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1.
Knee Surg Sports Traumatol Arthrosc ; 32(2): 461-472, 2024 Feb.
Article in English | MEDLINE | ID: mdl-38284904

ABSTRACT

PURPOSE: The purpose of this study was to evaluate a multidisciplinary intervention developed for patients with debilitating chronic pain after total knee arthroplasty (TKA) unresponsive to existing treatment options. METHODS: A treatment-based prospective cohort study was caried out in 30 TKA patients with debilitating chronic pain at least 1 year after TKA. The treatment was a multidisciplinary intervention. Main inclusion criteria: no indication for surgery. Primary outcome was function measured by KOOS-PS, OKS, OKS-APQ and WORQ. Secondary outcome measures were pain, fear of movement, self-efficacy, quality of life (QoL), health care and pain medication use, work rehabilitation and patient satisfaction. The assessments took place pre- and directly posttreatment, at 1, 3 and 12 months follow-up. The clinical relevance was assessed by predefined minimal important clinical change (MCIC). RESULTS: At baseline patients were on average 64.7 (±7.9) years old, 67% were female, and they had knee pain for 42 (10-360) months. The results at 12-month follow-up: first, a significant improvement was shown in function, pain, fear of movement, self-efficacy and QoL. Second, in 38.5%-69.2% of patients clinical relevant improvement was shown for functional outcome, 31% for pain, and 50% for self-efficacy. Third, 42% of patients reported 'no healthcare use in the past three months'. CONCLUSION: One year after a multidisciplinary treatment a clinically relevant improvement was shown in terms of function, pain, self-efficacy and QoL. It seems to be a promising treatment option in this difficult-to-treat patient group with debilitating chronic pain after TKA. Future research should examine the effect of the treatment in a larger study population, considering a control group, and focusing on the working population and evaluating cost-efficacy. LEVEL OF EVIDENCE: Level II.


Subject(s)
Arthroplasty, Replacement, Knee , Chronic Pain , Osteoarthritis, Knee , Humans , Female , Male , Arthroplasty, Replacement, Knee/adverse effects , Quality of Life , Osteoarthritis, Knee/surgery , Chronic Pain/etiology , Chronic Pain/therapy , Prospective Studies , Recovery of Function , Knee Joint/surgery , Treatment Outcome , Patient Reported Outcome Measures
2.
Eur Spine J ; 31(5): 1189-1196, 2022 05.
Article in English | MEDLINE | ID: mdl-35325299

ABSTRACT

OBJECTIVES: No evidence-based treatment exists for adult spinal deformity (ASD) patients with chronic low back pain (CLBP). AIM OF THIS STUDY: evaluate a combined physical and psychological programme (CPPP) for ASD patients with CLBP and to compare this with a non-ASD-cohort with CLBP. METHODS: Data were extracted from the database of CLBP-patients for whom surgery is not an option and completed CPPP. Two cohorts were selected: an ASD-cohort (n = 80) based on a Cobb angle of > 10° and a consecutive age- and gender-matched non-ASD-cohort (n = 240). PRIMARY OUTCOME: functional status (Oswestry Disability Index; ODI). SECONDARY OUTCOMES: pain intensity, self-efficacy and quality of life. ASSESSMENTS: pre and post treatment, one-month and one-year follow-up (FU). CLINICAL RELEVANCE: minimal important clinical change (MCIC; ODI 10 points), patient acceptable symptom state (PASS; ODI ≤ 22). RESULTS: Demographics ASD-cohort: 79% female, mean age 50.9 (± 14.1) years, mean CLBP duration 15.5 (± 12.5) years, mean Cobb angle 21.4 (± 9.4)°. Non-ASD-cohort: not significantly different. Both cohorts improved in functional status (F[1,318] = 142.982, p < .001; r = 0.31). The ASD-cohort improved from mean ODI 39.5(± 12.0) at baseline to mean ODI 31.8(± 16.5) at one-year FU. CLINICAL RELEVANCE: 51% of the ASD patients reached MCIC and 33% reached a PASS. An interaction effect is shown between time and both cohorts (F[1,318] = 8.2, p = .004; r = 0.03); however, not clinically relevant. All secondary outcomes: improvement at one-year FU. CONCLUSION: This is the first study showing beneficial outcomes of a non-surgical treatment in selected ASD patients with longstanding CLBP. Improvement is shown in functional status, and appeared equivalent to the non-ASD cohort. LEVEL OF EVIDENCE 1: Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.


Subject(s)
Low Back Pain , Adult , Cohort Studies , Cross-Sectional Studies , Disability Evaluation , Female , Humans , Low Back Pain/surgery , Male , Middle Aged , Quality of Life , Retrospective Studies , Treatment Outcome
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