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Gustafsson, K. (2023). Hip and Knee Osteoarthritis: Who Are the Patients Referred to First-Line Intervention and What Happens to Them?. (Doctoral dissertation). Linköping: Linköping University Electronic Press
Open this publication in new window or tab >>Hip and Knee Osteoarthritis: Who Are the Patients Referred to First-Line Intervention and What Happens to Them?
2023 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: First-line intervention to address osteoarthritis (OA) should include patient education, exercise therapy, and weight control if needed. Replacement surgery may be appropriate for patients who do not receive sufficient relief from non-surgical interventions. However, predicting the course of OA can be challenging. Some patients experience stable symptoms over time, while others may have a rapid increase in pain and functional impairment. This thesis aims to improve understanding of which patients are referred to first-line intervention for hip and knee OA and to identify factors that affect long-term outcomes in these patients.

Methods: The thesis includes studies of patients with hip and knee OA referred to a standardized first-line intervention programme. Study A (papers I, II, IV, V) is a register-based observational study that uses the Swedish Osteoarthritis Register (SOAR) to identify an OA population (n = 72 069). Data from the SOAR was merged with data from the Swedish Arthroplasty Register, Statistics Sweden and the National Board of Health and Welfare. The study also includes a matched reference cohort (n = 216 207) from the general Swedish population for comparison. Papers I and II compare socioeconomic status (SES) and comorbidities of the OA population in the SOAR with the reference cohort. Study B (paper III) is a qualitative study involving 16 patients with hip and knee OA who expressed a desire for surgery at referral to first-line intervention. The study includes interviews regarding the patients’ perspectives on healthcare and self-management of OA. Paper IV examines the time to replacement surgery and prognostic factors for surgery in the OA population. Paper V identifies factors associated with poorer patient-reported outcomes 1 year after hip replacement surgery.

Results: The OA population had higher SES and higher odds of having comorbidities than the reference cohort. The differences in comorbidities were greater in younger individuals and those with knee OA. Patients who expressed a desire for surgery before participating in first-line intervention described their perspectives on healthcare and self-management as a multifaceted picture of needs, expectations, and individual choices. Findings range from a passive approach towards managing the OA, described as a lack of control, a sense of being left alone by healthcare, having doubts and mistrusting the care provided, to a more active attitude manifested as a will to take control over the OA, instead of the OA taking control over the patient’s life. Of the patients registered in the SOAR, 46% with hip OA and 20% with knee OA were estimated to progress to replacement surgery within 5 years. The strongest prognostic factors were expressing a desire for surgery and having more severe OA symptoms. In addition, higher SES and the presence of comorbidities had an impact on the risk of progression to surgery. Among those who had undergone a hip replacement, 5%–11% showed poor patient-reported outcomes regarding pain, health-related quality of life, and satisfaction 1 year after surgery. Factors associated with poor outcomes were being older, classified as Charnley C (musculoskeletal comorbidities), or having several comorbidities, particularly depression.

Conclusions: Higher SES in the OA population referred to first-line intervention than in the general population indicates that OA care in Sweden may not be equal. The higher prevalence of comorbidities in the OA population suggests that OA care should include improving overall health. Furthermore, first-line OA intervention should be tailored to each patient’s perspectives to achieve the lifestyle changes that the interventions strive to accomplish, especially in patients expressing a desire for surgery at referral. Patients with hip and knee OA differ in their progression to surgery. Those with hip OA tend to progress faster and undergo replacement surgery more often than those with knee OA. Expressing a desire for surgery and having severe OA symptoms are prognostic factors, but other non-OA-related factors play a significant role. However, a large proportion of patients with OA do not require surgery within 5 years after referral to first-line intervention, especially those with knee OA. Identifying depression at the stage of referral to first-line OA intervention would allow increased time to optimize treatments and may help improve patient-reported outcomes after surgery.

Abstract [sv]

Bakgrund: Grundbehandling vid artros innefattar patientutbildning, träning och vid behov viktkontroll. Hos patienter som inte får tillräcklig effekt av icke-kirurgiska behandlingar kan protesoperation vara aktuellt. Sjukdomens förlopp är dock svårt att förutse. Många har stabila symtom över tid medan andra snabbt får tilltagande smärta och försämrad funktion.

