Quality of Life Trajectories in Total Knee Replacement Patients: What can they tell us?
Tew, M.*(1); Clarke, P.(1) Dalziel, K(1); Choong, P (2, 3); Smith, A(4); Dowsey, M (2, 3)
1 Centre for Health Policy, Melbourne School of Population and Global Health
2 Department of Surgery, The University of Melbourne
3 Department of Orthopaedics, St. Vincent’s Hospital
4 School of Physiotherapy and Exercise Science, Curtin University
There is growing evidence that patient-reported quality-of-life (QoL) is an important predictor of outcomes such as hospitalisation and mortality. Therefore, understanding patients’ QoL trajectories can reveal important information on disease progression and outcomes. The aim of this study was to employ latent class growth analysis (LCGA) to identify specific QoL trajectories following total knee replacement (TKR) and examine patient characteristics of identified trajectories.
Data on all patients who had TKR between 2006 and 2015 were extracted from the St. Vincent’s Melbourne Arthroplasty Outcomes Registry which captures patient demographics, co-morbidities and patient reported QoL (SF12). Utilities values at baseline (pre-surgery), year 1, 2, 3, 4 and 5 were derived from SF12 responses using published algorithm.
LCGA was conducted using utility scores to categorise patients based on their QoL trajectories over 5 years post-surgery. Assessment to identify the optimum number of classes was considered using goodness of fit measures and posterior probability diagnostics. Multinomial logistic regression was used to determine independent predictors of class membership to understand the patient characteristics that contribute to the heterogeneity in QoL trajectories.
1,553 patients contributed to the analysis. Preliminary analysis indicates the presence of 6 distinct QoL trajectories; no QoL improvement following surgery (18%), low baseline QoL with moderate QoL improvement (30%), slow gradual improvement (9%), significant improvement with sustained effect (19%), significant improvement without sustained effect (18%) and high baseline QoL with moderate improvement (7%). Age and presence of co-morbidities appear to be important predictors of declining trajectories. Patient-reported outcomes can reveal important unobserved heterogeneity among TKR patients suggesting greater scope for such measures in clinical practice beyond health economic evaluation.
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For more information about this abstract, please contact:
Michelle Tew, Centre for Health Policy, The University of Melbourne
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