Artikel
Gait Asymmetry is Associated with Hip Disability Osteoarthritis Outcome Score and EQ-5D-5L Outcome in Patients with Frailty Syndrome Undergoing Total Hip Arthroplasty – Preliminary Results of a Randomized Control Study
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Veröffentlicht: | 25. Oktober 2022 |
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Gliederung
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Objectives: The Frailty Syndrome is a geriatric condition determined by decreased capacities in various physiological systems and increased risk for falls, hospitalization, and death. Patient reported outcome measures (PROMs) are indispensable tools in determining the efficacy of a surgical intervention. Weight-bearing asymmetry is utilized as a biomechanical metric of functional recovery in clinical rehabilitation. However, it is still unclear whether PROMs and weight-bearing asymmetry are associated, which could provide further insights in subjective and objective measures of function and a new possibility of a targeted intervention. We hypothesize that PROMs are related to weight-bearing asymmetry in patients with Frailty Syndrome and osteoarthritis (OA).
Methods: We analyzed the preliminary preoperative data of patients who were included in a randomized controlled study assessing the effect of prehabilitation in patients with Frailty Syndrome scheduled for THA before undergoing prehabilitation and surgery. Frailty was determined by applying the criteria proposed by Fried et al. Preoperative data collection included EQ-5D-5L and the hip disability and osteoarthritis outcome score (HOOS). The patients performed the 2-minutes step test using instrumented insoles (loadsol®, Novel), which recorded the overall normal plantar force from each foot, transmitted via Bluetooth to a mobile device. The overall weight-bearing asymmetry was determined with the absolute weighted universal symmetry index (wUSI) using a customized script, where 0% indicates perfect symmetry and 100% total asymmetry. Linear regression analysis using Spearman's correlation coefficient was applied to investigate the relationship between EQ-5D-5L and HOOS, and wUSI.
Results and conclusion: Preliminary data of N=19 patients (N=10 females; 80.4 years; BMI 26.7 kg/m2) with Frailty Syndrome and OA undergoing THA and before prehabilitation were analyzed. Significant correlations between EQ-5D-5L subscales mobility (r=0.511; p=0.03), usual activities (r=0.568; p=0.014), pain/discomfort (r=0.615; p=0.007), and wUSI were identified. A significant negative correlation between the HOOS subscale quality of life and wUSI was detected (r=-0.488; p=0.034). HOOS subscales pain (r=-0.412; p=0.079), symptoms (r=-0.403; p=0.087), activities of daily living (r=-0.455; p=0.050 and function and sports (r=-0.426; p=0.069) remained without a significant result.
For the first-time significant correlations of health-related quality of life and hip-specific PROMs with weight-bearing asymmetry, in a patient population with Frailty Syndrome and OA, were detected. The association between widely used and validated outcome parameters indicates the relevance of weight-bearing asymmetry for the patient's quality of life. Additionally, it illustrates the significance of objective outcomes to complement clinical findings and supports the prediction of the overall functional improvement after THA.