Övergripande syfte: Att öka förståelsen kring vilka patienter som hänvisas till grundbehandling för höft- och knäartros i primärvården, och att identifiera faktorer som kan påverka långtidsutfall hos dessa individer.

Metod: Denna avhandling består av två studier uppdelade i fem delarbeten, där alla fokuserar på patienter i det stadie då de har sökt vård för artrossymtom och sen blivit hänvisade till att delta i standardiserad grundbehandling. Studie A (delarbete I, II, IV, V) är en registerbaserad observationsstudie som inkluderar patienter med höft- och knäartros som registrerats i Svenska Artrosregistret mellan maj 2008 och december 2016 (n = 72 069). Data på dessa patienter har sambearbetats med data från Svenska Ledprotesregistret, Statistiska Centralbyrån och Socialstyrelsen. Studien inkluderar även en referenskohort från den svenska normalbefolkningen för jämförelse, matchad på ålder, kön och bostadslän (n = 216 207). I delarbete I och II studeras socioekonomi och samsjuklighet i artrospopulationen i Svenska Artrosregistret, i jämförelse med referenskohorten. Studie B med delarbete III är en kvalitativ studie där patienter som uttrycker ett önskemål om att bli opererade före deltagande i grundbehandling intervjuas om deras perspektiv på sjukvård och egenvård vid artros (n = 16). Delarbete IV studerar tid till protesoperation hos artrospopulationen och prognostiska faktorer för progression till protesoperation. Delarbete V identifierar faktorer som är assocerade med sämre patientrapporterat utfall 1 år efter höftprotesoperation.

Resultat: Artrospopulationen hade högre socioekonomi och mer samsjuklighet jämfört med referenskohorten. Störst var skillnaderna i samsjuklighet hos patienter med knäartros och hos yngre individer. Patienter som uttryckte ett önskemål om att bli opererade före deltagande i grundbehandling, beskrev en mångfaciliterad bild av sjukvård och egenvård vid artros, utifrån sina egna behov, förväntningar och individualla val. Fynden sträckte sig från ett passivt förhållningssätt i att hantera artros, beskrivet som en brist på kontroll, en känsla av att vara lämnad ensam av sjukvården, att ha tvivel och misstro mot den vård som erbjuds, till en mer aktiv inställning manifesterat som en vilja att ta kontroll över sjukdomen istället för att den ska ta kontroll över patientens liv. Av de patienter som var registrerade i Svenska Artrosregistret, uppskattades 46% av de med höftartros och 20% av de med knäartros progrediera till en protesoperation inom 5 år. De starkast prognostiska faktorerna var önskemål om operation och att ha svårare artrossymtom. Flera faktorer som inte var direkt relaterade till artrossymtomen var också prognostiska för framtida protesoperation, men skiljde sig mellan höft- och knäartros, såsom högre socioekonomi, samsjuklighet, artros i flera leder, bilateral artros och övervikt/fetma. Bland de som genomgått en höftprotesoperation uppvisade 5-11% sämre patientrapporterat utfall efter operation i form av bristande förbättring i smärta, hälsorelaterad livskvalité eller att inte vara nöjda 1 år efter operationen. Faktorer associerade med sämre utfall var att vara äldre eller vara klassificerad som Charnley Class C (muskuloskeletal samsjuklighet), eller att ha mera samsjuklighet, särskilt depression.

