A Literature Review Of Outcomes And Experiences Of Total Knee Replacement Surgery

Citation

Woolhead, G. M., J. L. Donovan, and P. A. Dieppe. “Outcomes of total knee replacement: a qualitative study.” Rheumatology 44.8 (2005): 1032-1037.

Introduction

In this article the author investigates the experiences of the patients who have undergone a total knee replacement. The results of the research are intended to the physicians and the patients who may undergo such complex surgery.

Aims and research methods

The researcher obtained the desired data through in depth interviews. The interviews were conducted with 25 patients prior to knee replacement (3 months). After six months of surgery interviews were conducted again with 10 people to know the outcomes of the surgery. The data analysis was based on the constant comparison of data collected using audiotape and transcription method.

Scope

The research focused on the range of experiences of the patients and their point of view. The researcher takes into account the context of the individual and further reconceptualises their concepts.

Usefulness

The research process was useful in highlighting the complexity of the total knee replacement surgery. The research highlighted the process of recovery and discussed how difficult it is for the patients to come to terms with their outcomes. This constitutes the strength of the research. Further the research also indicates the high effectiveness of the surgery.

Further strength of the research includes highlighting the difference between the physician and the patient’s evaluation of the outcome.

The research may help improve and develop the health status questionnaires by the physicians for the patients undergoing the total knee replacement surgery.

Limitations

There is a need of broader data as only limited view of patients and their perceptions was obtained. The data collected failed to conceptualise the meaning of the patient’s narrations. It failed to capture the individual adaptations and true experiences or surgery outcomes. The qualitative findings were contradictory in terms of the views related to the health changes. These indicate the need of more sensitive assessments to ensure greater reliability of the data collected.

Conclusions

As per the results obtained it was found that the patients after the total knee replacement had contradictory experiences. The common experience was pain and discomfort along with the difficulty in mobility. Despite the concern overall outcomes of the patients were concluded to be successful.

Reflection

The article was useful for enhancing my knowledge on qualitative analysis and data interpretation method. The data has been presented in very easily understandable format with quotations.  It may form the basis of my qualitative research in future in similar or different field.

Citation

Escobar, A., et al. “Effect of patient characteristics on reported outcomes after total knee replacement.” Rheumatology 46.1 (2007): 112-119.

Introduction

In the article the researcher has investigated the patients who have underwent the total knee replacement surgery to evaluate the effect of the “pre-intervention factors”.

Aims and research methods

The researcher has carried out a prospective observational study. Two types of questionnaires were developed for the patients. One was the generic questionnaire (“Medical Outcomes Study Short Form-36” or SF-36) and other was the “Western Ontario and McMaster Universities Osteoarthritis Index” or WOMAC. Both questionnaires together consist of 12 domains and will be evaluated by means of separate multivariate models.

The assessment was conducted before and again after six months of surgery in seven hospitals.

Scope

The main focus of the study is to assess the effect of the factors (pre-intervention) such as obesity, age gender, baseline QoL (quality of life) scores, low back pain, social support, comorbidities and baseline mental health domain of the SF-36 questionnaires as well as its outcome on WOMAC index as reported by the patients with osteoarthritis after surgery.

Usefulness

The study results are useful for the physicians and patients as it identifies the pre-intervention characteristics that hamper the patients’ quality of life after the knee replacement surgery. The study is thus useful in identifying or determining as to which patients are more likely to benefit from the surgery. This is the strength of the research. Additional strength is the evidence that it provides in regards to improvement of the patient’s health related quality of life.

Limitations

The primary limitation of the study is the lack of analysis on different variable such as “unilateral vs bilateral interventions” and its correlation with the outcomes.

Further limitation of the study includes failure to study the HRQoL variables prior to the intervention. The patients were assessed while they were on the waiting list.

Conclusions

As per the results the baseline score of each domain selected was the main pre-intervention predictor. In the three WOMAC domains, low back pain, social support and the score of the SF-36 domain were the three predictors (pre-intervention). In reference to the SF-36 domains, the main predictors were low back pain, social support, comorbidities and baseline mental health score. Thus, it was concluded that the main predictor of the outcome when assessed after six months of surgery in total of 11 domains was the “pre-intervention score” in each domain.

