1
|
Stephens AR, El-Hassan R, Patel RK. Evaluation of Fluoroscopically Guided Transforaminal Selective Nerve Root Sleeve Injections for Lumbar Spinal Stenosis With Radiculopathy Utilizing Patient Reported Outcome Measurement Information System as an Outcome Measure. Arch Phys Med Rehabil 2024:S0003-9993(24)00831-1. [PMID: 38430994 DOI: 10.1016/j.apmr.2024.02.720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To evaluate the therapeutic effect of transforaminal selective nerve root sleeve injections (TFSNRIs) in a specific subset of patients with clinical symptoms and presentation consistent with spinal stenosis. DESIGN Retrospective review. SETTING Tertiary academic spine center. PARTICIPANTS A total of 176 patients with radicular leg pain with or without low back pain as well as ≥3 clinical features of spinal stenosis and corroborative radiographic features of spinal stenosis on lumbar spine magnetic resonance imaging without confounding spinal pathology (N=176). INTERVENTIONS Fluoroscopically guided transforaminal selective nerve root sleeve injections. MAIN OUTCOME MEASURES Patient Reported Outcome Measurement Information System (PROMIS) Physical Function (PF) v1.2/v2.0, Pain Interference (PI) v1.1, and PROMIS (D) v1.0 were collected at baseline and post-procedure short term (<3-months) and long-term (6-12 month) follow-up. Statistical analysis comparing baseline and postprocedural PROMIS scores was performed. Differences were compared with previously established minimal clinically important differences in the spine population. RESULTS For patients with spinal stenosis treated with TFSNRI, no statistically significant improvement was observed short- and long-term follow-up in PROMIS PF (P=.97, .77) and PROMIS Depression (P=.86, .85) scores. At short-term follow-up, PROMIS PI scores did significantly improve (P=.01) but the average difference of pre- and post-procedure scores did not reach clinical significance. No significant difference in PROMIS PI was noted at long-term follow-up (.75). CONCLUSIONS Although a statistically significant difference was observed for improvement in pain, in this retrospective study, TFSNRI did not provide clinically significant improvement in patients' function, pain, or depression for lumbar spinal stenosis at short- and long-term follow-up.
Collapse
Affiliation(s)
- Andrew R Stephens
- Department of Physical Medicine and Rehabilitation, University of Rochester Medical Center, Rochester, NY.
| | - Ramzi El-Hassan
- Department of Physical Medicine and Rehabilitation, University of Rochester Medical Center, Rochester, NY
| | - Rajeev K Patel
- Department of Physical Medicine and Rehabilitation, University of Rochester Medical Center, Rochester, NY
| |
Collapse
|
2
|
Kruse RC, Volfson E. Ultrasonic Fasciotomy for the Treatment of Chronic Plantar Fasciopathy: A Prospective Study. Clin J Sport Med 2024:00042752-990000000-00178. [PMID: 38407211 DOI: 10.1097/jsm.0000000000001215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/05/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVE To evaluate the long-term efficacy and safety of an ultrasonic fasciotomy for plantar fasciopathy. DESIGN Prospective observational study. SETTING Tertiary care academic medical center. PARTICIPANTS Patients with chronic plantar fasciopathy refractory to standard, conservative treatments were included in this study. INTERVENTIONS Patients underwent ultrasonic fasciotomy of the plantar fascia. MAIN OUTCOME MEASURES The primary outcome measures were change in visual analog scale at 12 and 52 weeks post-procedure compared with baseline as well as patients' self-reported satisfaction with the procedure. RESULTS Sixty-seven patients were included. There was a significant improvement in visual analog scale at all follow-up time points, with an average overall improvement of 5.87 (P < 0.0001). 94% of patients reported satisfaction with the outcomes of their procedure at 12 and 52 weeks. No procedural complications were seen. CONCLUSIONS This study demonstrates that an ultrasonic fasciotomy is a safe and effective treatment option for chronic plantar fasciopathy, with continued symptom improvement and a high degree of patient satisfaction up to 52 weeks post-procedure. CLINICAL RELEVANCE These findings suggest that an ultrasonic fasciotomy should be considered for patients with chronic plantar fasciopathy refractory to conservative treatments.
Collapse
Affiliation(s)
- Ryan C Kruse
- Department of Orthopedics and Rehabilitation, University of Iowa Sports Medicine, Iowa City, Iowa
| | - Elena Volfson
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
| |
Collapse
|
3
|
Christensen JC, Blackburn B, Browning B, Wilbur C, Trinity JD, Gililland JM, Pelt CE. Patient-reported outcomes measurement information system physical function and knee injury and osteoarthritis outcome score relationship on performance measures in people undergoing total knee arthroplasty. Disabil Rehabil 2023; 45:3677-3685. [PMID: 36255156 DOI: 10.1080/09638288.2022.2134934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 08/25/2022] [Accepted: 10/02/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Primary purpose was to identify relationships between performance-based measures onto both computerized adaptive testing [Physical Function-Computer Adaptive Testing (PF-CAT)] and joint-specific legacy [Knee injury and Osteoarthritis Outcome Score-Activities of Daily Living (KOOS-ADL)] instruments pre- and 12-month post-TKA. METHODS The PF-CAT and KOOS-ADL were identified as outcomes and performance on the 40-m fast-paced walking test, stair climb test and chair stand test were identified as predictors. Linear regression was used for all comparisons after adjusting for confounders. RESULTS Sixty-eight people with TKA (56.7% male) were tested. Better scores on the 40-m fast-paced walking (KOOS-ADL, p = 0.02), stair climb (KOOS-ADL, p = 0.05) and chair stand (KOOS-ADL, p < 0.01) associated with better self-reported scores pre-TKA. Better scores on the 40-m fast-paced walking (PF-CAT, p = 0.05; KOOS-ADL, p = 0.01), stair climb (KOOS-ADL, p < 0.01), chair stand (PF-CAT, p < 0.01) and range of motion (KOOS-ADL, p = 0.02) were associated with better self-reported scores 12-month post-TKA. Decrease knee range of motion related to poorer 40-m fast-paced walking (p = 0.01) and stair climb (p = 0.03) scores pre-TKA. Quadriceps weakness related to poorer 40-m fast-paced walking (p = 0.04) score pre-TKA. CONCLUSION Self-reported instruments are a moderate, but inconsistent surrogate to performance-based measures pre- and post-TKA. Our findings indicate that both self-reported and performance-based measures are necessary to fully characterize physical function and should be used jointly to aid in the recovery analysis of people undergoing TKA.Implications for RehabilitationMonitoring the trajectory of pre- to post-total knee arthroplasty (TKA) physical function is important as it directly relates to mortality, morbidity and poorer quality of life in older adults.Both self-reported and performance-based measures of physical function are used to determine progress in recovery for patients pre- and post- TKA.This study provides evidence that perceived physical function measures are a moderate, but an inconsistent, surrogate to objective physical function measures pre- and post-TKA.Joint specific deficits in knee range of motion and quadriceps strength were weakly associated with deficits in function measures pre-TKA, but no association was observed 12-month post-TKA.Our findings indicate that both self-reported and performance-based measures are necessary to fully characterize physical function and should be used jointly to aid in the complete recovery analysis of people undergoing TKA.
Collapse
Affiliation(s)
- Jesse C Christensen
- Department of Physical Therapy, University of Utah, Salt Lake City, UT, USA
- Department of Physical Medicine & Rehabilitation, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Brenna Blackburn
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Bennett Browning
- Department of Physical Therapy, University of Utah, Salt Lake City, UT, USA
| | - Chelsey Wilbur
- Department of Physical Therapy, University of Utah, Salt Lake City, UT, USA
| | - Joel D Trinity
- Department of Physical Therapy, University of Utah, Salt Lake City, UT, USA
- Department of Physical Medicine & Rehabilitation, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Jeremy M Gililland
- Department of Physical Medicine & Rehabilitation, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | | |
Collapse
|
4
|
Jayakumar P, Bozic K. Journal of the American Academy of Orthopaedic Surgeons Patient-Reported Outcome Measurements (PROMs) Special Issue: The Value of PROMs in Orthopaedic Surgery. J Am Acad Orthop Surg 2023; 31:1048-1056. [PMID: 37670717 DOI: 10.5435/jaaos-d-23-00500] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 06/07/2023] [Indexed: 09/07/2023] Open
Affiliation(s)
- Prakash Jayakumar
- From the the University of Texas at Austin, Dell Medical School, Austin, TX
| | | |
Collapse
|
5
|
Jayakumar P, Heng M, Okelana B, Vrahas M, Rodriguez-Villalon A, Joeris A. Patient-Reported Outcome Measurement in Orthopaedic Trauma. J Am Acad Orthop Surg 2023; 31:e906-e919. [PMID: 37796280 DOI: 10.5435/jaaos-d-23-00375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/01/2023] [Indexed: 10/06/2023] Open
Abstract
Patient-reported outcome (PRO) measurements are validated tools developed to quantify self-reported aspects of capability, mindset, and circumstances in a standardized fashion. While PRO measurements have primarily been used in the research realm, a growing body of work now underscores substantial opportunities in applying the data generated by these tools to advance patient-centered musculoskeletal care. Specifically, the insights into a patient's health status derived from these measures can augment the standard biomedical approach to the management of patients with orthopaedic trauma. For instance, PRO measures have demonstrated the high prevalence of psychological distress and social concerns within trauma populations and shown that mindsets and circumstances account for a substantial amount of the variation in levels of symptom intensity and capability in these patients. Such findings support the need for a more integrated, biopsychosocial, and multidisciplinary team-based approach to orthopaedic trauma care that include both technical and nontechnical skillsets. In this chapter, we explore the range of available fixed-scale and computer adaptive PRO measures that can quantify aspects of capability, mindsets, and circumstances of the patient with orthopaedic trauma during their experience of injury, recovery, and rehabilitation. Furthermore, we define human, technical, and system-level challenges within the often complex, dynamic, and clinically intense trauma setting. Finally, we highlight potential opportunities through successfully implementing PRO measurements for clinical decision support, shared decision making, predicting health outcomes, and developing advanced care pathways for patients and populations with orthopaedic trauma.