Konklusion: Högre socioekonomi hos artrospopulationen än normalbefolkningen indikerar att grundbehandling vid artros kanske inte når socioekonomiskt mer missgynnade grupper i vårt samhälle. Detta är problematiskt eftersom de ofta också har en högre sjukdomsbörda. Den högre prevalensen av samsjuklighet i artrospopulationen visar på vikten av att artrosvård innefattar insatser för att även förbättra den allmänna hälsan. Vidare bör grundbehandling vid artros individualiseras efter varje patients perspektiv för att uppnå de livsstilsförändringar som behandlingarna strävar efter att åstadkomma, särskilt hos patienter som uttrycker ett önskemål om operation när de hänvisas till grundbehandling. Fynden visade också att patienter med höftartros progredierar till operation fortare och i högre utsträckning än de med knäartros. Önskemål om operation och att ha svårare artrossymtom före deltagandet i grundbehandling var de starkaste prognostiska faktorerna för progression, men flera andra, icke-artrosrelaterade faktorer är också viktiga såsom högre socioekonomi och samsjuklighet. Många patienter med artros tycks dock inte vara aktuella för protesoperation inom 5 år efter hänvisning till grundbehandling, detta gäller särskilt för de med knäartros. Slutligen, visade sig depression vara en viktig faktor att identifiera före grundbehandling, då det skulle ge ökad tid för att optimera behandling och därigenom kunna bidra till att förbättra patientrapporterat utfall efter protesoperation.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2023. p. 101
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1861
National Category
Physiotherapy Orthopaedics
Identifiers
urn:nbn:se:liu:diva-197030 (URN)10.3384/9789180752176 (DOI)9789180752169 (ISBN)9789180752176 (ISBN)
Public defence
2023-09-22, Originalet, Qulturum, Building B4, Länssjukhuset Ryhov, Jönköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2023-08-18 Created: 2023-08-18 Last updated: 2023-08-18Bibliographically approved
Gustafsson, K., Kvist, J., Eriksson, M. & Rolfson, O. (2023). What Factors Identified in Initial Osteoarthritis Management Are Associated With Poor Patient-reported Outcomes After THA?: A Register-based Study. Clinical Orthopaedics and Related Research, 481(9), 1732-1742
Open this publication in new window or tab >>What Factors Identified in Initial Osteoarthritis Management Are Associated With Poor Patient-reported Outcomes After THA?: A Register-based Study
2023 (English)In: Clinical Orthopaedics and Related Research, ISSN 0009-921X, E-ISSN 1528-1132, Vol. 481, no 9, p. 1732-1742Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Some patients report long-term pain or no improvement in health-related quality of life (HRQoL) or are dissatisfied after THA. However, factors associated with these poorer patient-reported outcomes after surgery are inconsistent and have typically been studied in the late phase of hip osteoarthritis (OA) among patients already eligible for surgery. Earlier identification of risk factors would provide time to address modifiable factors, helping to improve patients' pain, HRQoL, and satisfaction after surgery and reduce the burden on orthopaedic clinics by referring patients who are better prepared for surgery.

QUESTIONS/PURPOSES: We analyzed data from patients with hip OA referred to a first-line OA intervention program in primary healthcare at a stage when they had not been referred for THA, and asked: (1) What percentage of patients who proceed to THA report lack of improvement in pain, lack of improvement in HRQoL as measured by the EQ-5D, or are not satisfied with surgery 1 year after THA? (2) What associations exist between baseline factors at referral to this first-line OA intervention program and these poorer patient-reported outcomes 1 year after THA?

METHODS: We included 3411 patients with hip OA (mean age 67 ± 9 years, 63% [2160 of 3411] women) who had been referred for first-line OA interventions between 2008 and 2015 and subsequently underwent THA for OA. All patients were initially identified through the Swedish Osteoarthritis Register, which follows and evaluates patients in a standardized national first-line OA intervention program. Then, we identified those who were also registered in the Swedish Arthroplasty Register with a THA during the study period. We included only those with complete patient-reported outcome measures for pain, HRQoL, and satisfaction preoperatively and 1-year postoperatively, representing 78% (3411 of 4368) of patients, who had the same baseline characteristics as nonrespondents. Multiple logistic regression was used to assess the associations between 14 baseline factors and the aforementioned patient-reported outcomes of pain, HRQoL, and satisfaction 1 year after THA, adjusted for all included factors.

