Functional and patient outcomes following Total Knee Arthroplasty :
a multiple-methods approach

Bin Sheeha, B

Abstract

Background and aims: Total knee arthroplasty (TKA) is the gold standard treatment for end-stage knee osteoarthritis. The main outcomes expected are reduced pain and improved function. There is conflicting evidence regarding functional changes post-TKA, which may be due to the nature of the assessment methods used. Commonly, functional changes are measured using Patient Reported Outcome Measures (PROMs) and performance-based measures (PBMs), where under/ overestimation, recall bias and participant research effect cannot be excluded. In addition, satisfaction post-TKA is significantly less than for post-total hip arthroplasty, which emphasises the need for further exploration of the reasons why and propose recommendations to improve it. Furthermore, long-term patient satisfaction and outcomes post-TKA are not predicted. Therefore, the current thesis aims to answer these research questions: Are individuals satisfied following TKA? Can we predict outcomes and satisfaction? What are individuals’ experiences? Do they improve their physical behaviour?
Methods: A multiple-methods approach was used to attain the research objectives, using different philosophical traditions (paradigms) to improve the accuracy of the findings and gain a complete picture of outcomes. It provided an opportunity to check outcomes post-TKA using quantitative and qualitative methods and to assess the findings for each method. A retrospective study assessed short- and long-term changes in PROMs to develop a prediction tool for outcomes and satisfaction; a focus-group discussion (FGD) explored, in depth, patients’ experiences, satisfaction and expectations post-TKA; and a prospective study assessed free-living physical behaviour (PB) and correlated it with commonly used outcome measures.
Results: PROMs significantly improved and reached a peak post-TKA at one year and remained there for several years, followed by a significant reduction at 10 years. Patients’ functional outcomes and satisfaction post-TKA are multifactorial, and the first year is key to long-term outcomes and satisfaction. Patient attitude, sufficient pre-operative education, outcome expectation modification, communication with the surgeon, and patients taking an active role in rehabilitation can all affect post-TKA outcomes and satisfaction. Physical behaviour (PB) improved post-TKA in both volume and pattern six and twelve months post-TKA. OKS score was not correlate or predict the physical activity or satisfaction post-TKA.
Conclusion
The prediction equation developed may help to estimate outcomes and satisfaction, design individual pre-TKA behavioural treatments and modify unrealistic expectations so as to improve outcomes and satisfaction post-TKA, in addition to general education classes to clarify overall experiences, such as: severity of symptoms post-TKA, pain-control options, expected care post-surgery from the surgeon and physiotherapy, possible functional limitations and improvements. There is a clear discordance between PB outcomes and PROMs, this emphasises the need to use objective methods in addition to PROMs, which merely track subjective improvements and may be influenced by recall bias. Although PB improved in terms of stepping, step numbers and patterns, it did not meet physical activity (PA) guideline recommendations. This affirms that arthroplasty alone is unlikely to improve PA and thus educational or behavioural treatments are recommended. Behavioural and motivational classes pre- and following Total Knee Arthroplasty may change sedentary behaviours to meet PA recommendations to improve overall health and enhance satisfaction.

Citation

a multiple-methods approach. (Thesis). University of Salford

• Thesis Type: Thesis
• Deposit Date: Apr 8, 2020
• Publicly Available Date: Apr 8, 2020
• Award Date: Jan 1, 2019