Collapse
Affiliation(s)
- Prakash Jayakumar
- From the AO Innovation Translation Center, Clinical Science, AO Foundation, Dübendorf, Switzerland (Jayakumar, Rodriguez-Villalon, and Joeris), the University of Miami Health System Miller School of Medicine, Miami, FL (Heng), The Department of Surgery and Perioperative Care, University of Texas at Austin, Austin, TX (Dr. Okelana), Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, CA (Dr. Vrahas), and Advancing Outcomes and Building Expertise in Research for Trauma Consortium
| | | | | | | | | | | |
Collapse
|
6
|
Zhang W, Singh SP, Clement A, Calfee RP, Bijsterbosch JD, Cheng AL. Improvements in Physical Function and Pain Interference and Changes in Mental Health Among Patients Seeking Musculoskeletal Care. JAMA Netw Open 2023; 6:e2320520. [PMID: 37378984 PMCID: PMC10308248 DOI: 10.1001/jamanetworkopen.2023.20520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 04/23/2023] [Indexed: 06/29/2023] Open
Abstract
Importance Among patients seeking care for musculoskeletal conditions, there is mixed evidence regarding whether traditional, structure-based care is associated with improvement in patients' mental health. Objective To determine whether improvements in physical function and pain interference are associated with meaningful improvements in anxiety and depression symptoms among patients seeking musculoskeletal care. Design, Setting, and Participants This cohort study included adult patients treated by an orthopedic department of a tertiary care US academic medical center from June 22, 2015, to February 9, 2022. Eligible participants presented between 4 and 6 times during the study period for 1 or more musculoskeletal conditions and completed Patient-Reported Outcomes Measurement Information System (PROMIS) measures as standard care at each visit. Exposure PROMIS Physical Function and Pain Interference scores. Main Outcomes and Measures Linear mixed effects models were used to determine whether improvements in PROMIS Anxiety and PROMIS Depression scores were associated with improved PROMIS Physical Function or Pain Interference scores after controlling for age, gender, race, and PROMIS Depression (for the anxiety model) or PROMIS Anxiety (for the depression model). Clinically meaningful improvement was defined as 3.0 points or more for PROMIS Anxiety and 3.2 points or more for PROMIS Depression. Results Among 11 236 patients (mean [SD] age, 57 [16] years), 7218 (64.2%) were women; 120 (1.1%) were Asian, 1288 (11.5%) were Black, and 9706 (86.4%) were White. Improvements in physical function (β = -0.14; 95% CI, -0.15 to -0.13; P < .001) and pain interference (β = 0.26; 95% CI, 0.25 to 0.26; P < .001) were each associated with improved anxiety symptoms. To reach a clinically meaningful improvement in anxiety symptoms, an improvement of 21 PROMIS points or more (95% CI, 20-23 points) on Physical Function or 12 points or more (95% CI, 12-12 points) on Pain Interference would be required. Improvements in physical function (β = -0.05; 95% CI, -0.06 to -0.04; P < .001) and pain interference (β = 0.04; 95% CI, 0.04 to 0.05; P < .001) were not associated with meaningfully improved depression symptoms. Conclusions and Relevance In this cohort study, substantial improvements in physical function and pain interference were required for association with any clinically meaningful improvement in anxiety symptoms, and were not associated with any meaningful improvement in depression symptoms. Patients seeking musculoskeletal care clinicians providing treatment cannot assume that addressing physical health will result in improved symptoms of depression or potentially even sufficiently improved symptoms of anxiety.
Collapse
Affiliation(s)
- Wei Zhang
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri
| | - Som P. Singh
- University of Missouri–Kansas City School of Medicine, Kansas City
| | - Amdiel Clement
- Washington University School of Medicine, St Louis, Missouri
| | - Ryan P. Calfee
- Division of Hand and Wrist, Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Janine D. Bijsterbosch
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri
| | - Abby L. Cheng
- Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri
| |
Collapse
|
7
|
Patient-Reported Outcomes Measurement Information System Is Not as Responsive as Legacy Scores in Detecting Patient Outcomes in Hip Preservation: A Systematic Review. Arthroscopy 2023; 39:838-850. [PMID: 35817373 DOI: 10.1016/j.arthro.2022.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 06/18/2022] [Accepted: 06/23/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate publication trends of Patient-Reported Outcomes Measurement Information System (PROMIS) in hip preservation literature, assess the usage of PROMIS as an outcome measure, and evaluate correlations of all available published PROMIS domains with legacy patient-reported outcomes (PROs). METHODS The PubMed, Scopus, Cochrane Central Register of Controlled Trials, and Google Scholar databases were queried for articles evaluating PROMIS scores among hip preservation populations. Inclusion criteria consisted of studies with Level IV evidence or above (per the Sackett et al. levels of evidence), such as case series and cohort studies, reporting on perioperative use of hip PROMIS scores. Exclusion criteria consisted of arthroplasty and trauma studies. Patient demographics, PROMIS usage, and PROMIS Pearson or Spearman correlation coefficients to historic PROs were recorded for each study. RESULTS Fifteen articles published between 2017 and 2021 were included in the analysis, with the majority (75%) published between 2020 and 2021. Studies assessing postoperative outcomes had follow-up periods ranging from 6 months to 5 years. The most common PROMIS domain reported was Physical Function (PF), and there was varying usage of other domains including Pain Intensity, Anxiety, and Depression. PROMIS validity was most often assessed in comparison to the modified Harris Hip Score (mHHS) by calculating the Pearson coefficient, which assumes normal data distribution, or Spearman coefficient, which is rank-based and does not require normal data distribution. Studies comparing PROMIS-PF with mHHS reported Pearson coefficients ranging from 0.49 to 0.72 and Spearman coefficients ranging from 0.67 to 0.71. CONCLUSIONS There has been a chronologic increase in PROMIS usage in hip preservation literature. PROMIS demonstrates moderate-to-strong correlations with legacy PROs, but there is substantial heterogeneity in follow-up periods, PROMIS domains used, and statistical methodology. The current data show that PROMIS is not as responsive as historically used, validated PROs in quantitatively assessing function and pain in hip preservation patients. CLINICAL RELEVANCE Surgeons using PROMIS solely should be aware that the score may not be as responsive as legacy PROs in closely assessing improvements or deterioration in patient performance after hip preservation surgery. Rather than being used alone, PROMIS may be useful as a replacement for a group of legacy PROs. Thus, when used alongside select legacy PROs, overall questionnaire burden can be reduced while maintaining a high level of accuracy in assessing health status.
Collapse
|
8
|
Beck EC. Editorial Commentary: Legacy Patient-Reported Outcome Measures Are Superior to Patient-Reported Outcomes Measurement Information System for Assessing Function After Hip Arthroscopy. Arthroscopy 2023; 39:851-852. [PMID: 36740300 DOI: 10.1016/j.arthro.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 08/19/2022] [Indexed: 02/07/2023]
Abstract
Patient-reported outcome measures (PROMs) are critical tools in hip preservation research for evaluating the efficacy of current treatments, as well as identifying risk factors associated with suboptimal outcomes. These measures have been used for quality improvement, for monitoring of health plan performance, and even for reimbursement models. Over the past 2 decades, legacy hip outcome scores have been developed that are patient-centric and evaluate hip-specific function after surgery. There has been a recent trend in using the Patient-Reported Outcomes Measurement Information System (PROMIS), a tool developed by the National Institutes of Health for evaluating PROMs, in the field of hip arthroscopy. However, on the basis of the evidence in the literature, it is unlikely that PROMIS is superior to legacy PROMs regarding evaluation of hip function, nor is it as responsive to quantifying meaningful changes in function that are important to patients. As such, clinicians and researchers alike should likely continue using legacy PROMs to evaluate patients' functional outcomes after hip arthroscopy while continuing to explore the clinical applications of other PROMIS domains.
Collapse
|
9
|
Zhang W, Singh SP, Clement A, Calfee RP, Bijsterbosch JD, Cheng AL. Relationships between improvement in physical function, pain interference, and mental health in musculoskeletal patients. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.12.23285824. [PMID: 36824736 PMCID: PMC9949185 DOI: 10.1101/2023.02.12.23285824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Importance Among patients seeking care for musculoskeletal conditions, there is mixed evidence regarding whether traditional, structure-based care is associated with improvement in patients' mental health. Objective To determine whether improvements in physical function and pain interference are associated with meaningful improvements in anxiety and depression symptoms among patients seeking musculoskeletal care. Design Retrospective cohort study from June 22, 2015 to February 9, 2022. Setting Orthopedic department of a tertiary care US academic medical center. Participants Consecutive sample of adult patients who presented to the musculoskeletal clinic 4 to 6 times during the study period and completed Patient-Reported Outcomes Measurement Information System (PROMIS) measures as standard care at each visit. Exposure PROMIS Physical Function and Pain Interference scores. Main Outcomes and Measures Linear mixed effects models were used to determine whether: 1) PROMIS Anxiety and 2) PROMIS Depression scores improved as a function of improved PROMIS Physical Function or Pain Interference scores, after controlling for age, gender, race, and PROMIS Depression (for the Anxiety model) and PROMIS Anxiety (for the Depression model). Clinically meaningful improvement was defined as ≥3.0 points for PROMIS Anxiety and ≥3.2 points for PROMIS Depression. Results Among 11,236 patients (mean [SD] age 57 [16] years), 9,706 (86%) were White, and 7,218 (64%) were women. Improvements in physical function (β=-0.14 [95% CI -0.15- -0.13], p<0.001) and pain interference (β=0.26 [0.25-0.26], p<0.001) were each associated with improved anxiety symptoms. To reach a clinically meaningful improvement in anxiety symptoms, an improvement of ≥21 [20-23] PROMIS points on Physical Function or ≥12 [12-12] points on Pain Interference would be required. Improvements in physical function (β=-0.05 [- 0.06- -0.04], p<0.001) and pain interference (β=0.04 [0.04-0.05], p<0.001) were not associated with meaningfully improved depression symptoms. Conclusions and Relevance In this cohort study, substantial improvements in physical function and pain interference were required for association with any clinically meaningful improvement in anxiety symptoms and were not associated with any meaningful improvement in depression symptoms. Among patients seeking musculoskeletal care, musculoskeletal clinicians and patients cannot assume that addressing physical health will result in improved symptoms of depression or potentially even sufficiently improved symptoms of anxiety. Key Points Question: Among patients seeking musculoskeletal care, are improvements in physical function and pain interference associated with meaningful changes in symptoms of anxiety and depression?Findings: In this large cohort study, improvement by ≥2.3 population-level standard deviations (SD) on PROMIS Physical Function or ≥1.2 SD on PROMIS Pain Interference were required for any association with meaningful improvement in anxiety symptoms. Improvements in physical function and pain interference were not associated with meaningfully improved depression symptoms.Meaning: Musculoskeletal clinicians and patients cannot assume that exclusively addressing the physical aspect of a musculoskeletal condition will improve symptoms of depression or potentially even anxiety.
Collapse
|
10
|
Gohy B, Opava CH, von Schreeb J, Van den Bergh R, Brus A, El Hamid Qaradaya A, Mafuko JM, Al-Abbasi O, Cherestal S, Fernandes L, Da Silva Frois A, Weerts E, Brodin N. Monitoring independence in daily life activities after trauma in humanitarian settings: Item reduction and assessment of content validity of the Activity Independence Measure-Trauma (AIM-T). PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001334. [PMID: 36962914 PMCID: PMC10021394 DOI: 10.1371/journal.pgph.0001334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/21/2022] [Indexed: 12/15/2022]
Abstract
A standardized set of measures to assess functioning after trauma in humanitarian settings has been called for. The Activity Independence Measure for Trauma (AIM-T) is a clinician-rated measure of independence in 20 daily activities among patients after trauma. Designed in Afghanistan, it has since been used in other contexts. Before recommending the AIM-T for wider use, its measurement properties required confirmation. This study aims at item reduction followed by content validity assessment of the AIM-T. Using a two-step revision process, first, routinely collected data from 635 patients at five facilities managing patients after trauma in Haiti, Burundi, Yemen, and Iraq were used for item reduction. This was performed by analyzing inter-item redundancy and distribution of the first version of the AIM-T (AIM-T1) item scores, resulting in a shortened version (AIM-T2). Second, content validity of the AIM-T2 was assessed by item content validity indices (I-CVI, 0-1) based on structured interviews with 23 health care professionals and 60 patients in Haiti, Burundi, and Iraq. Through the analyses, nine pairs of redundant items (r≥0.90) were identified in the AIM-T1, leading to the removal of nine items, and resulting in AIM-T2. All remaining items were judged highly relevant, appropriate, clear, feasible and representative by most of participants (I-CVI>0.5). Ten items with I-CVI 0.5-0.85 were revised to improve their cultural relevance or appropriateness and one item was added, resulting in the AIM-T3. In conclusion, the proposed 12-item AIM-T3 is overall relevant, clear, and representative of independence in daily activity after trauma and it includes items appropriate and feasible to be observed by clinicians across different humanitarian settings. While some additional measurement properties remain to be evaluated, the present version already has the potential to serve as a routine measure to assess patients after trauma in humanitarian settings.
