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Minimal clinically important improvement (MCII) and patient-acceptable symptom state (PASS) in total hip arthroplasty (THA) patients 1 year postoperatively.

https://arctichealth.org/en/permalink/ahliterature105924
Source
Acta Orthop. 2014 Feb;85(1):39-48
Publication Type
Article
Date
Feb-2014
Author
Aksel Paulsen
Ewa M Roos
Alma B Pedersen
Søren Overgaard
Author Affiliation
Department of Orthopaedic Surgery and Traumatology , Odense University Hospital, Institute of Clinical Research , University of Southern Denmark.
Source
Acta Orthop. 2014 Feb;85(1):39-48
Date
Feb-2014
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Arthroplasty, Replacement, Hip - psychology - rehabilitation
Cohort Studies
Denmark
Female
Follow-Up Studies
Humans
Male
Middle Aged
Osteoarthritis, Hip - surgery
Pain Measurement - methods
Patient satisfaction
Psychometrics
Quality of Life
Recovery of Function
Severity of Illness Index
Treatment Outcome
Young Adult
Abstract
The increased use of patient-reported outcomes (PROs) in orthopedics requires data on estimated minimal clinically important improvements (MCIIs) and patient-acceptable symptom states (PASSs). We wanted to find cut-points corresponding to minimal clinically important PRO change score and the acceptable postoperative PRO score, by estimating MCII and PASS 1 year after total hip arthroplasty (THA) for the Hip Dysfunction and Osteoarthritis Outcome Score (HOOS) and the EQ-5D.
THA patients from 16 different departments received 2 PROs and additional questions preoperatively and 1 year postoperatively. The PROs included were the HOOS subscales pain (HOOS Pain), physical function short form (HOOS-PS), and hip-related quality of life (HOOS QoL), and the EQ-5D. MCII and PASS were estimated using multiple anchor-based approaches.
Of 1,837 patients available, 1,335 answered the preoperative PROs, and 1,288 of them answered the 1-year follow-up. The MCIIs and PASSs were estimated to be: 24 and 91 (HOOS Pain), 23 and 88 (HOOS-PS), 17 and 83 (HOOS QoL), 0.31 and 0.92 (EQ-5D Index), and 23 and 85 (EQ-VAS), respectively. MCIIs corresponded to a 38-55% improvement from mean baseline PRO score and PASSs corresponded to absolute follow-up scores of 57-91% of the maximum score in THA patients 1 year after surgery.
This study improves the interpretability of PRO scores. The different estimation approaches presented may serve as a guide for future MCII and PASS estimations in other contexts. The cutoff points may serve as reference values in registry settings.
Notes
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PubMed ID
24286564 View in PubMed
Less detail

Predicting patient dissatisfaction following joint replacement surgery.

https://arctichealth.org/en/permalink/ahliterature154301
Source
J Rheumatol. 2008 Dec;35(12):2415-8
Publication Type
Article
Date
Dec-2008
Author
Rajiv Gandhi
J Roderick Davey
Nizar N Mahomed
Author Affiliation
Division of Orthopedic Surgery, University of Toronto, Toronto, Ontario, Canada. rajiv.gandhi@uhn.on.ca
Source
J Rheumatol. 2008 Dec;35(12):2415-8
Date
Dec-2008
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Arthroplasty, Replacement, Hip - psychology - rehabilitation
Arthroplasty, Replacement, Knee - psychology - rehabilitation
Brief Psychiatric Rating Scale
Female
Follow-Up Studies
Humans
Male
Mental health
Middle Aged
Ontario
Patient satisfaction
Registries
Abstract
The incidence of patient-reported dissatisfaction following total joint arthroplasty can be up to 30%. Our aim was to identify the preoperative patient-level predictors of patient dissatisfaction 1 year after surgery.
We surveyed 1720 patients undergoing primary hip or knee replacement surgery. Relevant covariates including demographic data, body mass index, sex, comorbidities, and education were recorded. Joint functional status and patient quality of life were assessed at baseline and at 1-year followup with the Western Ontario McMaster University Osteoarthritis Index (WOMAC) and Medical Outcomes Study Short Form-36 (SF-36) scales, respectively. Patient satisfaction with surgery was determined with 4 survey questions at 1-year followup.
There were no significant differences in demographic data between satisfied (n = 1290) and dissatisfied patients (n = 430). Logistic regression modeling showed that a lower preoperative SF-36 Mental Health score independently predicted patient dissatisfaction with surgery, adjusted for all relevant covariates (p
PubMed ID
19004032 View in PubMed
Less detail

The stability of utility scores: test-retest reliability and the interpretation of utility scores in elective total hip arthroplasty.

