Cristin-prosjekt-ID: 546392
Registrert av: SPREK Sist endret: 1. februar 2018 14:06
Cristin-prosjekt-ID: 546392
Registrert av: SPREK Sist endret: 1. februar 2018 14:06
Prosjekt

Smerter og helserelatert livskvalitet

prosjektleder

Anners Vetle Lerdal
ved Lovisenberg Diakonale Sykehus

prosjekteier / koordinerende forskningsansvarlig enhet

  • Lovisenberg Diakonale Sykehus

Godkjenninger

  • Regionale komitéer for medisinsk og helsefaglig forskningsetikk (REK) - 2011/1755

Kategorier

Helseprosjekttype

Annet studium

Tidsramme

Aktivt
Start: 1. oktober 2011 Slutt: 30. desember 2023

Beskrivelse Beskrivelse

Tittel

Smerter og helserelatert livskvalitet

Populærvitenskapelig sammendrag

Pain, symptom clusters and health related quality of life in patients receiving total knee Arthroplasty – a longitudinal study

Vitenskapelig sammendrag

Total knee arthroplasty (TKA) in osteoarthritis is a common procedure to relieve pain and improve function and quality of life (QOL). One in eight patients experience unexplained moderate/severe pain one year after receiving TKA. Pain control, together with physiotherapy is a determining factor for early recovery, and is considered important to achieve optimal knee function. Other symptoms besides pain are described, e.g. nausea, sleep deprivation and fatigue, and these factors may prolong the length of stay. The study has a longitudinal cohort design and involves the patients’ entire treatment trajectory from before surgery, during treatment while admitted to the hospital, in the early recovery phase and until one year after surgery. The study use innovative methods to evaluate symptoms and health outcomes, including Hierarchical Linear Modeling (HLM) and Growth Mixture Modeling (GMM). A complete sample of 203 Norwegian patients undergoing primary TKA have been followed from the day before until 12 months after surgery, and a replication study with 100 TKA patients has been conducted in St Petersburg, Russia. The overall aim is to gain new knowledge about factors contributing to adverse outcomes, and to contribute to new knowledge to improve pain and symptom management, recovery and outcome after TKA surgery. 

Publications based on this study that used HLM statistics have reported that higher levels of acute pain at rest and with activity on the day of surgery was associated with more days with a femoral block, higher opioid consumption and higher emotional response to OA. In addition, higher number of comorbidities, higher opioid consumption, and lower perceived control of OA predicted more hours per day in pain on the day of surgery.
Lower preoperative average and worst pain was associated with higher average and worst postoperative pain from postoperative day (POD) 1 to 4. A higher number of comorbidities, higher preoperative CRP values, and higher preoperative pain interference with function was associated with higher preoperative average pain. 
Older age, higher preoperative levels of fatigue, and poorer preoperative scores on symptoms and emotional responses to OA were associated with higher preoperative levels of worst pain. Male patients and those with lower preoperative scores for average pain had higher worst pain scores following surgery.  

The longitudinal results using GMM identified two subgroups with different trajectories of pain-related interference with walking during the first 12 months following TKA. The largest group of patients were named "Continuous Improvement class" (78%). These patients were characterized by gradual improvements over time. A smaller group of patients were named "Recurrent interference class" (22%). These patients were characterized by initial improvements during the first 3 months, followed by a worsening in pain with walking, returning to preoperative levels 12 months following surgery. Patients in the Recurrent Interference class had higher preoperative pain, fatigue and depression scores, and poorer preoperative illness perceptions, compared to the Continuous Improvement class. 

Utstyr

Pain: The Brief Pain Inventory (BPI) was used to measure pain. The BPI consists of four items that measure pain intensity (on an 11-point numeric rating scale from 0-10), seven questions on pain interference with functioning, a body map to localize the pain and one item on pain relief.

Symptoms: An abbreviated version of The Memorial Symptom Assessment Scale (MSAS) was used to assess a variety of physical and psychological symptoms. The MSAS contains a list of 32 symptoms and patients are asked to indicate whether or not they had each symptom during the past week (i.e., occurrence). If they experienced the symptom in the past week, they are asked to rate the level of distress it caused using a five-point Likert Scale. (i.e., 0 = not at all, 1 = mild, 2 = moderate, 3 = severe, 4 = very severe).

Sleep: Sleep disturbance in the past month was measured with the Pittsburgh Sleep Quality Index (PSQI). The 19 items are self-rated and a global score can range from 0 to 21.

