The Paradox of Patient-Reported Outcome Measures: Should We Prioritize “Feeling Better” or “Feeling Good” After Total Knee Arthroplasty?
The use of preoperative patient-reported outcome measure (PROM) thresholds for patient selection in arthroplasty care has been questioned recently. This study aimed to identify factors affecting achievement of the minimal clinically important difference (MCID) and patient acceptable symptom state (P...
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Veröffentlicht in: | The Journal of arthroplasty 2022-09, Vol.37 (9), p.1751-1758 |
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creator | Goh, Graham S. Baker, Colin M. Tarabichi, Saad Clark, Sean C. Austin, Matthew S. Lonner, Jess H. |
description | The use of preoperative patient-reported outcome measure (PROM) thresholds for patient selection in arthroplasty care has been questioned recently. This study aimed to identify factors affecting achievement of the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) after total knee arthroplasty (TKA) and determine the overlap between the two outcomes.
We identified 1,239 primary, unilateral TKAs performed at a single institution in 2015-2019. PROMs including the Knee injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR) and 12-item Short Form Health Survey (SF-12) were collected preoperatively and 1-year postoperatively. The likelihood of attaining PASS as per attainment of MCID was assessed. A multivariable regression was used to identify predictors of MCID and PASS.
In total, 71.3% achieved MCID and 75.5% achieved PASS for KOOS-JR. Only 7.7% achieved MCID but not PASS, whereas almost twice this number did not achieve MCID but did achieve PASS (11.9%). Poorer preoperative KOOS-JR (OR 0.925), better SF-12 physical (OR 1.025), and mental (OR 1.027) were associated with MCID attainment. In contrast, better preoperative KOOS-JR (OR 1.030) and SF-12 mental (OR 1.025) were associated with PASS attainment. Age, gender, race, ethnicity, body mass index, Charlson index, American Society of Anesthesiologists classification, and smoking status were not significant predictors.
Preoperative PROMs were associated with achieving MCID and PASS after TKA, albeit some positively and some negatively. In the era of value-based care, clinicians should not only strive to help patients “feel better” but also ensure that patients “feel good” after surgery. This study does not support the use of PROMs in prioritizing access to care. |
doi_str_mv | 10.1016/j.arth.2022.04.017 |
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We identified 1,239 primary, unilateral TKAs performed at a single institution in 2015-2019. PROMs including the Knee injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR) and 12-item Short Form Health Survey (SF-12) were collected preoperatively and 1-year postoperatively. The likelihood of attaining PASS as per attainment of MCID was assessed. A multivariable regression was used to identify predictors of MCID and PASS.
In total, 71.3% achieved MCID and 75.5% achieved PASS for KOOS-JR. Only 7.7% achieved MCID but not PASS, whereas almost twice this number did not achieve MCID but did achieve PASS (11.9%). Poorer preoperative KOOS-JR (OR 0.925), better SF-12 physical (OR 1.025), and mental (OR 1.027) were associated with MCID attainment. In contrast, better preoperative KOOS-JR (OR 1.030) and SF-12 mental (OR 1.025) were associated with PASS attainment. Age, gender, race, ethnicity, body mass index, Charlson index, American Society of Anesthesiologists classification, and smoking status were not significant predictors.
