Patients undergoing total hip replacement experience meaningful and lasting improvements in quality of life for at least five years after the procedure, reports a US study.
As pain and functioning improve after hip replacement surgery, so do scores on the "Short Form-6D" (SF-6D) – a widely used measure of patient-perceived QOL, according to the new research by Dr Michael A Mont of the Cleveland Clinic and colleagues. They write, "The SF-6D is one of the few straightforward, easily obtainable methods that provide clinicians quantifiable insight into a patient's quality of life."
The researchers analysed data on 188 patients, average age 69 years, who underwent total hip replacement (also called arthroplasty) at seven hospitals. Patients were evaluated with a standard quality of life (QOL) assessment, called the "Short Form 36" (SF-36), from which the SF-6D scores were calculated.
The SF-6D provides scores for six QOL domains: vitality, pain, mental health, social and physical functioning, and role limitations. The SF-6D has been used to assess the health benefits and economic value of many different treatments.
The results showed significant increases in the SF-6D score from before to after total hip replacement. Although scores peaked at one year, the improvement remained significant through five years' follow-up. Furthermore, the gains in SF-6D score remained well above the cutoff point for a large "effect size" – indicating clinically relevant improvement in QOL. The SF-6D scores corresponded to lasting improvements on standard assessments of hip pain and motion as well as the ability to perform everyday activities.
At a time of increased focus on the economic sustainability of the healthcare system, it is important to document the value of healthcare interventions. Total hip replacement is an effective procedure for which demand is expected to increase in the future. The new study appears to be the first to show that the SF-6D – an easy-to-use QOL measure – confirms the positive patient-perceived impact of hip replacement surgery.
Like other QOL assessments, the SF-6D has some disadvantages. However, Mont and co-authors note, "The SF-6D provides clinicians with a method of quantifying patient satisfaction and perception of their own health." This is an important concept in assessing the value, or "utility," of the procedure.
Another key advantage is the ability to calculate the SF-6D score from the SF-36 assessment – one of the most widely used evaluations of mental and physical health after surgery. Mont and colleagues conclude: "Therefore, widely incorporating the SF-6D into future postoperative assessments is straightforward, and having these values readily available may make prospective cost-effectiveness analyses considerably easier."
Abstract
Background: Following total hip arthroplasty, patients' perception of their postoperative improvement and health plays a large role in satisfaction with and success of the surgical procedure. The Short Form-6D (SF-6D) is a health-related quality-of-life measure that assigns numerical value to the perception of patients' own health. The purpose was to determine SF-6D values of patients after total hip arthroplasty, to determine whether score changes were clinically relevant, and to compare these with postoperative functional improvements.
Methods: We evaluated 188 patients who underwent primary total hip arthroplasty at 7 institutions and who had a mean age of 69 years (range, 47 to 88 years) and a mean body mass index of 28.8 kg/m (range, 19.8 to 38.9 kg/m). The SF-6D values were obtained from patients' SF-36 scores, and clinical relevance of value changes was determined using effect size. Using previous research, effect sizes were considered small between 0.2 and 0.5, moderate between 0.6 to 0.8, and large at >0.8. Clinical correlation was assessed using the Lower-Extremity Activity Scale and Harris hip scores. Patients were assessed preoperatively and postoperatively at 6 months and 1, 2, 3, and 5 years.
Results: The SF-6D scores improved from preoperatively and achieved significance (p < 0.05) at all points. The effect size demonstrated good clinical relevance up to the latest follow-up: 1.27 at 6 months, 1.30 at 1 year, 1.07 at 2 years, 1.08 at 3 years, and 1.05 at 5 years. The Lower-Extremity Activity Scale improved at all follow-up points from preoperatively to 1.8 at 6 months, 2.0 at 1 year, 1.8 at 2 years, 1.5 at 3 years, and 1.6 points at 5 years. The Harris hip score improved to 38 points at 6 months, 40 points at 1 year, 38 points at 2 years, 39 points at 3 years, and 41 points at 5 years postoperatively. The improvements in the Lower-Extremity Activity Scale and the Harris hip score significantly positively correlated (p < 0.01) with the SF-6D scores at all time points.
Conclusions: SF-6D scores after total hip arthroplasty correlate with functional outcomes and have clinical relevance, as demonstrated by their effect size. Incorporating this straightforward and easy-to-use measurement tool when evaluating patients following total hip arthroplasty will facilitate future cost-utility analyses.
Authors
Randa K Elmallah, Morad Chughtai, Farshad Adib, Kevin J Bozic, Steven M Kurtz, Michael A Mont
[link url="https://www.sciencedaily.com/releases/2017/03/170315182335.htm"]Wolters Kluwer Health material[/link]
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