Collapse
Affiliation(s)
- Bérangère Gohy
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Humanity & Inclusion, Rehabilitation technical direction, Brussels, Belgium
| | - Christina H. Opava
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Johan von Schreeb
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Aude Brus
- Impact & Information Division, Humanity & Inclusion, Innovation, Brussels, Belgium
| | | | - Jean-Marie Mafuko
- Médecins Sans Frontières, Operational Center Brussels, Bujumbura, Burundi
| | - Omar Al-Abbasi
- Médecins Sans Frontières, Operational Center Brussels, Erbil, Iraq
| | - Sophia Cherestal
- Médecins Sans Frontières, Operational Center Brussels, Port-au-Prince, Haiti
| | - Livia Fernandes
- Médecins Sans Frontières, Operational Center Paris, Baghdad, Iraq
| | | | - Eric Weerts
- Humanity & Inclusion, Rehabilitation technical direction, Brussels, Belgium
| | - The AIM-T Study Group
- Médecins Sans Frontières, Operational Center Brussels, Brussels, Belgium
- Médecins Sans Frontières, Operational Center Paris, Gaza, Palestinian territories
- Médecins Sans Frontières, Operational Center Brussels, Bujumbura, Burundi
- Médecins Sans Frontières, Operational Center Brussels, Port-au-Prince, Haiti
- Médecins Sans Frontières, Operational Center Paris, Baghdad, Iraq
- Médecins Sans Frontières, Operational Center Paris, Paris, France
- Médecins Sans Frontières, Operational Center Paris, Aden, Yemen
- Humanity & Inclusion, Bujumbura, Burundi
| | - Nina Brodin
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Division of Physiotherapy, Department of Orthopaedics, Danderyd Hospital Corp., Danderyd, Sweden
| |
Collapse
|
11
|
El-Hassan R, Michalik A, Snyder J, Laplante BL, Everett C, Patel R. First-Time Lumbar Medial Branch Radiofrequency Ablation: Patient-Reported Outcomes Measurement Information System as a Metric of Outcome. Arch Phys Med Rehabil 2022; 103:2311-2315. [PMID: 35429466 DOI: 10.1016/j.apmr.2022.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/09/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To investigate the ability of Patient-Reported Outcomes Measurement Information System (PROMIS) to capture the therapeutic effect of first-time medial branch radiofrequency ablation (RFA). DESIGN Before-after trial. SETTING Single academic spine center. PARTICIPANTS Patients who underwent first-time medial branch RFA for lumbar facet joint pain identified by dual comparative medial branch block with ≥80% pain relief between January 1, 2015 and September 1, 2019 were identified using procedural billing codes. Charts were reviewed manually to confirm accuracy and strict adherence to the 80% pain relief threshold for each medial branch block. Thirty-nine patients met the criteria and were included in this study (N=39). INTERVENTIONS Medial branch RFA. MAIN OUTCOME MEASURES PROMIS score domains of Depression, Pain Interference, and Physical Function collected pre- and post RFA were compared. Pretreatment scores were within 6 weeks prior to the first medial branch block. Posttreatment scores were between 5 weeks and 6 months after RFA. Paired-sample t test analyses were used to calculate responsiveness to treatment, with significance assigned as P<.05 prior to acquiring data. Effect size was calculated using Cohen's d. RESULTS PROMIS domains of Pain Interference and Physical Function demonstrated a statistically significant improvement (P=.004 and P=.017, respectively). The PROMIS domain of Depression did not demonstrate a statistically significant change (P=.12). The effect size was medium (d=-0.43) for Pain Interference, small/medium (d=0.31) for Physical Function, and small (d=-0.12) for Depression. CONCLUSIONS Medial branch RFA as a treatment for lumbar facet syndrome is associated with a statistical improvement in PROMIS domains of Physical Function and Pain Interference.
Collapse
Affiliation(s)
- Ramzi El-Hassan
- Department of Physical Medicine and Rehabilitation, University of Rochester Medical Center, Rochester, NY.
| | - Adam Michalik
- Department of Physical Medicine and Rehabilitation, University of Rochester Medical Center, Rochester, NY
| | - James Snyder
- Department of Physical Medicine and Rehabilitation, University of Rochester Medical Center, Rochester, NY
| | - Ben L Laplante
- Department of Physical Medicine and Rehabilitation, University of Rochester Medical Center, Rochester, NY
| | - Clifford Everett
- Department of Physical Medicine and Rehabilitation, University of Rochester Medical Center, Rochester, NY
| | - Rajeev Patel
- Department of Physical Medicine and Rehabilitation, University of Rochester Medical Center, Rochester, NY
| |
Collapse
|
12
|
Shipp MM, Sanghavi KK, Kolm P, Zhang G, Miller KE, Giladi AM. Preoperative Patient-Reported Data Indicate the Risk of Prolonged Opioid Use After Hand and Upper Extremity Surgeries. J Hand Surg Am 2022; 47:1068-1075. [PMID: 36031463 PMCID: PMC9637740 DOI: 10.1016/j.jhsa.2022.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 05/16/2022] [Accepted: 06/29/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Opioids play an important role in pain management after surgery but also increase the risk of prolonged opioid use in patients. The identification of patients who are more likely to use opioids after intended short-term treatment is critical for employing alternative management approaches or targeted interventions for the prevention of opioid-related problems. We used patient-reported data (PRD) and electronic health record information to identify factors predictive of prolonged opioid use after surgery. METHODS We used our institutional registry containing data on all patients who underwent elective upper extremity surgeries. We evaluated factors associated with prolonged opioid use in the cohort from the year 2018 to 2019. We then validated our results using the 2020 cohort. The predictive variables included preoperative PRD and electronic health record data. Opioid use was determined based on patient reports and/or filled opioid prescriptions 3 months after surgery. We conducted bivariate regression, followed by multivariable regression analyses, and model validation using area under the receiver operating curve. RESULTS We included 2,114 patients. In our final model on the 2018-2019 electronic health records and PRD data (n = 1,589), including numerous patient-reported outcome questionnaire scores, patients who were underweight and had undergone trauma-related surgery had higher odds of being on opioids at 3 months. Additionally, each 5-unit decrease in the preoperative Patient-Reported Outcomes Measurement Information System Global Physical Health score was associated with a 30% increased odds of being on opioids at 3 months. The area under the receiver operating curve of our model was 70.4%. On validation using data from the 2020 cohort, the area under the receiver operating curve was 60.3%. The Hosmer-Lemeshow test indicated a good fit. CONCLUSIONS We found that preoperative questionnaire scores were associated with prolonged postoperative opioid use, independent of other variables. Furthermore, PRD may provide unique patient-level insights, alongside other factors, to improve our understanding of postsurgical pain management. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
Collapse
Affiliation(s)
- Michael M Shipp
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD
| | - Kavya K Sanghavi
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD; MedStar Health Research Institute, Hyattsville, MD
| | - Paul Kolm
- MedStar Health Research Institute, Hyattsville, MD
| | - Gongliang Zhang
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD; MedStar Health Research Institute, Hyattsville, MD
| | - Kristen E Miller
- MedStar Health Research Institute, Hyattsville, MD; National Center for Human Factors in Healthcare, MedStar Health Research Institute, Hyattsville, MD
| | - Aviram M Giladi
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD.
| |
Collapse
|
13
|
Giordano NA, Kane A, Rodriguez R, Papay D, Canales B, Kirk KF, Buckenmaier CC, Highland KB. Changes in actigraphy metrics associated with PROMIS measures after orthopaedic surgery. Int J Nurs Pract 2022; 28:e13089. [PMID: 35983591 DOI: 10.1111/ijn.13089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/22/2022] [Accepted: 07/21/2022] [Indexed: 11/30/2022]
Abstract
AIM This study examined the feasibility of integrating actigraphy devices into orthopaedic surgical settings to assess the concurrent validity between objective actigraphy data and PROMIS measures. Additionally, the association between changes in actigraphy data and longitudinal changes in PROMIS measures was examined. METHODS Data were collected from 17 participants using actigraphy devices the week prior to and after orthopaedic surgery from 02/2019 to 03/2020. Participants completed PROMIS measures (Physical Function, Sleep Disturbance, Pain Interference) preoperatively and up to 6 months postoperatively. Nonparametric correlations (rs ) assessed for concurrent validity. Linear mixed-effects models examined the association between changes in actigraphy data and PROMIS measures. RESULTS Prolonged wake after sleep onset was associated with increased sleep disturbances (rs = 0.49; p = 0.045) and pain interference (rs = 0.51; p = 0.04). Changes in pain interference were correlated with increased awakenings (rs = 0.54; p = 0.03). Increased wake after sleep onset was associated with worsening sleep disturbance (β = 0.12; p = 0.01) and pain interference scores over the postoperative period (β = 0.12; p = 0.02). CONCLUSIONS This study is among the first to examine changes in objective actigraphy data and longitudinal PROMIS measures following orthopaedic surgery and illustrates the feasibility of incorporating actigraphy into surgical settings to evaluate postoperative recovery.
Collapse
Affiliation(s)
- Nicholas A Giordano
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Alexandra Kane
- Defense and Veterans Center for Integrative Pain Management, Department of Anesthesiology, Uniformed Services University, Rockville, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Rockville, Maryland, USA
| | - Ramiro Rodriguez
- F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, Maryland, USA
| | - Diane Papay
- Defense and Veterans Center for Integrative Pain Management, Department of Anesthesiology, Uniformed Services University, Rockville, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Rockville, Maryland, USA
| | - Bryanna Canales
- Defense and Veterans Center for Integrative Pain Management, Department of Anesthesiology, Uniformed Services University, Rockville, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Rockville, Maryland, USA
| | - Keri F Kirk
- Department of Family Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Chester C Buckenmaier
- Defense and Veterans Center for Integrative Pain Management, Department of Anesthesiology, Uniformed Services University, Rockville, Maryland, USA
| | - Krista B Highland
- Defense and Veterans Center for Integrative Pain Management, Department of Anesthesiology, Uniformed Services University, Rockville, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Rockville, Maryland, USA
| |
Collapse
|
14
|
Versluijs Y, Bandell D, Kortlever J, Ring D. The Influence of Symptoms of Anger on Pain Intensity and Activity Intolerance. J Clin Psychol Med Settings 2022:10.1007/s10880-022-09894-5. [PMID: 35750973 DOI: 10.1007/s10880-022-09894-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 10/17/2022]
Abstract
This study assessed the association of anger, anxiety, and depression, and cognitive bias with pain and activity tolerance among patients with a musculoskeletal illness or injury expected to last more than a month. 102 Patients completed emotional thermometers to quantify symptoms of anger, anxiety, depression; the abbreviated Pain Catastrophizing Scale; a pain intensity scale; Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function Computer Adaptive Test; the Spielberger State-Trait Anxiety Inventory and demographic questionnaires. Controlling for potential confounding in multivariable analysis we found greater activity intolerance was associated with retired work-status and greater depressive symptoms, but not with greater symptoms of anger. In addition, greater pain intensity was associated with greater symptoms of depression and greater catastrophic thinking, but not with greater symptoms of anger. Anger emotions do not contribute to symptom intensity and activity intolerance in musculoskeletal illness. Attention can be directed at addressing psychological distress and cognitive bias.