Preoperative PROMs were associated with achieving MCID and PASS after TKA, albeit some positively and some negatively. In the era of value-based care, clinicians should not only strive to help patients “feel better” but also ensure that patients “feel good” after surgery. This study does not support the use of PROMs in prioritizing access to care.</description><identifier>ISSN: 0883-5403</identifier><identifier>EISSN: 1532-8406</identifier><identifier>DOI: 10.1016/j.arth.2022.04.017</identifier><identifier>PMID: 35436528</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>acceptable symptom state ; clinically important difference ; knee arthroplasty ; patient-reported outcomes ; prior authorization ; value-based care</subject><ispartof>The Journal of arthroplasty, 2022-09, Vol.37 (9), p.1751-1758</ispartof><rights>2022 Elsevier Inc.</rights><rights>Copyright © 2022 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c356t-e3a307dbfd0d4ca136981f1bbdb1c4a1e72671fe7e14508ce13de9a063d17d243</citedby><cites>FETCH-LOGICAL-c356t-e3a307dbfd0d4ca136981f1bbdb1c4a1e72671fe7e14508ce13de9a063d17d243</cites><orcidid>0000-0003-3053-3900 ; 0000-0003-2333-1788</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0883540322004454$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35436528$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Goh, Graham S.</creatorcontrib><creatorcontrib>Baker, Colin M.</creatorcontrib><creatorcontrib>Tarabichi, Saad</creatorcontrib><creatorcontrib>Clark, Sean C.</creatorcontrib><creatorcontrib>Austin, Matthew S.</creatorcontrib><creatorcontrib>Lonner, Jess H.</creatorcontrib><title>The Paradox of Patient-Reported Outcome Measures: Should We Prioritize “Feeling Better” or “Feeling Good” After Total Knee Arthroplasty?</title><title>The Journal of arthroplasty</title><addtitle>J Arthroplasty</addtitle><description>The use of preoperative patient-reported outcome measure (PROM) thresholds for patient selection in arthroplasty care has been questioned recently. This study aimed to identify factors affecting achievement of the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) after total knee arthroplasty (TKA) and determine the overlap between the two outcomes.
We identified 1,239 primary, unilateral TKAs performed at a single institution in 2015-2019. PROMs including the Knee injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR) and 12-item Short Form Health Survey (SF-12) were collected preoperatively and 1-year postoperatively. The likelihood of attaining PASS as per attainment of MCID was assessed. A multivariable regression was used to identify predictors of MCID and PASS.
In total, 71.3% achieved MCID and 75.5% achieved PASS for KOOS-JR. Only 7.7% achieved MCID but not PASS, whereas almost twice this number did not achieve MCID but did achieve PASS (11.9%). Poorer preoperative KOOS-JR (OR 0.925), better SF-12 physical (OR 1.025), and mental (OR 1.027) were associated with MCID attainment. In contrast, better preoperative KOOS-JR (OR 1.030) and SF-12 mental (OR 1.025) were associated with PASS attainment. Age, gender, race, ethnicity, body mass index, Charlson index, American Society of Anesthesiologists classification, and smoking status were not significant predictors.
Preoperative PROMs were associated with achieving MCID and PASS after TKA, albeit some positively and some negatively. In the era of value-based care, clinicians should not only strive to help patients “feel better” but also ensure that patients “feel good” after surgery. This study does not support the use of PROMs in prioritizing access to care.</description><subject>acceptable symptom state</subject><subject>clinically important difference</subject><subject>knee arthroplasty</subject><subject>patient-reported outcomes</subject><subject>prior authorization</subject><subject>value-based care</subject><issn>0883-5403</issn><issn>1532-8406</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNp9UcuOEzEQtBCIDQs_wAH5yGUGtx8zE4SEwopdEIsWQRBHy2P3EEeTONgexHLaT-AD4Of2S3CUBXHi1K3uqpKqipCHwGpg0DxZ1ybmVc0Z5zWTNYP2FpmBErzqJGtukxnrOlEpycQRuZfSmjEApeRdciSUFI3i3Yz8WK6QvjPRuPCNhqGs2eM2V-9xF2JGRy-mbMMG6Vs0aYqYntIPqzCNjn4qvOhD9Nl_R3p99fMUcfTbz_QF5ozx-uoXDfHf-1kIbn9dDOVNlyGbkb7ZItJFcRHDbjQpXz6_T-4MZkz44GYek4-nL5cnr6rzi7PXJ4vzygrV5AqFEax1_eCYk9aAaOYdDND3rgcrDWDLmxYGbBGkYp1FEA7nhjXCQeu4FMfk8UF3F8OXCVPWG58sjqPZYpiS5iUf1UkO8wLlB6iNIaWIg95FvzHxUgPT-yb0Wu-b0PsmNJO6NFFIj270p36D7i_lT_QF8OwAwOLyq8eoky3RW3Q-os3aBf8__d_d4J9a</recordid><startdate>20220901</startdate><enddate>20220901</enddate><creator>Goh, Graham S.