Perception Of Need Research Articles

Parental perception of mental health needs in young children

There is evidence of unmet psychiatric needs in children under 6. These young children are dependent on their parents to identify their mental health needs. This study tested child and parent associations with parent perception of young child mental health need. Parents of 917 children (aged 2-6 years) completed a diagnostic interview about their child assessing depression, anxiety, ODD/CD, ADHD, and impairment. Parents were surveyed about their own depression, anxiety, and asked about their psychiatric impairment. Parents were also asked whether they perceived their child as having a mental health need. Only 38.8% of children who met criteria for a diagnosis were perceived by their parents as having a need, similar to previously studied rates in school-aged children. Perception of need was associated with higher levels of symptoms and impairment. Thresholds for at least half of parents perceiving their child as having a need were relatively high: 19 or more symptoms, or 4 or more impairments. There was evidence of specificity: children with depressive disorders were more likely to be perceived as in need compared with other disorders. In terms of parent factors, more parental depressive symptoms were associated with higher perception of child need when the child had a diagnosis. Parental psychological impairment was associated with higher perception of need when the child had no diagnosis. Most preschool children that meet criteria for a psychiatric disorder are not perceived as needing help by their parents, which is dependent on both child and parent factors.

Self-management in Multiple Sclerosis (MS): Comparing Perceptions of Need Between People with MS, Carepartners, and MS Providers

<h3>Research Objectives</h3> People with Multiple Sclerosis (MS) face challenges managing complex symptoms and navigating daily life. Self-management interventions (SMIs) may help, but research is lacking on the perceived need for SMIs and how perceptions may differ between people with MS (PwMS), carepartners, and MS providers. This exploratory study: 1) determines the need for an MS SMI; 2) identifies similarities and differences in perceived need between PwMS, carepartners, and providers; and 3) generates ideas to inform future self-management research. <h3>Design</h3> A qualitative, exploratory study using focus group (FG) methodology with PwMS (3 FGs), carepartners (1 FG), and medical and rehabilitation MS providers (2 FGs). FGs were audio-recorded, transcribed, then analyzed using the Collaborative Qualitative Analysis approach. Setting: A comprehensive MS care center in urban, southern USA. <h3>Participants</h3> Participants represent a convenience sample of 16 PwMS, 4 carepartners, 6 medical providers, 10 rehabilitation providers. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> The FG moderator's guide included questions about: 1) priority MS symptoms; 2) barriers and facilitators to self-managing MS; 3) MS self-management strategies; 4) program and resource gaps. <h3>Results</h3> Results confirm that PwMS experience self-management challenges. PwMS and carepartner FGs revealed similar findings related to barriers and facilitators to self-managing MS and agreed that an SMI would be beneficial. While providers also agreed an MS SMI is needed, there were differences between groups in relation to barriers to self-management. Specifically, societal perceptions/stigma and the built environment were identified by PwMS as barriers, but not providers. PwMS also discussed the importance of alternative therapies and wellness activities, not discussed similarly by all provider types. <h3>Conclusions</h3> PwMS may benefit from SMIs. Obtaining input from PwMS, their carepartners and providers provides a holistic picture of the barriers to self-management that can inform content development. <h3>Author(s) Disclosures</h3> None.

Associations between dental care approachability and dental attendance among women pregnant with an Indigenous child: a cross-sectional study

