PMID- 35288247
OWN - NLM
STAT- MEDLINE
DCOM- 20220608
LR  - 20220728
IS  - 1532-8406 (Electronic)
IS  - 0883-5403 (Linking)
VI  - 37
IP  - 7S
DP  - 2022 Jul
TI  - Functional Outcomes of a Musculoskeletal Integrated Practice Providing 
      Comprehensive Whole Person Care for Hip Osteoarthritis.
PG  - S471-S478.e1
LID - S0883-5403(22)00289-3 [pii]
LID - 10.1016/j.arth.2022.03.019 [doi]
AB  - BACKGROUND: Outcomes of hip osteoarthritis (OA) management within integrated 
      practice units (IPUs) are lacking. This study reports 6-month and 1-year 
      patient-reported outcomes (PROs) of IPU care, the proportion of patients 
      achieving minimal clinically important difference (MCID) and substantial clinical 
      benefit (SCB) at 1 year, and baseline factors associated with the likelihood of 
      achieving MCID and SCB. METHODS: We retrospectively evaluated 1009 new patients 
      presenting to an IPU with hip OA between October 2017 and June 2020. Patients 
      experienced multidisciplinary team-based management. Individuals with baseline 
      and 6-month PROs or baseline and 1-year PROs (Hip Disability and Osteoarthritis 
      Outcome Score Joint Replacement, HOOS JR) were included. We used anchor-based 
      MCID and SCB thresholds and multivariable binary logistic regression models to 
      identify baseline factors associated with achieving 1-year MCID and SCB. RESULTS: 
      HOOS JR increased from baseline to 6 months (Delta = 19.1 +/- 2.1, P = .065) and 
      baseline to 1 year (Delta = 35.8 +/- 2.9, P < .001). At 1 year, 72.7% (IPU only) and 
      88% (IPU-based total hip arthroplasty [THA]) achieved MCID (P < .001), and 62.3% 
      (IPU only) and 88% (IPU-based THA) achieved SCB (P < .001). In multivariable 
      regression, lower baseline HOOS JR scores (r = 0.96, P = .04), undergoing THA 
      (r = 0.213, P < .001), and fewer symptoms of generalized anxiety (r = 0.932, P = 
      .018) were independently associated with achieving MCID at 1 year. The same 
      factors were independently associated with achieving SCB at 1 year. Lower 
      baseline anxiety (Generalized Anxiety Disorder Questionnaire-7 item) and greater 
      hip-related preoperative limitations result in greater likelihood of achieving 
      MCID and SCB. CONCLUSION: Significant improvements in patient outcomes can be 
      achieved by IPUs providing comprehensive care for hip OA including the management 
      of psychological distress. Future prospective studies should compare the outcomes 
      of IPUs with traditional care in managing diverse patient phenotypes.
CI  - Copyright (c) 2022 Elsevier Inc. All rights reserved.
FAU - Jayakumar, Prakash
AU  - Jayakumar P
AD  - The University of Texas at Austin, Dell Medical School, Austin, TX.
FAU - Galea, Vincent P
AU  - Galea VP
AD  - The University of Texas at Austin, Dell Medical School, Austin, TX; New York 
      Medical College, School of Medicine, New York, NY.
FAU - Geng, Michael
AU  - Geng M
AD  - The University of Texas at Austin, Dell Medical School, Austin, TX; Texas A&M 
      University, Engineering Medicine Program, Houston, TX.
FAU - Moore, Meredith G
AU  - Moore MG
AD  - The University of Texas at Austin, Dell Medical School, Austin, TX; Department of 
      Plastic Surgery, University of South Florida, Tampa, FL.
FAU - Bozic, Kevin J
AU  - Bozic KJ
AD  - The University of Texas at Austin, Dell Medical School, Austin, TX.
FAU - Koenig, Karl M
AU  - Koenig KM
AD  - The University of Texas at Austin, Dell Medical School, Austin, TX.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20220312
PL  - United States
TA  - J Arthroplasty
JT  - The Journal of arthroplasty
JID - 8703515
SB  - IM
MH  - Humans
MH  - Minimal Clinically Important Difference
MH  - *Osteoarthritis, Hip/complications/surgery
MH  - Prospective Studies
MH  - Retrospective Studies
MH  - Treatment Outcome
OTO - NOTNLM
OT  - biopsychosocial model
OT  - hip osteoarthritis
OT  - multidisciplinary team-based care
OT  - patient reported outcomes
OT  - value based health care
EDAT- 2022/03/16 06:00
MHDA- 2022/06/09 06:00
CRDT- 2022/03/15 05:41
PHST- 2021/12/02 00:00 [received]
PHST- 2022/03/03 00:00 [revised]
PHST- 2022/03/03 00:00 [accepted]
PHST- 2022/03/16 06:00 [pubmed]
PHST- 2022/06/09 06:00 [medline]
PHST- 2022/03/15 05:41 [entrez]
AID - S0883-5403(22)00289-3 [pii]
AID - 10.1016/j.arth.2022.03.019 [doi]
PST - ppublish
SO  - J Arthroplasty. 2022 Jul;37(7S):S471-S478.e1. doi: 10.1016/j.arth.2022.03.019. 
      Epub 2022 Mar 12.