</creator><creator>Baker, Colin M.</creator><creator>Tarabichi, Saad</creator><creator>Clark, Sean C.</creator><creator>Austin, Matthew S.</creator><creator>Lonner, Jess H.</creator><general>Elsevier Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-3053-3900</orcidid><orcidid>https://orcid.org/0000-0003-2333-1788</orcidid></search><sort><creationdate>20220901</creationdate><title>The Paradox of Patient-Reported Outcome Measures: Should We Prioritize “Feeling Better” or “Feeling Good” After Total Knee Arthroplasty?</title><author>Goh, Graham S. ; Baker, Colin M. ; Tarabichi, Saad ; Clark, Sean C. ; Austin, Matthew S. ; Lonner, Jess H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c356t-e3a307dbfd0d4ca136981f1bbdb1c4a1e72671fe7e14508ce13de9a063d17d243</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>acceptable symptom state</topic><topic>clinically important difference</topic><topic>knee arthroplasty</topic><topic>patient-reported outcomes</topic><topic>prior authorization</topic><topic>value-based care</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Goh, Graham S.</creatorcontrib><creatorcontrib>Baker, Colin M.</creatorcontrib><creatorcontrib>Tarabichi, Saad</creatorcontrib><creatorcontrib>Clark, Sean C.</creatorcontrib><creatorcontrib>Austin, Matthew S.</creatorcontrib><creatorcontrib>Lonner, Jess H.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of arthroplasty</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Goh, Graham S.</au><au>Baker, Colin M.</au><au>Tarabichi, Saad</au><au>Clark, Sean C.</au><au>Austin, Matthew S.</au><au>Lonner, Jess H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Paradox of Patient-Reported Outcome Measures: Should We Prioritize “Feeling Better” or “Feeling Good” After Total Knee Arthroplasty?</atitle><jtitle>The Journal of arthroplasty</jtitle><addtitle>J Arthroplasty</addtitle><date>2022-09-01</date><risdate>2022</risdate><volume>37</volume><issue>9</issue><spage>1751</spage><epage>1758</epage><pages>1751-1758</pages><issn>0883-5403</issn><eissn>1532-8406</eissn><abstract>The use of preoperative patient-reported outcome measure (PROM) thresholds for patient selection in arthroplasty care has been questioned recently. This study aimed to identify factors affecting achievement of the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) after total knee arthroplasty (TKA) and determine the overlap between the two outcomes.
We identified 1,239 primary, unilateral TKAs performed at a single institution in 2015-2019. PROMs including the Knee injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR) and 12-item Short Form Health Survey (SF-12) were collected preoperatively and 1-year postoperatively. The likelihood of attaining PASS as per attainment of MCID was assessed. A multivariable regression was used to identify predictors of MCID and PASS.
In total, 71.3% achieved MCID and 75.5% achieved PASS for KOOS-JR. Only 7.7% achieved MCID but not PASS, whereas almost twice this number did not achieve MCID but did achieve PASS (11.9%). Poorer preoperative KOOS-JR (OR 0.925), better SF-12 physical (OR 1.025), and mental (OR 1.027) were associated with MCID attainment. In contrast, better preoperative KOOS-JR (OR 1.030) and SF-12 mental (OR 1.025) were associated with PASS attainment. Age, gender, race, ethnicity, body mass index, Charlson index, American Society of Anesthesiologists classification, and smoking status were not significant predictors.
Preoperative PROMs were associated with achieving MCID and PASS after TKA, albeit some positively and some negatively. In the era of value-based care, clinicians should not only strive to help patients “feel better” but also ensure that patients “feel good” after surgery. This study does not support the use of PROMs in prioritizing access to care.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>35436528</pmid><doi>10.1016/j.arth.2022.04.017</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0003-3053-3900</orcidid><orcidid>https://orcid.org/0000-0003-2333-1788</orcidid></addata></record> |
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subjects | acceptable symptom state clinically important difference knee arthroplasty patient-reported outcomes prior authorization value-based care |
title | The Paradox of Patient-Reported Outcome Measures: Should We Prioritize “Feeling Better” or “Feeling Good” After Total Knee Arthroplasty? |
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