Laurence S G Teoh1, Jillian P Eyles1, Joanna Makovey1, Matthew Williams1, C Kent Kwoh2, David J Hunter1. 1. Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia. 2. Department of Medicine, University of Arizona Arthritis Center and Division of Rheumatology, University of Arizona College of Medicine, Tucson, Arizona, USA.
Abstract
AIM: To determine the impact of an osteoarthritis-specific multidisciplinary conservative care program (OACCP) on willingness for surgery (WFS) and to identify changes and factors in our cohort that influence and predict willingness for surgery. METHODS: Consecutive OACCP participants with hip or knee OA, with WFS (willing, unsure or unwilling) data for at least two appointments were included. The proportions of unwilling versus willing/unsure patients at baseline and last appointment were compared using McNemar's test. Logistic regression was used to analyze baseline age, gender, main language, educational status, living situation, number of comorbidities, index joint, non-index joint osteoarthritis, completion of program, baseline and change in pain, function, depression, body mass index and 6-min walk test (6MWT) for association with changing WFS. RESULTS: At baseline 203/409 were unwilling for surgery while by final appointment 234/409 were unwilling (P = 0.002). Of the 206 initially willing/unsure participants, 63/206 (30.6%) became unwilling by final appointment. Index joint, completion of program, baseline and change in pain, self-reported function and 6MWT were independently associated with becoming unwilling. Final model from multivariate logistic regression analysis regarding becoming unwilling included baseline pain (P < 0.001), change in pain (P < 0.001), completion of program (P < 0.001) and age (P = 0.004). CONCLUSION: A conservative OA-specific treatment program that improves pain and function can reduce willingness for surgery among participants with hip or knee OA. The strongest determinants of this reduction in willingness were baseline and change in pain, completion of the program and participant age.
AIM: To determine the impact of an osteoarthritis-specific multidisciplinary conservative care program (OACCP) on willingness for surgery (WFS) and to identify changes and factors in our cohort that influence and predict willingness for surgery. METHODS: Consecutive OACCP participants with hip or knee OA, with WFS (willing, unsure or unwilling) data for at least two appointments were included. The proportions of unwilling versus willing/unsure patients at baseline and last appointment were compared using McNemar's test. Logistic regression was used to analyze baseline age, gender, main language, educational status, living situation, number of comorbidities, index joint, non-index joint osteoarthritis, completion of program, baseline and change in pain, function, depression, body mass index and 6-min walk test (6MWT) for association with changing WFS. RESULTS: At baseline 203/409 were unwilling for surgery while by final appointment 234/409 were unwilling (P = 0.002). Of the 206 initially willing/unsure participants, 63/206 (30.6%) became unwilling by final appointment. Index joint, completion of program, baseline and change in pain, self-reported function and 6MWT were independently associated with becoming unwilling. Final model from multivariate logistic regression analysis regarding becoming unwilling included baseline pain (P < 0.001), change in pain (P < 0.001), completion of program (P < 0.001) and age (P = 0.004). CONCLUSION: A conservative OA-specific treatment program that improves pain and function can reduce willingness for surgery among participants with hip or knee OA. The strongest determinants of this reduction in willingness were baseline and change in pain, completion of the program and participant age.
Authors: Matthew S Harkey; Kate L Lapane; Shao-Hsien Liu; Grace H Lo; Timothy E McAlindon; Jeffrey B Driban Journal: J Rheumatol Date: 2020-06-15 Impact factor: 4.666
Authors: Chamila Dabare; Kim Le Marshall; Albert Leung; Carolyn J Page; Peter F Choong; Keith K Lim Journal: Int J Rheum Dis Date: 2017-05-10 Impact factor: 2.454
Authors: Dirk Zajonz; Johannes K M Fakler; Anna-Judith Dahse; Fujiaoshou Junping Zhao; Melanie Edel; Christoph Josten; Andreas Roth Journal: Patient Saf Surg Date: 2017-08-30
Authors: Andrea Dell'Isola; Thèrèse Jönsson; Ola Rolfson; Anna Cronström; Martin Englund; Leif Dahlberg Journal: Arthritis Care Res (Hoboken) Date: 2021-06 Impact factor: 4.794