Fatigue: An abbreviated version of the Lee Fatigue Scale (LFS) consisting of 5 items was used to measure current fatigue.

Mood states (depression and anxiety): The Hospital Anxiety and Depression Scale (HADS) was used to measure self-reported psychological distress. The HADS has been found to perform well as a screening for symptoms of anxiety and depression in the general population and in patients with cancer. The scale consists of 14 items, 7 on the depression subscale and 7 on the anxiety subscale.

Health-related quality of life (HRQoL): The widely used EuroQol-5 (EQ-5D) was used to measure HRQoL. It has 5 items assessing different dimensions of health status, and one item assessing the respondent’s own perception of his/her overall health on a visual analog scale.

Activities of Daily Living: The Lawton Instrumental Activities of Daily Living Scale (IADL) assesses eight independent living skills, i.e. shopping, food preparation, housekeeping, laundering, mode of transportation,  responsibility for own mediations and finances. The respondent rates their highest level of functioning in the different categories.

Clinical assessments
Knee functioning was measured by the American Knee Society Score (AKSS). The AKSS measures pain, stability and ROM, with deductions for flexion contractures, extension lag and malalignment. A well-aligned knee with no pain, 125 degrees of motion and negligible anteroposterior or mediolateral instability obtains 100 points. Walking distance and stair climbing are the main parameters in the Function Score with a deduction for use of a walking aid. High inter- and intraobserver variations of the AKSS in patients with knee arthroplasty are descried.

prosjektdeltakere

prosjektleder
Aktiv cristin-person

Anners Vetle Lerdal

  • Tilknyttet:
    Prosjektleder
    ved Lovisenberg Diakonale Sykehus
Aktiv cristin-person

Kristin Halvorsen

  • Tilknyttet:
    Prosjektdeltaker
    ved Institutt for sykepleie og helsefremmende arbeid ved OsloMet - storbyuniversitetet
Aktiv cristin-person

Simen Alexander Steindal

  • Tilknyttet:
    Prosjektdeltaker
    ved Lovisenberg diakonale høgskole

Marita Nordhaug

  • Tilknyttet:
    Prosjektdeltaker
    ved OsloMet - storbyuniversitetet
Aktiv cristin-person

Bjørn Lau

  • Tilknyttet:
    Prosjektdeltaker
    ved Lovisenberg Diakonale Sykehus
1 - 5 av 9 | Neste | Siste »

Resultater Resultater

Prediktorer for nedsatt gangfunksjon ett år etter innsatt kneprotese – en subgruppeanalyse.

Lindberg, Maren Falch; Rustøen, Tone; Rosseland, Leiv Arne; Lerdal, Anners. 2016, Health South-East Research Conference. UIO, LDS, OUSVitenskapelig foredrag

Smertepåvirkning av gangfunksjon gjennom det første året etter innsatt total kneprotese.

Lindberg, Maren Falch; Rustøen, Tone; Rosseland, Leiv Arne; Lerdal, Anners. 2016, Ortopedisk høstmøte. UIO, LDS, OUSVitenskapelig foredrag

Factors that can predict pain with walking, 12 months after total knee arthroplasty: A trajectory analysis of 202 patients.

Lindberg, Maren Falch; Miaskowski, Christine; Rustøen, Tone; Rosseland, Leiv Arne; Cooper, Bruce A.; Lerdal, Anners. 2016, Acta Orthopaedica. LDS, UIO, OUS, UoCSFVitenskapelig artikkel

The relationship between pain with walking and self-rated health 12 months following total knee arthroplasty: a longitudinal study.

Lindberg, Maren Falch; Rustøen, Tone; Christine, Miaskowski; Rosseland, Leiv Arne; Lerdal, Anners. 2017, BMC Musculoskeletal Disorders. UIO, LDS, OUS, UoCSFVitenskapelig artikkel

Pain trajectories and patient satisfaction after TKA: results of a two-center Russian-Norwegian study.

Lindberg, Maren Falch; Kornilov, Nikolai; Saraev, Alexander; Rosseland, Leiv Arne; Rustøen, Tone; Miaskowski, Christine; Cooper, Bruce A.; Lerdal, Anners. 2016, Vreden.s Readings. UIO, LDS, OUS, UoCSF, RNIITOVitenskapelig foredrag
1 - 5 av 13 | Neste | Siste »