Collapse
Affiliation(s)
- Yvonne Versluijs
- Department of Surgery and Perioperative Care, Dell Medical School-The University of Texas at Austin, 1701 Trinity Street, Austin, TX, 78712, USA.,Department of Trauma Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - David Bandell
- Department of Surgery and Perioperative Care, Dell Medical School-The University of Texas at Austin, 1701 Trinity Street, Austin, TX, 78712, USA
| | - Joost Kortlever
- Department of Surgery and Perioperative Care, Dell Medical School-The University of Texas at Austin, 1701 Trinity Street, Austin, TX, 78712, USA
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School-The University of Texas at Austin, 1701 Trinity Street, Austin, TX, 78712, USA.
| |
Collapse
|
15
|
Dalton JF, Furdock R, Cluts L, Jilakara B, Mcdonald D, Calfee R, Cipriano C. Pre- and Post-Operative Patient-Reported Outcome Measurement Information System Scores in Patients Treated for Benign Versus Malignant Soft Tissue Tumors. Cureus 2022; 14:e25534. [PMID: 35800809 PMCID: PMC9246055 DOI: 10.7759/cureus.25534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2022] [Indexed: 11/05/2022] Open
|
16
|
Hunt D, Zhang T, Koenig S, Aneizi A, Perraut G, Shasti K, Wahl AJ, Meredith SJ, Henn RF. Predictors of PROMIS Physical Function at 2 Years following Knee Surgery. J Knee Surg 2022; 35:521-528. [PMID: 32898902 DOI: 10.1055/s-0040-1716360] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The purpose of this study was to evaluate Patient-Reported Outcomes Measurement Information System physical function (PROMIS PF) 2 years following knee surgery, and identify preoperative factors associated with postoperative PROMIS PF. Three hundred and sixty-five patients, age 17 years and older, undergoing knee surgery at one institution were studied. Patients completed multiple questionnaires prior to surgery and again 2 years postoperatively including PROMIS PF, International Knee Documentation Committee (IKDC), joint and body numeric pain scales (NPS), Tegner's activity scale (TAS), and Marx's activity rating scale (MARS). Mean PROMIS PF improved from 41.4 to 50.9 at 2 years postoperatively (p < 0.001) and was strongly correlated with 2-year IKDC scores. Older age, female gender, non-Hispanic ethnicity, unemployment, lower income, government insurance, smoking, preoperative opioid use, having a legal claim, comorbidities, previous surgeries, higher body mass index (BMI), and knee arthroplasty were associated with worse 2-year PROMIS PF. Multivariable analysis confirmed that lower BMI, less NPS body pain, and higher MARS were independent predictors of greater 2-year PROMIS PF and better improvement in PROMIS PF. In this large, broad cohort of knee surgery patients, multiple preoperative factors were associated with PROMIS PF 2 years postoperatively. PROMIS PF scores improved significantly, but worse 2 year PROMIS PF scores and less improvement from baseline were independently predicted by higher BMI, greater NPS body pain, and lower MARS activity level. PROMIS PF can be implemented as an efficient means to assess outcomes after knee surgery.
Collapse
Affiliation(s)
- Darius Hunt
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Tina Zhang
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Scott Koenig
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Ali Aneizi
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Gregory Perraut
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Keyan Shasti
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Alexander J Wahl
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Sean J Meredith
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| |
Collapse
|
17
|
Furdock RJ, Jilakara B, Moon TJ, Bute N, Rhea L, McDonald D, Cipriano CA. Depression Is Transiently Increased in Patients Undergoing Two-Stage Revision Arthroplasty. Arthroplast Today 2022; 13:136-141. [PMID: 35106350 PMCID: PMC8784305 DOI: 10.1016/j.artd.2021.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/27/2021] [Accepted: 10/24/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The implications of two-stage revision on mental health are poorly understood. The purpose of this study is to determine (1) whether patients undergoing two-stage revision total hip and knee arthroplasty for prosthetic joint infection were more likely to get Patient-Reported Outcomes Measurement Information System (PROMIS) Depression scores consistent with major depressive disorder (MDD) than those undergoing aseptic revision and (2) whether these symptoms resolved after the procedure. METHODS Records of all 366 patients that underwent revision total hip or knee arthroplasty from January 1, 2015, - June 20, 2019, were reviewed. Forty-two patients were excluded for missing PROMIS Depression scores or incomplete treatment. Preoperative (<3 months), early postoperative (2-8 weeks), and final postoperative (6-18 months) Depression scores were collected. Patients crossing the PROMIS Depression threshold equivalent to a Patient Health Questionnaire-9 score ≥10, indicative of MDD, were evaluated. RESULTS More two-stage revision patients developed Depression scores indicative of MDD perioperatively than the aseptic cohort (20.0% vs 6.5%, P = .01). Two-stage revision patients had higher (worse) median Depression scores preoperatively (54.8 vs 51.3, P = .04) and at early follow-up (54.3 vs 49.9, P = .01), but not at final follow-up (50.4 vs 49.1, P = .39). Across all patients, Depression scores improved by 2.4 points at early follow-up (95% confidence interval:1.1-3.7; P < .001) and 3 points at final follow-up (95% confidence interval:1.5-4.5; P < .001; minimal clinically important difference 3.0). CONCLUSIONS Twenty percent of two-stage revision arthroplasty patients, compared to <7% of aseptic revision patients, developed PROMIS Depression scores consistent with MDD during treatment. At final follow-up, a clinically significant improvement in Depression scores from baseline was evident in both cohorts.
Collapse
Affiliation(s)
- Ryan J. Furdock
- Department of Orthopaedics, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Bharadwaj Jilakara
- Department of Orthopaedics, Washington University in St. Louis School of Medicine, St Louis, MO, USA
| | - Tyler J. Moon
- Department of Orthopaedics, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Neelansh Bute
- Department of Orthopaedics, Washington University in St. Louis School of Medicine, St Louis, MO, USA
| | - Lee Rhea
- Department of Orthopaedics, Washington University in St. Louis School of Medicine, St Louis, MO, USA
| | - Douglas McDonald
- Department of Orthopaedics, Washington University in St. Louis School of Medicine, St Louis, MO, USA
| | - Cara A. Cipriano
- Department of Orthopaedics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| |
Collapse
|
18
|
Wong LH, Meeker JE. The promise of computer adaptive testing in collection of orthopaedic outcomes: an evaluation of PROMIS utilization. J Patient Rep Outcomes 2022; 6:2. [PMID: 34982280 PMCID: PMC8727662 DOI: 10.1186/s41687-021-00407-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/15/2021] [Indexed: 12/30/2022] Open
Abstract
Background A crucial component to improving patient care is better clinician understanding of patients’ health-related quality of life (HRQoL). In orthopaedic surgery, HRQoL assessment instruments such as the NIH developed Patient Reported Outcomes Measurement Information System (PROMIS), provide surgeons with a framework to assess how a treatment or medical condition is affecting each patient’s HRQoL. PROMIS has been demonstrated as a valuable instrument in many diseases; however, the extent to which orthopaedic surgery subspecialties have used and validated PROMIS measures in peer-reviewed research is unclear. Methods Systematic scoping methodology was used to investigate the characteristics of studies using PROMIS to assess HRQoL measures as orthopaedic surgical outcomes as well as studies validating computerized adaptive test (CAT) PROMIS physical health (PH) domains including: Physical Function (PF), Upper Extremity (UE), Lower Extremity (LE). Results A systematic search of PubMed identified 391 publications utilizing PROMIS in orthopaedics; 153 (39%) were PROMIS PH CAT validation publications. One-hundred publications were in Hand and Upper Extremity, 69 in Spine, 44 in Adult Reconstruction, 43 in Foot and Ankle, 43 in Sports, 37 in Trauma, 31 in General orthopaedics, and 24 in Tumor. From 2011 through 2020 there was an upward trend in orthopaedic PROMIS publications each year (range, 1–153) and an increase in studies investigating or utilizing PROMIS PH CAT domains (range, 1–105). Eighty-five percent (n = 130) of orthopaedic surgery PROMIS PH CAT validation publications (n = 153) analyzed PF; 30% (n = 46) analyzed UE; 3% (n = 4) analyzed LE. Conclusions PROMIS utilization within orthopaedics as a whole has significantly increased within the past decade, particularly within PROMIS CAT domains. The existing literature reviewed in this scoping study demonstrates that PROMIS PH CAT domains (PF, UE, and LE) are reliable, responsive, and interpretable in most contexts of patient care throughout all orthopaedic surgery subspecialties. The expanded use of PROMIS CATs in orthopaedic surgery highlights the potential for improved quality of patient care. While challenges of integrating PROMIS into electronic medical records exist, expanded use of PROMIS CAT measurement instruments throughout orthopaedic surgery should be performed. Plain english summary In orthopaedic surgery, health-related quality of life tools such as the NIH developed Patient Reported Outcomes Measurement Information System (PROMIS), offer patients an opportunity to better understand their medical condition and be involved in their own care. Additionally, PROMIS provides surgeons with a framework to assess how a treatment or medical condition is affecting each patient’s functional status and quality of life. The efficacy of PROMIS has been demonstrated in many diseases; however, its application throughout orthopaedic care has yet to be depicted. This study sought to identify the extent to which all orthopaedic surgery subspecialties have used and validated PROMIS measures in peer-reviewed research in order to identify its potential as an applicable and valuable tool across specialties. We determined that PROMIS utilization has significantly increased within the past decade. The existing literature reviewed in this scoping study demonstrates that the PROMIS computerized adaptive test domains evaluating physical function status are reliable, responsive, and interpretable in most contexts of patient care throughout all orthopaedic surgery subspecialties. Based on these results, this study recommends the expanded and more uniform use of PROMIS computerized adaptive test measurement instruments in the clinical care of orthopaedic patients. Supplementary Information The online version contains supplementary material available at 10.1186/s41687-021-00407-w.
Collapse
Affiliation(s)
- Liam H Wong
- School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - James E Meeker
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, 3303 S. Bond Avenue, Portland, OR, 97239, USA.
| |
Collapse
|
19
|
Christensen J, Peters C, Gililland J, Stoddard G, Pelt C. Physical activity, pain interference and comorbidities relate to PROMIS physical function in younger adults following total knee arthroplasty. Disabil Rehabil 2021; 43:3741-3747. [PMID: 32315208 DOI: 10.1080/09638288.2020.1749944] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 02/28/2020] [Accepted: 03/27/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To determine if preoperative physical and psychological health risk factors are influential on physical function and satisfaction scores in a cohort of relatively younger adults one year post-total knee arthroplasty. METHODS Sixty-five patients were recruited pre- and one year post-total knee arthroplasty. Physical (i.e., body mass index, sex, physical activity level, number of comorbidities) and psychological (i.e., depression, expectations, pain inference) health risk factors were obtained pre-total knee arthroplasty and compared to Patient-Reported Outcomes Measurement Information System physical function computerized adaptive testing and satisfaction scores one year post-total knee arthroplasty. RESULTS Bootstrap inclusion fraction methods were performed to compare the stability of each predictor variable prior to final regression analyzes. Poorer preoperative physical activity level (standardized regression coefficient = 0.37; p < 0.01), pain interference (standardized regression coefficient = -0.24; p = 0.03) and greater comorbidities (standardized regression coefficient = -0.27; p = 0.01) resulted in worse physical function scores one year post-total knee arthroplasty. Greater preoperative comorbidities (odds ratio = 0.63; p < 0.01) resulted in worse satisfaction scores one year post-total knee arthroplasty. No other predictor variable had any relationship on either clinical outcome (p > 0.05). CONCLUSION Younger adults with greater comorbidities, lower physical activity level and higher pain interference scores preoperatively reported poorer functional recovery one year post-total knee arthroplasty. Understanding how preoperative status of younger adults undergoing total knee arthroplasty may lead to better improved surgical decision making and health care delivery for this vulnerable and growing patient subgroup.Implications for RehabilitationProjections estimate total knee arthroplasty in relatively younger adults (<65 years) will make up the majority of surgical procedures performed in the United States within the next two decades, however little is known in this patient population.This study provides evidence that relatively younger adults with greater comorbidities, lower physical activity level and higher pain interference scores preoperatively result in poorer functional recovery one year post-total knee arthroplasty.The results also suggest greater comorbidities identified preoperatively have the largest influence on one year satisfaction scores in younger adults post-total knee arthroplasty.Modifiable characteristics such as improving physical activity level, incorporating pain management strategies and reducing comorbidities preoperatively or adopting into postoperative rehabilitative care may influence the postoperative physical function and satisfaction scores in relatively younger adults undergoing total knee arthroplasty.
