Subjektive Krankheitstheorien und funktionaler Verlauf nach Knie- und Hüftgelenkersatz

Bethge, Matthias; Bartel, Susanne; Streibelt, Marco; Lassahn, C.; Thren, K.

doi:10.1055/s-0030-1250149

Cited by 13 publications

(11 citation statements)

References 22 publications

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“…Table 1 shows that 14 studies (40 %) had low risk of bias for the follow-up domain. Eight studies [ 14 – 21 ] had a high risk of bias on this domain. One study [ 22 ] had a loss to follow-up of >20 % in the first and third year, but a low loss to follow-up at 5 and 7 years, so that risk of bias was unclear.…”

Section: Resultsmentioning

confidence: 99%

“…Two included high risk of bias studies (6 %) reported an association between patient expectations and outcomes. Bethge et al [ 14 ] found that patients who expected an enduring illness and did not expect treatment to be helpful had worse postoperative scores on the HHS. Judge et al [ 18 ] showed that patients with high expectations were more likely to improve on the WOMAC scale.…”

Section: Resultsmentioning

confidence: 99%

“…This was also found in a high risk of bias study by Gordon et al [ 38 ], in which the authors stated that patients with low preoperative scores had the highest gain, although they did not reach the same absolute levels as patients with high preoperative scores. No associations were found in eight studies that tested associations of different HRQoL scores on outcomes, such as WOMAC, pain, satisfaction, EQ-5D, SF-36 and WOMAC [ 14 , 16 , 18 , 21 , 23 , 32 , 36 , 42 ]. Two of these studies had low risk of bias [ 36 , 42 ].…”

Section: Resultsmentioning

confidence: 99%

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Preoperative predictors for outcomes after total hip replacement in patients with osteoarthritis: a systematic review

Hofstede

Gademan

Vlieland

et al. 2016

BMC Musculoskelet Disord

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BackgroundThis systematic review examines which patient related factors influence functional and clinical outcomes after total hip arthroplasty (THA) in patients with hip osteoarthritis (OA).MethodsWe performed a systematic review according to the PRISMA guidelines. We searched databases and trial registries for prospective studies including OA patients who underwent primary THA. Studies with preoperative measurements on predictors, with at least 1 year follow-up were included. Risk of bias and confounding was assessed for two domains: follow-up rate and looking at independent effects.ResultsThirty-five studies were included (138,039 patients). Only nine studies (29 %) had low risk of bias for all domains thus suggesting an overall low quality of evidence. Studies were heterogeneous in the predictors tested and in the observed directions of the associations. Overall, preoperative function (13 studies (37 %), 2 with low risk of bias) and radiological OA (6 studies (17 %), 1 with low risk of bias) were predictors with the most consistent findings. Worse preoperative function and more severe radiological OA were associated with larger postoperative improvement. However, these patients never reached the level of postoperative functioning as patients with better preoperative function or less severe radiological OA. For age, gender, comorbidity, pain and quality of life the results of studies were conflicting. For BMI, some studies (n = 5, 2 with low risk of bias) found worse outcomes for patients with higher BMI. However, substantial improvement was still achieved regardless of their BMI.ConclusionThere is not enough evidence to draw succinct conclusions on preoperative predictors for postoperative outcome in THA, as results of studies are conflicting and the methodological quality is low. Results suggest to focus on preoperative function and radiological osteoarthritis to decide when THA will be most effective. The present mapping of current evidence on the relationship between patient related factors and outcomes provides better information compared to individual studies and may help to set patient expectations before surgery. In addition, these findings may contribute to discussions on how to achieve the best possible postoperative outcome for specific patient groups.Trial registrationThis systematic review was registered in Prospero, registration number RD42014009977.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-1070-3) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Preoperative predictors for outcomes after total hip replacement in patients with osteoarthritis: a systematic review

Hofstede

Gademan

Vlieland

et al. 2016

BMC Musculoskelet Disord

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“…A very important aspect remained unaddressed: Asking patients about their own beliefs and concepts of sickness, health and the origin of their disease as well as asking about complementary medicine and “self-treatment”. This whole area was not covered in the included literature, despite there being strong evidence that this can be an important part of recovery [ 23 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

What is a good doctor?