RESULTS: Five percent (156 of 3411) of the study population lacked improvement in pain, 11% (385 of 3411) reported no improvement in HRQoL, and 10% (339 of 3411) reported they were not satisfied with surgery 1 year after THA. Charnley Class C (multiple-joint OA or another condition that affects the ability to walk) was associated with all outcomes: lack of improvement in pain (OR 1.84 [95% CI 1.24 to 2.71]; p = 0.002), lack of improvement in HRQoL (OR 1.83 [95% CI 1.42 to 2.36]; p < 0.001), and not being satisfied (OR 1.40 [95% CI 1.07 to 1.82]; p = 0.01). Older age was associated with a lack of improvement in pain (OR per year 1.03 [95% CI 1.01 to 1.05]; p = 0.02), lack of improvement in HRQoL (OR per year 1.04 [95% CI 1.03 to 1.06]; p < 0.001), and not being satisfied (OR per year 1.03 [95% CI 1.01 to 1.05]; p < 0.001). Depression was associated with a lack of improvement in pain (OR 1.54 [95% CI 1.00 to 2.35]; p = 0.050) and with not being satisfied (OR 1.50 [95% CI 1.11 to 2.04]; p = 0.01) but not with a lack of improvement in HRQoL (OR 1.04 [95% CI 0.76 to 1.43]; p = 0.79). Having four or more comorbidities was associated with a lack of improvement in HRQoL (OR 2.08 [95% CI 1.39 to 3.10]; p < 0.001) but not with a lack of improvement in pain and not being satisfied.

CONCLUSION: The results of this study showed that older age, Charley Class C, and depression in patients with first-line OA interventions were risk factors associated with poorer outcomes regarding pain, HRQoL, and satisfaction after THA. Screening patients with hip OA for depression early in the disease course would provide increased time to optimize treatments and may contribute to better patient-reported pain, HRQoL, and satisfaction after future THA. Further research should focus on identifying the optimal time for surgery in patients with depression, as well as what targeted interventions for depression can improve outcome of surgery in these patients.

LEVEL OF EVIDENCE: Level III, therapeutic study.

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS & WILKINS, 2023
National Category
Orthopaedics
Identifiers
urn:nbn:se:liu:diva-197025 (URN)10.1097/CORR.0000000000002681 (DOI)001052335400016 ()37159269 (PubMedID)
Note

Funding: AFA Insurance, Sweden; Futurum - Academy for Health and Care; Region Jonkoping County Sweden; Medical Research Council of Southeast, Sweden

Available from: 2023-08-18 Created: 2023-08-18 Last updated: 2023-10-09Bibliographically approved
Gustafsson, K., Kvist, J., Zhou, C., Eriksson, M. & Rolfson, O. (2022). Progression to arthroplasty surgery among patients with hip and knee osteoarthritis: a study from the Swedish BOA Register. The Bone & Joint Journal, 104-B(7), 792-800
Open this publication in new window or tab >>Progression to arthroplasty surgery among patients with hip and knee osteoarthritis: a study from the Swedish BOA Register
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2022 (English)In: The Bone & Joint Journal, ISSN 2049-4394, E-ISSN 2049-4408, Vol. 104-B, no 7, p. 792-800Article in journal (Refereed) Published
Abstract [en]

AIMS: The aim of this study was to estimate time to arthroplasty among patients with hip and knee osteoarthritis (OA), and to identify factors at enrolment to first-line intervention that are prognostic for progression to surgery.

METHODS: In this longitudinal register-based observational study, we identified 72,069 patients with hip and knee OA in the Better Management of Patients with Osteoarthritis Register (BOA), who were referred for first-line OA intervention, between May 2008 and December 2016. Patients were followed until the first primary arthroplasty surgery before 31 December 2016, stratified into a hip and a knee OA cohort. Data were analyzed with Kaplan-Meier and multivariable-adjusted Cox regression.

RESULTS: At five years, Kaplan-Meier estimates showed that 46% (95% confidence interval (CI) 44.6 to 46.9) of those with hip OA, and 20% (95% CI 19.7 to 21.0) of those with knee OA, had progressed to arthroplasty. The strongest prognostic factors were desire for surgery (hazard ratio (HR) hip 3.12 (95% CI 2.95 to 3.31), HR knee 2.72 (95% CI 2.55 to 2.90)), walking difficulties (HR hip 2.20 (95% CI 1.97 to 2.46), HR knee 1.95 (95% CI 1.73 to 2.20)), and frequent pain (HR hip 1.56 (95% CI 1.40 to 1.73), HR knee 1.77 (95% CI 1.58 to 2.00)). In hip OA, the probability of progression to surgery was lower among those with comorbidities (e.g. ≥ four conditions; HR 0.64 (95% CI 0.59 to 0.69)), with no detectable effects in the knee OA cohort. Instead, being overweight or obese increased the probability of OA progress in the knee cohort (HR 1.25 (95% CI 1.15 to 1.37)), but not among those with hip OA.

