Summary:
In adults with obesity and osteoarthritis awaiting elective hip or knee arthroplasty, the Flinders Program of self-management support (a structured, individualized chronic disease self-management program) in addition to usual preoperative care demonstrated significant improvements in osteoarthritis-specific quality of life domains including social support (d=0.43, P=0.03) and social activity (d=0.47, P=0.005), but no significant differences in general health-related quality of life (SF-36 scores) compared to usual preoperative care alone without structured self-management support, with no adverse effects reported.
| PICO | Description |
|---|---|
| Population | Adults with obesity and osteoarthritis awaiting elective hip or knee arthroplasty. |
| Intervention | The Flinders Program of self-management support in addition to usual preoperative care. |
| Comparison | Usual preoperative care alone without structured self-management support. |
| Outcome | Significant improvements in social support (d=0.43) and social activity (d=0.47). No change in general SF-36 scores. No adverse effects. |
Clinical Context
Patients with obesity awaiting joint replacement experience declining function, persistent pain, and reduced quality of life during the waiting period.
Clinical Pearls
1. Social Domains Improved Most: Benefits were concentrated in social support and social activity rather than physical function or pain.
2. Condition-Specific vs Generic Measures: The OAKHQoL (osteoarthritis-specific) detected benefits while SF-36 showed no differences.
3. Meaningful Effect Sizes: Effect sizes of 0.43-0.47 represent small-to-moderate, clinically meaningful effects.
4. Preoperative Optimization Opportunity: The waiting period before surgery can be utilized for self-management programs.
Practical Application
Offer structured self-management support to patients with obesity awaiting joint replacement. Set appropriate expectations about benefits.
Study Limitations
Limited sample size. Single-center design. Intervention wasn’t blinded. Long-term and postoperative outcomes not reported.
Bottom Line
Self-management support significantly improves social quality of life domains for patients with obesity awaiting joint replacement.
Source: Sahafi L, et al. “Preliminary Efficacy of a Self-Management Programme to Improve Quality-of-Life in Patients With Obesity and Osteoarthritis Awaiting Arthroplasty: A Randomised Trial.” Read article
