Health-related quality of life after rehabilitation from knee surgery in rural and urban settings: a quasi-experimental study.

BACKGROUND

Injury to the knee joint is associated with physical disability, stiffness, pain, restriction of movement and impairment of the person's quality of life, with a few treatment options, including surgery and rehabilitation. This study aims to evaluate the impact of a rehabilitation program on the quality of life reported by patients living in rural and urban areas after knee surgery, using patient-reported outcome measures (PROMs).

METHODS

This quasi-experimental study with two groups of participants undergoing primary knee surgery was carried out in two rehabilitation centers, one in an urban area and another in a rural one. The same intervention was structured, with assessments at the start of the study (t0) and after a 4-week program (t1), and a comparison was made between the gains in rural and urban areas. We used descriptive and inferential analysis to analyze the effect of the intervention on health-related quality of life (HRQoL) using a linear regression model.

RESULTS

Participants (n = 62 aged between 19 and 84 years (40% of the sample aged over 65years) and 61.9% female, showed improvements in their EQ-5D-5L and HADS scores after the rehabilitation program. Considering the dimensions of HRQoL in both groups, there was a significant improvement in all the components in the rural context (p < 0.005), and improvements in the Mobility (t = 3.48; p = 0.002) and EQ_VAS (t = - 3.77; p = 0.001) components in the urban context. The effect of the program on health gains considering the Mobility was significantly greater in the rural group (- 0.97) compared to the urban group (- 0.13), as well as in the Pain/Disability (- 0.73) vs. (- 0.13) respectively. After analyzing the confounding factors, the rehabilitation center variable indicated gains of the EQ-5D-5L dimensions in a rural context (β= -0.390; t = - 3.041; p = 0.004), with an average reduction in health problems.

CONCLUSION

There is evidence that the application of PROMs in rehabilitation programs after knee surgery is fundamental, considering the improvements in HRQoL and the optimization of anxiety/depression states in different contexts. PROMs should be applied systematically in clinical practice throughout the rehabilitation process, objectively measuring the results perceived by patients, and according to each context achieving health gains.

TRIAL REGISTRATION: registry-ClinicTrials; trial registration number-NCT06206018; data of registration-16/01/2024.