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Article: Total Hip Arthroplasty

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1 Article: Total Hip Arthroplasty on Mon Nov 21, 2011 8:34 pm

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One of my patient's had a total hip arthroplasty and the article I researched was based on the patient's evaluation of their care. I found it interesting, hope you do too.


The value of short and simple measures to assess outcomes for patients of total hip replacement surgery

A number of patient assessed outcome measures have recently been developed in the form of questionnaires for use in evaluative health research, assessing issues such as functional status and health related quality of life. Several such measures have been applied to total hip replacement. Because of the need to measure specific forms of pain and the problems of mobility in older patients who may experience substantial symptoms for other reasons than hip disease, the Oxford Hip Score was developed specifically to assess the patient’s perceptions of pain, mobility, and function in relation to problems of the hip. An opportunity to examine the usefulness of the Oxford Hip Score was provided by the National Total Hip Replacement Project (NTHRP).
Design—A survey of patients’ health status before undergoing primary hip replacement surgery and three months and one year after surgery.
Setting—143 hospitals in three NHS English regions; 7151 patients admitted for primary total hip replacement surgery over a period of 13 months from September 1996.
Main measures—for patients, Oxford Hip Score and satisfaction with hip replacement and, for surgeons, American Anesthiologists’ Society (ASA) classification of physical status.
Evidence was obtained of small potential biases from this approach to assessing outcomes. Older and less healthy patients were somewhat less likely to complete the Oxford Hip Score. This is a potential problem found with patient assessed outcome measures more generally. This evidence reinforces the need for short instruments that minimize the burden to patients of assessing outcomes.
Response rates to the postal questionnaire at three and 12 months follow up were 85.2% and 80.7%, respectively. Including all three administrations of the questionnaire, all except two items of the Oxford Hip Score were completed by 97% or more respondents and only one item at one administration appeared marginally to reduce the reliability of the score.
Conclusions: The instrument was very responsive to change over time and score changes for the Oxford Hip Score related well to patients’ satisfaction with their surgery. The instrument is an appropriate measure in terms of validity, responsiveness, and feasibility for evaluating total hip replacement. Qualitative evidence has an important and distinct role in the evaluation of health care. The NTHRP reported here, investigators have collaborated with the College of Health to analyze answers to open ended questions about their experiences. In the context of patient assessed outcomes, qualitative evidence is essential in initially identifying issues of concern to patients that need to be included in outcome measures. McMurray and colleagues also used qualitative evidence to suggest reasons for difficulties respondents may have with an instrument. However, it is less clear how qualitative evidence can contribute to identifying the modest but important benefits that may be associated with different surgical strategies. Health service researchers need to be able to detect such divergences in order to improve the quality of total hip replacement surgery.
Reference: qualitysafety.bmj.com Quality in Healthcare 2000. Institute of Health Sciences, University of Oxford,Headington, Oxford OX3 7LF,UK R Fitzpatrick,professor of public health and primary care.

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