Preoperative predictors of health-related quality of life changes (EQ-5D and EQ VAS) after total hip and knee replacement: a systematic review

Abstract

Background Patient-reported outcomes are of ever-increasing importance in medical decision-making. The EQ-5D is one of the generic instruments measuring health-related quality of life (HRQoL) in arthroplasty. This review aimed to identify possible predictors of HRQoL changes for patients undergoing total knee replacements (TKR) or total hip replacements (THR). Methods A systematic literature review according to the PRISMA guidelines was conducted, searching several databases. Preoperative to postoperative HRQoL changes were evaluated in patients undergoing THR or TKR, using the EQ-5D visual analog scale (VAS) or the preference-based EQ-5D Index were evaluated. Articles were considered with prospectively or retrospectively collected data, as well as registry data, each with statistical analyses of patient-related factors. Results Eight hundred eighty-two articles were found, of which 21 studies met the inclusion criteria. Predictors were distinguished in alterable and non-alterable ones. The EQ-5D Index indicated a tendency towards beneficial improvements for patients with a high body mass index (BMI) (> 40) and no significant results for the VAS. Additionally, one study found that patient education and preoperative physiotherapy appeared to enhance HRQoL. Some evidence indicated that male gender was negatively associated with changes in the VAS and the EQ-5D Index, but one study reported the opposite. Changes in VAS and EQ-5D Index were lower for older patients, whereas a higher educational level seemed to be advantageous. A high Charnley class led to deteriorating changes in VAS, although a high Kellgren Lawrence classification was positively associated with the EQ-5D Index, in a limited number of studies. For all results, clinical relevance was calculated differently and mainly reported as uncertain or small. Conclusions The literature on this topic was weak and offers only limited guidance. Results for alterable predictors, such as the BMI, indicated valuable improvements for highly obese patients. Further, high-quality research is required to support medical decision-making. Level of evidence Level IV, according to the OCEBM Levels of Evidence Working Group.

Effects of medical interventions on health-related quality of life in chronic disease – systematic review and meta-analysis of the 19 most common diagnoses

“…Recent studies confirmed this high responsiveness of the EQ-5D in knee arthroplasty ( 41 ). It is still unclear whether patient characteristics have an influence on changes in the EQ-5D Index after arthroplasty, a clear effect has so far only been shown for body mass index ( 42 ). The negative effect size shown in our study for femur fracture confirms other meta-analytic findings that older patients with hip fracture in particular do not experience a full recovery of their HRQoL to baseline values ( 43 ).…”

Does an Adductor Canal Block Influence Patient-Reported Outcomes at One Year Following Total Knee Arthroplasty?

“…Alternatively, as with functional knee outcome, the follow-up questionnaire being at one year may have meant any effect on HRQoL attributable to post-operative pain-management technique may be masked by other factors. Post-operative EQ-5D has been shown to be predicted by age, sex, education, obesity, socioeconomic status, anxiety and depression [ 22 ]. A regression analysis was completed including available confounding factors in our study (sex, socioeconomic group, ASA grade, pre-operative functional scores), and there remained no significant difference in EQ-5D change between groups.…”

First knee for pain and function versus second knee for quality of life

“… 29 The EQ-VAS is a scale on which a patient rates their current health ‘today’ from 0 (the worst imaginable health) to 100 (the best imaginable health), with an estimated MCID between 6.4 and 15 points. 30 , 31 …”