CONCLUSION: Patients with hip OA progressed faster and to a greater extent to arthroplasty than patients with knee OA. Progression was strongly influenced by patients' desire for surgery and by factors related to severity of OA symptoms, but factors not directly related to OA symptoms are also of importance. However, a large proportion of patients with OA do not seem to require surgery within five years, especially among those with knee OA. Cite this article: Bone Joint J 2022;104-B(7):792-800.

Place, publisher, year, edition, pages
London: British Editorial Society of Bone and Joint Surgery, 2022
Keywords
Arthroplasty surgery, First-line intervention, Hip, Knee, Osteoarthritis, Osteoarthritis (OA), arthroplasty surgery, comorbidities, hip and knee osteoarthritis, knees, obesity, overweight, primary arthroplasty
National Category
Medical and Health Sciences Clinical Medicine Orthopaedics
Identifiers
urn:nbn:se:liu:diva-192714 (URN)10.1302/0301-620X.104B7.BJJ-2021-1766.R1 (DOI)000994156900003 ()35775173 (PubMedID)2-s2.0-85133266103 (Scopus ID)
Available from: 2023-03-27 Created: 2023-03-27 Last updated: 2023-08-18Bibliographically approved
Gustafsson, K., Kvist, J., Eriksson, M., Dell'Isola, A., Zhou, C., Dahlberg, L. E. & Rolfson, O. (2021). Health status of individuals referred to first-line intervention for hip and knee osteoarthritis compared with the general population: an observational register-based study. BMJ Open, 11(9), Article ID e049476.
Open this publication in new window or tab >>Health status of individuals referred to first-line intervention for hip and knee osteoarthritis compared with the general population: an observational register-based study
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2021 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 11, no 9, article id e049476Article in journal (Refereed) Published
Abstract [en]

Objectives

To describe the prevalence of comorbidities in a population referred to standardised first-line intervention (patient education and exercise) for hip and knee osteoarthritis (OA), in comparison with the general population. Furthermore, we aimed to evaluate if eventual differences were associated with socioeconomic inequalities.

Design

Register-based study.

Setting

Primary healthcare, Sweden.

Participants

Individuals with hip and/or knee OA included in the Better Management for Patients with Osteoarthritis Register between 2008 and 2016 and and an age-matched, sex-matched and residence-matched reference cohort (1:3) from the general Swedish population.

Outcome measures

Comorbidities were identified with the RxRisk Index, the Elixhauser Comorbidity Index and the Charlson Comorbidity Index, and presented with descriptive statistics as (1) individual diseases, (2) disease categories and (3) scores for each index. The prevalence of comorbidities in the two populations was tested using logistic regression, with separate analyses for age groups and the most affected joint. We then adjusted the analyses for socioeconomic status.

Results

In this OA population, 85% had >= 1 comorbidity compared with 78% of the reference cohort (OR; 1.62 (95% CI 1.59 to 1.66)). Cardiovascular/blood diseases were the most common comorbidities in both populations (OA, 59%; reference, 54%), with OR; 1.22 (95% CI 1.20 to 1.24) for the OA population. Younger individuals with OA were more comorbid than their matched references overall, and population differences decreased with age (eg, >= 3 comorbidities, aged <= 45 years OR; 1.74 (95% CI 1.52 to 1.98), >= 81 years OR; 0.95 (95% CI 0.87 to 1.04)). Individuals with knee OA were more comorbid than those with hip OA overall. Adjustment for socioeconomic status did not change the estimates.

Conclusion

Comorbidities were more common among individuals with hip and knee OA than among matched references from the general population. The differences could not be explained by socioeconomic status.