BackgroundOral health during pregnancy is vital for both mother and child. Indigenous Australians face many barriers in accessing dental care. Service approachability is one of the key domains in accessing health services. There is little empirical evidence of the association between service approachability and dental care attendance or oral health outcome. The aim of this study is to examine the relationship between dental service approachability on dental care attendance and self-reported gum disease among South Australian women pregnant with an Aboriginal child.MethodsFour hundred and twenty-seven women pregnant with an Aboriginal child completed questionnaires in both metropolitan and regional health settings in South Australia in 2011. Four variables related to approachability of dental services: (1) perception of need; (2) service-related health literacy; (3) oral health beliefs and; (4) trust and expectation of dental service. The association between service approachability-related factors, dental utilisation and self-reported gum disease during pregnancy were assessed using Generalised Poisson regression models, after adjusting for age, remoteness, employment status and education. Estimates were presented as adjusted prevalence ratios (APR).ResultsMost participants (85.8%) reported a need for dental care, had positive oral health beliefs (88.3%) and had expectations towards dental care (86.2%). Dental service utilisation during pregnancy was low (35.7%). Many participants (78.0%) expressed knowing what to do if they needed dental care, while most (39.8%) doubted that dental care would be available the next day. Poor health service literacy was identified as a risk factor for non-optimal dental attendance (APR = 0.86, 95%CI 0.74–0.99). Perceived need for dental care was positively associated with self-reported gum disease (APR = 1.24, 95%CI 1.06–1.45).ConclusionInability to navigate the dental care system was a risk factor for poor dental attendance among South Australian women pregnant with an Aboriginal child. Perceived need for dental care was associated with gum disease.

Barriers and facilitators to the access to specialized female genital cutting healthcare services: Experiences of Somali and Sudanese women in Norway.

BackgroundGirls and women subjected to female genital cutting (FGC) risk experiencing obstetrical, gynecological, sexual, and psychological health problems. Therefore, Norway has established low-threshold specialized healthcare services where girls and women with FGC-related health problems can directly seek medical attention. Nevertheless, we lack data about access to these services, especially for non-maternity-related purposes. In this article, we explore experiences of seeking medical attention for health problems that are potentially FGC-related, aiming to identify factors that hinder or facilitate access to FGC-specialized services.MethodsWe conducted a qualitative study in three Norwegian cities employing semi-structured repeat interviews with 26 girls and women subjected to FGC, participant observation, and three validation focus group discussions with 17 additional participants. We thematically analyzed the data and approached access as a dynamic process of interactions between individuals and the healthcare system that lasts from an initial perception of need until reception of healthcare appropriate to that need.FindingsWe identified several barriers to healthcare, including 1) uncertainty about FGC as a cause of experienced health problems, 2) unfamiliarity with FGC-specialized services, 3) lack of assessment by general practitioners of FGC as a potential cause of health problems, and 4) negative interactions with healthcare providers. In contrast, factors facilitating healthcare included: 1) receiving information on FGC-related health problems and FGC-specialized services from a non-profit immigrant organization, 2) referral to gynecologists with good knowledge of FGC, and 3) positive interactions with healthcare providers.ConclusionAssessing whether FGC is the cause for experienced health problems requires diagnostic competency and should not be left entirely to the patients. We recommend that Norwegian policymakers acknowledge the central role of GPs in the clinical management of patients with FGC-related health problems and provide them with comprehensive training on FGC.

Description of the use of multicriteria to support pricing and reimbursement decisions by European health technology assessment bodies

BackgroundHeterogeneity in drug access throughout Europe may be influenced by differences in drug-assessment strategies. The EUnetHTA’s assessment core model (EUnetHTA-core) and the EVIDEM’s multicriteria framework are reference methodologies in this context, the latter including a wider compromise between non-contextual and contextual criteria. Compliance of 37 European Health Technology Assessment bodies (HTAb) with EUnetHTA-core has been reported, but the use of EVIDEM by this HTAb is still unknown.MethodsTo describe the uptake and use of multicriteria approaches to evaluate drug value by European HTAb using EVIDEM as reference framework, a multicriteria framework was obtained based on EVIDEM model. The criteria used for drug appraisal by HTAb was extracted from the EUnetHTA report, and completed through search of websites, publications and HTAb reports. Use of EVIDEM assessment model in 37 European HTAb has been described semi-quantitatively and summarized using an alignment heatmap.ResultsAligned, medium or misaligned profiles were seen for 24,3%, 51,4% and 24,3% of HTAb when matching to EVIDEM dimensions and criteria was considered. HTAb with explicit responsibilities in providing specific advice on reimbursement showed more aligned profiles on contextual and non-contextual dimensions.ConclusionsEUnetHTA’s core model is limited in assessing medicines while EVIDEM’s framework provides contextual dimension used by some HTAb in Europe that can be escalated to other agencies. Most of the 37 European HTAb have room to broaden their contextual assessment tools, especially when social and medical perception of need requires to be explicit to support payer’s decision on reimbursement.

