J Rheumatol
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Comparative Study
The importance of patient expectations in predicting functional outcomes after total joint arthroplasty.
To evaluate the relationship between patient expectations of total joint arthroplasty (TJA) and health related quality of life plus satisfaction 6 months after surgery. Methods. This prospective cohort study included patients undergoing primary total hip (THA) and knee arthroplasty (TKA). Patients were evaluated with self-report questionnaires prior to surgery and 6 months post-surgery. Medical Outcomes Study Short Form 36 (SF-36), the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC), and a satisfaction scale were used to evaluate outcomes at final followup. Multivariate regression models were used to evaluate the impact of expectations on outcomes. ⋯ Patient expectations were important independent predictors of improved functional outcomes and satisfaction following TJA. Greater understanding of the relationship between expectations and outcomes may improve the process of care and outcomes of TJA.
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Randomized Controlled Trial Comparative Study Clinical Trial
Improving physical functional status in patients with fibromyalgia: a brief cognitive behavioral intervention.
Sustained improvement in physical functional status was the primary goal of a brief, 6 session cognitive behavioral therapy (CBT) protocol for fibromyalgia (FM). ⋯ Lasting improvements in physical functioning have been among the most difficult outcomes to obtain in studies of FM. These data suggest that the inclusion of CBT to a standard medical regimen for FM can favorably influence physical functioning in a subset of patients.
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Comparative Study
Hospital experience and mortality in patients with systemic lupus erythematosus: which patients benefit most from treatment at highly experienced hospitals?
To determine if hospitalization at a hospital experienced in the treatment of systemic lupus erythematosus (SLE), compared to hospitalization at a less experienced hospital, is associated with decreased in-hospital mortality in all subsets of patients with SLE, or if the decrease in mortality is greater for patients with particular demographic characteristics, manifestations of SLE, or reasons for hospitalization. ⋯ Risks of in-hospital mortality for patients with SLE were similar between highly experienced hospitals and less experienced hospitals for patients with private medical insurance, but patients without private insurance had much lower risks of mortality if hospitalized at highly experienced hospitals. The benefit of hospitalization at highly experienced hospitals was more consistent across subgroups of patients with a hospitalization due to SLE, suggesting that differences specifically in the treatment of SLE, rather than differences in the general quality of medical care, account for the lower mortality among patients with SLE hospitalized at highly experienced hospitals.
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To address costs of total joint replacement surgery from the patients' perspective by determining patient out-of-pocket costs during the first year following joint replacement, and to explore whether health status presurgery or in the immediate 3 months postsurgery were determinants of costs. In light of the different outcomes experienced by patients with total knee replacement (TKR) and total hip replacement (THR), any differences in costs between the 2 groups were also explored. ⋯ OA patients undergoing THR and TKR have substantial out-of-pocket costs presurgery, which fall dramatically over the first postoperative year. Poorer presurgery health status predicted greater expenditure during the first postoperative year, which might be taken into consideration when patients are making a choice about the timing of joint surgery.