Decline in health-related quality of life reported by more than half of those waiting for joint replacement surgery : a prospective cohort study

Ackerman, Ilana N., Bennell, Kim L. and Osborne, Richard H. 2011, Decline in health-related quality of life reported by more than half of those waiting for joint replacement surgery : a prospective cohort study, BMC musculoskeletal disorders, vol. 12, no. 108, pp. 1-9.

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Title Decline in health-related quality of life reported by more than half of those waiting for joint replacement surgery : a prospective cohort study
Author(s) Ackerman, Ilana N.
Bennell, Kim L.
Osborne, Richard H.
Journal name BMC musculoskeletal disorders
Volume number 12
Issue number 108
Start page 1
End page 9
Total pages 9
Publisher BioMed Central
Place of publication London, United Kingdom
Publication date 2011
ISSN 1471-2474
Summary Background: In many healthcare systems, people with severe joint disease wait months to years for joint replacement surgery. There are little empirical data on the health consequences of this delay and it is unclear whether people with substantial morbidity at entry to the waiting list continue to deteriorate further while awaiting surgery. This study investigated changes in Health-Related Quality of Life (HRQoL), health status and psychological distress among people waiting for total hip (THR) and knee replacement (TKR) surgery at a major metropolitan Australian public hospital.

Methods: 134 patients completed questionnaires including the Assessment of Quality of Life (AQoL) instrument, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Kessler Psychological Distress Scale after entering an orthopaedic waiting list (baseline) and before surgery (preadmission). To quantify potential decline in wellbeing, we calculated the proportion of people experiencing clinically important deterioration using published guidelines and compared HRQoL and psychological distress outcomes with population norms.

Results: Most participants (69%) waited ≥6 months for surgery (median 286 days, IQR 169-375 days). Despite poor physical and psychological wellbeing at baseline, there was an overall deterioration in HRQoL during the waiting period (mean AQoL change -0.04, 95%CI -0.08 to -0.01), with 53% of participants experiencing decline in HRQoL (≥0.04 AQoL units). HRQoL prior to surgery remained substantially lower than Australian population norms (mean sample AQoL 0.37, 95%CI 0.33 to 0.42 vs mean population AQoL 0.83, 95%CI 0.82 to 0.84). Twenty-five per cent of participants showed decline in health status (≥9.6 WOMAC units) over the waiting period and prevalence of high psychological distress remained high at preadmission (RR 3.5, 95%CI 2.8 to 4.5). Most participants considered their pain (84%), fatigue (76%), quality of life (73%) and confidence in managing their health (55%) had worsened while waiting for surgery.

Conclusions: Despite substantial initial morbidity, over half of the participants awaiting joint replacement experienced deterioration in HRQoL during the waiting period. These data provide much-needed evidence to guide health professionals and policymakers in the design of care pathways and resource allocation for people who require joint replacement surgery.
Language eng
Field of Research 111717 Primary Health Care
Socio Economic Objective 920205 Health Education and Promotion
HERDC Research category C1.1 Refereed article in a scholarly journal
Copyright notice ©2011, Ackerman et al.
Persistent URL http://hdl.handle.net/10536/DRO/DU:30040980

Document type: Journal Article
Collection: School of Health and Social Development
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