The research concluded that the heath related quality of the life post operation will improve in reference to the predictors mentioned above.

Reflection

The paper is well presented with the tabular charts and is convenient to follow the results. Further strength of the study is the use of broad sample and use of two types of questionnaires

It may be useful for my research in long run where in case I have to conduct similar assessments in the same or different field.  

Citation

“Who Gets Osteoarthritis? (AIHW)”. Aihw.Gov.Au, 2017, https://www.aihw.gov.au/osteoarthritis/who-gets-osteoarthritis/.

Introduction

The author of the webpage discusses about osteoarthritis and who gets it.

Aims and research methods

The author of the article conducts secondary research to investigate the prevalence of osteoarthritis in Australia and its change in the last 15 years and who gets it.

Scope

The paper focuses on the prevalence of the osteoarthritis in Australia and the age group most commonly effected.

The paper covers the comorbidities related to the health issue. It also specifically focuses on the prevalence of osteoarthritis in “Aboriginal and Torres Strait Islander people” and inequalities in this regard.

Usefulness

The major strength of the paper is the discussion on the medication used for management of the illness, hospitalisation and the treatment of osteoarthritis. The paper also covers the role of the GP in the treatment of the illness

It is useful for the effected and the vulnerable group of people in Australia as it create awareness on the illness and the way of treatment.

The illness was found to be more common in females and males which may help women to go for early intervention. Information on the comorbidities such as mental health problem, cardiovascular disease, diabetes, asthma and cancer and how it affects health quality may help people to uptake health promoting activities.  

Limitations

Since the data collected is based on the secondary research it is expected to be of high reliability which minimises the limitations. However, any flaw in the research conducted by the actual researchers may falsify the given information.

Conclusions

It is concluded that with age (from the age of 45) the prevalence of the illness also rises. It is concluded from the online article that there is no significant difference in the prevalence of the illness in the major cities, remote areas, outer and inner regional areas of Australia. However, the prevalence is high in area with low socioeconomic condition. There was no inequality found between the Indigenous and non Indigenous Australians after adjusting for age.

Reflection

The article is not of much importance for my research in future as it is not a core research based article and is more an informative paper. However, the rich information may help the physician and other researchers to develop intervention for the highly vulnerable people in Australia.  Presentation of the data through graphs is eye catching. It helps in tracking the change in the prevalence of the illness and its management.

Citation

Day, Gary E. “The Australian Health Care System, 4th edn, by S. Duckett and S. Willcox.” (2011): 1-16.

Introduction

The author of the article analyses the Australian Health Care system.

Aims and research methods

The author of the article aims to provide a detailed analysis on the Australian health care system. The paper uses the framework which has also been used by the “World Health Organisation” to evaluate the health system. The framework is effective in depicting the role of governments, social solidarity, individuals, legitimacy, and intermediaries, population size and composition, Gross Domestic Product, governance and stewardship in the Socio-political environment of the health system.

Scope

The paper highlights the inputs (workforce, finance) and the outputs (patients related) of the health care system. Further the paper focuses on evaluating the health care system in terms of the quality, efficiency, acceptability and equity.  

Usefulness

The usefulness of the article is highlighting the fact that the design of the health system must align with the demand and supply of the service. The strength of the paper is its emphasis on the non-objective nature of the health service needs. The paper analysed that how policies can intervene to shape the need (changing demand or supply of health services). The analysis of the paper is not only useful for other health care systems but also aids various researchers to make effective interventions through introduction of policies.

Limitations

The limitation of the article is the stereotypic depiction of the content without presenting any tabular charts and graphs. The discussion on the topic related to separation between funding, purchasing, and provision of the health services is not very clear.

Conclusions

The article concludes that the health care system is situated in broad “socio-political environment” which both effects and is affected by it. Further the analysis concluded that the outputs (that is patient treated) and the health care outcomes such as changed environments are not distributed across all members of the society evenly. It concludes that if the health system changes are not considered acceptable it may have adverse impact.

It concludes that only high quality services should contribute to social solidarity. It emphasises that only by understanding the efficiency that one can clearly measure the clinical outcomes of a health program.

Reflection

Overall the article is not of great importance to my research in future related to total knee replacement. However, the system perspective on health may help develop effective interventions considering the socio-political environment in which the health care is operating.