Abstract
Data on disease severity, co-morbidity, and process of care were obtained from the medical records of 356 patients without rheumatoid arthritis undergoing a first unilateral total hip replacement at four teaching hospitals in California and Massachusetts. Sociodemographic characteristics, functional status prior and subsequent to hospitalization, and improvement in health status were measured with a patient questionnaire 12 months after discharge. Completed questionnaires were received from 284 patients, a reponse rate of 79.8%. The questionnaire was acceptable to patients, reliable, and had good construct validity. The data indicate substantial benefits from hip arthroplasty. As expected, pre-surgical functioning was a strong predictor of outcomes 1 year after surgery. Controlling for pre-surgical functioning, age was not related to outcomes.
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BergnerM. Quality of care, health status, and clinical research.Med Care 1989;27: S148-S156.
ClearyPD, GreenfieldS, MulleyAG, et al Variations in length of stay and outcomes for six medical and surgical conditions in Massachusetts and California.JAMA 1991;266: 73–79.
DeyoRA. The quality of life, research, and care.Ann Intern Med 1991;114: 695–697.
ThierSO. Forces motivating the use of health status assessment measures in clinical setting and related clinical research.Med Care 1992;30: MS15-MS22.
RoizenMF, CoalsonD, HaywardRSA, et al. Can patients use an automated questionnaire to define their current health status?Med Care 1992;30: MS74-MS84.
LohrKN. Applications of health status assessment measures in clinical practice: Overview of the third conference on advances in health status assessment.Med Care 1992;30: MS1-MS14.
PatrickDL. Strategies for improving and expanding the application of health status measures in clinical settings: Discussion.Med Care 1992;30: MS198-MS201.
Stewart AL. The medical outcomes study framework of health indicators. In: Stewart AL, Ware JE Jr., eds.Measuring Functioning and Well-being. The Medical Outcomes Study Approach. Duke University Press, 1992: 12–24.
Cleary PD, Fowler FJ, Weissman J, Massagli MP, Wilson I, Seage GR, Gatsonis C, Epstein A. Health-related quality of life in persons with AIDS.Med Care 1992; in press.
CarlssonAS. 351 total hip replacements according to Charnley. A review of complications and function.Acta Orthop Scand 1981;52: 339–244.
DesHarnaisSI, ChesneyJD, WroblewskiRT, FlemingST, McMahonLFJr. The risk-adjusted mortality index: A new measure of hospital performance.Med Care 1988;26: 1129–1145.
IlstrupDM, NolanDR, BeckenbaughRD, CoventryMB. Factors influencing the results in 2,012 total hip arthoplasties.Clin Orthop Rel Res 1973;95: 250–262.
JohnstonRC, FitzgeraldRH, HarrisWH, PossR, MullerME, SledgeCB. Clinical and radiographic evaluation of total hip replacement: A standard system of terminology for reporting results.J Bone Joint Surg 1990;72A: 161–168.
McCoyTH, SalvatiEA, RanawatCS, WilsonPDJr. A fifteen-year follow-up study of one hundred Charnley low-friction arthroplasties.Orthop Clin N Am 1988;19: 467–476.
ParamoJA, RochaE. Deep vein thrombosis and related platelet changes after total hip replacement.Haemostasis 1985;15: 389–394.
WilcockGK. A comparison of total hip replacement in patients aged 69 years or less and 70 years or over.Gerontology 1981;27: 85–88.
FriesJF, SpitzPW, YoungDY. The dimensions of health outcomes: The Health Assessment Questionnaire, Disability and Pain scales.J Rheumatol 1982;9: 789–793.
DeyoRA, InuiTS. Toward clinical applications of health status measures: Sensitivity of scales to clinically important changes.Health Serv Res 1984;19: 275–289.
NevittMC, EpsteinWV, MasemM, MurrayWR. Work disability before and after total hip arthro-plasty: Assessment of effectiveness in reducing disability.Arthritis Rheum 1984;27: 410–421.
LiangMH, LarsonMG, CullenKE, SchwartzJA. Comparative measurement efficiency and sensitivity of five health status instruments for arthritis research.Arthritis Rheum 1985;28: 542–547.
McDowellI, NewellC.Measuring Health: A Guide to Rating Scales and Questionnaires. New York: Oxford University Press, 1987.
GalanteJ. Evaluation of results of total hip replacement.J Bone Joint Surg 1990;72A: 159–160.
