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Effects of Inpatient Rehabilitation in Hip and Knee Osteoarthritis: A Naturalistic Prospective Cohort Study With Intraindividual Control of Effects

Published:April 15, 2013DOI:https://doi.org/10.1016/j.apmr.2013.03.026

      Abstract

      Objectives

      To quantify pain, function, and health-related quality of life in comparison with normative data, and to quantify intervention effects.

      Design

      Naturalistic cohort study without a control group. Correction of the effects observed during the intervention by those observed during waiting time prior to the intervention.

      Setting

      Inpatient rehabilitation clinic.

      Participants

      Patients with hip (n=88) and knee (n=164) osteoarthritis.

      Intervention

      Comprehensive, multidisciplinary inpatient rehabilitation lasting 3 weeks.

      Main Outcome Measures

      Medical Outcomes Study 36-Item Short-Form Health Survey and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).

      Results

      Four or more comorbid conditions had 45.3% of the hip and 51.8% of the knee patients on entry to and discharge from the clinic. On entry, physical health and some dimensions of psychosocial health were significantly diminished compared with population norms. At discharge, hip osteoarthritis had improved by a corrected effect size of .20 to .47 in pain, .04 to .39 in function, and −.04 to .32 in psychosocial health. Knee osteoarthritis showed a corrected effect size of .43 to .62 in pain, .19 to .51 in function, and .19 to .30 in psychosocial health. All but 1 effect in WOMAC pain and WOMAC function were higher than the minimal clinically important differences.

      Conclusions

      Hip and knee osteoarthritis patients admitted to the inpatient intervention were affected by a substantial burden of disease and comorbidities. Inpatient rehabilitation resulted in small to moderate, statistically significant, and clinically important improvements in pain, function, and psychosocial health.

      Keywords

      List of abbreviations:

      ES (effect size), MCID (minimal clinically important difference), RCT (randomized controlled trial), SF-36 (Medical Outcomes Study 36-Item Short-Form Health Survey), SMD (standardized mean difference), WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index)
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