The effect of co-morbidities on health-related quality of life in patients placed on the waiting list for total joint replacement

• Published in: Health and quality of life outcomes Vol. 5; no. 1; p. 16
• Main Authors: Tuominen, Ulla, Blom, Marja, Hirvonen, Johanna, Seitsalo, Seppo, Lehto, Matti, Paavolainen, Pekka, Hietanieni, Kalevi, Rissanen, Pekka, Sintonen, Harri
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 15.03.2007; BioMed Central; BMC
• Subjects: Adult; Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip - statistics & numerical data; Arthroplasty, Replacement, Knee - statistics & numerical data; Comorbidity; Female; Finland - epidemiology; Humans; Male; Middle Aged; Osteoarthritis, Hip - epidemiology; Osteoarthritis, Knee - epidemiology; Pain Measurement; Quality of Life; Surveys and Questionnaires; Waiting Lists; Finland
• ISSN: 1477-7525; 1477-7525
• DOI: 10.1186/1477-7525-5-16

Co-morbidity is a powerful predictor of health care outcomes and costs, as well as an important cofounder in epidemiologic studies. The effect of co-morbidities is generally related to mortality or complications. This study evaluated the association between co-morbidity and health-related quality of life (HRQoL) in patients awaiting total joint replacement. A total of 893 patients were recruited to the study between August 2002 and November 2003 in four Finnish hospitals. The effect of co-morbidity on HRQoL was measured by the generic 15D instrument and by a Visual Analog Scale (VAS). Comparative variance analysis of socio-demographic and clinical characteristics was described by using either an independent samples t-test or the Chi-square test. The differences in each of the 15D dimensions and the overall 15D single index score for patients were calculated. Two-sided p-values were calculated with the Levene Test for Equality of Variances. Patients with co-morbidity totaled 649; the incidence of co-morbidity was 73%. The mean number of co-morbidities among the patients was two. At baseline the 15D score in patients with and without co-morbidity was 0.778 vs 0.816, respectively. The difference of the score (0.038) was clinically and statistically significant (P < 0.001). The patients' scores with and without co-morbidity on the different 15D dimensions related to osteoarthritis-moving, sleeping, usual activities, discomfort and symptoms, vitality and sexual activity-were low in both groups. Patients with co-morbidity scored lower on the dimensions of moving, vitality and sexual activity compared to the patients without co-morbidity. Co-morbidity was significantly associated with a reduced HRQoL. Patients without co-morbidity had poorer VAS, arthritis had strong effect to their quality of life compared to the patients with co-morbidity. Assessing co-morbidity in patients placed on the waiting list for joint replacement may be useful method to prioritization in medical decision-making for healthcare delivery. The assessment of co-morbidities during waiting time is important as well as evaluating how the co-morbidity may affect the final outcomes of the total joint replacement.