Place, publisher, year, edition, pages
London, United Kingdom: BMJ Publishing Group Ltd, 2021
Keywords
General Medicine
National Category
Physiotherapy
Identifiers
urn:nbn:se:liu:diva-179771 (URN)10.1136/bmjopen-2021-049476 (DOI)000698586600033 ()34518262 (PubMedID)2-s2.0-85115277176 (Scopus ID)
Note

Funding: AFA Insurance, Sweden; Futurum -Academy for Health and Care, Region Jönkoping County, Sweden; Medical Research Council of Southeast Sweden

Available from: 2021-10-01 Created: 2021-10-01 Last updated: 2023-08-28Bibliographically approved
Abbott, A., Limbäck-Svensson, G., Zhou, C., Gustafsson, K. & Rolfson, O. (2020). Dispenced prescriptions of analgesics prior to entering an osteoarthritis care program. a national registry linkage study. Paper presented at OARSI 2020 World Congress. Osteoarthritis and Cartilage, 28, S59-S60
Open this publication in new window or tab >>Dispenced prescriptions of analgesics prior to entering an osteoarthritis care program. a national registry linkage study
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2020 (English)In: Osteoarthritis and Cartilage, ISSN 1063-4584, E-ISSN 1522-9653, Vol. 28, p. S59-S60Article in journal, Meeting abstract (Refereed) Published
Place, publisher, year, edition, pages
Elsevier, 2020
National Category
Clinical Medicine Health Sciences
Identifiers
urn:nbn:se:liu:diva-174215 (URN)10.1016/j.joca.2020.02.092 (DOI)000527813600081 ()
Conference
OARSI 2020 World Congress
Available from: 2021-03-16 Created: 2021-03-16 Last updated: 2022-08-24Bibliographically approved
Gustafsson, K., Rolfson, O., Eriksson, M., Dahlberg, L. & Kvist, J. (2018). Study protocol for an observational register-based study on health and risk factors in patients with hip and knee osteoarthritis. BMJ Open, 8(10), Article ID e022812.
Open this publication in new window or tab >>Study protocol for an observational register-based study on health and risk factors in patients with hip and knee osteoarthritis
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2018 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 8, no 10, article id e022812Article in journal (Refereed) Published
Abstract [en]

Introduction Hip and knee osteoarthritis is a leading cause of disability worldwide. Currently, the course of deterioration in pain and physical functioning in individuals with osteoarthritis is difficult to predict. Factors such as socioeconomic status and comorbidity contribute to progression of osteoarthritis, but clear associations have not been established. There is a need for early identification of individuals with slow disease development and a good prognosis, and those that should be recommended for future joint replacement surgery.

Methods and analysis This nationwide register-based study will use data for approximately 75 000 patients who sought and received core treatment for osteoarthritis in primary healthcare, and were registered in the Swedish population-based National Quality Register for Better Management of Patients with Osteoarthritis. These data will be merged with data for replacement surgery, socioeconomic factors, healthcare consumption and comorbidity from the Swedish Hip Arthroplasty Register, the Swedish Knee Arthroplasty Register, Statistics Sweden and the National Board of Health and Welfare, Sweden. The linkage will be performed using personal identity numbers that are unique to all citizens in Sweden.

Ethics and dissemination The study was approved by the Regional Ethical Review Board in Gothenburg, Sweden (dnr 1059–16). The results from this study will be submitted to peer-reviewed journals and reported at suitable national and international meetings.

Trial registration number NCT03438630.

Place, publisher, year, edition, pages
British Medical Journal Publishing Group, 2018
National Category
Occupational Therapy
Identifiers
urn:nbn:se:liu:diva-151890 (URN)10.1136/bmjopen-2018-022812 (DOI)000454739500118 ()
Note

Funding agencies: AFA Insurance, Sweden [160176]; Futurum-Academy for Health and Care, Region Jonkoping County, Sweden [559951, 557821]

