Health Outcomes And Influencing Factors In Patients With Knee Osteoarthritis Before And After Total Knee Arthroplasty:A Study Based On Growth Mixed Model

Objective:To sort out the theoretical framework of factors influencing health outcomes of patients with knee osteoarthritis(KOA)based on health ecology theory and health promotion theory,and to identify a multidimensional evaluation tool set for health outcomes of KOA patients.Using the design of cross-sectional comparison and longitudinal tracking,using Growth Mixture Modeling(GMM)to analyze the heterogeneity of total knee replacement(TKA)patients and the influencing factors of health outcomes,and propose the health outcomes of TKA patients optimize strategies to improve the health outcomes of TKA patients.Methods:1.Literature research method:Systematically review the theoretical basis and research results related to patient’s health outcome measurement and TKA patient’s health outcome influencing factors at home and abroad,and construct an evaluation framework for factors affecting the health outcomes of KOA patients.2.Expert consultation method:20 experts were consulted based on professional reputation and research directions to form a multi-dimensional assessment tool sets for health outcomes of KOA patients.3.Questionnaire method:525 TKA patients who met the inclusion and exclusion criteria in 4 public tertiary hospitals in Guangdong Province were followed up at five time points.To understand the changes in the health outcomes of TKA patients.4.Semi-structured interviews:Semi-structured interviews were conducted with 10 TKA patients and 15 healthcare professionals to gain insight into changes in patient health outcomes and the impact of post-operative follow-up evaluations on patient health outcomes.5.Data processing and analysis methods:Nvivo 11.0,R4.0.2 and Mplus 8.3 software were used for data analysis and modelling.Statistical analysis was carried out using a combination of one-way ANOVA,chi-square test,robust regression analysis based on MM estimation,logistic regression model,GMM model,and generalised estimating equation model.Results:1.A multidimensional evaluation toolset for health outcomes of KOA patients was established.the mean of the authority coefficients of 20 experts was 0.87;the weighted mean recommendation coefficients of the authority coefficients of the visual anbiguity score(VAS)scale,KOOS-PS scale,EQ-5D-5L scale,and overall satisfaction with health services scale were 0.443,0.075,0.350,and 0.311,respectively.The weighting of health outcome indicators was 3:3:3:1.2.No exercise habits and obesity are risk factors that affect the preoperative health outcomes of TKA patients.The comprehensive score of the patient’s health outcomes before surgery was(-0.35±0.832)points.Patients who exercise more than 30 minutes a day had a higher comprehensive score of health outcomes than those without any exercise,with a β(95%CI)of 0.206(0.072,0.340);obese patients had a lower comprehensive score of health outcomes than patients with normal weight,with a β(95%CI)was-0.202(-0.329,-0.076).3.Gradual improvement in patient health outcomes over time after TKA.The follow-up evaluation of the postoperative health outcomes of TKA patients found that the comprehensive scores of their health outcomes were(-0.426±0.778)points,(-0.035±0.722)points,(0.369±0.595)points and(0.592±0.537)points at 7 days,1 month,6 months,and 6 months after surgery.4.Group heterogeneity in health outcomes of TKA patients during postoperative recovery was identified.Gender,per capita monthly household income,and rheumatoid arthritis are factors that affect group heterogeneity.Taking the"increasing group" as the reference group,women are more likely to be classified into the "stationary group" than men,with an OR value(95%CI)of 2.473(1.077,6.730);patients with a family monthly income of less than RMB 2,000,compared with patients with over RMB 4,000 of family income were more likely to be classified into the "stable group" with an OR value(95%CI)was 0.339(0.124,0.791);patients with rheumatoid arthritis are more likely to be classified into the"stable group" with an OR value(95%CI)was 2.244(1.055,4.567).5.There was less change in satisfaction with post-operative medical care for TKA patients over time.Conclusions:1.The multi-dimensional evaluation tool set for TKA patient’s health outcomes determined in this study is suitable for the follow-up evaluation of TKA patient’s health outcomes.2.Weight control,appropriate exercise,early diagnosis and early intervention are all beneficial to the early health of KOA patients.Primary care institutions need to popularise the proper prevention of KOA as early as possible to reduce the incidence of KOA.3.TKA is effective in improving the health outcomes of KOA patients.Medical staff should provide targeted health guidance for different subgroups.4.With the support of information technology,the construction of a cross-regional,cross-disciplinary and standardised health outcome sharing database for KOA patients,dynamic tracking of TKA patient’s health outcomes and will facilitate continued improvement in TKA patient’s health outcomes.