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

Abstract

Aim This paper is the report of a study exploring the efficacy of a health maintenance clinic intervention for patients with severe osteoarthritis of the hip and knee whilst awaiting primary joint replacement surgery. Background Historically in the UK patients with severe osteoarthritis waited many months for their hip and knee replacement surgery. The waiting time was often in the absence of support and advice relating to symptom management. A health maintenance intervention was developed to provide support to patients whilst awaiting their joint replacement and to optimise their health status ahead of the procedure. Methods A randomised control trial (RCT) compared usual care (pre-operative assessment only) to a new intervention (health maintenance clinic plus pre-operative assessment). A sample of 250 people with osteoarthritis waiting for joint replacement were recruited via an orthopaedic out-patient department between 2005 and 2006. To assess the effectiveness of the intervention outcome, measures were recorded at two points in time (on referral to the waiting list and at 2 weeks prior to surgery). Results No significant difference between the total score on the disease specific outcome measure was found (p = 0.69). However, participants in the experimental group were significantly more satisfied with their care (p = 0.001) and had fewer incidences of postponement of surgery (p = 0.002). Conclusion A tailored intervention for symptom management in the pre-operative period increases patient satisfaction which may have a positive impact on concordance and postoperative recovery. Also, reducing the number of surgical postponements has a positive economic value for health care providers.