Achieving Important Improvement in WOMAC Pain and Function By Three Months Post-Surgery Influences Satisfaction 1 Year Following Total Knee Replacement (TKR)

Aileen Davis¹, Selahadin Ibrahim², Sheilah Hogg-Johnson³, Rosalind Wong⁴, Dorcas Beaton⁵, Bert Chesworth⁶, Rajiv Gandhi⁷, Nizar Mahomed⁸, Anthony V. Perruccio⁹, Vai Rajgopal¹⁰ and James Waddell¹¹, ¹Health Care and Outcomes Research, Krembil Research Institute, University Health Network, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada, ²Institute for Work and Health, Toronto, ON, Canada, ³Canadian Memorial Chiropractic College, Toronto, ON, Canada, ⁴Krembil Research Institute, Health Care and Outcomes Research, Toronto, ON, Canada, ⁵University of Toronto, Department of Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, and the Institute for Health Policy Management and Evaluation, Toronto, ON, Canada, ⁶Western University, London, ON, Canada, ⁷Department of Surgery - Orthopedics, Toronto Western Hospital, Assistant Professor, Department of Surgery, University of Toronto, Toronto, ON, Canada, ⁸Orthopaedics, University Health Network, Toronto, ON, Canada, ⁹Arthritis Program, Krembil Research Institute, University Health Network, Toronto, ON, Canada, ¹⁰Orthopaedics, Middle Sex Hospital Alliance, Strathroy, ON, Canada, ¹¹Orthopaedics, Saint Michael's Hospital, Toronto, ON, Canada

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: functional status, longitudinal studies, outcomes and pain, Total Knee Arthroplasty (TKA)

Session Information

Date: Monday, October 22, 2018

Title: Health Services Research Poster II – ACR/ARHP

Session Type: ACR/ARHP Combined Abstract Session

Session Time: 9:00AM-11:00AM

Background/Purpose: Understanding the impact of the time of achievement of important improvement (II) in pain and function may further understanding of outcome and inform care pathways for people with TKR. This work evaluated if the time to achieve II in WOMAC pain and function and Late Life Disability (LLDI) higher demand function was associated with satisfaction.

Methods: We followed 354 patients to 1-year post-TKR. Demographic and health information, WOMAC pain and function and LLDI limitation subscales and outcome expectations for pain, other symptoms, mobility/activities of daily living (ADL), and participation in social roles/instrumental activities of daily living (IADL) were completed pre-surgery. WOMAC and LLDI also were completed 3, 6, and 12 months post-surgery. Satisfaction was completed at 12 months. All were scored 0-100 with higher scores indicating better outcome. We derived an ordinal variable of achieved II by 3, 6 or 12 months post-surgery or not achieved for each outcome. We categorized those with baseline scores precluding II achievement who reached the measure ceiling as achieving II. We used a Bayesian path model with non-informative priors to evaluate if time to II achievement was associated with satisfaction, adjusting for age, sex, education, obesity, depression, comorbidity count and self-rated health. Expectations were modeled as individual predictors. The Bayesian model (model 1) provided a single estimator for ordinal II variables, so we fit a generalized linear model to understand which time of II achievement was associated with satisfaction (model 2).

Results: Mean age 65 years; 65% female. Mean pre-surgery pain, function and high demand activities scores were 47.8 (sd=17.8), 50.3 (sd=18.5) and 59.2 (sd=11.0). Mean satisfaction was 80.7 (sd=21.9). Those with II in pain, function and high demand activities by 3 months had higher satisfaction scores (range 87.8-89.3 vs 64.7-69.8). Fifty-seven, 47, 57 and 15% expected improvement in pain, other symptoms, mobility/ADL and social roles/IADL. In model 1 (Figure 1), earlier II achievement in pain (estimate -0.191) and function (estimate -0.389) was directly associated with more satisfaction and higher expectation for mobility/ADL improvements (-0.106) was directly associated with less satisfaction. Earlier achievement of II in function was associated with higher demand II achievement (0.628); II in higher demand activities was not associated with satisfaction. Other significant effects were indirect. Achievement of II in pain, function and high demand activities by 3 months was significantly associated with higher satisfaction as compared to achievement by 6 or 12 months (2-5 fold impact) or not achieving II (12-17 fold impact) (model 2).

Conclusion: Efforts to minimize recovery time post TKR should be tested to determine if more people recover more quickly and are satisfied with their outcomes.

Disclosure: A. Davis, None; S. Ibrahim, None; S. Hogg-Johnson, None; R. Wong, None; D. Beaton, None; B. Chesworth, None; R. Gandhi, None; N. Mahomed, None; A. V. Perruccio, None; V. Rajgopal, None; J. Waddell, None.

To cite this abstract in AMA style:

Davis A, Ibrahim S, Hogg-Johnson S, Wong R, Beaton D, Chesworth B, Gandhi R, Mahomed N, Perruccio AV, Rajgopal V, Waddell J. Achieving Important Improvement in WOMAC Pain and Function By Three Months Post-Surgery Influences Satisfaction 1 Year Following Total Knee Replacement (TKR) [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/achieving-important-improvement-in-womac-pain-and-function-by-three-months-post-surgery-influences-satisfaction-1-year-following-total-knee-replacement-tkr/. Accessed .

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