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dc.contributor.authorCobos, Raquel
dc.contributor.authorLatorre, Amaia
dc.contributor.authorAizpuru Barandiaran, Felipe ORCID
dc.contributor.authorGuenaga, José I.
dc.contributor.authorSarasqueta, Cristina
dc.contributor.authorEscobar, Antonio
dc.contributor.authorGarcía, Lidia
dc.contributor.authorHerrera Espiñeira, Carmen
dc.date.accessioned2011-06-15T09:04:20Z
dc.date.available2011-06-15T09:04:20Z
dc.date.issued2010
dc.identifier.citationBMC Musculoskeletal Disorders 11(249) : (2010)es
dc.identifier.issn1471-2474
dc.identifier.urihttp://hdl.handle.net/10810/4216
dc.description.abstractBackground Total knee (TKR) and hip (THR) replacement (arthroplasty) are effective surgical procedures that relieve pain, improve patients' quality of life and increase functional capacity. Studies on variations in medical practice usually place the indications for performing these procedures to be highly variable, because surgeons appear to follow different criteria when recommending surgery in patients with different severity levels. We therefore proposed a study to evaluate inter-hospital variability in arthroplasty indication. Methods The pre-surgical condition of 1603 patients included was compared by their personal characteristics, clinical situation and self-perceived health status. Patients were asked to complete two health-related quality of life questionnaires: the generic SF-12 (Short Form) and the specific WOMAC (Western Ontario and Mcmaster Universities) scale. The type of patient undergoing primary arthroplasty was similar in the 15 different hospitals evaluated. The variability in baseline WOMAC score between hospitals in THR and TKR indication was described by range, mean and standard deviation (SD), mean and standard deviation weighted by the number of procedures at each hospital, high/low ratio or extremal quotient (EQ5-95), variation coefficient (CV5-95) and weighted variation coefficient (WCV5-95) for 5-95 percentile range. The variability in subjective and objective signs was evaluated using median, range and WCV5-95. The appropriateness of the procedures performed was calculated using a specific threshold proposed by Quintana et al for assessing pain and functional capacity. Results The variability expressed as WCV5-95 was very low, between 0.05 and 0.11 for all three dimensions on WOMAC scale for both types of procedure in all participating hospitals. The variability in the physical and mental SF-12 components was very low for both types of procedure (0.08 and 0.07 for hip and 0.03 and 0.07 for knee surgery patients). However, a moderate-high variability was detected in subjective-objective signs. Among all the surgeries performed, approximately a quarter of them could be considered to be inappropriate. Conclusions A greater inter-hospital variability was observed for objective than for subjective signs for both procedures, suggesting that the differences in clinical criteria followed by surgeons when indicating arthroplasty are the main responsible factors for the variation in surgery rates.es
dc.description.sponsorshipMinisterio de Sanidad y Consumo (040938) y Departamento de Sanidad del Gobierno Vascoes
dc.language.isoenges
dc.publisherBioMed Centrales
dc.rightsinfo:eu-repo/semantics/openAccesses
dc.subjectquality of lifees
dc.subjectjoint replacementes
dc.subjectorthopedic surgeonses
dc.subjectgender differenceses
dc.subjectosteoarthritises
dc.subjecthealthes
dc.subjectpopulationes
dc.subjectoutcomeses
dc.subjectarthroplastyes
dc.subjectOntarioes
dc.titleVariability of indication criteria in knee and hip replacement: an observational studyes
dc.typeinfo:eu-repo/semantics/articlees
dc.rights.holder© 2010 Cobos et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.es
dc.relation.publisherversionhttp://www.biomedcentral.com/1471-2474/11/249es
dc.identifier.doi10.1186/1471-2474-11-249
dc.departamentoesBioquímica y biología moleculares_ES
dc.departamentoeuBiokimika eta biologia molekularraes_ES
dc.subject.categoriaORTHOPEDICS AND SPORTS MEDICINE


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