BergnerM, BobbittRA, CarterWB, GilsonES. The Sickness Impact Profile: development and final revision of a health status measure.Med Care 1981;19: 787–805.
KaplanRM, BushJW, BerryCC. Health status: types of validity for an index of well-being.Health Serv Res 1976;11: 478–507.
JetteAM. Functional capacity evaluation: An empirical approach.Arch Phys Med Rehab 1980;61: 85–89.
MeenanRF, GertmanPM, MasonJM. Measuring health status in arthritis: the arthritis impact measurement scales.Arthritis Rheum 1980;23: 146–152.
JetteAM, DaviesAR, ClearyPD, et al. The functional status questionnaire: Its reliability and validity when used in primary care.J Gen Intern Med 1986;1: 143–149.
GreenfieldS, BlancoDM, ElashoffRM, GanzPA. Patterns of care related to age of breast cancer patients.JAMA 1987;257: 2766–2770.
GreenfieldS, AronowHU, ElashoffRM, WatanabeD. Flaws in mortality data: The hazards of ignoring comorbid disease.JAMA 1988;260: 2253–2255.
Greenfield S, Apolone G, McNeil BJ, Cleary PD. The importance of co-existent disease in the occurrence of post operative complications and one year recovery in patients undergoing total hip replacement.Med Care 1993; in press.
OwensWD, FeltsJA, SpitznagelELJr. ASA Physical Status Classifications: A study of consistency of ratings.Anesthesiology 1978;49: 239–243.
ClearyPD, GreenfieldS, McNeilBJ. Assessing quality of life after surgery.Controlled Clin Trails 1991;12: 189S-203S.
JetteAM, ClearyPD. Functional disability assessment.Phys Ther 1987;67: 1854–1859.
StewartAL, HaysRD, WareJEJr. The MOS short-form General Health Survey: Reliability and validity in a patient population.Med Care 1988;26: 724–735.
NunnallyJC.Psychometric Theory. New York: McGraw-Hill, 1978.
ClearyPD, AngelR. The analysis of relationships involving dichotomous dependent variables.J Health Soc Behav 1984;25: 334–348.
DraperNR, SmithH.Applied Regression Analysis. New York: John Wiley & Sons, 1966.
GuadagnoliE, ClearyPD. Age-related item non-response in surveys of recently discharged patients.J Gerontol 1992;47: 206–212.
LiangMH, CullenKE, LarsonMG, et al. Cost-effectiveness of total joint arthroplasty in osteoarthritis.Arthritis Rheum 1986;29: 937–943.
BurtonKE, WrightV. Functional assessment.Br J Rheumatol 1983;22: 44–47.
RoushSE. Patient-perceived functional outcomes associated with elective hip and knee arthroplasties.Phys Ther 1985;65: 1496–1500.
JetteAM, HarrisBA, ClearyPD, CampionEW. Functional recovery following hip fracture.Arch Phys Med Rehab 1987;68: 735–740.
CummingsSR, PhillipsSL, WheatME, et al. Recovery of function after hip fracture: The role of social supports.J Am Geriatr Soc 1988;36: 801–806.
GartlandJJ. Orthopaedic research. Deficiencies in experimental design and determinations of outcome.J Bone Joint Surg 1988;70A: 1357–1364.
LiangMH, CullenKE. Evaluation of outcomes in total joint arthroplasty for rheumatoid arthritis.Clin Orthop Rel Res 1984;182: 41–45.
CourtoisB, VarielR, LeSaoutJ, KerboulB, LefevreC. A propos de 87 luxations de prothese totale de la hanche.Int Orthop 1985;9: 189–193.
SchurmanDJ, BlochDA, SegalMR, TannerCM. Conventional cemented total hip arthoplasty. Assessment of clinical factors associated with revision for mechanical failure.Clin Orthop Rel Res 1989;240: 173–180.
HarrisWH, SledgeCB. Total hip and total knee replacement.N Engl J Med 1990;323: 725–731.
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The work reported in this manuscript was supported in part by grants from the National Institute on Aging (AG08331-01), the Robert Wood Johnson Foundation and the John A. Hartford Foundation.
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Cleary, P.D., Reilly, D.T., Greenfield, S. et al. Using patient reports to assess health-related quality of life after total hip replacement. Qual Life Res 2, 3–11 (1993). https://doi.org/10.1007/BF00642884
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DOI: https://doi.org/10.1007/BF00642884