https://arctichealth.org/en/permalink/ahliterature180838
Source
Qual Life Res. 2004 Feb;13(1):15-22
Publication Type
Article
Date
Feb-2004
Author
D. Feeny
C M Blanchard
J L Mahon
R. Bourne
C. Rorabeck
L. Stitt
S. Webster-Bogaert
Author Affiliation
Institute of Health Economics, Edmonton, Alberta, Canada. dfeeny@pharmacy.ualberta.ca
Source
Qual Life Res. 2004 Feb;13(1):15-22
Date
Feb-2004
Language
English
Publication Type
Article
Keywords
Analysis of Variance
Arthroplasty, Replacement, Hip - psychology - rehabilitation
Attitude to Health
Follow-Up Studies
Humans
Ontario
Osteoarthritis, Hip - classification - surgery
Outcome Assessment (Health Care) - methods
Quality of Life
Reproducibility of Results
Sickness Impact Profile
Surgical Procedures, Elective - psychology - rehabilitation
Abstract
Are utility scores for hypothetical health states stable over time even when the health of the patient changes dramatically? Can investigators who use scores for hypothetical states be confident about the stability of those scores? The first purpose is to assess the stability of standard gamble utility scores for three hypothetical health states describing mild, moderate, and severe osteoarthritis (OA) (test-retest reliability). How should investigators interpret utility scores? The second purpose is to provide evidence on the marker-state approach to assist in interpreting utility scores.
SG scores for three hypothetical marker states and the patient's current state were obtained at multiple times in a longitudinal study of elective total hip arthroplasty (THA). SG scores for current health increased from a mean of 0.59 pre-surgery to 0.76 post-surgery.
Test-retest reliability was assessed using the intra-class correlation coefficient (ICC). The effects of time on scores were analysed using an analysis of covariance.
At the group level the marker-state scores were stable. Mean scores for mild, moderate, and severe OA were 0.69, 0.61, and 0.41. With respect to test-retest reliability, ICCs varied from 0.49 to 0.62. In general, time did not affect the scores for the three marker states.
Group-level standard gamble scores are stable. At the individual level scores for hypothetical health states are somewhat stable over time. The marker states assist in interpretation indicating that, on average, THA converted moderate OA to better than mild.
PubMed ID
15058783 View in PubMed
Less detail

A systematic review of patient reported outcomes and patient experience in enhanced recovery after orthopaedic surgery.

https://arctichealth.org/en/permalink/ahliterature104375
Source
Ann R Coll Surg Engl. 2014 Mar;96(2):89-94
Publication Type
Article
Date
Mar-2014
Author
E L Jones
T W Wainwright
J D Foster
J R A Smith
R G Middleton
N K Francis
Author Affiliation
Yeovil District Hospital NHS Foundation Trust, UK.
Source
Ann R Coll Surg Engl. 2014 Mar;96(2):89-94
Date
Mar-2014
Language
English
Publication Type
Article
Keywords
Arthroplasty, Replacement, Hip - psychology - rehabilitation
Arthroplasty, Replacement, Knee - psychology - rehabilitation
Denmark
Great Britain
Humans
Length of Stay
Patient Outcome Assessment
Patient satisfaction
Postoperative Care - rehabilitation
Quality of Life
Abstract
Orthopaedic enhanced recovery after surgery (ERAS) providers are encouraged to estimate the actual benefit of ERAS according to the patient's opinion by using patient generated data alongside traditional measures such as length of stay. The aim of this paper was to systemically review the literature on the use of patient generated information in orthopaedic ERAS across the whole perioperative pathway.
Publications were identified using Embase(™), MEDLINE(®), AMED, CINAHL(®) (Cumulative Index to Nursing and Allied Health Literature), the Cochrane Library and the British Nursing Index. Search terms related to experiences, acceptance, satisfaction or perception of ERAS and quality of life (QoL).
Of the 596 abstracts found, 8 papers were identified that met the inclusion criteria. A total of 2,208 patients undergoing elective hip and knee arthroplasty were included. Patient satisfaction was reported in 6 papers. Scores were high in all patients and not adversely affected by length of stay. QoL was reported in 2 papers and showed that QoL scores continued to increase up to 12 months following ERAS. Qualitative methods were used in one study, which highlighted problems with support following discharge. There is a paucity of data reporting on patient experience in orthopaedic ERAS. However, ERAS does not compromise patient satisfaction or QoL after elective hip or knee surgery. The measurement of patient experience should be standardised with further research.
PubMed ID
24780662 View in PubMed
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Willingness to go through surgery again validated the WOMAC clinically important difference from THR/TKR surgery.

https://arctichealth.org/en/permalink/ahliterature155786
Source
J Clin Epidemiol. 2008 Sep;61(9):907-18
Publication Type
Article
Date
Sep-2008
Author
Bert M Chesworth
Nizar N Mahomed
Robert B Bourne
Aileen M Davis
Author Affiliation
School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, Elborn College, 1201 Western Road, London, Ontario, Canada. bcheswor@uwo.ca
Source
J Clin Epidemiol. 2008 Sep;61(9):907-18
Date
Sep-2008
Language
English
Publication Type
Article
Keywords
Aged
Arthroplasty, Replacement, Hip - psychology - rehabilitation
Arthroplasty, Replacement, Knee - psychology - rehabilitation
Female
Health status
Health Status Indicators
Humans
Male
Ontario - epidemiology
Osteoarthritis - epidemiology - psychology - rehabilitation
Pain Measurement - methods
Pain, Postoperative - psychology
Patient satisfaction
Probability
Quality of Life - psychology
Questionnaires
Reoperation - psychology
Severity of Illness Index
Abstract
The objective was to determine the clinically important difference (CID) from primary total hip replacement (THR) and total knee replacement (TKR) surgeries using the Western Ontario McMaster University (WOMAC) osteoarthritis index.
WOMAC scores were collected at decision for and 1 year after surgery (n=2,709). Transition ratings (15-point scale) were obtained at 1 year for pain and function, as well as a global assessment of willingness to go through surgery again. A "good deal better" defined the positive CID. WOMAC change scores for transition ratings and willingness to go through surgery again were evaluated using receiver operating characteristic curves. Patient characteristics within transition rating categories were examined.
For THR, the positive CIDs were 41 of 100 for pain and 34 of 100 for function. The negative CIDs were 35 and 33, respectively. For TKR, the positive CIDs were 36 for pain and 33 for function. The negative CIDs were 30 and 25, respectively. Change scores for willingness to go through surgery again validated CID values. Postoperative complications decreased the likelihood of a positive CID.
Improvement that is "a good deal better" is an appropriate threshold for the THR/TKR positive CID. Attaining a positive CID is negatively related to postoperative complications.
PubMed ID
18687289 View in PubMed
Less detail