[Effects of rehabilitation after hip replacement surgery on postoperative complaints regarding the disease and limitation of function].
BACKGROUND
The study was conducted in co-operation with a German health insurance fund (Gmünder Ersatzkasse, GEK) to identify determinants of outcomes of hip surgery from the patient's perspective.


METHODS
In September 1997 all beneficiaries (age 40-75 yrs.) who had been treated in hospital for osteoarthrosis of the hip (ICD-715/820) (n = 1352) were sent a questionnaire on average 5.2 months (T1) postoperatively. The standardized questionnaire contained, among others, items about pre- and postoperative subjective assessment of disease specific symptoms (Lequesne Index), complications, comorbidity (Katz-Index), health related quality of life (SF-36) and discharge (home or for inpatient rehabilitation). The response rate at T1 was 67.8%. Patients with hip surgery (n = 390) were sent a second questionnaire 17.2 months (T2) postoperatively. After the two mailings, data from 293 patients were available for analysis. Descriptive and multivariate analyses (GSK model) were performed to reveal determinants of disease specific symptom alleviation.


RESULTS
Patients (57.6% male) were 61 years of age on average, and 61.2% reported no comorbidity. 88.4% had undergone total hip replacement. A third of the patients reported at least one complication. 70.6% were discharged for inpatient rehabilitation. Univariately, a substantial (and statistically highly significant) decrease was observed in the Lequesne Index over time: (recalled) preoperative: 14.2 points; postoperative T1: 5.6 pts.; postoperative T2: 4.4 pts. This result is confirmed by multivariate analyses (estimated values: pre = 13.8; T1 = 6.9; T2 = 5.7) although it is modified by an interaction effect between the variables "Lequesne Index" and "Discharge". In patients discharged home, the preoperative Lequesne Index is an estimated 13.3, at T1 = 6.9 and T2 = 6.2. The respective estimated values for patients discharged for inpatient rehabilitation are: preoperative 14.3; T1 = 6.9; T2 = 5.2.


CONCLUSIONS
Patients receiving inpatient rehabilitation scored higher on the Lequesne Index (higher burden of disease) before hip surgery. In the short term, their improvements are higher than those of the patient group discharged home (-7.4 pts. versus -6.4 pts.) and continue to be higher in the medium term (-9.1 pts. versus -7.1 pts.). Inpatient rehabilitation after hip surgery leads to better disease specific health outcomes than direct discharge home.
Bitzer
E M
EM
Institut für Sozialmedizin, Epidemiologie und Gesundheitssystemforschung (ISEG), Hannover. bitzer@iseg.org
Dörning
H
H
Schwartz
F W
FW
D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000523:psychology / Q000534:rehabilitation*; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011788:Quality of Life / Q000523:psychology*; D020127:Recovery of Function; D012046:Rehabilitation / Q000379:methods; D012114:Residential Treatment; D011795:Surveys and Questionnaires