Collapse
|
20
|
Anderson AB, Tenan MS, Dickens JF. Latent Factor Analysis of the PROMIS and Single Assessment Numeric Evaluation in Patients Undergoing Shoulder Surgery. Mil Med 2021; 187:e882-e888. [PMID: 34345906 DOI: 10.1093/milmed/usab327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/25/2021] [Accepted: 07/23/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Patient-reported outcomes (PROs) are reporting tools that quantify patients' perceptions of their mental and physical health. Many PROs may inadvertently measure the same or overlapping theoretical constructs (e.g., pain, function, depression, etc.), which is both inefficient and a patient burden. The purpose of this study was to examine the functional relationship of the Single Assessment Numeric Evaluation (SANE) score and general constructs measured with the NIH Patient-Reported Outcomes Measurement Information System (PROMIS) in young patients undergoing shoulder surgery. MATERIAL AND METHODS This study was an institutional review board approved retrospective case control of the Military Orthopaedics Tracking Injuries and Outcomes Network using 805 patients and 1,373 observations. All patients underwent shoulder surgery and had multiple observations ranging from 28 days pre-surgery to 428 days post-surgery. Correlation matrices and exploratory factor analysis were used to examine how each of the measured variables (PROMIS physical function, PROMIS pain interference, PROMIS sleep disturbance, PROMIS anxiety, PROMIS depression, and SANE surveys) contribute or "weigh" on latent factors, which are then mapped to a theoretical construct. This statistical method helps uncover structural relationships between measured variables. RESULTS The PROMIS and SANE surveys collectively weigh on two latent factors: psychological health (measured variables: PROMIS anxiety [0.95] and PROMIS depression [0.86]) and physical capabilities (measured variables: PROMIS physical function [0.81], PROMIS pain interference [-0.82], PROMIS sleep disturbance [-0.51], and SANE [0.68]). Although the physical capability construct is functionally related to psychological health (-0.45), there is no direct relation between SANE and measures of depression or anxiety. CONCLUSIONS This study supports the use of the SANE as a valid single question to assess physical function providing similar information to the PROMIS in regard to measuring physical capabilities. Its simplicity makes it easy to use and implement with minimal uplift or change in workflow.
Collapse
Affiliation(s)
- Ashley B Anderson
- Department of Surgery Division of Orthopaedics, USU-Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Matthew S Tenan
- Enterprise Intelligence and Data Solutions Program Management Office, Solutions Delivery Division Defense Health Agency, College Park, MD 20740, USA.,Department of Surgery Division of Orthopaedics, USU-Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Jonathan F Dickens
- Department of Surgery Division of Orthopaedics, USU-Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| |
Collapse
|
21
|
Lake A, Cerza SP, Butler L, Oishi S, Brown A. The impact of therapeutic camp on children with congenital hand differences. COGENT PSYCHOLOGY 2021. [DOI: 10.1080/23311908.2021.1938439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Amy Lake
- Department of Therapy Services, Scottish Rite Hospital for Children, Dallas, Texas, USA
| | - Shelby Parker Cerza
- Department of Clinical and Orthopaedic Research, Scottish Rite Hospital for Children, Dallas, Texas, USA
| | - Lesley Butler
- Department of Clinical and Orthopaedic Research, Scottish Rite Hospital for Children, Dallas, Texas, USA
| | - Scott Oishi
- Center of Excellence in Hand Disorders & Department of Hand Surgery, Scottish Rite Hospital for Children, Dallas, Texas, USA
| | - Andrea Brown
- Department of Child Life Services, Scottish Rite Hospital for Children, Dallas, Texas, USA
| |
Collapse
|
22
|
Longitudinal study of knee load avoidant movement behavior after total knee arthroplasty with recommendations for future retraining interventions. Knee 2021; 30:90-99. [PMID: 33878682 PMCID: PMC8691226 DOI: 10.1016/j.knee.2021.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/22/2021] [Accepted: 03/20/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study aimed to evaluate clinical and biomechanical changes in self-report survey, quadriceps strength and gait analysis over 3- and 6-months post-total knee arthroplasty (TKA) and confirm the immediate effects of two forms of kinetic biofeedback on improving inter-limb biomechanics during a physically demanding decline walking task. METHODS Thirty patients with unilateral TKA underwent testing at 3- and 6-months following surgery. All underwent self-report survey, quadriceps strength and gait analysis testing. Patients were assigned to one of two types of biofeedback [vertical ground reaction force (vGRF), knee extensor moment (KEM)]. RESULTS No decrease in gait asymmetry was observed in non-biofeedback trials over time (p > 0.05), despite significant improvements in self-report physical function (p < 0.01, Cohen d = 0.44), pain interference (p = 0.01, Cohen d = 0.68), numeric knee pain (p = 0.01, Cohen d = 0.74) and quadriceps strength (p = 0.01, Cohen d = 0.49) outcomes. KEM biofeedback induced significant decrease in total support moment (p = 0.05, Cohen f2 = 0.14) and knee extensor moment (p = 0.05, Cohen f2 = 0.21) asymmetry compared to using vGRF biofeedback at 6-months. vGRF biofeedback demonstrated significant decrease in hip flexion kinematic asymmetry compared to KEM biofeedback (p = 0.05, Cohen f2 = 0.18) at 6-months. CONCLUSION Gait compensation remained similar from 3- to 6-months during a task requiring greater knee demand compared to overground walking post-TKA, despite improvements in self-report survey and quadriceps strength. Single session gait symmetry training at 6-month supports findings at 3-month testing that motor learning is possible. KEM biofeedback is more effective at immediately improving joint kinetic loading compared to vGRF biofeedback post-TKA.
Collapse
|
23
|
Hanley AW, Gililland J, Erickson J, Pelt C, Peters C, Rojas J, Garland EL. Brief preoperative mind-body therapies for total joint arthroplasty patients: a randomized controlled trial. Pain 2021; 162:1749-1757. [PMID: 33449510 PMCID: PMC8119303 DOI: 10.1097/j.pain.0000000000002195] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/08/2020] [Indexed: 12/16/2022]
Abstract
ABSTRACT Although knee and hip replacements are intended to relieve pain and improve function, up to 44% of knee replacement patients and 27% of hip replacement patients report persistent postoperative joint pain. Improving surgical pain management is essential. We conducted a single-site, 3-arm, parallel-group randomized clinical trial conducted at an orthopedic clinic, among patients undergoing total joint arthroplasty (TJA) of the hip or knee. Mindfulness meditation (MM), hypnotic suggestion (HS), and cognitive-behavioral pain psychoeducation (cognitive-behavioral pain psychoeducation) were each delivered in a single, 15-minute group session as part of a 2-hour, preoperative education program. Preoperative outcomes-pain intensity, pain unpleasantness, pain medication desire, and anxiety-were measured with numeric rating scales. Postoperative physical functioning at 6-week follow-up was assessed with the Patient-Reported Outcomes Measurement Information System Physical Function computer adaptive test. Total joint arthroplasty patients were randomized to preoperative MM, HS, or cognitive-behavioral pain psychoeducation (n = 285). Mindfulness meditation and HS led to significantly less preoperative pain intensity, pain unpleasantness, and anxiety. Mindfulness meditation also decreased preoperative pain medication desire relative to cognitive-behavioral pain psychoeducation and increased postoperative physical functioning at 6-week follow-up relative to HS and cognitive-behavioral pain psychoeducation. Moderation analysis revealed the surgery type did not differentially impact the 3 interventions. Thus, a single session of a simple, scripted MM intervention may be able to immediately decrease TJA patients' preoperative clinical symptomology and improve postoperative physical function. As such, embedding brief MM interventions in surgical care pathways has the potential to improve surgical outcomes for the millions of patients receiving TJA each year.
Collapse
Affiliation(s)
- Adam W. Hanley
- Center on Mindfulness and Integrative Health Intervention Development (C-MIIND), University of Utah
- College of Social Work, University of Utah
| | - Jeremy Gililland
- University of Utah Department of Orthopaedic Surgery
- Salt Lake City Veterans Affairs Medical Center
| | - Jill Erickson
- University of Utah Department of Orthopaedic Surgery
| | | | | | - Jamie Rojas
- Center on Mindfulness and Integrative Health Intervention Development (C-MIIND), University of Utah
- College of Social Work, University of Utah
| | - Eric L. Garland
- Center on Mindfulness and Integrative Health Intervention Development (C-MIIND), University of Utah
- College of Social Work, University of Utah
- Salt Lake City Veterans Affairs Medical Center
| |
Collapse
|
24
|
Abstract
Distal radius fractures (DRFs) are among the most common upper extremity injuries. Multiple medical conditions now are evaluated by standardized outcome sets that enable comparability. Recent international working groups have provided consensus statements for outcomes measurement after DRFs. These statements emphasized the growing importance of patient-reported outcome measures as well as traditional measures, including pain assessment, radiographic alignment, performance, and assessment of complications. A standardized instrument and timeline for measuring outcomes following DRFs offers clinicians, researchers, and health care economists a powerful tool. This article reviews the current evidence and provides recommendations for a DRF standardized outcome set.
Collapse
Affiliation(s)
- Matthew J Hall
- Harvard Combined Orthopaedic Residency Program, 55 Fruit Street, Boston, MA 02114, USA
| | - Peter J Ostergaard
- Harvard Combined Orthopaedic Residency Program, 55 Fruit Street, Boston, MA 02114, USA
| | - Tamara D Rozental
- Division of Hand and Upper Extremity Surgery, Department of Orthopedics, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Stoneman 10, Boston, MA 02115, USA.
| |
Collapse
|
25
|
Versluijs Y, Lemmers M, Brown LE, Gonzalez AI, Kortlever JTP, Ring D. The Correlation of Communication Effectiveness and Patient Satisfaction. J Patient Exp 2021; 8:2374373521998839. [PMID: 34179403 PMCID: PMC8205353 DOI: 10.1177/2374373521998839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study assessed the correlation of 9 questions addressing communication effectiveness (the Communication Effectiveness Questionnaire [CEQ]) with other patient-reported experience measures (PREMs; satisfaction, perceived empathy) as well as patient-reported outcome measures (PROMs; pain intensity, activity tolerance) in patients with musculoskeletal illness or injury. In a cross-sectional study, 210 patients visiting an orthopedic surgeon completed the CEQ and measures of satisfaction with the visit, perceived empathy, pain intensity, and activity tolerance. We evaluated correlations between CEQ and other PREMs and CEQ and PROMs. We measured ceiling effects of the PREMs. Communication effectiveness correlated moderately with other PREMs such as satisfaction (ρ = 0.54; P < .001) and perceived empathy (ρ = 0.54; P < .001). Communication effectiveness did not correlate with PROMs: pain intensity (ρ = -0.01; P = .93) and activity tolerance (ρ = -0.05; P = .44). All of the experience measures have high ceiling effects: perceived empathy 37%, satisfaction 80%, and CEQ 46%. The observation of notable correlations of various PREMs, combined with their high ceiling effects, direct us to identify a likely common statistical construct (which we hypothesize as "relationship") accounting for variation in PREMs, and then develop a PREM which measures that construct in a manner that results in a Gaussian distribution of scores. At least within the limitations of current experience measures, there seems to be no association between illness (PROMs) and experience (PREMs).
