Total Knee Arthroplasty Clinical Trial
Official title:
A Psychometric Analysis of the Arabic Version of Oxford Knee Score Before and After Total Knee Arthroplasty in a Middle East Population and an Exploration of Outcomes Post-total Knee Arthroplasty in the Middle East
The intention is to explore whether there are factors, which can help us to understand why
some patient outcomes, following total knee arthroplasty are not successful and identify
prediction factors for progression. Assessment of outcomes pre- and post-surgery with
objective tools is a way to explore prediction tools for good/poor progression and improve
patient selection and timing for surgery.
The first aim of this project is determine the psychometric properties of the Arabic Version
of Oxford Knee Score, including internal consistency, reliability and validity before and
post-total knee arthroplasty in both males and females in a Middle East population. The
second aim is to assess the reliability of the Star Excursion Balance Test for measuring the
dynamic balance. The final aim is explore outcomes post-total knee arthroplasty among Middle
East patients using the Arabic Version of Oxford Knee Score, physical activity measures and
performance-based measurements such as: 30 s chair-stand test, stair-climb test, timed
up-and-go test and a 6 m walk test while adhering to Osteoarthritis Research Society
International recommendations.
Project objectives
To gain an understanding of recovery post-TKA in a Saudi population and explore whether there
are factors which can help us to understand why some patient outcomes are not successful and
identify prediction factors for progression. It is a prospective study measuring outcomes six
months post-TKA with the following objectives:
- Examine the internal consistency, reliability and validity of the Arabic Version of
Oxford Knee Score before and after total knee arthroplasty in both male and female
Middle East patients.
- Examine the test- re-test reliability of the Star Excursion Balance Test in both male
and female Middle Eastern patients.
- Measure patient outcomes post-total knee arthroplasty using patient self-reporting
activity measurements and the Arabic Version of Oxford Knee Score;
- Evaluate physical activity level improvements post-knee arthroplasty using objective
methods and an accelerometer: ActivPAL;
- Assess functional recovery post-knee arthroplasty according to Osteoarthritis Research
Society International recommendations using performance-based measurements, such as: 30
s chair-stand test, stair-climb test, timed up-and-go test and a 6 m walk test alongside
functional balance.
The rationale which led to this project;
Knee osteoarthritis (OA) is a major cause of disability around the world; it is the most
common chronic condition in primary care in the UK. By 2030 it is predicted to be the
greatest cause of disability in the general population . An effective end-stage treatment for
knee OA is knee-replacement surgery, which was first done in the 1970s and 1980s.
In England and Wales, the number of knee-replacement procedures recorded by the National
Joint Registry in 2013 was 91,703, which represents an increase of 0.9 % over 2012. The data
analysis by the National Joint Registry and the Office of National Statistics suggests that,
by 2030, primary TKAs will increase by 117% from the 2012 level. Subsequently, TKA revision
surgeries are expected to increase incrementally by 332%. There is a similar estimation of
demand for revision TKA surgeries in the United States; by 2030, they are expected to rise by
601% from the 2005 level. The United States estimation of primary TKA is for growth of 673%
from the 2005 level, which is similar to England and Wales's upper-limit projections.
Post-TKA, 75-85% of patients report satisfaction with surgery outcomes, while the remaining
15-25% are dissatisfied (Klit, Jacobsen, Rosenlund, Sonne-Holm, & Troelsen, 2014). Total knee
arthroplasty's success has traditionally been evaluated from the surgeon's perspective, e.g.
the presence of surgical complications or implant survival. This is gradually changing to
involve the patient in measuring health outcomes and decision-making processes.
Patient-reported outcome measures (PROMs) have evolved to explore patient perspectives by
monitoring the quality of care in health organizations and conducting clinical trial
outcomes.
PROM results cannot exclude the Research Participant Effect (RPE) or subjective
over/underestimation due to psychosocial effects or pain from other joints, such as hips or
back. Hence, objective clinical evaluation methods can minimize patients' subjective
over/underestimations of outcomes, though RPE can not be excluded. Objective assessment has
some advantages over PROMs, such as a lack of ceiling effects and more precision and
responsiveness, and it does not require cultural and language adaptation. Performance-based
Outcome Measures (PBOMs) have the advantage of being objective measures that do not overlap
with pain measurement. They are sensitive to detecting change, responsive, have a minimal
ceiling effect and are feasible.
PROMs and PBOM measurement tools assess different aspects of function post-TKA. PROMs mainly
assess patients' functional ability beliefs and experiences, while objective functional
assessment instruments and PBOM measurement tools evaluate patients' actual ability and
function. Therefore, to conduct comprehensive functional assessments post-TKA, PROMs,
objective functional assessment instruments and PBM measurement tools are recommended.
To the best of our knowledge, no study has explored the outcome post TKA using the PROMs,
PBOMs and functional balance measurement tools in Saudi male and female population or
explored possible accurate prediction factors for outcomes post-TKA. Reliable outcome
prediction could, however, improve patient selection for surgery, as appropriate timing for
surgery depends on patient symptoms and efficient patient preparation for surgery if it is to
be cost-effective. Accurate preoperative prediction is crucial to minimize the potential for
unrealistic expectations about outcomes.
This study will investigate outcomes post-total knee arthroplasty and factors that may
predict good/poor progression using three categories of outcome measurements in order to
minimize subjective over/ underestimation of surgical outcomes. Thus, the study seeks to
explore accurate and objective prediction factors of post-total knee arthroplasty
progression.
Potentially, reliable outcome predictions could improve patient selection for surgery, as
appropriate timing for surgery depends on patients' symptoms and efficient patient
preparation for surgery, if it is to be cost-effective. Accurate preoperative prediction is
crucial to minimize the potential for unrealistic expectations about outcomes.
;
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