A Review on Nonpharmacological Treatment of Diabetic Mellitus: Myth V/S Reality

There are many reasons for medical myths occur. Most often they are passed from one generation to another by word of mouth. The origins of some myths are difficult to find out. Understanding those myths and misconceptions in patients with diabetes is important in providing better care to those.1 Diabetes mellitus (DM) is a lifestyle related painless morbidity that produces complex behavior of an individual 'living with disease'. There is a strong influence in the life of those individuals during the treatment of illness. Understanding those myths and misconceptions, and providing education to those individuals and their caregivers are necessary. In the more recent effect of this lifelong disease many factors affect prognosis including education, occupation, attitudes, values, beliefs, and perceptions of need for optimum management, which are shaped over time by cultural and social exposures.2 Myths existing about diabetes in the public have become a major hurdle for its proper treatment and control.3 Keywords: myths, diabetes and lifestyle.

Perceptions of Need for Palliative Care in Recently Hospitalized Patients With Systolic Heart Failure

ContextThe symptom burden associated with heart failure (HF) remains high despite improvements in therapy and calls for the integration of palliative care into traditional HF care. Little is also known about how patients with HF perceive palliative care and patient-level characteristics associated with the need for palliative care, which could influence the utilization of palliative care in HF management. ObjectivesTo identify characteristics of HF patients associated with perceived need for palliative care. MethodsWe analyzed data from the Hopeful Heart Trial, which studied the efficacy of a collaborative care intervention for treating both systolic HF and depression. Palliative care preferences were collected during routine study follow-up. We assessed the association of perceived need for palliative care during study follow-up and baseline data on sociodemographics, clinical measures, and patient-centered outcomes. We then used descriptive statistics and logistic regression to analyze our data. ResultsParticipants were on average 64 years old, male, and reported severe HF symptoms and poor to below average quality of life (. Most had unfavorable impressions of palliative care, but many still perceived a need for palliative care. Factors associated with perceived need for palliative care included depression, non-white race, more severe HF symptoms, and lower mental & physical health-related quality of life. ConclusionHF patients’ beliefs about palliative care may affect utilization of palliative care. Specific characteristics can help identify patients with HF who may benefit from palliative care involvement. Education targeted towards patients with selected attributes may help incorporate palliative care into HF management.

What a great deal…I need that! Updating need drives frugal consumers’ responses to deep discounts

Frugal individuals are known as restrained and disciplined spenders but also exhibit strong deal-seeking tendencies. The unexpected presentation of a deep discount brings these facets of frugality into apparent conflict. How might frugal consumers resolve this conflict? Qualitative analysis of interviews with frugal consumers (study 1) led us to focus on perceptions of need as a potential resolution to these conflicting motives. Two experiments then documented a psychological process by which frugal consumers updated their perceived need for a deeply discounted offering, resulting in enhanced purchase intentions. Less frugal consumers did not exhibit such a process in the face of deep discounts. Study 2 provided evidence consistent with updating need as a mechanism for enhancing purchase intentions. Study 3 replicated these effects, provided direct evidence that need updating in response to deep discounts only occurs among frugal consumers, and revealed that the offering must be at least moderately needed.

