Clinical Orthopaedics and Related Research®

, Volume 472, Issue 6, pp 1868–1876 | Cite as

Education Attainment is Associated With Patient-reported Outcomes: Findings From the Swedish Hip Arthroplasty Register

  • Meridith E. Greene
  • Ola Rolfson
  • Szilard Nemes
  • Max Gordon
  • Henrik Malchau
  • Göran Garellick
Clinical Research
First Online:
Received:
Accepted:

Abstract

Background

Age, sex, and medical comorbidities may be associated with differences in patient-reported outcome scores after THA. Highest level of education may be a surrogate for socioeconomic status, but the degree to which this is associated with patient-reported outcomes after THA is not known.

Questions/purposes

We investigated the national Swedish Hip Arthroplasty Register for the association of education attainment on patient-reported outcomes 1 year after THA; specifically, we evaluated level of education attainment against health-related quality of life (HRQoL), pain reduction, and satisfaction with treatment 1 year after THA.

Methods

All THAs for osteoarthritis performed from 2005 through 2007 with complete patient-reported outcome measures (representing 49% of the THAs performed for this diagnosis) were selected from the Swedish Hip Arthroplasty Register. These cases were merged with national databases containing education attainment, marital status, and comorbidities (n = 11,464; mean age of patients, 64 years). The patient-reported outcome measure protocol included the HRQoL measure EuroQol five-dimension scale (EQ-5D), a VAS for pain, the Charnley classification survey, and a VAS addressing THA satisfaction. Linear regression analyses determined the association of preoperative patient factors with patient-reported outcomes.

Results

High education attainment was associated with higher HRQoL (EQ-5D index ßhigh = 0.03 ± 0.01; EQ VAS ßhigh = 2.6 ± 0.5) after THA, whereas those with low and medium education were at risk for lower HRQoL. High education was associated with less pain after treatment (ßhigh = −3.3 ± 0.05). Individuals with low or medium education were at risk for less satisfaction with THA (p < 0.001).

Conclusions

Our results suggest clinicians should support patients with low and medium education to a greater extent. Identification of patients who will benefit most from THA and educating those at risk for poorer outcomes, like patients with low and medium education, ultimately may improve patient satisfaction, HRQoL, pain, and the cost utility of THA.

Level of Evidence

Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

Keywords

Minimal Important Difference Education Attainment Bayesian Model Average Posterior Inclusion Probability High Education Attainment 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.

Notes

Acknowledgments

We thank Thomas Eisler MD, for help in initiating this important work investigating the influence of socioeconomic status on patient-reported outcomes and for his role in obtaining local ethical approval.

Supplementary material

11999_2014_3504_MOESM1_ESM.doc (4.2 mb)
Supplementary material 1 (DOC 4330 kb)

References

  1. 1.
    Anakwe RE, Jenkins PJ, Moran M. Predicting dissatisfaction after total hip arthroplasty: a study of 850 patients. J Arthroplasty. 2011;26:209–213.PubMedCrossRefGoogle Scholar
  2. 2.
    Bischoff-Ferrari HA, Lingard EA, Losina E, Baron JA, Roos EM, Phillips CB, Mahomed NN, Barrett J, Katz JN. Psychosocial and geriatric correlates of functional status after total hip replacement. Arthritis Rheum. 2004;51:829–835.PubMedCrossRefGoogle Scholar
  3. 3.
    Callaghan JJ, Dysart SH, Savory CF, Hopkinson WJ. Assessing the results of hip replacement: a comparison of five different rating systems. J Bone Joint Surg Br. 1990;72:1008–1009.PubMedGoogle Scholar
  4. 4.
    Cleveland RJ, Schwartz TA, Prizer LP, Randolph R, Schoster B, Renner JB, Jordan JM, Callahan LF. Associations of educational attainment, occupation and community poverty with hip osteoarthritis. Arthritis Care Res (Hoboken). 2013;65:954–961.PubMedCrossRefGoogle Scholar
  5. 5.
    Dixon T, Shaw M, Ebrahim S, Dieppe P. Trends in hip and knee joint replacement: socioeconomic inequalities and projections of need. Ann Rheum Dis. 2004;63:825–830.PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Dixon T, Urquhart DM, Berry P, Bhatia K, Wang Y, Graves S, Cicuttini FM. Variation in rates of hip and knee joint replacement in Australia based on socio-economic status, geographical locality, birthplace and indigenous status. ANZ J Surg. 2011;81:26–31.PubMedCrossRefGoogle Scholar
  7. 7.
    EuroQolGroup. EuroQol: a new facility for the measurement of health-related quality of life. Health Policy. 1990;16:199–208.Google Scholar
  8. 8.
    Fortin PR, Clarke AE, Joseph L, Liang MH, Tanzer M, Ferland D, Phillips C, Partridge AJ, Belisle P, Fossel AH, Mahomed N, Sledge CB, Katz JN. Outcomes of total hip and knee replacement: preoperative functional status predicts outcomes at six months after surgery. Arthritis Rheum. 1999;42:1722–1728.PubMedCrossRefGoogle Scholar
  9. 9.
    Genell A, Nemes S, Steineck G, Dickman PW. Model selection in medical research: a simulation study comparing Bayesian model averaging and stepwise regression. BMC Med Res Methodol. 2010;10:108.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Hannan MT, Anderson JJ, Pincus T, Felson DT. Educational attainment and osteoarthritis: differential associations with radiographic changes and symptom reporting. J Clin Epidemiol. 1992;45:139–147.PubMedCrossRefGoogle Scholar
  11. 11.
    Hawker GA, Wright JG, Glazier RH, Coyte PC, Harvey B, Williams JI, Badley EM. The effect of education and income on need and willingness to undergo total joint arthroplasty. Arthritis Rheum. 2002;46:3331–3339.PubMedCrossRefGoogle Scholar
  12. 12.
    Hoeting JA, Madigan D, Raftery AE, Volinsky CT. Bayesian model averaging: a utorial. Statistical Science. 1999;14:382–417.CrossRefGoogle Scholar
  13. 13.
    Juhakoski R, Malmivaara A, Lakka TA, Tenhonen S, Hannila ML, Arokoski JP. Determinants of pain and functioning in hip osteoarthritis: a two-year prospective study. Clin Rehabil. 2013;27:281–287.PubMedCrossRefGoogle Scholar
  14. 14.
    Karrholm J, Garellick G, Rogmark C, Herberts P. Swedish Hip Arthroplasty Register: Annual Report 2007. Gothenburg, Sweden: Swedish Hip Arthroplasty Register; 2008.Google Scholar
  15. 15.
    Kass RE, Raftery AE. Bayes factors. J Am Statist Assoc. 1995;90:773–795.CrossRefGoogle Scholar
  16. 16.
    Keurentjes JC, Blane D, Bartley M, Keurentjes JJ, Fiocco M, Nelissen RG. Socio-economic position has no effect on improvement in health-related quality of life and patient satisfaction in total hip and knee replacement: a cohort study. PLoS One. 2013;8:e56785.PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    King MT. A point of minimal important difference (MID): a critique of terminology and methods. Expert Rev Pharmacoecon Outcomes Res. 2011;11:171–184.PubMedCrossRefGoogle Scholar
  18. 18.
    Leigh JP, Fries JF. Occupation, income, and education as independent covariates of arthritis in four national probability samples. Arthritis Rheum. 1991;34:984–995.PubMedCrossRefGoogle Scholar
  19. 19.
    R Core Team. R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2013. Available at: http://www.eea.europa.eu/data-and-maps/indicators/oxygen-consuming-substances-in-rivers/r-development-core-team-2006. Accessed January 16, 2014.
  20. 20.
    Raftery AE. Bayesian model selection in social research. Sociol Methodol. 1995;25:111–163.CrossRefGoogle Scholar
  21. 21.
    Rolfson O, Dahlberg LE, Nilsson JA, Malchau H, Garellick G. Variables determining outcome in total hip replacement surgery. J Bone Joint Surg Br. 2009;91:157–161.PubMedCrossRefGoogle Scholar
  22. 22.
    Rolfson O, Karrholm J, Dahlberg LE, Garellick G. Patient-reported outcomes in the Swedish Hip Arthroplasty Register: results of a nationwide prospective observational study. J Bone Joint Surg Br. 2011;93:867–875.PubMedCrossRefGoogle Scholar
  23. 23.
    Ross CE, Wu C-L. The links between education and health. Am Sociol Rev. 1995;60:719–745.CrossRefGoogle Scholar
  24. 24.
    Schafer T, Krummenauer F, Mettelsiefen J, Kirschner S, Gunther KP. Social, educational, and occupational predictors of total hip replacement outcome. Osteoarthritis Cartilage. 2010;18:1036–1042.PubMedCrossRefGoogle Scholar
  25. 25.
    Singh JA, Lewallen D. Age, gender, obesity, and depression are associated with patient-related pain and function outcome after revision total hip arthroplasty. Clin Rheumatol. 2009;28:1419–1430.PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Stevens M, Wagenmakers R, Groothoff JW, Bulstra SK, van den Akker-Scheek I, Zijlstra W. Physical activity behavior after total hip arthroplasty (THA): a prediction based on patient characteristics. Patient Educ Couns. 2007;69:196–199.PubMedCrossRefGoogle Scholar
  27. 27.
    Walters SJ, Brazier JE. Comparison of the minimally important difference for two health state utility measures: EQ-5D and SF-6D. Qual Life Res. 2005;14:1523–1532.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2014

Authors and Affiliations

  • Meridith E. Greene
    • 1
    • 2
    • 3
  • Ola Rolfson
    • 1
    • 4
  • Szilard Nemes
    • 1
  • Max Gordon
    • 1
    • 5
  • Henrik Malchau
    • 1
    • 2
    • 4
  • Göran Garellick
    • 1
    • 4
  1. 1.Swedish Hip Arthroplasty RegisterGothenburgSweden
  2. 2.Harris Orthopaedic LaboratoryMassachusetts General HospitalBostonUSA
  3. 3.Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
  4. 4.Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
  5. 5.Department of Clinical Sciences at Danderyd HospitalKarolinska InstituteStockholmSweden

Personalised recommendations