Abstract
Introduction and Aims: In this study, we identify issues of importance to adult Juvenile Rheumatoid Arthritis (JRA) patients before and after total hip arthroplasty (THA) and determine if these issues are included in widely utilised, standardised outcome measures for THA (Western-Ontario and McMaster Universities Arthritis Index – WOMAC; Patient Specific Index – PASI).
Method: Adult JRA patients who underwent THA between 1986 and 1999 at our institution participated in the study (n=31). An independent observer gathered data, including patient demographics, a post-operative WOMAC questionnaire, post-operative patient-generated items from the PASI, a retrospectively completed pre-operative PASI form, and changes in items from pre-operative to post-operative PASI. Descriptive analysis was completed on demographic information and clinical outcomes, as well as for the WOMAC and PASI scores. Spearman’s rank correlation coefficients were calculated to describe the association between WOMAC and PASI scores.
Results: Issues deemed important by JRA patients included four symptom areas (pain, joint motion, strength, discomfort) and five activity areas (light household, leisure, clothing, sports, sex); some patients indicated they had no symptoms or difficulties. Before surgery, issues identified as relevant by patients were predominantly symptoms, whereas at follow-up, patients primarily identified recreational and social activities as the issues relevant to them.
Comparison of post-operative WOMAC questionnaires with pre-operative and post-operative PASI questionnaires revealed fundamental differences between items found in the standardised WOMAC and items deemed important by the patient. The WOMAC included less than 10% of the unweighted content deemed important by these patients at follow-up. The shift in the PASI towards more physically demanding activities after surgery indicates that patients improved, which is not reflected in the WOMAC. Correlations between post-operative WOMAC and PASI scores for pain subscales were low to moderate (Spearman rank correlation coefficient: rs = 0.53) and 63% of JRA patients had higher PASI than WOMAC normalised scores.
Conclusion: The self-generated, self-reported portion of the PASI provided a different perspective on the impact of THA in adult JRA patients and more information on issues important to these patients. The WOMAC did not include content deemed to be important by JRA patients and did not correlate well with the PASI.
These abstracts were prepared by Editorial Secretary, George Sikorski. Correspondence should be addressed to Australian Orthopaedic Association, Ground Floor, The William Bland Centre, 229 Macquarie Street, Sydney, NSW 2000, Australia.
At least one of the authors is receiving or has received material benefits or support from a commercial source.
