Project team:
Prof. Dr. Lena Ansmann
Dr. Martin Stevens
Dr. Gesine Seeber
PD Dr. Anna Levke Brütt
Prof. Dr. Djordje Lazovic
Yvet Mooiweer, MSc

Duration:
March 2021 – February 2024

Funding institution:
Ministry for Science and Culture of Lower Saxony

Project description:
Osteoarthritis is a growing problem due to, amongst others, the ageing population, physical inactivity, and the obesity pandemic. For patients presenting with symptomatic end-stage hip osteoarthritis, a total hip arthroplasty (THA) is most often the treatment of choice, meant to provide functional improvements and a decrease in OA-related pain. However, little to no consensus exists about the best rehabilitation approach, resulting in large differences in THA rehabilitation programs worldwide.

A good example of the different approaches for rehabilitation after THA can be seen between the neighbouring countries Germany and the Netherlands. While patients in Germany usually receive an extensive rehabilitation including a three-week in-patient rehabilitation in specialized facilities followed by out-patient rehabilitation measures, patients in the Netherlands usually are discharged to their home environment within 2 or 3 days with postoperative rehabilitation depending on the patients’ health insurance package.

A previous study comparing the outcomes of rehabilitation after primary THA in Germany versus the Netherlands showed that a significantly larger proportion of the German patients was satisfied at 12 weeks and 6 months postoperatively. In addition, functional outcomes were in favour for the German patients. However, in a study including THA revision patients an opposite pattern was found with a higher satisfaction in Dutch patients. This raises the question in how far patient and healthcare system characteristics are of influence on the patients’ expectations and eventually their satisfaction levels. Especially patient expectations and self-efficacy might be two important characteristics influencing rehabilitation outcomes of THA patients. In addition, they may also partly explain any between-country outcome differences.

First of all, the research project “Hip-Across” aims to explore more about the way health care system characteristics may influence the expectations and self-efficacy of patients receiving a THA. Secondly it will be studied whether and how these expectations and self-efficacy differ between German and Dutch patients, and how these may influence the outcome after THA. In order to answer these questions, first a systematic review of the currently available scientific literature on the relation between preoperative expectations and postoperative outcomes will be conducted. Secondly, qualitative interviews will be held with patients and health care providers on both sides of the border to gain a better understanding of (1) the differences between both health care systems; (2) the expectations patients have; and (3) the expectations that the health care system convey. Third, a prospective comparative study will be conducted examining the influence of health care system characteristics and patient’s self-efficacy on expectations of German and Dutch patients, respectively. The outcomes of this study can be used to get a better insight into the differences between the two healthcare systems, and their strengths and weaknesses. Besides the insights into the influence of the patient´s characteristics on the outcome following THA might lead to an improvement in the information and treatment provided to patients with end stage osteoarthritis.