Available from: 2018-10-09 Created: 2018-10-09 Last updated: 2023-08-28
Gustafsson, K., Fältström, A., Öberg, U. & Kammerlind, A.-S. (2017). Written instructions versus physiotherapist-supervised rehabilitation after acute ankle sprain. European Journal of Physiotherapy, 19(2), 76-83
Open this publication in new window or tab >>Written instructions versus physiotherapist-supervised rehabilitation after acute ankle sprain
2017 (English)In: European Journal of Physiotherapy, ISSN 2167-9169, E-ISSN 2167-9177, Vol. 19, no 2, p. 76-83Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to compare the effects of written instructions (WIs) versus physiotherapist-supervised rehabilitation on patient-rated ankle function, satisfaction and physical activity ability after an acute ankle sprain. Thirty-nine patients with an acute ankle sprain, recruited from an emergency department, received WIs on functional rehabilitation (WI group). The patients were evaluated six weeks and three months after their injury with the disease-specific Foot and Ankle Outcome Score (FAOS). The patients also rated how satisfied they were with their ankle and physical activity ability using visual analogue scales. The results from the WI group were compared with a group of patients (n ¼ 33) who received physiotherapist-supervised rehabilitation in a previous study (PT group). We found that compared with the PT group, the WI group had significantly worse scores in all of the FAOS subscales six weeks after the injury, and in three of five subscales three months after the injury. They also rated significantly lower satisfaction and significantly lower physical activity ability at both follow-ups. In conclusion, physiotherapist-supervised rehabilitation was more effective than WIs on improving patient-rated ankle function, satisfaction and physical activity ability after an acute ankle sprain.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2017
Keywords
FAOS, home-based physiotherapy treatment, Patient education hand out, self-care
National Category
Medical and Health Sciences Health Sciences Physiotherapy
Identifiers
urn:nbn:se:liu:diva-136104 (URN)10.1080/21679169.2016.1251966 (DOI)
Available from: 2017-03-27 Created: 2017-03-27 Last updated: 2018-11-20
Hultman, K., Fältström, A. & Öberg, U. (2010). The effect of early physiotherapy after an acute ankle sprain. Advances in Physiotherapy, 12(2), 65-73
Open this publication in new window or tab >>The effect of early physiotherapy after an acute ankle sprain
2010 (English)In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 12, no 2, p. 65-73Article in journal (Refereed) Published
Abstract [en]

Ankle sprain is one of the most common injuries treated in emergency departments (ED). In clinical practice, these injuries are expected to heal by themselves, often without any treatment other than short information about the RICE regime (rest, ice, compression and elevation). Still, remaining symptoms are reported to occur in 30% of the cases. The aim of this study was to evaluate the effect of early physiotherapy intervention after an acute ankle sprain. Sixty-five patients were recruited from the ED at a general hospital in Sweden (mean age 35 years; 30 women), and allocated into an intervention group with early physiotherapy or a control group. Both groups were evaluated 6 weeks and 3 months after their injury. As primary outcome, the disease-specific Foot and Ankle Outcome Score (FAOS) was used. The patients also rated their physical activity ability and how satisfied they were with their ankle on a visual analogue scale (VAS). The intervention group made significant improvements compared with the control group at both evaluations measured with FAOS and the VAS questions. These findings indicate that early physiotherapy intervention has a positive effect on patient-focused foot and ankle function after an acute ankle sprain. © 2010 Informa UK Ltd.

Place, publisher, year, edition, pages
Taylor & Francis, 2010
Keywords
FAOS, Outcome, Rehabilitation, Self-care, acute disease, adult, aged, ankle sprain, article, controlled study, early intervention, emergency ward, female, human, joint function, major clinical study, male, outcome assessment, physical activity, physiotherapy, therapy effect
National Category
Health Sciences
Identifiers
urn:nbn:se:liu:diva-152672 (URN)10.3109/14038190903174262 (DOI)2-s2.0-77953218583 (Scopus ID)
Note

Cited By :5; Export Date: 12 November 2018; Article; CODEN: APDHA; Correspondence Address: Hultman, K.; Department of Physiotherapy, Ryhov County Hospital, S-551 85 Jönköping, Sweden; email: kristin.hultman@lj.se

Available from: 2018-11-12 Created: 2018-11-12 Last updated: 2018-11-16Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-3403-229x

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