Classifying health-related quality of life outcomes of total hip arthroplasty

Abstract

Background: Primary total hip arthroplasty (THA) is an effective treatment for hip osteoarthritis, assessed by whatever distribution-based measures of responsiveness. Yet, the group level evaluation has provided very little evidence contributes to our understanding of the large variation of treatment outcome. The objective is to develop criteria that classify individual treatment health related quality of life (HRQOL) outcome after primary THA, adjusted by preoperative scores.

Methods: We prospectively measured 147 patients' disease specific HRQOL on the date of consultation and 12 months post operation by Western Ontario McMaster Universities Osteoarthritis Index (WOMAC). Regression models were used to determine the "expected" outcome for a certain individual baseline score. The ceiling effect of WOMAC measurement is addressed by implementing a left-censoring method.

Results: The classification criteria are chosen to be the lower boundary of the 95% confidence interval (CI) of the estimated median from the regression. The robustness of the classification criteria was demonstrated using the Monte-Carlo simulation.

Conclusion: The classification criteria are robust and can be applied in general orthopaedic research when the sample size is reasonable large (over 500).

Figure 1

The distribution of baseline WOMAC functional scores.

Figure 2

The distribution of follow-up WOMAC function scores.

Figure 3

The distribution of the logarithms of follow-up WOMAC functional scores.

Figure 4

95% confidence interval for the median of expected function outcomes.

Figure 5

The average of the median estimates from simulation.

Figure 6

Average of the estimated median and classification criteria.

Figure 7

The coefficient of variation of the classification criteria from simulation (Different sample size).

Figure 8

The coefficient of variation of the classification criteria from simulation (Different censor point).