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UBC Theses and Dissertations

Measure what matters : changes in health-related quality of life outcomes among patients undergoing surgery for end-stage ankle arthritis Rajapakshe, Shanika


End-stage ankle arthritis (ESAA) is a debilitating condition that negatively affects patients’ health-related quality of life (HRQoL). If patients fail conservative treatment, they are treated with ankle arthrodesis (AA) or total ankle replacement (TAR). These surgical procedures have been associated with changes in general and ankle-specific HRQoL. However, there is little understanding of how these treatments affect other aspects of HRQoL, such as depression symptoms and pain, or whether these changes are meaningful to patients. This thesis is based on a cohort of prospectively recruited patients treated with AA or TAR for their ESAA. This thesis aims to 1) measure changes in aspects of HRQoL that have not been previously investigated, such as depression symptoms and pain, 2) determine if changes in HRQoL over the peri-operative period are meaningful to patients, and 3) determine the effects of potentially modifiable health-system factors, such as wait times and utilization of post-operative physiotherapy, on patients’ changes in HRQoL. Out of 190 eligible patients, 89 were included in the analysis. Participants with the worst pre-operative HRQoL experienced the largest changes. Changes in ankle-specific HRQoL were correlated with changes in pain and depression symptoms. The effects of wait times and post-operative physiotherapy on changes in HRQoL were found to be minimal. However, while most participants saw statistically significant changes in all aspects of HRQoL that were measured, not all participants found these changes to be meaningful. More research is required to understand why certain ESAA patients treated with AA and TAR do not see meaningful changes to aspects of their HRQoL.

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