Steiner-Hofbauer

Schrank

Holzinger

2017

Wien Med Wochenschr

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SummaryChanges in medical curricula have led to a shift of focus in medical education. The goal was to implement a more practical approach to teaching and thereby create better doctors. However, the question of what makes a good doctor is not easy to answer. This article gives an overview on the literature about this topic. A systematized review and narrative synthesis were conducted including 20 articles about the features of good doctors. Qualitative and quantitative studies as well as questionnaires were included. These studies reported research involving students, doctors, patients, and nurses. The resulting characteristics of good doctors fell into six categories: (1) General interpersonal qualities, (2) Communication and patient involvement, (3) Medical competence, (4) Ethics, (5) Medical management, (6) Teaching, research, and continuous education. The different stakeholders showed different ideas of the concept of a good doctor. Interestingly, patients had a stronger focus on communication skills, whereas doctors put more emphasis on medical skills. Balancing this discrepancy will be a challenge for future medical education.

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“…Similarly, in another study, preoperative illness-related concern was found to be associated with poorer functional outcome 1 year after TKA (Bethge et al. 2010). There was a correlation between a higher degree of distress and lower use of problem-focused coping strategies (Folkman and Moskowitz 2004), which may in turn result in avoidance of activity.…”

Section: Discussionmentioning

confidence: 99%

Factors that can predict pain with walking, 12 months after total knee arthroplasty

Lindberg¹,

Miaskowski

Rustøen

et al. 2016

Acta Orthopaedica

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Background and purpose — Functional limitations after total knee arthroplasty (TKA) are common. In this longitudinal study, we wanted to identify subgroups of patients with distinct trajectories of pain-related interference with walking during the first year after TKA and to determine which demographic, clinical, symptom-related, and psychological characteristics were associated with being part of this subgroup.Patients and methods — Patients scheduled for primary TKA for osteoarthritis (n = 202) completed questionnaires that evaluated perception of pain, fatigue, anxiety, depression, and illness on the day before surgery. Clinical characteristics were obtained from the medical records. Interference of pain with walking was assessed preoperatively, on postoperative day 4, and at 6 weeks, 3 months, and 12 months after TKA.Results — Using growth mixture modeling, 2 subgroups of patients were identified with distinct trajectories of pain-related interference with walking over time. Patients in the Continuous Improvement class (n = 157, 78%) had lower preoperative interference scores and reported a gradual decline in pain-related interference with walking over the first 12 months after TKA. Patients in the Recurrent Interference class (n = 45, 22%) reported a high degree of preoperative pain-related interference with walking, initial improvement during the first 3 months after TKA, and then a gradual increase—returning to preoperative levels at 12 months. Patients in the Recurrent Interference class had higher preoperative pain, fatigue, and depression scores, and poorer perception of illness than the Continuous Improvement class.Interpretation — 1 in 5 patients did not improve in pain-related interference with walking at 12 months after TKA. Future studies should test the efficacy of interventions designed to modify preoperative characteristics.

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Subjektive Krankheitstheorien und funktionaler Verlauf nach Knie- und Hüftgelenkersatz

Abstract: The results confirmed the prognostic relevance of illness perceptions for the functional outcome and indicate the importance of preoperative counselling and the potential benefit of patient-oriented education that is aimed at modifying illness perceptions.

Cited by 13 publications

References 22 publications

Preoperative predictors for outcomes after total hip replacement in patients with osteoarthritis: a systematic review

Preoperative predictors for outcomes after total hip replacement in patients with osteoarthritis: a systematic review

What is a good doctor?

Factors that can predict pain with walking, 12 months after total knee arthroplasty

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