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Publication - Professor Ashley Blom

    Is social support associated with patient-reported outcomes after joint replacement?

    A systematic review and meta-analysis


    Wylde, V, Kunutsor, SK, Lenguerrand, E, Jackson, J, Blom, AW & Beswick, AD, 2019, ‘Is social support associated with patient-reported outcomes after joint replacement?: A systematic review and meta-analysis’. The Lancet Rheumatology.


    Identifying prognostic factors for outcomes after joint replacement could improve the provision of stratified care. This study evaluated whether social support is a prognostic factor for better patient-reported outcomes after total hip replacement (THR) and total knee replacement (TKR).

    In this systematic review, MEDLINE, Embase and PsycINFO were searched from inception to April 2019. Cohort studies evaluating the association between social support and patientreported outcomes at three months or longer after THR or TKR were included. Outcomes included pain, function, satisfaction and general health. Data were extracted from study reports. Study quality was assessed using the QUIPS tool. Data were synthesized using metaanalysis and narrative synthesis. The review was registered on PROSPERO (CRD42016041485).

    Searches identified 5,810 articles and 56 studies with data from 119,165 patients were included. In meta-analysis, the presence of social support had a beneficial effect on long-term post-operative WOMAC (2,022 patients; mean difference 2.88; 95% CIs 1.30; 4.46) and Oxford Knee Score (69,570 patients; 0.29; 0.12, 0.45). Social support measured using a validated questionnaire was found to be associated with WOMAC pain (671 patients; 0.04; 0.00, 0.08) but not WOMAC function (671 patients; -0.01; -0.12, 0.11). The presence of social support had a positive association with some SF-36 subscales but not others. For all outcomes, results of narrative synthesis were inconsistent.

    There is evidence that social support is a prognostic factor for some outcomes after joint replacement. Development and evaluation of complex interventions to improve social support and social integration is warranted.

    Full details in the University publications repository