A cross-sectional look at patient concerns in the first six weeks following primary total knee arthroplasty.

Ravi Rastogi,Aileen M Davis,Bert M Chesworth

doi:10.1186/1477-7525-5-48

Abstract

BackgroundTo date, no researchers have investigated patient concerns in the first six weeks following primary total knee arthroplasty (TKA). An understanding of patient concerns at a time when physical therapists are involved in the treatment of these patients will aid clinicians in providing patient-centered care. Linking of items to the International Classification of Functioning, Disability and Health (ICF) allows for comparison and sharing of data amongst researchers, as the ICF is the accepted framework for evaluating disability in rehabilitation. The objective of this study was to identify patient concerns in the first six weeks following primary TKA and link these concerns to components of the ICF and map them to commonly used outcome measures.MethodsIndividual interviews were conducted to identify patient concerns during their recovery following primary TKA. Concerns identified by patients were analysed for content and linked to the components of the ICF using the operational definitions of the ICF components. These concerns were mapped to the WOMAC, KOOS and Oxford Knee Scale.ResultsThirty patients (18 female) with an average age (SD) of 68.4 (11.1) years completed the study. Patients identified 32 concerns. Twenty-two percent (n = 7) of the concerns linked to Body Function and Structure, 47% (n = 15) to Activity, 13% (n = 4) to Participation, and 13% (n = 4) to the Environmental Factors component of the ICF. Six percent (n = 2) of the concerns did not link to the ICF. Of the 32 concerns identified by patients 14 mapped to the KOOS, 11 to the WOMAC and 4 to the Oxford Knee Scale.ConclusionPatient concerns linked to four different components of the ICF indicating that patients are involved in or are thinking of multiple aspects of life even in this early phase of recovery. The KOOS was found to be the most appropriate for use based on the patients' perspective. However, less than half of the concerns identified by patients were covered by the KOOS, WOMAC or Oxford Knee Scale indicating that other existing measures that evaluate the concepts identified as important to patients should be considered when evaluating outcomes during this acute phase of recovery following primary TKA.

Highlights

To date, no researchers have investigated patient concerns in the first six weeks following primary total knee arthroplasty (TKA)
This study has identified 32 concerns that are important to patients during their recovery in the first six weeks following primary TKA
It is possible that this study may not have captured all patient concerns within the first six weeks following primary TKA surgery. Another limitation of this study was that non-English speaking individuals were not included. This is the first study that has identified concerns that are important to patients in the first six weeks following their primary TKA

Summary

Introduction

No researchers have investigated patient concerns in the first six weeks following primary total knee arthroplasty (TKA). Trousdale et al [8] and Moran et al [9] have both reported patient concerns prior to total hip arthroplasty (THA) and TKA These authors do not report if the items of concern in their respective questionnaires were generated by directly asking patients. Weiss et al [10] investigated what functional activities were important to patients one year after TKA surgery Based on their findings they have suggested, "that conventional questionnaires and scoring systems may be missing important information about knee function" in patients who have had a joint replacement [10]

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