Quality of Life Research

, Volume 28, Issue 2, pp 503–508 | Cite as

The paradox of self-rated health following joint replacement surgery

  • Thomas PernegerEmail author
  • Anne Lübbeke



Self-rated health is a commonly used patient-reported outcome, but its responsiveness to is not well documented. We examined the ability of self-rated health to capture health changes attributable to a highly effective surgical intervention.


Prospective study of patients with severe osteoarthritis of the hip (N = 990) or knee (N = 907) who underwent total hip replacement (THA) or total knee replacement (TKA). Self-rated health was assessed pre-operatively and 1 year after surgery on a scale between “excellent” and “poor,” along with other health items (other 11 items of the SF12 questionnaire) and multi-item Pain and Function scales.


On average, self-rated health was unchanged by surgery. In both THA and TKA cohorts, of 10 patients, 6 rated their health the same after surgery as before, 2 gave a higher rating, and 2 gave a lower rating. In contrast, major improvements were observed for all other SF12 items, and for the Pain and Function scales, in both cohorts of patients. Nevertheless, both before and after surgery, self-rated health was associated with the other SF12 items and with Pain and Function scores. These associations were stronger after surgery than before.


Self-rated health was not responsive to major improvements in health, documented by other instruments, attributable to joint replacement surgery. However, self-rated health was even more strongly associated with concurrent assessments of more specific health problems after surgery than before. Caution is advised in interpreting changes in self-rated health following health-altering interventions.


Self-rated health Responsiveness to change Joint replacement surgery SF12 WOMAC 



The Geneva Arthroplasty Registry is supported in part by the Fondation pour la Recherche Ostéo-Articulaire.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Jylhä, M. (2009). What is self-rated health and why does it predict mortality? Towards a unified conceptual model. Social Science & Medicine, 69, 307–316.CrossRefGoogle Scholar
  2. 2.
    Fayers, P. M., & Sprangers, M. A. G. (2002). Understanding self-rated health. Lancet, 359, 187–188.CrossRefGoogle Scholar
  3. 3.
    Garbarski, D. (2016). Research in and prospects for the measurement of health using self-rated health. Public Opinion Quarterly, 80, 977–997.CrossRefGoogle Scholar
  4. 4.
    DeSalvo, K. B., Bloser, N., Reynolds, K., He, J., & Muntner, P. (2005). Mortality prediction with a single general sefl-rated health question: A meta-analysis. Journal of General Internal Medicine, 21, 267–275.CrossRefGoogle Scholar
  5. 5.
    Lima-Costa, F. M., Cesar, C. C., Chor, D., & Proietti, F. A. (2012). Self-rated health compared with objectively measured health status as a tool for mortality risk screening in older adults: 10-year follow-up of the Bambui Cohort Study on Aging. American Journal of Epidemiology, 175, 228–235.CrossRefGoogle Scholar
  6. 6.
    DeSalvo, K. B., Fan, V. S., McDonnell, M. B., et al. (2005). Predicting mortality and healthcare utilization with a single question. Health Services Research, 40, 1233–1246.CrossRefGoogle Scholar
  7. 7.
    DeSalvo, K. B., Jones, T. M., Peabody, J., et al. (2009). Health care expenditure prediction with a single item, self-rated health measure. Medical Care, 47, 440–447.CrossRefGoogle Scholar
  8. 8.
    Latham, K., & Peek, C. W. (2013). Self-rated health and morbidity onset among late midlife US adults. The Journals of Gerontology, 68, 107–116.CrossRefGoogle Scholar
  9. 9.
    Perneger, T. V., Gayet-Ageron, A., Courvoisier, D. S., Agoritsas, T., & Cullati, S. (2013). Self-rated health: Analysis of distances and transitions between response options. Quality of Life Research, 22, 2761–2768.CrossRefGoogle Scholar
  10. 10.
    Meng, X., & D’Arcy, C. (2016). Determinants of self-rated health among Canadian seniors over time: A longitudinal population-based study. Social Indicators Research, 126, 1343–1353.CrossRefGoogle Scholar
  11. 11.
    Bailis, D. S., Segall, A., & Chipperfield, J. G. (2003). Two views of self-rated general health status. Social Science & Medicine, 56, 203–217.CrossRefGoogle Scholar
  12. 12.
    Lübbeke, A., Garavaglia, G., Barea, C., & Hoffmeyer, P. Why do we need hospital-based registries? The Geneva Hip Arthroplasty Registry. EFORT publication 2010. Accessed February 26, 2018, from
  13. 13.
    Gandek, B., Ware, J. E., Aaronson, N. K., et al. (1998). Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: Results from the IQOLA Project. International quality of life assessment. Journal of Clinical Epidemiology, 51, 1171–1178.CrossRefGoogle Scholar
  14. 14.
    Leplège, A., Ecosse, E., Verdier, A., & Perneger, T. V. (1998). The French SF-36 Health Survey: Translation, cultural adaptation, and preliminary psychometric evaluation. Journal of Clinical Epidemiology, 51, 1013–1023.CrossRefGoogle Scholar
  15. 15.
    Whitehouse, S. L., Lingard, E. A., Katz, J. N., & Learmonth, I. D. (2003). Development and testing of a reduced WOMAC function scale. The Journal of Bone and Joint Surgery (British), 85, 706–711.CrossRefGoogle Scholar
  16. 16.
    Zahiri, C. A., Schmalzried, T. P., Szuszczewicz, E. S., & Amstutz, H. C. (1998). Assessing activity in joint replacement patients. The Journal of Arthroplasty, 13, 890–895.CrossRefGoogle Scholar
  17. 17.
    Perruccio, A. V., Davis, A. M., Hogg-Johnson, S., & Badley, E. M. (2011). Importance of self-rated health and mental well-being in predicting health outcomes following total joingt replacement surgery for osteoarthritis. Arthritis Care & Research, 63:973–981.CrossRefGoogle Scholar
  18. 18.
    Sprangers, M. A., & Schwartz, C. E. (1999). Integrating response shift into health-related quality of life research: A theoretical model. Social Science & Medicine, 48, 1507–1515.CrossRefGoogle Scholar
  19. 19.
    Barclay-Goddard, R., Epstein, J. D., & Mayo, N. E. (2009). Response shift: A brief overview and proposed research priorities. Quality of Life Research, 18, 335–348.CrossRefGoogle Scholar
  20. 20.
    Ubel, P. A., Peeters, Y., & Smith, D. (2010). Abandoning the language of “response shift”: A plea for conceptual clarity in distinguishing scale recalibration from true changes in quality of life. Quality of Life Research, 19, 465–471.CrossRefGoogle Scholar
  21. 21.
    Razmjou, H., Yee, A., Ford, M., & Finkelstein, J. A. (2006). Response shift in outcome assessment in patients undergoing total knee arthroplasty. JBJS, 88, 2590–2595.CrossRefGoogle Scholar
  22. 22.
    Zajacova, A., & Dowd, J. B. (2011). Reliability of self-rated health in US adults. American Journal of Epidemiology, 174, 977–983.CrossRefGoogle Scholar
  23. 23.
    Garbarski, D., Dykema, J., Croes, K. D., & Edwards, D. F. (2017). How participants report their health status: cognitive interviews of self-rated health across race/ethnicity, gender, age, and educational attainment. BMC Public Health, 17, 771.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Division of Clinical EpidemiologyGeneva University HospitalsGenevaSwitzerland
  2. 2.University of GenevaGenevaSwitzerland
  3. 3.Division of Orthopedic Surgery and TraumatologyGeneva University HospitalsGenevaSwitzerland

Personalised recommendations