Social support may be a prognostic factor for some joint-specific and general health outcomes after hip or knee replacement, say researchers writing in The Lancet Rheumatology this month.
Although both total hip and knee replacement surgery is successful for many patients, 10-30 percent of patients have long-term pain and functional limitations after surgery. The identification of prognostic factors for a poor outcome after joint replacement is of increasing interest and could facilitate the provision of stratified care and optimize outcomes. Systematic reviews are needed to summarize the existing literature on this topic.
Social isolation and loneliness are prevalent among patients undergoing joint replacement. While social support has been shown to have a protective effect on general health, its effect on outcomes after joint replacement is unclear. Previous systematic reviews have provided a broad overview of prognostic factors for outcomes after hip and knee replacement but did not focus on social support.
“This systematic review and meta-analysis is, to our knowledge, the most comprehensive evaluation to date of whether social support is a prognostic factor for patient-reported outcomes at three months or longer after primary total hip replacement or total knee replacement,” wrote the authors, led by Vikki Wylde, Ph.D., of the University of Bristol in the U.K.
This systematic review and meta-analysis included 56 cohort studies, comprising 119,165 patients, found on MEDLINE, Embase, and PsycINFO from inception to April 5, 2019. Patient-reported outcomes were pain, function, satisfaction, and general health, which were evaluated with the WOMAC, Oxford Knee Score, and SF-36 questionnaires.
“Numerous potential mechanisms exist by which social support could influence outcomes, such as by reducing loneliness, providing psychological support, increasing the ability to cope with stress, providing material resources to aid recovery, and increasing self-efficacy and confidence in resuming activities and mobilizing after surgery,” the authors wrote.
The presence of social support had a beneficial effect on the long-term postoperative WOMAC (2,022 patients; mean difference 2·88 [95% CI 1·30 to 4·46]) and Oxford Knee Score (69,570 patients; 0·29 [0·12 to 0·45]). Social support was found to be associated with WOMAC pain (671 patients; mean difference 0·04 [95% CI 0·00 to 0·08]) but not with WOMAC function (671 patients; −0·01 [–0·12 to 0·11]). The presence of social support had a positive association with some SF-36 subscales but not others.
“These findings highlight the need for the development and evaluation of interventions to improve modifiable aspects of social support and integration in this patient population,” the authors wrote.
“In the context of orthopedic surgery, patients often find group-based rehabilitation or educational sessions positive,” the authors wrote. “Involving spouses and other immediate family members in patients' experience of joint replacement could improve the informational and emotional support available to patients.”
However, the results should be interpreted with caveats, as measurement of social support was rudimentary in most studies and the effects were small.
“To understand the relative contributions of social support towards improving outcomes after surgery, future studies should use validated patient-reported outcome measures to assess the quality of different facets of social support,” the authors wrote.
Vikki Wylde, Setor K Kunutsor, ErikLenguerrand, et al. “Association of social support with patient-reported outcomes after joint replacement: a systematic review and meta-analysis.” The Lancet Rheumatology. October 2, 2019. DOI:https://doi.org/10.1016/S2665-9913(19)30050-5