Predictors of Patient-Reported Outcomes After Hyaluronic Acid Injections: Effect of Expectations and Psychological Stress.

Anya Hall, Donghoon Lee, Richard Campbell, Ryan Paul, Morgan Leider, Brandon Smith, Kevin Freedman, Fotios Tjoumakaris
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Abstract

Introduction: Hyaluronic acid (HA) injections are a common nonsurgical treatment of knee osteoarthritis (OA). Patient expectations and psychological stress are believed to affect outcomes after orthopaedic procedures.

Methods: This was a prospective cohort study seeking to identify factors predictive of greater patient-reported outcomes after HA injections, particularly expectations and psychological stress. 250 patients receiving a series of HA injections for knee OA were enrolled, with 196 being included for analysis. Demographics, surgical history, and preoperative Kellgren-Lawrence severity scores were collected, and patients completed the Knee Osteoarthritis Outcome Score (KOOS) questionnaire, a modified KOOS questionnaire assessing their 6-month postinjection expectations, and the Perceived Stress Scale before the first injection. Outcomes were assessed at 3 weeks and 3 and 6 months after the final injection.

Results: KOOS scores improved from preinjection to 6-month follow-up but did not meet patients' expectations or minimal clinically important difference. Expectations correlated with 6-month KOOS pain, activities of daily living, sport, and quality of life subscales (ρ = 0.19 to 0.34), but not the symptom subscale (P = 0.10). Expectations (ρ = 0.31 to 0.37), younger age (ρ = -0.17 to -0.18), and greater perceived stress (ρ = 0.23) correlated with greater improvement from baseline KOOSs. Lower body mass index (ρ = -0.19 to -0.22), male sex (ρ = -0.17), and greater preinjection function (ρ = 0.37 to 0.46) correlated with greater 6-month outcomes. Stress measured on the Perceived Stress Scale did not correlate with 6-month KOOSs (P ≥ 0.27). Lower Kellgren-Lawrence severity score was weakly associated with greater 6-month KOOS activities of daily living and sport scores (ρ = -0.15 to -0.16) and greater improvement in the KOOS symptom score (ρ = -0.15).

Discussion: This study identified that higher expectations, lower body mass index, younger age, male sex, lower radiographic severity, greater preinjection function, and greater perceived stress are associated with greater patient outcomes after HA injection. Physicians should consider these factors when counseling patients with knee OA about viscosupplementation.

Study type: Prospective Cohort Study (Level of Evidence II).

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透明质酸注射后患者报告结果的预测因素:期望和心理压力的影响。
导言:透明质酸(HA)注射是治疗膝关节骨关节炎(OA)的一种常见非手术疗法。患者的期望和心理压力被认为会影响矫形手术后的疗效:本研究是一项前瞻性队列研究,旨在确定患者报告的 HA 注射后更大疗效的预测因素,尤其是期望值和心理压力。250名患者因膝关节OA接受了一系列HA注射,其中196人被纳入分析。研究人员收集了患者的人口统计学资料、手术史和术前 Kellgren-Lawrence 严重程度评分,并在首次注射前完成了膝骨关节炎结果评分 (KOOS) 问卷、评估注射后 6 个月期望值的改良 KOOS 问卷和感知压力量表。最后一次注射后 3 周、3 个月和 6 个月时对结果进行评估:结果:KOOS评分从注射前到6个月随访期间均有所改善,但未达到患者的期望值或最小临床重要差异。期望值与 6 个月的 KOOS 疼痛、日常生活活动、运动和生活质量分量表相关(ρ = 0.19 至 0.34),但与症状分量表无关(P = 0.10)。期望值(ρ = 0.31 至 0.37)、年龄(ρ = -0.17 至 -0.18)和感知到的压力(ρ = 0.23)与 KOOSs 从基线得到更大改善相关。体重指数较低(ρ = -0.19至-0.22)、性别为男性(ρ = -0.17)和注射前功能较强(ρ = 0.37至0.46)与6个月后的改善程度相关。用感知压力量表测量的压力与 6 个月的 KOOSs 无关(P ≥ 0.27)。较低的 Kellgren-Lawrence 严重程度评分与较高的 6 个月 KOOS 日常生活活动和运动评分(ρ = -0.15 至 -0.16)以及较高的 KOOS 症状评分(ρ = -0.15)呈弱相关:本研究发现,较高的期望值、较低的体重指数、较年轻的年龄、男性、较低的放射学严重程度、较强的注射前功能和较大的感知压力与患者注射 HA 后的较好疗效相关。医生在向膝关节 OA 患者提供有关粘度补充剂的咨询时应考虑这些因素:研究类型:前瞻性队列研究(证据等级 II)。
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来源期刊
CiteScore
2.60
自引率
6.70%
发文量
282
审稿时长
8 weeks
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