Collapse
Affiliation(s)
- Yvonne Versluijs
- Department of Surgery and Perioperative Care, Dell Medical School-The University of Texas at Austin, Austin, TX, USA.,Department of Trauma Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Maartje Lemmers
- Department of Surgery and Perioperative Care, Dell Medical School-The University of Texas at Austin, Austin, TX, USA
| | - Laura E Brown
- Center for Health Communication, Dell Medical School-The University of Texas at Austin, Austin, TX, USA
| | - Amanda I Gonzalez
- Department of Surgery and Perioperative Care, Dell Medical School-The University of Texas at Austin, Austin, TX, USA
| | - Joost T P Kortlever
- Department of Surgery and Perioperative Care, Dell Medical School-The University of Texas at Austin, Austin, TX, USA
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School-The University of Texas at Austin, Austin, TX, USA
| |
Collapse
|
26
|
Michalik AJ, Patel RK. Evaluation of transforaminal epidural steroid injections for discogenic axial lumbosacral back pain utilizing PROMIS as an outcome measure. Spine J 2021; 21:202-211. [PMID: 33091610 DOI: 10.1016/j.spinee.2020.10.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/17/2020] [Accepted: 10/14/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Discogenic lumbosacral back pain continues to present a challenging clinical entity with limited, controversial therapeutic options. No study to date has evaluated the efficacy of fluoroscopically guided transforaminal epidural steroid injections (TFESI) in a homogenous patient population with axial lumbosacral back pain from discogenic pathology utilizing strict, explicitly clinical and radiographic criteria. Additionally, there is a paucity of published data utilizing Patient Reported Outcome Measurement Information System (PROMIS) scores as an outcome measure for interventional spine procedures. PURPOSE Evaluate the therapeutic effect of TFESIs in a specific subset of patients with discogenic axial lumbosacral back pain. Investigate PROMIS as an outcome measure for interventional spine procedures targeting focal degenerative spinal pathology. STUDY DESIGN/SETTING Retrospective review of patients presenting to a multidisciplinary, tertiary academic spine center. PATIENT SAMPLE Three thousand eight hundred eighty-one patients were screened for inclusion. A total of 26 patients with discogenic axial low back, based on strict clinical and radiographic criteria, underwent TFESIs. All patients had axial low back pain without radicular pain, ≥3 clinical features of discogenic pain, corroborative radiographic features of active discogenic pathology on lumbar spine magnetic resonance imaging without confounding spinal pathology. OUTCOME MEASURES PROMIS Pain Interference (PI) v1.1, PROMIS Physical Function (PF) v1.2/v2.0, and PROMIS Depression (D) v1.0 outcome scores were collected at baseline and postprocedure follow-up. METHODS Query of an institutional, patient reported outcome database and subsequent retrospective review of electronic medical records was performed. Statistical analysis comparing baseline and postprocedural PROMIS outcome scores and correlation between these instruments was performed. Additionally, an exploratory investigation of minimal clinically important difference achievement rates was performed. RESULTS Analysis determined a statistically significant improvement in PROMIS PI (p=.017, 95% CI=-8.02 to -1.82) and PROMIS PF (p=.003, 95% CI=0.91-8.72) scores after treatment with TFESIs. At post treatment time points, TFESI had medium effect size on pain (d=0.55) and function (d=0.59). Change in PROMIS D scores (p=.488, 95% CI -1.74-3.54; d=.08) did not demonstrate statistical significance. Pearson correlation demonstrated a moderate negative correlation (r=-0.544, p=.004) between PROMIS PF with PROMIS PI. Correlation between PROMIS PF (r=-0.239, p=.24) and PROMIS PI (r=0.198, p=.33) with PROMIS D was not significant. Fourteen (53.8%) and 9 (34.6%) subjects achieved minimum clinically important difference (MCID) for PROMIS PI and PROMIS PF, respectively. Nine subjects (34.6%) achieved MCID for PROMIS D despite not otherwise reaching statistical significance otherwise. CONCLUSIONS Utilizing PROMIS as an outcome measure, discogenic axial lumbosacral back pain patients appear to benefit from TFESI in terms of pain and physical function. This study contributes to the growing body of literature utilizing PROMIS scores in patients with clinical sequelae of degenerative spinal pathology; however, prospective studies are needed.
Collapse
Affiliation(s)
- Adam J Michalik
- University of Utah School of Medicine, Division of Physical Medicine and Rehabilitation, Salt Lake City, UT, USA.
| | - Rajeev K Patel
- University of Rochester Medical Center, Department of Physical Medicine and Rehabilitation, Rochester, NY, USA
| |
Collapse
|
27
|
Burssens A, De Roos D, Barg A, Welck MJ, Krähenbühl N, Saltzman CL, Victor J. Alignment of the hindfoot in total knee arthroplasty: a systematic review of clinical and radiological outcomes. Bone Joint J 2021; 103-B:87-97. [PMID: 33380206 DOI: 10.1302/0301-620x.103b1.bjj-2020-0143.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIMS Patients with a deformity of the hindfoot present a particular challenge when performing total knee arthroplasty (TKA). The literature contains little information about the relationship between TKA and hindfoot alignment. This systematic review aimed to determine from both clinical and radiological studies whether TKA would alter a preoperative hindfoot deformity and whether the outcome of TKA is affected by the presence of a postoperative hindfoot deformity. METHODS A systematic literature search was performed in the databases PubMed, EMBASE, Cochrane Library, and Web of Science. Search terms consisted of "total knee arthroplasty/replacement" combined with "hindfoot/ankle alignment". Inclusion criteria were all English language studies analyzing the association between TKA and the alignment of the hindfoot, including the clinical or radiological outcomes. Exclusion criteria consisted of TKA performed with a concomitant extra-articular osteotomy and case reports or expert opinions. An assessment of quality was conducted using the modified Methodological Index for Non-Randomized Studies (MINORS). The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and registered in the PROSPERO database (CRD42019106980). RESULTS A total of 17 studies were found to be eligible for review. They included six prospective and ten retrospective studies, and one case-control study. The effects of TKA showed a clinical improvement in the hindfoot deformity in three studies, but did not if there was osteoarthritis (OA) of the ankle (one study) or a persistent deformity of the knee (one study). The radiological alignment of the hindfoot corrected in 11 studies, but did not in the presence of a rigid hindfoot varus deformity (in two studies). The effects of a hindfoot deformity on TKA included a clinical association with instability of the knee in one study, and a shift in the radiological weightbearing axis in two studies. The mean MINORS score was 9.4 out of 16 (7 to 12). CONCLUSION TKA improves both the function and alignment of the hindfoot in patients with a preoperative deformity of the hindfoot. This may not apply if there is a persistent deformity of the knee, a rigid hindfoot varus deformity, or OA of the ankle. Moreover, a persistent deformity of the hindfoot may adversely affect the stability and longevity of a TKA. These findings should be interpreted with caution due to the moderate methodological quality of the studies which were included. Therefore, further prospective studies are needed in order to determine at which stage correction of a hindfoot deformity is required to optimize the outcome of a TKA. Cite this article: Bone Joint J 2021;103-B(1):87-97.
Collapse
Affiliation(s)
- Arne Burssens
- Department of Orthopaedics, Royal National Orthopaedic Hospital, UCL Institute of Orthopaedics and Musculoskelatal Science, Stanmore, UK.,Department of Orthopaedics, University Hospital of Ghent, Ghent, Belgium
| | - Dries De Roos
- Department of Orthopaedics, University Hospital of Ghent, Ghent, Belgium
| | - Alexej Barg
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Matt J Welck
- Department of Orthopaedics, Royal National Orthopaedic Hospital, UCL Institute of Orthopaedics and Musculoskelatal Science, Stanmore, UK
| | - Nicola Krähenbühl
- Deparment of Orthopaedics and Traumatology, Kantonsspital Baselland, Liestal, Switzerland.,Department of Orthopaedics and Traumatology, Universitätsklinik Balgrist, Zurich, Switzerland
| | - Charles L Saltzman
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Jan Victor
- Department of Orthopaedics, University Hospital of Ghent, Ghent, Belgium
| |
Collapse
|
28
|
Tyser AR, Allen CM, Presson AP, Stephens AR, Petron DJ, Walsh W, Kazmers NH. Evaluating the performance of PROMIS and QuickDASH instruments in an intercollegiate Division 1 athlete population. J Shoulder Elbow Surg 2021; 30:158-164. [PMID: 33317702 PMCID: PMC7738759 DOI: 10.1016/j.jse.2020.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/23/2020] [Accepted: 05/04/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Athletes demonstrate high levels of physical function, leading to difficulties in patient-reported outcome scoring and interpretation. In particular, the ability of patient-reported outcome (PRO) instruments to adequately discriminate between high levels of upper extremity function-that is, the ceiling effect-is limited. This study evaluated performance characteristics of the shortened version of the Disabilities of the Arm, Shoulder, and Hand (QuickDASH) survey and Patient-Reported Outcomes Measurement Information System (PROMIS) metrics in a population of Division 1 intercollegiate athletes, with specific attention to ceiling effects. METHODS At a single institution, Division I intercollegiate athletes cleared for full participation in the 2018-2019 season were eligible. The following PROs were collected prospectively via tablet computer: PROMIS upper extremity (UE) computer adaptive test (CAT), PROMIS physical function (PF) CAT, QuickDASH, and QuickDASH Sports/Performing Arts Module. Descriptive statistics, and ceiling and floor effects, were calculated. The proportion of athletes with maximal scores on each PRO were compared to normative values using the 1-sample Wilcoxon signed rank test. RESULTS A total of 268 participants were included; the mean age was 19.9 ± 1.5 years, 49% were female, and 61% were overhead athletes. Large ceiling effects were observed for the UE CAT (46%), QuickDASH (58%), and QuickDASH Sports Module (82%). The PF CAT demonstrated a relatively low ceiling effect of 6.7%. Athlete scores were all significantly better than published age-matched values from a normative population for all instruments, with the exception of no difference on the QuickDASH for males. DISCUSSION AND/OR CONCLUSION The PROMIS UE CAT and QuickDash instruments are limited in their ability to assess and discriminate upper extremity function in highly functioning individuals such as Division I athletes. The PROMIS PF CAT, a measure of general physical function, did not suffer from a large ceiling effect.