Further psychometric evaluation of the My Family’s Accessibility and Community Engagement (My FACE) tool: Mothers’ ratings of perceptions of community accessibility and engagement for their child with disabilities

Background/aimMy Family’s Accessibility and Community Engagement (My FACE) measures mothers’ perceptions of community accessibility and engagement for families raising children with a disability. This study investigated the construct validity including the factor structure and internal reliability of the MyFace scale. MethodsConstruct validity was evaluated using hypothesis testing. Structural validity was confirmed with factor analysis. Internal reliability was measured using Cronbach alpha. The nine-item MyFACE includes items representing common community destinations. A 5-point Likert scale measured perceptions of need for change and inclusion. ResultsMothers (N = 83) completed an online survey with MyFACE, maternal and childhood disability scales. Hypothesis testing revealed correlations with MyFACE: Depression Anxiety Stress Scales (DASS)-stress (r = −.25, n = 72, p = .037), DASS-anxiety (r = −.41, n = 70, p < .001,), and DASS-depression (r = −.27, n = 72, p = .023,) scales. MyFACE scores correlated with mothers’ total Health Promoting Activity Scale (HPAS) scores (r = .40, n = 74, p < .001). HPAS was the strongest predictor of variation in MyFACE scores F(5, 66) = 5.68, p < .001. Factor analysis demonstrated unidimensionality. Internal reliability was excellent (Cronbach alpha = .80). ConclusionsThe MyFACE tool is psychometrically sound. Compared to child factors, maternal mental health and health promoting behaviour had more influence on mothers’ perceptions of family community accessibility and engagement. The MyFACE measures a unique, previously unmeasurable family construct.

Determinants of IBD-related disability: a cross-sectional survey from the GETAID.

The burden of inflammatory bowel disease (IBD) is rising worldwide. The goal of IBD treatment is to achieve clinical and endoscopic remission but also prevent disability. To identify the predictive factors of disability in a large population of patients with IBD. We conducted a cross-sectional survey in 42 tertiary centres in France and Belgium. A self-administered questionnaire was designed to explore patients and their IBD characteristics. IBD-disk is a validated tool to measure disability in patients with IBD. The IBD-disk score was then calculated for each patient. Based on a previous study, an overall IBD-disk score ≥40 was associated with moderate-to-severe disability. Among the 2011 patients, 1700 were analysed, including 746 (44%) in self-reported clinical remission and 752 (44.2%) declaring clinical activity. The patient global assessment of global remission was missing in 200 (11.8%) of 1700 patients. Moderate-to-severe disability was significantly increased in patients with BMI >25kg/m2 (OR=1.66; 95% CI [1.29-2.14]), in those having perception of need for a psychotherapist (OR=2.24; 95% CI [1.79-3.05]) and social worker (OR=1.54; 95% CI [1.08-2.21]). Conversely, male gender (OR=0.83; 95% CI [0.69-0.99]), ulcerative colitis (OR=0.69; 95% CI [0.53-0.92]), self-reported clinical remission (OR=0.59; 95% CI [0.46-0.77]) and employed or student occupational status (OR=0.69; 95% CI [0.52-0.92]) were inversely correlated with disability. Overall, 257 (34.5%) patients who declared being in clinical remission had disability. Determinants of IBD-related disability include IBD-related factors but also psychological and social factors. This highlights the importance of a multidisciplinary team in the management of patients with IBD.

