Recovery after short-stay total hip and knee arthroplasty. Evaluation of a support program and outcome determination

As a result of the increasing demand for total hip arthroplasties (THA) and total knee arthroplasties (TKA), waiting lists are growing. To cope with this problem, many hospitals have introduced short-stay programs; a consequence is increased responsibility of the patient regarding his own rehabilitation. Although it is clear that the success of a total hip or knee arthroplasty not only depends on an effective surgical procedure but also on adequate rehabilitation afterwards, hospitals do not provide additional support after discharge. The scope of the thesis is to influence and evaluate outcome after short-stay total hip and knee arthroplasty. The thesis is based on 5 papers. Three papers are addressing the first objective of the thesis, which is to develop a support program after short-stay total hip and knee arthroplasty and to determine its effectiveness. The development of a theory-driven support program, called the Groningen Orthopedic Exit Strategy (GOES), is described. Aim of the GOES is to improve the rehabilitation of total hip and knee arthroplasty patients after shortened hospital stay. Research is performed into the validation of the GOES. An experimental study was set up. Unfortunately, no differences were seen between the two groups in terms of changes between preoperative and postoperative values on questionnaires (self-efficacy, social support, pain-coping, WOMAC, SF-36, Physical Activity Questionnaire). The third study evaluates the contributions of preoperative and short-term postoperative self-efficacy in predicting long-term outcome after total hip and knee arthroplasty. Short-term postoperative self-efficacy seems a better predictor of long-term outcome after total hip or knee arthroplasty than preoperative self-efficacy. Interventions should therefore focus on enhancing short-term postoperative rather than preoperative self-efficacy. The second objective of the thesis is to assess recovery after total hip or knee arthroplasty not only with self-report measures but also objectively with a relatively novel, ambulatory measuring device, and to compare the performance-based outcome with self-report outcome. Aim of the first study was to describe the spatio-temporal measures of gait recovery after THA, whereby the different aspects of gait function are measured with an ambulatory measuring device in an extensive test protocol, including walking at different speeds while performing an additional cognitive task and while performing an endurance test. It is concluded that assessment of recovery of gait function requires more than only assessment of “normal” walking. Particularly, an analysis of walking at different speeds and walking while performing an additional cognitive task demonstrate different aspects of gait recovery after THA. In the second study the relationship between self-report and performance-based measures of physical functioning after THA was determined at multiple moments. It is concluded that pain and the diminishing pain after surgery appear as explanatory factors in the discrepancy between self-report and performance-based outcome measures.