Prof. Dr. Lena Ansmann
A/Prof. Dr. Martin Stevens
Dr. Dr. Gesine H. Seeber (ScD)
PD Dr. Anna Levke Brütt
Yvet Mooiweer, MSc

March 2021 - October 2024

Ministry of Science and Culture of Lower Saxony

Osteoarthritis is a growing problem due to the ageing population, physical inactivity and the increasing prevalence of obesity, among other factors. In patients with symptomatic end-stage hip osteoarthritis, total hip arthroplasty (THA) is usually the treatment of choice to achieve functional improvement and a reduction in OA-related pain. However, there is no international consensus on the most effective rehabilitation approach, which leads to major differences in the rehabilitation concepts of different countries.

A good example of the different approaches to rehabilitation after TBI can be seen between the neighbouring countries of Germany and the Netherlands. While patients in Germany generally receive comprehensive rehabilitation with three weeks of inpatient rehabilitation in specialised facilities and subsequent outpatient rehabilitation measures, patients in the Netherlands are usually discharged to their home environment after just two or three days. While all patients with statutory or private health insurance in Germany receive comparable services, the scope of post-operative rehabilitation in the Netherlands depends on the individual benefits package of the respective health insurance provider.

An earlier study comparing the results of rehabilitation after primary THA in German with those in the Netherlands showed that a significantly higher proportion of German patients were satisfied after 12 weeks and 6 months postoperatively. In addition, the functional outcomes were better in the German patients. However, in a study that included patients with a THA revision, an opposite picture was found with higher satisfaction in Dutch patients. This raises the question of the extent to which patient and healthcare system characteristics have an impact on patient expectations and ultimately patient satisfaction. In particular, expectations and self-efficacy could be two important factors influencing the rehabilitation outcomes of HTEP patients. In addition, they may also explain some of the differences in outcomes between countries.

The research project "Hip-Across" aims to learn more about how characteristics of the healthcare system can influence patients' expectations and self-efficacy after THA. It also aims to investigate whether and how these expectations and self-efficacy differ between German and Dutch patients and how they can influence the outcome after a THA. To answer these questions, first, a systematic review of the currently available scientific literature on the relationship between preoperative expectations and postoperative outcomes will be conducted. Second, qualitative interviews will be conducted with patients and healthcare providers on both sides of the border to gain a better understanding of (1) the differences between the two healthcare systems, (2) patient expectations and (3) the expectations conveyed by the healthcare system. Third, a prospective comparative study will be conducted to investigate the influence of healthcare system characteristics and patient self-efficacy on the expectations of German and Dutch patients, respectively. The results of this study can be used to gain a better insight into the differences between the two healthcare systems and their strengths and weaknesses. In addition, the findings on the influence of patient characteristics on the outcome after THA could lead to an improvement in the information and treatment of patients with end-stage osteoarthritis.