Collapse
Affiliation(s)
- Andrew R Tyser
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Chelsea M Allen
- Department of Pediatric Research Enterprise, University of Utah, Salt Lake City, UT, USA
| | - Angela P Presson
- Department of Pediatric Research Enterprise, University of Utah, Salt Lake City, UT, USA; Division of Public Health, University of Utah, Salt Lake City, UT, USA
| | - Andrew R Stephens
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA; School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - David J Petron
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Wyatt Walsh
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Nikolas H Kazmers
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA.
| |
Collapse
|
29
|
Is the Patient-Reported Outcome Measurement Information System Feasible in Bundled Payment for Care Improvement Total Knee Arthroplasty Patients? J Arthroplasty 2021; 36:6-12. [PMID: 32933798 DOI: 10.1016/j.arth.2020.07.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/13/2020] [Accepted: 07/16/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Several bundled payment plans, like the Bundled Payment for Care Improvement (BPCI) initiative for total joint arthroplasty, have been introduced to decrease costs and improve clinical care. Measuring clinical outcomes with efficient, standardized methodologies is essential to determine the relative value of total joint arthroplasty care. We investigated feasibility and responsiveness of the recently developed Patient-Reported Outcomes Measurement Information System (PROMIS) in total knee arthroplasty (TKA) patients. METHODS We included patients with preoperative and 1-year PROMIS Physical Function (PF), Pain Interference (PI), and Depression (DEP) scores who received unilateral primary TKA. Burden was assessed using the number of questions and time required for PROMIS completion. The minimum clinically important difference was defined as 5. Floor/ceiling effects were noted if more than 15% of patients responded with the lowest/highest possible score, respectively. Wilcoxon rank-sum test was used to compare categorical data. Analysis of variance was used for PROMIS comparisons. RESULTS In total, 172 knees (54 BPCI) were included. Floor effects were identified for DEP at baseline (non-BPCI) and follow-up (both groups), and for PI at follow-up only (BPCI). Patients required 140 seconds and 16 questions to answer all 3 PROMIS domains. Sixty-seven percent, 60%, and 44% of knees achieved minimum clinically important difference in PI, PF, and DEP scores respectively, with no significant difference between groups. The BPCI cohort was older (P < .001) with a higher American Society of Anesthesiologists score (P = .028). There were no significant differences in scores between BPCI and non-BPCI patients. CONCLUSION PROMIS is feasible and time-efficient in BPCI patients undergoing primary TKA. There were no significant differences in outcomes between BPCI and non-BPCI knees. LEVEL OF EVIDENCE Level III.
Collapse
|
30
|
Yagnik GP, Santos ED, Rothfeld AA, Uribe JW, Cohn TM. Spanish translation and cross-language validation of the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form. J Shoulder Elbow Surg 2021; 30:151-157. [PMID: 33317701 DOI: 10.1016/j.jse.2020.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/07/2020] [Accepted: 05/12/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form is one of the most frequently used outcomes score for shoulder pathology. The patient report section of the ASES questionnaire (p-ASES) is easy to complete, can be quickly administered, and is applicable to a wide range of shoulder pathologies, yet a validated Spanish translation of this questionnaire does not currently exist for diverse Spanish-speaking populations. The purpose of this study was to translate and culturally adapt the patient report section of the ASES to Spanish and to assess its validity and reliability among a culturally diverse group of Spanish-speaking patients, typically seen in the United States. METHODS The p-ASES Standardized Shoulder Assessment Form was translated into Spanish using a universal approach for translation and cultural adaptation of instruments. A total of 127 Spanish-speaking patients with shoulder pain were included in the study and asked to complete the Spanish translated p-ASES form, the Patient-Reported Outcomes Measurement Information System (PROMIS) v1.2 Physical Function SF 20a in Spanish and a demographics questionnaire. Construct validity was tested using correlational analysis between the Spanish translation of the p-ASES to the Spanish translation of the PROMIS v1.2 Physical Function Short Form 20a. Reliability was measured using both test-retest reliability and internal consistency (Cronbach α) in a subgroup of 27 patients who completed both surveys at a separate time point. RESULTS The p-ASES demonstrated desirable convergent validity with the validated Spanish version of the PROMIS v1.2 Physical Function Short Form 20a with a strong correlation (r = 0.82, P < .04) for Spanish speakers. The Spanish translation of the p-ASES proved to be a reliable tool with a high degree of internal consistency across question items (α = 0.90). The Spanish p-ASES also demonstrated excellent test-retest reliability with a strong correlation (r = 0.87, P < .001) between time 1 and time 2. CONCLUSION The Spanish p-ASES is both a valid and reliable tool for assessing shoulder function in Spanish-speaking patients from diverse cultural backgrounds and it demonstrates psychometric properties equivalent to those of the English-language version.
Collapse
Affiliation(s)
- Gautam P Yagnik
- Miami Orthopedics and Sports Medicine Institute at Baptist Health South Florida, Miami, FL, USA; Florida International University Herbert Wertheim College of Medicine, Miami, FL, USA.
| | - Estevao D Santos
- Miami Orthopedics and Sports Medicine Institute at Baptist Health South Florida, Miami, FL, USA; Florida International University Herbert Wertheim College of Medicine, Miami, FL, USA
| | - Alex A Rothfeld
- Miami Orthopedics and Sports Medicine Institute at Baptist Health South Florida, Miami, FL, USA; Florida International University Herbert Wertheim College of Medicine, Miami, FL, USA
| | - John W Uribe
- Miami Orthopedics and Sports Medicine Institute at Baptist Health South Florida, Miami, FL, USA; Florida International University Herbert Wertheim College of Medicine, Miami, FL, USA
| | - Tanya M Cohn
- Miami Orthopedics and Sports Medicine Institute at Baptist Health South Florida, Miami, FL, USA; Florida International University Herbert Wertheim College of Medicine, Miami, FL, USA
| |
Collapse
|
31
|
Hamilton DF, Giesinger JM, Giesinger K. Technological developments enable measuring and using patient-reported outcomes data in orthopaedic clinical practice. World J Orthop 2020; 11:584-594. [PMID: 33362994 PMCID: PMC7745490 DOI: 10.5312/wjo.v11.i12.584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 10/30/2020] [Accepted: 11/12/2020] [Indexed: 02/06/2023] Open
Abstract
Patient-reported outcomes measures form the backbone of outcomes evaluation in orthopaedics, with most of the literature now relying on these scoring tools to measure change in patient health status. This patient-reported information is increasingly collected routinely by orthopaedic providers but use of the data is typically restricted to academic research. Developments in electronic data capture and the outcome tools themselves now allow use of this data as part of the clinical consultation. This review evaluates the role of patient reported outcomes data as a tool to enhance daily orthopaedic clinical practice, and documents how develop-ments in electronic outcome measures, computer-adaptive questionnaire design and instant graphical display of questionnaire can facilitate enhanced patient-clinician shared decision making.
Collapse
Affiliation(s)
- David F Hamilton
- School of Health and Social Care, Edinburgh Napier University, Edinburgh EH114BN, United Kingdom
| | - Johannes M Giesinger
- University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck 6020, Austria
| | - Karlmeinrad Giesinger
- Department of Orthopaedics and Traumatology, Kantonsspital St Gallen, St Gallen 9000, Switzerland
| |
Collapse
|
32
|
Mauntel TC, Tenan MS, Freedman BA, Potter BK, Provencher MT, Tokish JM, Lee IE, Rhon DI, Bailey JR, Burns TC, Cameron KL, Grenier ES, Haley CA, Leclere LE, McDonald LS, Owens BD, Pallis MP, Posner MA, Rivera JC, Roach CJ, Robins RJ, Schmitz MR, Sheean AJ, Slabaugh MA, Volk WR, Dickens JF. The Military Orthopedics Tracking Injuries and Outcomes Network: A Solution for Improving Musculoskeletal Care in the Military Health System. Mil Med 2020; 187:e282-e289. [DOI: 10.1093/milmed/usaa304] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/29/2020] [Accepted: 11/16/2020] [Indexed: 12/26/2022] Open
Abstract
Abstract
Introduction
Musculoskeletal injuries are an endemic amongst U.S. Military Service Members and significantly strain the Department of Defense’s Military Health System. The Military Health System aims to provide Service Members, military retirees, and their families the right care at the right time. The Military Orthopedics Tracking Injuries and Outcomes Network (MOTION) captures the data that can optimize musculoskeletal care within the Military Health System. This report provides MOTION structural framework and highlights how it can be used to optimize musculoskeletal care.
Materials and Methods
MOTION established an internet-based data capture system, the MOTION Musculoskeletal Data Portal. All adult Military Health System patients who undergo orthopedic surgery are eligible for entry into the database. All data are collected as routine standard of care, with patients and orthopedic surgeons inputting validated global and condition-specific patient reported outcomes and operative case data, respectively. Patients have the option to consent to allow their standard of care data to be utilized within an institutional review board approved observational research study. MOTION data can be merged with other existing data systems (e.g., electronic medical record) to develop a comprehensive dataset of relevant information. In pursuit of enhancing musculoskeletal injury patient outcomes MOTION aims to: (1) identify factors which predict favorable outcomes; (2) develop models which inform the surgeon and military commanders if patients are behind, on, or ahead of schedule for their targeted return-to-duty/activity; and (3) develop predictive models to better inform patients and surgeons of the likelihood of a positive outcome for various treatment options to enhance patient counseling and expectation management.
Results
This is a protocol article describing the intent and methodology for MOTION; thus, to date, there are no results to report.
Conclusions
MOTION was established to capture the data that are necessary to improve military medical readiness and optimize medical resource utilization through the systematic evaluation of short- and long-term musculoskeletal injury patient outcomes. The systematic enhancement of musculoskeletal injury care through data analyses aligns with the National Defense Authorization Act (2017) and Defense Health Agency’s Quadruple Aim, which emphasizes optimizing healthcare delivery and Service Member medical readiness. This transformative approach to musculoskeletal care can be applied across disciplines within the Military Health System.
Collapse
Affiliation(s)
- Timothy C Mauntel
- DoD-VA Extremity Trauma and Amuptation Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD 20889
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20889
| | | | | | - Benjamin K Potter
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD 20889
| | - Matthew T Provencher
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20889
- The Steadman Clinic and Philippon Research Institute, Vail, CO 81657
| | | | - Ian E Lee
- Defense Health Agency, Falls Church, VA 22042
| | - Daniel I Rhon
- US Army Office of the Surgeon General, Falls Church, VA 22042
| | | | | | | | | | | | | | | | - Brett D Owens
- University Orthopaedics, East Providence, RI 02914
- Department of Orthopaedic Surgery, Brown University, Providence, RI 02914
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20889
| | - Mark P Pallis
- Geisinger Musculoskeletal Institute, Wilkes Barre, PA 18702
| | | | - Jessica C Rivera
- Louisiana State University Health Sciences Center, New Orleans, LA 70112
| | | | - Richard J Robins
- Department of Orthopaedics, United States Air Force Academy, US Air Force Academy, CO 80840
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20889
| | | | | | - Mark A Slabaugh
- Department of Orthopaedics, United States Air Force Academy, US Air Force Academy, CO 80840
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20889
| | - William R Volk
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD 20889
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20889
| | - Jonathan F Dickens
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD 20889
- Department of Orthopaedics, Keller Army Community Hospital, West Point, NY 10996
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20889
| |
Collapse
|
33
|
Giordano NA, Kane A, Jannace KC, Rojas W, Lindl MJ, Lujan E, Gelfand H, Kent ML, Highland KB. Discrete and Dynamic Postoperative Pain Catastrophizing Trajectories Across 6 Months: A Prospective Observational Study. Arch Phys Med Rehabil 2020; 101:1754-1762. [DOI: 10.1016/j.apmr.2020.04.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 04/10/2020] [Accepted: 04/28/2020] [Indexed: 01/08/2023]
|
34
|
Liegl G, Rose M, Knebel F, Stengel A, Buttgereit F, Obbarius A, Fischer HF, Nolte S. Using subdomain-specific item sets affected PROMIS physical function scores differently in cardiology and rheumatology patients. J Clin Epidemiol 2020; 127:151-160. [PMID: 32781113 DOI: 10.1016/j.jclinepi.2020.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 07/22/2020] [Accepted: 08/05/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The Patient-Reported Outcomes Measurement Information System (PROMIS) physical function (PF) item bank has been developed to standardize patient-reported PF across medical fields. However, evidence of scoring equivalence across cardiology and rheumatology patients is still missing. Therefore, this study aims to investigate both (1) the extent of disease-related differential item functioning (DIF) and (2) the impact of the disease group on using subdomain-specific item sets for generating PROMIS PF scores in cardiology and rheumatology patients. STUDY DESIGN AND SETTING Ordinal regression was used to evaluate DIF between cardiology (n = 201) and rheumatology (n = 200) inpatients. To explore the disease-specific impact of PF subdomains on scoring, we compared scores derived from the full item bank with scores derived from subdomain-specific item sets for each disease group. RESULTS DIF was detected in 18 items, predominately from the upper extremity subdomain. When upper extremity items were used, cardiology patients reached systematically higher scores than using the full item bank. Rheumatology patients scored substantially higher when mobility items were used. CONCLUSION Applying the PROMIS PF metric to disease-specific item sets including items from differing subdomains may lead to biased comparisons of PF levels across disease groups. Disease-specific item parameters should be provided for items showing DIF, and subdomain-related content balancing is recommended for scoring the generic PROMIS PF construct.
