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. 2019 Nov;1(3):e174-e186.
doi: 10.1016/S2665-9913(19)30050-5. Epub 2019 Oct 2.

Is social support associated with patient-reported outcomes after joint replacement? A systematic review and meta-analysis

V Wylde  1   2 , S K Kunutsor  1   2 , E Lenguerrand  1 , J Jackson  3 , A W Blom  1   2 , A D Beswick  1
Affiliations

Is social support associated with patient-reported outcomes after joint replacement? A systematic review and meta-analysis

V Wylde et al. Lancet Rheumatol. 2019 Nov.

Abstract

Background: Identifying prognostic factors for outcomes after joint replacement could improve the provision of stratified care. This systematic review evaluated whether social support is a prognostic factor for better patient-reported outcomes after total hip replacement (THR) and total knee replacement (TKR).

Methods: MEDLINE, Embase and PsycINFO were searched from inception to April 2019. Cohort studies evaluating the association between social support and patient-reported outcomes at three months or longer after THR or TKR were included. Data were extracted from study reports. Study quality was assessed using the QUIPS tool. Data were synthesized using meta-analysis and narrative synthesis. The review was registered on PROSPERO (CRD42016041485).

Findings: Searches identified 5,810 articles and 56 studies with data from 119,165 patients were included. In meta-analysis, the presence of social support had a beneficial effect on long-term post-operative WOMAC (mean difference 2.88; 95% CIs 1.30; 4.46) and Oxford Knee Score (0.29; 0.12, 0.45). Social support measured using a validated questionnaire was found to be associated with WOMAC pain (0.04; 0.00, 0.08) but not WOMAC function (-0.01; -0.12, 0.11). The presence of social support had a positive association with some SF-36 subscales but not others. For all outcomes, results of narrative synthesis were inconsistent.

Interpretation: There is evidence that social support is a prognostic factor for some outcomes after joint replacement. Development and evaluation of complex interventions to improve social support and social integration is warranted.

Funding: This study was supported by the NIHR Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol.

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Conflict of interest statement

Declaration of Interests None of the authors declare any competing interest with the submitted work. Outside of the submitted work, VW and AWB receive institutional research funding from Stryker.

Figures

Figure 1
Figure 1. PRISMA flow chart
Figure 2
Figure 2. Meta-analysis of the association between social support (measured as present/absent or using a patient-reported outcome measure) and WOMAC outcomes
Figure 3
Figure 3. Meta-analysis of the association between social support (measured as present/absent) and Oxford Knee Score outcomes
Figure 4
Figure 4. Meta-analysis of the association between social support (measured as present/absent) and SF-36 outcomes
See this image and copyright information in PMC

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