Gender differences in predictors of technology threat avoidance

PurposeThe purpose of this paper is to examine gender differences in predictors of technology threat avoidance motivation and behavior among working US adults. Implications were considered in regard to cybersecurity awareness training motivation and perceptions of need for protective cybersecurity behavior in the workplace.Design/methodology/approachA single-shot regression-based study used ordinal regression supported by K-means clustering to evaluate the moderating effects of gender on predictors of technology threat avoidance motivation and behavior on a sample of n = 206 US adult workers.FindingsThe regression model explained 47.5% of variance in avoidance motivation and 39% of avoidance behavior variance. Gender moderated predictive associations between several independent variables and avoidance motivation: perceived susceptibility, perceived effectiveness, perceived cost and self-efficacy. Gender also moderated the association between avoidance motivation and avoidance behavior.Research limitations/implicationsThe predictive impact of gender extends beyond the main effects in technology threat avoidance. Data frequency distributions and inter-variable relationships should be routinely considered in threat avoidance studies, especially if sample variables exhibit non-normal frequency distributions and nonlinear associations.Practical implicationsGender was significantly associated with threat avoidance motivation and avoidance behavior and exhibited notable associations with antecedents of avoidance motivation. Related insights can inform the design and delivery of training content relating to technology threat avoidance as organizations strive to more effectively leverage information technology end-users as protective assets for the enterprise.Originality/valueThe uniqueness of this study derives from its focus and findings regarding the moderating effects of gender on technology threat avoidance factors and techniques used to measure and evaluate the associations between them.

Factors associated with the knowledge of obstetric danger signs, and perceptions of the need for obstetric care amongst married young women in northern Nigeria.

BackgroundMarried adolescents contribute to poor maternal health indicators in many low-and middle-income countries, where restrictive social norms hinder access to, and utilisation of maternal health services. Addressing these barriers is key to improving health outcomes of young mothers and their children.AimThis study assessed married young women’s knowledge of obstetric danger signs and perceptions of the need to attend obstetric services.MethodsA cross sectional descriptive design, interviewing 1624 randomly selected married young women aged 12–25 years. Data were collected in early 2017 using an interviewer-administered questionnaire on mobile phones, and exported into a statistical software for analysis.ResultsWe found low levels of knowledge of danger signs, especially those pertaining to the post-partum period. Respondents’ age, literacy and household wealth were significantly associated with knowledge of danger signs across the continuum of care. Awareness of danger signs during delivery, was strongly associated with perceptions of need for antenatal care (odds ratio[OR]= 2.269; p < 0.05), and delivery in a health facility (OR = 1.883; P < 0.05). Most respondents believed they must wait for their husband’s approval to attend a health facility when in labour.ConclusionOur findings show that the low levels of knowledge of obstetric danger signs, low perceptions of the importance of facility delivery, and the need to obtain husband’s permission before seeking care, are highly contextualised and reflect the socio-cultural and economic circumstances of married young women in northern Nigeria. Interventions must consider these cultural context, and include a strong male-involvement component.

91756 A participatory approach to develop regional health priorities for clinical and translational research

ABSTRACT IMPACT: Regional health issues can be best addressed at the population-level and input from the communities is vital for prioritization of health issues. OBJECTIVES/GOALS: The Great Plains IDeA-CTR (GP IDeA-CTR) was developed to increase clinical and translational research (CTR) that can address regional health priorities. Here we describe a collaborative process used to identify regional health priorities using existing surveillance data and community input. METHODS/STUDY POPULATION: We used a participatory approach that included a partnership between the GP IDeA CTR Community-Engagement and Biostatistics, Epidemiology, and Research Design Cores to ensure priorities were data driven and also aligned with community-based perceptions of need. First, aggregated surveillance data across Nebraska, North Dakota, and South Dakota was presented to the GP IDeA CTR Community Advisory Board (CAB). Second, CAB members formed small groups and considered the information and generated priority health area lists. Third, small group lists were considered and discussed by the full CAB to finalize priority areas. Finally, the CAB reviewed the priorities annually thereafter. RESULTS/ANTICIPATED RESULTS: We identified priority areas for CTR that included (1) behavioral health, (2) injury prevention, (3) obesity, (4) technology to improve health care access, (5) connecting clinical/community services, and (5) addressing health disparities. These priorities align with population-based surveillance data that show lack of mental health care access, high prevalence of obesity, higher incidence of accidents, and existing racial, ethnic, and geographic health disparities. The CAB highlighted that research was also needed to improve how people can access the health innovations developed through CTR to address the other priority health issues with a goal to have an impact on population health. DISCUSSION/SIGNIFICANCE OF FINDINGS: By integrating data- and community-driven approaches we identified regional health priority areas that if addressed, can have significant impact in the GP IDeA CTR region. The priorities are listed on all GP IDeA-CTR funding announcements to encourage CTR in these areas.

