Abstract
BackgroundTo address both the growing burden of joint disease and the gaps in medical access in developing nations, medical relief organizations have begun to launch programs to perform total joint replacement (TJR) on resident populations in developing countries. One outcome of TJR of particular interest is physical activity (PA) since it is strongly linked to general health. This study evaluates the amount of postoperative participation in PA in low-income patients who received total joint replacement in the Dominican Republic and identifies preoperative predictors of postoperative PA level.MethodsWe used the Yale Physical Activity Survey (YPAS) to assess participation in postoperative PA 1–4 years following total knee or hip replacement. We compared the amount of aerobic PA reported by postoperative TJR patients with the levels of PA recommended by the CDC and WHO. We also analyzed preoperative determinants of postoperative participation in aerobic PA in bivariate and multivariate analyses.Results64 patients out of 170 eligible subjects (52/128 TKR and 14/42 THR) who received TJR between 2009–2012 returned for an annual follow-up visit in 2013, with a mean treatment-to-follow-up time of 2.1 years. 43.3% of respondents met CDC/WHO criteria for sufficient participation in aerobic PA. Multivariate analyses including data from 56 individuals identified that patients who were both younger than 65 and at least two years postoperative had an adjusted mean activity dimensions summary index (ADSI) 22.9 points higher than patients who were 65 or older and one year postoperative. Patients who lived with friends or family had adjusted mean ADSI 17.2 points higher than patients living alone. Patients who had the most optimistic preoperative expectations of outcome had adjusted mean ADSI scores that were 19.8 points higher than those who were less optimistic.ConclusionThe TJR patients in the Dominican cohort participate in less PA than recommended by the CDC/WHO. Additionally, several associations were identified that potentially affect PA in this population; specifically, participants who are older than 65, recently postoperative, less optimistic about postoperative outcomes and who live alone participate in less PA.
Highlights
To address both the growing burden of joint disease and the gaps in medical access in developing nations, medical relief organizations have begun to launch programs to perform total joint replacement (TJR) on resident populations in developing countries
We evaluate the physical activity (PA) level of low-income patients from the DR who received TJR during Operation Walk (Op Walk) Boston’s 2009–2012 trips; we benchmarked this against the levels of PA recommended by the Centers for Disease Control (CDC) and World Health Organization (WHO); and we analyzed potential preoperative determinants of postoperative participation in PA
No statistically significant differences were detected in age, sex, BMI, Western Ontario and MacMaster Universities Arthritis Index (WOMAC) pain and function scales, and 36 Question Short Form Health Survey (SF-36) physical function and mental health scales between those who returned for a follow-up visit in 2013 and those who did not
Summary
To address both the growing burden of joint disease and the gaps in medical access in developing nations, medical relief organizations have begun to launch programs to perform total joint replacement (TJR) on resident populations in developing countries. Access to TJR is limited due to high cost and lack of available resources and appropriately trained surgeons. To address both the growing burden of joint disease in developing nations and gaps in access to treatment, medical relief programs have been launched in developing countries to perform TJR on resident populations and to transfer critical knowledge and skills to personnel at host facilities [9]
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