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The Oxford Knee Score is a reliable predictor of patients in a health state worse than death and awaiting total knee arthroplasty
BACKGROUND: The health-related quality of life of patients awaiting a total knee arthroplasty (TKA) deteriorates with increasing time to surgery and identification of those with the worst quality of life may help to prioritize patients. The aims were to identify and validate independent variable(s)...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9345743/ https://www.ncbi.nlm.nih.gov/pubmed/35918759 http://dx.doi.org/10.1186/s42836-022-00132-9 |
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author | Clement, N. D. Afzal, I. Liu, P. Phoon, K. M. Asopa, V. Sochart, D. H. Kader, D. F. |
author_facet | Clement, N. D. Afzal, I. Liu, P. Phoon, K. M. Asopa, V. Sochart, D. H. Kader, D. F. |
author_sort | Clement, N. D. |
collection | PubMed |
description | BACKGROUND: The health-related quality of life of patients awaiting a total knee arthroplasty (TKA) deteriorates with increasing time to surgery and identification of those with the worst quality of life may help to prioritize patients. The aims were to identify and validate independent variable(s) associated with a health state worse than death (WTD) in patients awaiting a TKA and whether these variables influenced patients-reported outcome measures. METHODS: A retrospective cohort of 5857 patients undergoing a primary TKA was identified from an established arthroplasty database. Patient demographics, body mass index (BMI), index of multiple deprivation, Oxford Knee Score (OKS), EuroQoL five dimension (EQ-5D) 3 level, and visual analogue scale (EQ-VAS) were collected preoperatively and one year postoperatively. An EQ-5D utility of less than zero was defined as WTD. A randomly selected subset of patients (n = 3076) was used to validate the variable that was most predictive of a state WTD and to assess the influence on patient-reported outcomes. RESULTS: There were 771 (13.2%) patients with a health state WTD. Increasing social deprivation (P = 0.050), worse preoperative OKS (P < 0.001), or EQ-VAS (P < 0.001) were independently associated with a health state WTD. The OKS was the most reliable predictor (area under curve 88.9%, 95% CI 87.8 to 90.1, P < 0.001) of a health state WTD. A threshold value of 16 or less, 80% sensitive and specific, was validated and confirmed to have a negative predictive value of 97.5%. Patients with an OKS of 16 or less had a significantly greater improvement in their OKS (difference 6.9, P < 0.001) and EQ-5D score (difference 0.257, P < 0.001). When adjusting for confounding factors, a health status WTD was not associated with worse postoperative OKS (difference –0.6, 95% CI –1.4 to 0.3, P = 0.177), EQ-5D (difference –0.016, 95% CI –0.036 to 0.003, P = 0.097) or patient satisfaction (difference –1.8, 95% CI –4.3 to 0.7, P = 0.162). CONCLUSION: A threshold score 16 or less in OKS was a reliable predictor of a health status WTD and was associated with a greater improvement in knee-specific and health-related quality of life following TKA. |
format | Online Article Text |
id | pubmed-9345743 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-93457432022-08-03 The Oxford Knee Score is a reliable predictor of patients in a health state worse than death and awaiting total knee arthroplasty Clement, N. D. Afzal, I. Liu, P. Phoon, K. M. Asopa, V. Sochart, D. H. Kader, D. F. Arthroplasty Research BACKGROUND: The health-related quality of life of patients awaiting a total knee arthroplasty (TKA) deteriorates with increasing time to surgery and identification of those with the worst quality of life may help to prioritize patients. The aims were to identify and validate independent variable(s) associated with a health state worse than death (WTD) in patients awaiting a TKA and whether these variables influenced patients-reported outcome measures. METHODS: A retrospective cohort of 5857 patients undergoing a primary TKA was identified from an established arthroplasty database. Patient demographics, body mass index (BMI), index of multiple deprivation, Oxford Knee Score (OKS), EuroQoL five dimension (EQ-5D) 3 level, and visual analogue scale (EQ-VAS) were collected preoperatively and one year postoperatively. An EQ-5D utility of less than zero was defined as WTD. A randomly selected subset of patients (n = 3076) was used to validate the variable that was most predictive of a state WTD and to assess the influence on patient-reported outcomes. RESULTS: There were 771 (13.2%) patients with a health state WTD. Increasing social deprivation (P = 0.050), worse preoperative OKS (P < 0.001), or EQ-VAS (P < 0.001) were independently associated with a health state WTD. The OKS was the most reliable predictor (area under curve 88.9%, 95% CI 87.8 to 90.1, P < 0.001) of a health state WTD. A threshold value of 16 or less, 80% sensitive and specific, was validated and confirmed to have a negative predictive value of 97.5%. Patients with an OKS of 16 or less had a significantly greater improvement in their OKS (difference 6.9, P < 0.001) and EQ-5D score (difference 0.257, P < 0.001). When adjusting for confounding factors, a health status WTD was not associated with worse postoperative OKS (difference –0.6, 95% CI –1.4 to 0.3, P = 0.177), EQ-5D (difference –0.016, 95% CI –0.036 to 0.003, P = 0.097) or patient satisfaction (difference –1.8, 95% CI –4.3 to 0.7, P = 0.162). CONCLUSION: A threshold score 16 or less in OKS was a reliable predictor of a health status WTD and was associated with a greater improvement in knee-specific and health-related quality of life following TKA. BioMed Central 2022-08-03 /pmc/articles/PMC9345743/ /pubmed/35918759 http://dx.doi.org/10.1186/s42836-022-00132-9 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/ Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Research Clement, N. D. Afzal, I. Liu, P. Phoon, K. M. Asopa, V. Sochart, D. H. Kader, D. F. The Oxford Knee Score is a reliable predictor of patients in a health state worse than death and awaiting total knee arthroplasty |
title | The Oxford Knee Score is a reliable predictor of patients in a health state worse than death and awaiting total knee arthroplasty |
title_full | The Oxford Knee Score is a reliable predictor of patients in a health state worse than death and awaiting total knee arthroplasty |
title_fullStr | The Oxford Knee Score is a reliable predictor of patients in a health state worse than death and awaiting total knee arthroplasty |
title_full_unstemmed | The Oxford Knee Score is a reliable predictor of patients in a health state worse than death and awaiting total knee arthroplasty |
title_short | The Oxford Knee Score is a reliable predictor of patients in a health state worse than death and awaiting total knee arthroplasty |
title_sort | oxford knee score is a reliable predictor of patients in a health state worse than death and awaiting total knee arthroplasty |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9345743/ https://www.ncbi.nlm.nih.gov/pubmed/35918759 http://dx.doi.org/10.1186/s42836-022-00132-9 |
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