title: A prospective cohort study examining medical and social factors associated with engagement in life activities following total hip replacement.
abstract: Studies show limited improvement in the frequency of engaging in life activities after joint replacement. However, there is a paucity of research that has examined factors, including other life events, which influence engagement following total hip replacement (THR). This research sought to identify factors associated with engaging in life activities following THR.
  
  
  
  A prospective cohort study was conducted with 376 people who had a THR for osteoarthritis (OA). Data were collected pre-surgery and 1 year post-surgery. The primary outcome was change in frequency in engagement in life activities (Late Life Disability Index (LLDI): higher scores indicate higher frequency of engagement (range 0-80)). Analyses included multivariable regression. Factors considered included: positive/negative life events, a new comorbidity, another joint replacement and complications post-surgery.
  
  
  
  Participants' mean age was 64 years; 46% were male. 68% of participants had at least one comorbidity pre-surgery; 36% reported at least one new comorbidity after surgery. The mean change in LLDI frequency was an increase of 6.29 (±8.10). 36% reported one or more positive impact life events in the year following surgery; 63% reported one or more negative life events. The number of positive life events (beta = 1.24; 95% CI: 0.49, 1.99) was significantly associated with change in LLDI frequency after adjusting for age, sex, education, body mass index (BMI), comorbidities pre-surgery, number of symptomatic joints and pre-surgery pain and function, LLDI limitations and depression.
  
  
  
  These findings highlight the significant influence of social factors and life circumstances on engagement in life activities following THR.
authors.affiliation: Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada. Electronic address: crystal.mackay@utoronto.ca.
authors.forename: C
authors.initials: C
authors.lastname: MacKay
authors.affiliation: Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Electronic address: Fiona.Webster@utoronto.ca.
authors.forename: F
authors.initials: F
authors.lastname: Webster
authors.affiliation: Division of Health Care and Outcomes Research, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada. Electronic address: viji.venkataramanan@sickkids.ca.
authors.forename: V
authors.initials: V
authors.lastname: Venkataramanan
authors.affiliation: Department of Public Health, University of Helsinki, Helsinki, Finland. Electronic address: jessica.bytautas@helsinki.fi.
authors.forename: J
authors.initials: J
authors.lastname: Bytautas
authors.affiliation: Division of Health Care and Outcomes Research, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Arthritis Program, Division of Orthopaedics, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada. Electronic address: perrucci@uhnres.utoronto.ca.
authors.forename: A V
authors.initials: AV
authors.lastname: Perruccio
authors.affiliation: Division of Health Care and Outcomes Research, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada. Electronic address: rwong@uhnresearch.ca.
authors.forename: R
authors.initials: R
authors.lastname: Wong
authors.affiliation: School of Rehabilitation, Université de Montréal, Montreal, Quebec, Canada. Electronic address: lccarlesso@gmail.com.
authors.forename: L
authors.initials: L
authors.lastname: Carlesso
authors.affiliation: Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Division of Health Care and Outcomes Research, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada; Rehabilitation Science Institute, University of Toronto, Toronto, Ontario, Canada. Electronic address: adavis@uhnresearch.ca.
authors.forename: A M
authors.initials: AM
authors.lastname: Davis
mesh_terms: D000203:Activities of Daily Living; D019644:Arthroplasty, Replacement, Hip / Q000534:rehabilitation*; D019645:Arthroplasty, Replacement, Knee / Q000534:rehabilitation; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000071069:Multiple Chronic Conditions / Q000534:rehabilitation; D015207:Osteoarthritis, Hip / Q000534:rehabilitation*; D020370:Osteoarthritis, Knee / Q000534:rehabilitation; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology / Q000534:rehabilitation; D011446:Prospective Studies; D011788:Quality of Life
keywords: Life activities; Osteoarthritis; Total hip replacement