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|Title: ||The Trajectory of Recovery and the Inter-relationships of Symptoms, Activity and Participation in the First Year Following Total Hip and Knee Replacement|
|Authors: ||Davis, AM|
|Keywords: ||knee replacement, hip replacement, recovery, outcomes, path analysis|
|Issue Date: ||Aug-2011|
|Publisher: ||Osteoarthritis & Cartilage|
|Citation: ||Osteoarthritis & Cartilage. E-pub ahead of print 24August 2011. http://dx.doi.org/10.1016/j.joca.2011.08.007|
|Abstract: ||Objective: Primary hip (THR) and knee (TKR) replacement outcomes typically include pain and
function with a single time of follow-up post-surgery. This research evaluated the trajectory of
recovery and inter-relationships within and across time of physical impairments (PI) (e.g.
symptoms), activity limitations (AL), and social participation restrictions (PR) in the year
following THR and TKR for osteoarthritis.
Design: Participants (hip: n=437; knee: 494) completed measures pre-surgery and at 2 weeks, 1,
3, 6 and 12 months post-surgery. These included PI (HOOS/KOOS symptoms and Chronic Pain
Grade); AL (HOOS/KOOS activities of daily living and sports/leisure activities); and, PR (Late
Life Disability and the Calderdale community mobility). RANOVA was used to evaluate the
trajectory of recovery of outcomes and the inter-relationships of PI, AL and PR were evaluated
using path analysis. All analyses were adjusted for age, sex, obesity, THR/TKR, low back pain
Results: THR: age 31-86 years with 55% female; TKR: age 35-88 years with 65% female.
Significant improvements in outcomes were observed over time. However, improvements were
lagged over time with earlier improvements in PI and AL and later improvements in PR. Within
and across time, PI was associated with AL and AL was associated with PR. The magnitude of
these inter-relationships varied over time.
Conclusion: Given the lagged inter-relationship of PI, AL and PR, the provision and timing of
interventions targeting all constructs are critical to maximizing outcome. Current care pathways
focusing on short-term follow-up with limited attention to social and community participation
should be re-evaluated.|
|Appears in Collections:||UofT Faculty publications|
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