger age, male sex, lower radiographic severity, greater preinjection function, and greater perceived stress are associated with greater patient outcomes after HA injection. Physicians should consider these factors when counseling patients with knee OA about viscosupplementation.

STUDY TYPE

Prospective Cohort Study (Level of Evidence II).

摘要

简介

透明质酸（HA）注射是治疗膝关节骨关节炎（OA）的常见非手术方法。患者的期望和心理压力被认为会影响骨科手术后的结果。

方法

这是一项前瞻性队列研究，旨在确定预测 HA 注射后患者报告结果更好的因素，特别是期望和心理压力。共招募了 250 名接受膝关节 OA 系列 HA 注射的患者，其中 196 名进行了分析。收集了人口统计学、手术史和术前 Kellgren-Lawrence 严重程度评分，患者在第一次注射前完成了膝关节骨关节炎结局评分（KOOS）问卷、评估其 6 个月后注射期望的改良 KOOS 问卷以及感知压力量表。在最后一次注射后 3 周、3 个月和 6 个月进行了结果评估。

结果

KOOS 评分从注射前到 6 个月随访时有所改善，但未达到患者的期望或最小临床重要差异。期望与 6 个月 KOOS 疼痛、日常生活活动、运动和生活质量子量表相关（ρ=0.19 至 0.34），但与症状子量表无关（P=0.10）。期望（ρ=0.31 至 0.37）、年龄较小（ρ=-0.17 至 -0.18）和感知压力较大（ρ=0.23）与从基线 KOOS 改善相关。较低的身体质量指数（ρ=-0.19 至 -0.22）、男性（ρ=-0.17）和较高的术前功能（ρ=0.37 至 0.46）与 6 个月后的结果更好相关。感知压力量表上测量的压力与 6 个月 KOOS 无关（P≥0.27）。较低的 Kellgren-Lawrence 严重程度评分与 6 个月 KOOS 日常生活活动和运动评分的改善相关（ρ=-0.15 至 -0.16），并且与 KOOS 症状评分的改善相关（ρ=-0.15）。