Collapse
Affiliation(s)
- Gregor Liegl
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.
| | - Matthias Rose
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Fabian Knebel
- Clinic for Cardiology and Angiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Andreas Stengel
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany; Clinic for Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany; Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
| | - Frank Buttgereit
- Clinic for Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Alexander Obbarius
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - H Felix Fischer
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Sandra Nolte
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany; Population Health Strategic Research Centre, School of Health and Social Development, Deakin University, Burwood, Australia
| |
Collapse
|
35
|
Suriani RJ, Kassam HF, Passarelli NR, Esparza R, Kovacevic D. Validation of PROMIS Global-10 compared with legacy instruments in patients with shoulder instability. Shoulder Elbow 2020; 12:243-252. [PMID: 32788929 PMCID: PMC7400719 DOI: 10.1177/1758573219843617] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 03/14/2019] [Accepted: 03/19/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Outcomes instruments are used to measure patients' subjective assessment of health status. The Patient-Reported Outcomes Measurement Information System (PROMIS) Global-10 was developed to be a concise yet comprehensive instrument that provides physical and mental health scores and an estimated EuroQol-5 Dimension (EQ-5D) score. METHODS A total of 175 prospectively enrolled patients with shoulder instability completed the PROMIS Global-10, EQ-5D, American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and Western Ontario Shoulder Instability Index. Spearman correlations between PROMIS scores and the legacy instruments were calculated. Bland-Altman analysis assessed agreement between estimated and actual EQ-5D scores. Floor and ceiling effects were recorded. RESULTS Correlation between actual and estimated EQ-5D was excellent-good (0.64/p < 0.0005), but Bland-Altman agreement revealed high variability for estimated EQ-5D scores (95% CI: -0.30 to +0.34). Correlation of PROMIS physical scores was excellent-good with ASES (0.69/p < 0.0005), good with SANE (0.43/p<0.0005), and poor with WOSI (0.17/p = 0.13). Correlation between PROMIS mental scores and all legacy instruments was poor. CONCLUSIONS PROMIS Global-10 physical function scores show high correlation with ASES but poor correlation with other legacy instruments, suggesting it is an unreliable outcomes instrument in populations with shoulder instability. The PROMIS Global-10 cannot replace actual EQ-5D scores for cost-effectiveness assessment in this population. LEVEL OF EVIDENCE Level II, study of diagnostic test.
Collapse
Affiliation(s)
| | | | | | | | - David Kovacevic
- David Kovacevic, Department of Orthopaedics and Rehabilitation, School of Medicine, Yale University, 47 College Street, Office 221D, New Haven, CT 06510, USA.
| |
Collapse
|
36
|
Nadarajah V, Stevens KN, Henry L, Jauregui JJ, Smuda MP, Ventimiglia DJ, Gilotra MN, Hasan SA, Henn RF. Patients undergoing shoulder surgery have high preoperative expectations. Knee Surg Sports Traumatol Arthrosc 2020; 28:2377-2385. [PMID: 31912166 DOI: 10.1007/s00167-019-05824-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 12/09/2019] [Indexed: 01/06/2023]
Abstract
PURPOSE The primary aims of this study were to (1) assess the preoperative expectations of patients undergoing shoulder surgery, and (2) determine the relationship between preoperative patient demographics, PROs, and preoperative patient expectations. It was hypothesized that younger patients with worse function and worse health status had higher expectations of shoulder surgery. METHODS Data from a total of 319 patients (319 shoulders) from 2015-2018 were analyzed. Patients completed a series of questionnaires covering demographics and patient-reported outcome measures. Expectations of treatment were evaluated using the Musculoskeletal Outcomes Data Evaluation and Management System. Bivariate analyses were performed to determine the significance of identified associations. RESULTS The study population consisted of 186 males and 133 females. The mean age was 46.9 (± 17.2), and the mean BMI was 30.1 (± 6.8). Overall, patients had high expectations of shoulder surgery, with a mean score of 84.7 (± 19.3). The most commonly performed procedure in the study population was arthroscopic rotator cuff repair. There was a significant association between pre-treatment expectations and ethnicity, previous shoulder surgery, employment status, income level, tobacco use, preoperative opioid use, depression, and ASA score. CONCLUSION The findings suggest that patients undergoing shoulder surgery have high overall preoperative expectations, which were significantly associated with ethnicity, surgical history, opioid use, and employment status, and with multiple patient-reported outcome measures including physical function, pain interference, fatigue, and depression. Nevertheless, by discussing expectations preoperatively, orthopaedic surgeons can help patients develop high but realistic expectations to improve outcomes and satisfaction. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Vidushan Nadarajah
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.,Department of Orthopaedics, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Kali N Stevens
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Leah Henry
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Julio J Jauregui
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Michael P Smuda
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Dominic J Ventimiglia
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mohit N Gilotra
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - S Ashfaq Hasan
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA. .,University of Maryland Rehabilitation and Orthopaedic Institute, 2200 Kernan Drive, Baltimore, MD, 21207, USA.
| |
Collapse
|
37
|
Kohring JM, Houck JR, Oh I, Flemister AS, Ketz JP, Baumhauer JF. Pattern of recovery and outcomes of patient reported physical function and pain interference after ankle fusion: a retrospective cohort study. J Patient Rep Outcomes 2020; 4:40. [PMID: 32462241 PMCID: PMC7253567 DOI: 10.1186/s41687-020-00203-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 05/03/2020] [Indexed: 12/26/2022] Open
Abstract
Background Research on outcomes after ankle fusion focuses on basic activities of daily living, fusion rates, and gait parameters. Little has been reported on the patient’s perspective after surgery. The purpose of this study was to determine the change in patient reported physical function and pain interference after ankle fusion surgery to guide patient expectations and improve provider communication. Methods This was a retrospective review of prospectively collected patient reported outcome measurement information system (PROMIS) data in 88 ankle arthrodesis procedures performed from May 2015 to March 2018. The PROMIS Physical function (PF) and pain interference (PI) measures were collected as routine care. Linear mixed models were used to assess differences at each follow-up point for PF and PI. Preoperative to last follow-up in the 120–365 day interval was assessed using analysis of variance. Outcomes included T-scores, z-scores, and PROMIS-Preference (PROPr) utility scores for PF and PI and the percentage of patients improving by at least 4 T-score points. Results The linear mixed model analysis for PF after the 120–149 days, and for PI, after 90–119 days, indicated recovery plateaued at 39–40 for PF and 57–59 for PI T-scores. The change in the PI T-score was the greatest with a mean T-score improvement of − 5.4 (95% CI − 7.7 to − 3.1). The proportion of patients improving more than 4 points was 66.2% for either PF or PI or both. The change in utility T-scores for both PF (0.06, 95% CI 0.02 to 0.11) and PI (0.15, 95% CI 0.09 to 0.20) was significantly improved, however, only PI approached clinical significance. Conclusion Average patients undergoing ankle fusion experience clinically meaningful improvement in pain more so than physical function. Average patient recovery showed progressive improvement in pain and function until the four-month postoperative time point. Traditional dogma states that recovery after an ankle fusion maximizes at a year, however based on the findings in this study, 4 months is a more accurate marker of recovery. A decline in function or an increase in pain after 4 months from surgery may help to predict nonunion and other complications after ankle arthrodesis. Level of evidence Level II, prospective single cohort study.
Collapse
Affiliation(s)
- Jessica M Kohring
- Department of Orthopaedics, University of Rochester, 601 Elmwood Avenue, Box 665, Rochester, NY, 14642, USA
| | - Jeffrey R Houck
- Department of Physical Therapy, George Fox University, Newberg, OR, USA
| | - Irvin Oh
- Department of Orthopaedics, University of Rochester, 601 Elmwood Avenue, Box 665, Rochester, NY, 14642, USA
| | - Adolf S Flemister
- Department of Orthopaedics, University of Rochester, 601 Elmwood Avenue, Box 665, Rochester, NY, 14642, USA
| | - John P Ketz
- Department of Orthopaedics, University of Rochester, 601 Elmwood Avenue, Box 665, Rochester, NY, 14642, USA
| | - Judith F Baumhauer
- Department of Orthopaedics, University of Rochester, 601 Elmwood Avenue, Box 665, Rochester, NY, 14642, USA.
| |
Collapse
|
38
|
Lawrie CM, Abu-Amer W, Barrack RL, Clohisy JC. Is the Patient-Reported Outcome Measurement Information System Feasible in Bundled Payment for Care Improvement in Total Hip Arthroplasty Patients? J Arthroplasty 2020; 35:1179-1185. [PMID: 31932103 DOI: 10.1016/j.arth.2019.12.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/29/2019] [Accepted: 12/11/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The Patient-Reported Outcomes Measurement Information System (PROMIS) is increasingly used to assess patient health. The Bundled Payment for Care Improvement (BPCI) initiative for total hip arthroplasty (THA) was introduced to decrease costs and improve clinical care. We investigated differences between BPCI and non-BPCI THA patients and their PROMIS scores, along with its feasibility and responsiveness in these populations. METHODS We included all consecutive patients receiving unilateral primary THA who also had preoperative and one-year postoperative PROMIS physical function (PF), PROMIS pain interference (PI), and PROMIS depression (DEP) scores. Demographics and PROMIS scores were compared. Test burden was assessed using the number of questions and time required for PROMIS completion. The minimum clinically important difference was defined as 5. Floor and ceiling effects were noted if more than 15% of patients responded with the lowest or highest possible score, respectively. Wilcoxon rank-sum test was used to compare categorical data. ANOVA was used for PROMIS comparisons. RESULTS 290 hips (86 BPCI, 30%) were included. The BPCI cohort was older (P < .001) with a higher American Society of Anesthesiologists physical status classification system (P = .0045). There were significant differences in baseline scores of PF and DEP between BPCI and non-BPCI (P = .046 and P = .048, respectively). Both groups showed significant improvement at follow-up in all scores (all P < .001). Significantly more non-BPCI patients achieved minimum clinically important difference at follow-up in PI and PF (P = .047 and P = .023, respectively). