What is the current evidence of the impact on quality of life whilst waiting for management/treatment of orthopaedic/musculoskeletal complaints? A systematic scoping review
To describe quality of life (QoL) outcome measures that are reported in the literature in patients waiting for outpatient orthopaedic/musculoskeletal specialist care and how waiting impacts on QoL in these terms.
A subset of studies reporting on QoL outcome measures were extracted from literature identified in a recent scoping search of Medline, Embase, Pubmed, NHS Economic Evaluation Database (Prospero registration CRD42016047332). The systematic scoping search examined impacts on patients waiting for orthopaedic specialist care. Two independent reviewers ranked study design using the National Health and Medical Research Council aetiology evidence hierarchy, and appraised study quality using Critical Appraisal Skills Programme tools. QoL measures were mapped against waiting period timepoints.
The scoping search yielded 142 articles, of which 18 reported on impact on QoL. These studies reported only on patients waiting for hip and/or knee replacement surgery. The most recent study reported on data collected in 2006/7. The Western Ontario and McMaster Universities Arthritis Index and the SF-36 were the most commonly reported QoL measures. QoL was measured at variable timepoints in the waiting period (from a few weeks to greater than 12 months). The impact of waiting on QoL was inconsistent.
The evidence base was over 10 years old, reported only on patients with hip and knee problems, and on limited QoL outcome measures, and with inconsistent findings. A better understanding of the impact on QoL for patients waiting for specialist care could be gained by using standard timepoints in the waiting period, patients with other orthopaedic conditions, comprehensive QoL measures, as well as expectations, choices and perspectives of patients waiting for specialist care.
KeywordsOrthopaedics Waiting list Quality of life Systematic review
Data management and formatting support was available from Ashley Fulton, Heath Pillen and Holly Bowen.
AT and JM for literature searching, critical appraisal; AT, JM, KG for debating and organising the findings; drafting and reading subsequent drafts and editing the manuscript.
Compliance with ethical standards
Conflict of interest
All authors declare that they have no conflict of interests.
This article does not contain any studies with human participants or animals performed by any of the authors.
- 5.Hirvonen, J., Blom, M., Tuominen, U., Seitsalo, S., Lehto, M., Paavolainen, P., Hietaniemi, K., Rissanen, P., & Sintonen, H. (2006). Health-related quality of life in patients waiting for major joint replacement. A comparison between patients and population controls. Health and Related Quality of Life Outcomes. https://doi.org/10.1186/1477-7525-4-3.Google Scholar
- 17.Sanmartin, C., Berthelot, J.-M., & McIntosh, C. N. (2007). Determinants of unacceptable waiting time for specialized services in Canada. Healthcare Policy, 2(3), 141–154.Google Scholar
- 19.Desmeules, F., Dionne, C. E., Belzile, E., Bourbonnais, R., & Frémont, P. (2010). The impacts of pre-surgery wait for total knee replacement on pain, function and health-related quality of life six months after surgery. Journal of Evaluation in Clinical Practice, 1–10.Google Scholar
- 21.Morris, J., Twizeyemariya, A., & Grimmer, K. (2017). The cost of waiting on an orthopaedic waiting list: A scoping review. Asia Pacific Journal of Health Management, 12(2), 42–54.Google Scholar
- 24.Critical Appraisal Skills Programme (CASP). (2014). CASP checklists http://media.wix.com/ugd/dded87_40b9ff0bf53840478331915a8ed8b2fb.pdf. Oxford: CASP.
- 25.Hoogeboom, T. J., van den Ende, C. H. M., van der Slius, G., Elings, J., Dronkers, J. J., Aiken, A. B., & van Meeteren, N. L. U. (2009). The impact of waiting for total joint replacement on pain and functional status: A systematic review. Osteoarthritis and Cartilage, 17, 1420–1427.CrossRefPubMedGoogle Scholar
- 28.Hirvonen, J., Tuominen, U., Seitsalo, S., Lehto, M., Paavolainen, P., Hietaniemi, K., Rissanen, P., Sintonen, H., & Blom, M. (2009). The effect of waiting time on Health-related quality of life, pain and physical function in patients awaiting primary total hip replacement: A randomized controlled trial. Value in Health, 12(6), 942–947.CrossRefPubMedGoogle Scholar
- 29.Nunez, M., Nunez, E., Segur, J. M., Macule, F., Quinto, L., Hernandez, M. V., & Vilalta, C. (2006). The effect of an educational program to improve health-related quality of life in patients with osteoarthritis on waiting list for total knee replacement: A randomized study. Osteoarthritis and Cartilage, 14, 279–285.CrossRefPubMedGoogle Scholar
- 30.Ackerman, I. N., Bennell, K. L., & Osborne, R. H. (2011). Decline in health-related quality of life reported by more than half of those waiting for joint replacement surgery: A prospective cohort study. BMC Musculoskeletal Disorders, 108(12), 1–9.Google Scholar
- 40.Tuominen, U., Sintonen, H., Hirvonen, J., Seitsalo, S., Paavolainen, P., Lehto, M., Hietaniemi, K., & Blom, M. (2010). Is longer waiting time for total knee replacement associated with health outcomes and medication costs? Randomized clinical trial. Value in Health, 13(8), 998–1004.CrossRefPubMedGoogle Scholar
- 46.Culvenor, A. G., Engen, C. N., Øiestad, B. E., Engebretsen, L., & Risberg, M. A. (2015). Defining the presence of radiographic knee osteoarthritis: A comparison between the Kellgren and Lawrence system and OARSI atlas criteria. Knee Surgery, Arthroscopy and Sports Traumatology, 23, 3532–3539.CrossRefGoogle Scholar
- 51.Komatsu, D., Hasegawa, Y., Kojima, T., Seki, T., Higuchi, Y., & Ishiguro, N. (2016). Absence of a relationship between joint space narrowing and osteophyte formation in early knee osteoarthritis among Japanese community dwelling elderly individuals: A cross-sectional study. Modern Rheumatology. https://doi.org/10.1080/14397595.2016.1232775.Google Scholar
- 53.Parson, G., Jester, R., & Godfrey, H. (2013). A randomised controlled trial to evaluate the efficacy of a health maintenance clinic intervention for patients undergoing elective primary total hip and knee replacement surgery. International Journal of Orthopaedic and Trauma Nursing, 17, 171–179.CrossRefGoogle Scholar
- 55.Roos, E. M., Klassbo, M., & Lohmander, L. S. (1999). WOMAC osteoarthritis index. Reliability, validity, and responsiveness in patients with arthroscopically assessed osteoarthritis. Western Ontario and MacMaster Universities. Scandinavian Journal of Rheumatology, 28(4), 210–215.CrossRefPubMedGoogle Scholar
- 62.McElhone, K., Abbott, J., Sutton, C., Mullen, M., Lanyon, P., Rahman, A., Yee, C., Akil, M., Bruce, I. N., Ahmad, Y., & Gordon, C. (2016). The L. sensitivity to change and minimal important differences of the LupusQoL in patients with systemic lupus erythematosus. Arthritis Care & Research, 68(10), 1505–1513.CrossRefGoogle Scholar
- 63.Conner-Spady, B. L., Marshall, D. A., Hawker, G. A., Bohm, E., Dunbar, M. J., Frank, C., & Noseworthy, T. W. (2015). You’ll know when you’re ready: A qualitative study exploring how patients decide when the time is right for joint replacement surgery. BMC Health Services Research, 14(1), pp. 1–10.Google Scholar