Affordability, availability and tolerability of anti-seizure medications are better predictors of adherence than beliefs: Changing paradigms from a low resource setting

ObjectivesAnti-seizure medication (ASM) non-adherence contributes to treatment gap and increases mortality and morbidity associated with epilepsy. Beliefs about medications are considered better predictors of ASM non-adherence than clinico-demographic factors. We aimed to look into ASM non-adherence rates among adults with epilepsy (AWE), identify the contributing barriers and determine whether medication beliefs were more powerful predictors than clinico-demographic factors. MethodsThis was a cross-sectional study of AWE receiving ASMs. Participants (n = 304) were assessed by validated questionnaires, for non-adherence (8-item Morisky Medication Adherence Scale) and perceptions of ASMs (Beliefs about Medicines Questionnaire) along with clinico-demographic details. ResultsOur group with high literacy and low-income had a high non-adherence rate (55 %) despite having positive beliefs (Mean necessity-concern differential [NCD] = 2.86). Among the beliefs, ASM non-adherence was significantly associated with ASM-concern (t = 4.23, p < 0.001) and NCD (t = −4.11, p < 0.001). Stepwise multiple linear regression analysis showed that non-adherence was significantly associated with per-capita income (β −0.215, p < 0.001), ASM side effects (β 0.177, p = 0.001), high seizure frequency (β 0.167, p = 0.002), ASM availability (β −0.151, p = 0.004), ASM costs (β −0.134, p = 0.013 and NCD (β −0.184, p = 0.001). NCD accounted for 2.9 % of the variance in non-adherence whereas the other clinico-demographic variables together accounted for 14.6 %. ConclusionWe describe a paradigm shift in AWE with high non-adherence to ASMs, wherein clinico-demographic variables emerge as better predictors of non-adherence than beliefs. High literacy facilitates the perception of need for ASMs whereas costs and side effects hamper adherence.

Reproductive health Knowledge needs among secondary school students in Mid Nile Delta Region, Egypt

Background: Adolescent are increasingly vulnerable to negative reproductive health outcomes; such as HIV/AIDS, STDs, violent and unwanted sex, limited access to contraceptives, and early or forced marriage. Little is known about youth educational needs about reproductive health in Egypt.Objectives: assess needs for reproductive health information among secondary student.Methods: cross sectional study was conducted from the start of October, 2019 till the end of November, 2019. It encompassed 942 secondary school students in Gharbia Governorate using a predesigned questionnaireResults: The suitable age of marriage was reported by 67.9% to be 20-30years. The majority of students were aware that tobacco smoking and addiction adversely affect reproductive health (74.5% and 84.1%, respectively. Only 18.3% had information about risks associated with early marriage. Shyness to as about issues related to reproductive health was reported by 33.5% and only 15.2% always communicate with parents about reproductive health. The main source of information was the internet (51.9%). Among participants, 12% reported exposure to sexual harassment and 25.6% reported having a friend or relative suffering from sexual harassment. The high perception of need for information as reported by students was for the following topics: masturbation and its hazards (68.3%), issues related to male and female circumcision (64.7%), sexually transmitted infections and AIDS (60.4%), hazards of extramarital relations (56.9%) and safe motherhood (54.2%).Conclusion: secondary school students are in need of information about reproductive health. There is a need to implement appropriate programs to improve the reproductive health of school students.

Acceptability of bisphosphonates among patients, clinicians and managers: a systematic review and framework synthesis

ObjectiveTo explore the acceptability of different bisphosphonate regimens for the treatment of osteoporosis among patients, clinicians and managers, payers and academics.DesignA systematic review of primary qualitative studies. Seven databases were...

