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Observational Study
, 90 (4), 306-311

Minor Influence of Patient Education and Physiotherapy Interventions Before Total Hip Replacement on Patient-Reported Outcomes: An Observational Study of 30,756 Patients in the Swedish Hip Arthroplasty Register

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Observational Study

Minor Influence of Patient Education and Physiotherapy Interventions Before Total Hip Replacement on Patient-Reported Outcomes: An Observational Study of 30,756 Patients in the Swedish Hip Arthroplasty Register

Christopher Torisho et al. Acta Orthop.

Abstract

Background and purpose - It is unclear whether physiotherapy interventions or patient education before total hip replacement (THR) is beneficial for patients postoperatively. Utilizing the Swedish Hip Arthroplasty Register (SHAR), we retrospectively studied the influence of preoperative self-reported exposure to physiotherapy and/or patient education on patient-reported outcomes 1 year after THR. Patients and methods - Data covering all THRs performed in Sweden for osteoarthritis, between the years 2012 and 2015, was obtained from SHAR. There were 30,756 patients with complete data. Multiple linear regression modelling was performed with 1-year postoperative PROMs (hip pain on a visual analogue scale [VAS], with the quality of life measures EQ-5D index and EQ VAS, and surgery satisfaction VAS) as dependent variables. Self-reported physiotherapy and patient education (yes or no) were used as independent variables. Results - Physiotherapy was associated with slightly less pain VAS (-0.7, 95% CI -1.1 to -0.3), better EQ-5D index (0.01, CI 0.00-0.01), EQ VAS (0.8, CI 0.4-1.2), and better satisfaction VAS (-0.7, CI -1.2 to -0.2). Patient education was associated with slightly better EQ-5D index (0.01, CI 0.00-0.01) and EQ VAS (0.7, CI 0.2-1.1). Interpretation - Even though we found statistically significant differences in favor of physiotherapy and patient education, the magnitude of those were too small and inconsistent to conclude a truly positive influence. Further research is needed with more specific and demarcated physiotherapy interventions.

Figures

Figure 1.
Figure 1.
The flowchart describes the selection of patients. As defined here, excluded patients form 3 groups: missing 1, missing 2, and missing 3, further investigated in the missing data/non-respondent analysis (see Appendix). Abbreviations: THR = total hip replacement, OA = osteoarthritis, BMI = body mass index, ASA = American Association of Anesthesiologists’ classification.
Figure 2.
Figure 2.
Linear regression results with the dependent variable pain VAS 1 year postoperatively.
Figure 3.
Figure 3.
Linear regression results with the dependent variable EQ-5D 1 year postoperatively.
Figure 4.
Figure 4.
Linear regression results with the dependent variable EQ VAS 1 year postoperatively.
Figure 5.
Figure 5.
Linear regression results with the dependent variable satisfaction 1 year postoperatively.

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