October 23, 2019
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Social support linked to improved outcomes after joint replacement surgery

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Vikki Wylde

Social support appears to be a prognostic factor for some outcomes, including long-term beneficial impacts on certain WOMAC and Oxford Knee scores, following total hip or knee replacement, according to findings published in The Lancet Rheumatology.

“Social isolation and loneliness are prevalent among patients undergoing joint replacement,” Vikki Wylde, PhD, from Bristol Medical School at the University of Bristol, U.K., and colleagues wrote. “Social support is defined as the provision of psychological and material resources within a social network and has been shown to have a protective effect on general health. However, the effect of social support on outcomes after joint replacement is unclear.”

To examine whether social support is a predictor of improved patient-reported outcomes following total hip or knee replacement, Wylde and colleagues conducted a systematic review and meta-analysis of studies found on Medline, Embase and PsycInfo, published from inception to April 5, 2019. Eligible studies included those that analyzed the association between social support and patient-reported outcomes at least 3 months following total hip or knee replacement.

Patient-reported outcomes included pain, function, satisfaction and general health, based on the WOMAC index, the Oxford Knee Score, and 36-item short form health survey (SF-36) questionnaires. A total of 5,814 articles and studies were identified and screened, of which 56 were included in the final analysis. These records, of which 13 were included in the meta-analysis and 43 in the researchers’ narrative synthesis, represented 119,165 patients.

 
Social support appears to be a prognostic factor for some outcomes following total hip or knee replacement, according to findings.
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According to the researchers, the meta-analysis found that social support had a beneficial impact on long-term WOMAC (mean difference = 2.88; 95% CI, 1.3-4.46) and Oxford Knee Score (mean difference = 0.29; 05% CI, 0.12-0.45) in the fixed-effects model. When measured by a validated questionnaire, social support as was associated with WOMAC pain (mean difference = 0.04; 95% CI, 0-0.08) in the fixed-effects model, but not with WOMAC function ( –0.01; 95% CI, –0.12-0.11) in the random-effects model.

In addition, social support was reported to have a positive association with some SF-36 subscales but not others. Results of the narrative synthesis were inconsistent for all outcomes.

“From the 56 studies we identified and analyzed on this topic, we found evidence that the presence of social support, such as being married, was associated with better long-term pain and function outcomes after joint replacement,” Wylde told Healio Rheumatology.

“This suggests that future research to improve social support or social integration is needed, particularly given that social isolation is common among older people,” she added. “For example, this could include interventions to widen social-support networks such as peer-support or group-based activities, or through ensuring that family members are fully involved in the pathway through joint replacement.” – by Jason Laday

Disclosure: Wylde reports institutional research funding from Stryker outside of this study.