The effect of co-morbidities on health-related quality of life in patients placed on the waiting list for total joint replacement

Objective. To evaluate the efficacy on physical functioning and safety of tailored exercise therapy in patients with knee osteoarthritis (OA) and comorbidities. Methods. In a randomized controlled trial, 126 participants were included with a clinical diagnosis of knee OA and at least 1 of the following target comorbidities: coronary disease, heart failure, type 2 diabetes mellitus, chronic obstructive pulmonary disease, or obesity (body mass index ‡30 kg/m 2 ), with severity score ‡2 on the Cumulative Illness Rating Scale. The intervention group received a 20-week, individualized, comorbidity-adapted exercise program consisting of aerobic and strength training and training of daily activities. The control group received their current medical care for knee OA and were placed on a waiting list for exercise therapy. Primary outcome measures were the Western Ontario and McMaster Universities Osteoarthritis Index, subscale physical functioning (WOMAC-pf), and the 6-minute walk test (6MWT). Measurements were performed at baseline, after 20 weeks (directly posttreatment), and at 3 months posttreatment. Results. Statistically significant physical functioning differences over time were found between the intervention and control group (WOMAC: B 5 27.43 [95% confidence interval (95% CI) 29.99, 24.87], P < 0.001; and 6MWT: B 5 34.16 [95% CI 17.68, 50.64], P < 0.001) in favor of the intervention group. At 3 months followup, the mean improvements in the intervention group were 33% on the WOMAC scale and 15% on the 6MWT. These improvements are of clinical relevance. No serious adverse events occurred during the intervention. Conclusion. This is the first study showing that tailored exercise therapy is efficacious in improving physical functioning and safe in patients with knee OA and severe comorbidities.

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“…Comorbidity is present in 68-85% of patients with OA (6)(7)(8). Frequently, more than 1 comorbid disease is present (8).…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Tailored Exercise Therapy on Physical Functioning in Patients With Knee Osteoarthritis and Comorbidity: A Randomized Controlled Trial

MSc

Leeden

Cheung

et al. 2017

Arthritis Care & Research

104

100

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“…Emerging demographic and epidemiologic studies are projecting large increases in the demand for primary and revision arthroplasty over the next two decades [14][15][16]. Furthermore, THA is being performed in patients who are older and infirm [1,12,13,21,22,35,38,41].…”

Section: Introductionmentioning

confidence: 99%

Early Mortality after Modern Total Hip Arthroplasty

Aynardi

Pulido

Parvızı

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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“…For Query 1, six articles [3,[8][9][10][11][12] were returned initially and, after application of inclusion criteria, three articles [3,8,9] were included in the analysis. Arthroplasty reduced the weighted mean preoperative VAS pain score from 6.4 cm (on a 10-cm scale) for all patients awaiting joint arthroplasty (both hips and knees) to 2.9 cm at 3 months after surgery (Table 3).…”

Section: Resultsmentioning

confidence: 99%

Comparing the Cumulative Pain Patients Experience Waiting for Knee Arthroplasty to their Postoperative Pain

Schwenk¹,

Dexter²,

Epstein³

2013

J Anesth Clin Res

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Introduction: Reduction of pain is a major goal of anesthesiologists treating patients undergoing knee arthroplasty. This has been achieved traditionally through the use of regional analgesia. Although these techniques decrease postoperative pain, they inherently do not affect the longstanding pain patients experience as they wait for surgery. Our objectives were to quantify: 1) the decrease in pain achieved by surgical joint replacement; and 2) the decrease in postoperative pain achievable through femoral nerve blocks versus opioids. From a systems-based perspective, we wanted to determine how much reduction in waiting time before surgery would be necessary to achieve an equal cumulative pain decrease (i.e, pain x duration of pain) as that afforded by regional techniques in the immediate postoperative period. Materials and methods:A systematic review using PubMed was performed to obtain: 1) articles reporting preoperative pain scores for patients awaiting joint arthroplasty; 2) articles with knee arthroplasty patients who received femoral nerve blocks; and 3) articles providing duration on joint arthroplasty waiting lists. Cumulative pain was assessed by the area under the response curve of pain scores vs. time, a methodology that is simple and valid. This was calculated by multiplying mean pain scores by the duration of pain. Results:The decrease in knee pain subsequent to arthroplasty (6.4/10 vs. 2.9/10) is similar to the decrease in pain afforded by femoral nerve blocks for knee arthroplasty (4.7/10 vs. 2.0/10). Waiting times in many countries exceed 3 months. A decrease in waiting time by about 2 days results in a decrease in the area under the curve of Conclusion: Reducing waiting time for knee arthroplasty decreases total pain experienced by patients and is one systems-based approach that anesthesiologists could take to relieve pain. Further studies are needed to evaluate how best to accomplish this goal.pain comparable to that afforded by femoral nerve blocks.

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The effect of co-morbidities on health-related quality of life in patients placed on the waiting list for total joint replacement

Cited by 64 publications

References 21 publications

Efficacy of Tailored Exercise Therapy on Physical Functioning in Patients With Knee Osteoarthritis and Comorbidity: A Randomized Controlled Trial

Efficacy of Tailored Exercise Therapy on Physical Functioning in Patients With Knee Osteoarthritis and Comorbidity: A Randomized Controlled Trial

Early Mortality after Modern Total Hip Arthroplasty

Comparing the Cumulative Pain Patients Experience Waiting for Knee Arthroplasty to their Postoperative Pain

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