한국적 영어학습의 도구적 동기척도 타당화 연구: 필요성 개념을 중심으로

한국적 영어학습의 도구적 동기척도 타당화 연구: 필요성 개념을 중심으로

English

The aim of this study was to examine the entrepreneurial intentions of university students at two major universities in Yemen. The entrepreneurial intentions of students were determined using demographic, personality, environmental and situational variables. The primary data were collected through a questionnaire survey method. A total of 487 students have been included from different programs such as economics, commerce, sciences, computer and IT, medical sciences, agriculture, engineering, art and law. To analyze the data, descriptive statistics, principal component factor analysis, t-test, analysis of variance, correlation and regression analysis were employed. The results indicate that individual perceptions of need for achievement, self-efficacy, locus of control and situational variable have a significant impact on entrepreneurial intention, but not instrumental readiness. Age and entrepreneurial experience have a significant impact, but not gender and university. The study recommends that students should develop their entrepreneurial capacity by following informal and formal training of different entrepreneurial skills needed to run a business. Government and universities should organize entrepreneurship training courses and establishing entrepreneurship centers, incubators and support entrepreneurial start-ups activity. &nbsp; Key words: University students, entrepreneurial intention, Yemen.

Do Men and Women Perceive Corruption Differently? Gender Differences in Perception of Need and Greed Corruption

Do men and women perceive corruption differently? While evidence suggest that there is a strong link between gender and corruption, and that gender differences can at least partly be derived from men and women having different attitudes towards corruption, most studies to date focus on gender differences in perceptions of the scale or severity of the corruption in general, rather than its different forms. However, we argue that factors such as role socialization, social status and life experiences may make men and women perceive different kinds of corruption. Drawing on the distinction between ‘need’ and ‘greed’ corruption, we suggest that women are more likely than men to perceive that corruption is driven by need rather than greed. In particular, women may be more likely to be exposed to need corruption because of their greater care taking responsibilities both in the professional and private sphere, and, much in line with marginalization theory, have easier access to forms of corruption that are less dependent upon embeddedness in collusive networks. Using unique survey data, we show that women and men indeed differ in their perceptions of need vs. greed, and that women perceive more need corruption, while men perceive more greed corruption. This suggests that perceptions of different forms of corruption are indeed gendered and we discuss the implication of this for anti-corruption policy.

The Functional Outcomes of Patients With Knee Osteoarthritis Managed Nonoperatively at the Joint Clinic at 5-Year Follow-Up: Does Surgical Avoidance Mean Success?

BackgroundNonoperative management of patients with knee osteoarthritis (OA) through multidisciplinary programs may delay or reduce the need for total knee arthroplasty (TKA). However, avoidance of surgery may not represent success for the patient. MethodsA cohort of 120 patients with knee OA managed with at least 6 months of supervised nonoperative treatment coordinated through the Joint Clinic were reviewed at 5 years. Outcomes including Oxford knee score (OKS), Short Form 12 (SF-12), and SF-6D and other measures including analgesia use, global change, and perception of need for surgery were collected and compared with those from the cohort who had undergone TKA. ResultsSeventy (62.5%) surviving patients were still being managed nonoperatively. There was no significant change in any outcome score (OKS, SF-12 physical component score, SF-12 mental component score, SF-6D) (P = .26 to .84). Forty-two patients had undergone TKA with mean time to surgery 29.0 months (range, 9-69 months). In this group, the mean OKS fell from 17.9 at baseline to 10.3 (range, 3-21) preoperatively (P < .0001) and at 5 years there was a significant improvement from baseline in OKS, SF-12 physical component score, and SF-6D scores (P < .0001). All outcome scores and change in scores were significantly higher for the surgical group (all P < .001). ConclusionAlthough a high proportion of patients with knee OA have avoided surgery at 5 years, their outcomes show no improvement from baseline and are poorer than those who have undergone TKA. Avoidance of surgery should not necessarily be regarded as an indicator of success of nonoperative treatment for the patient.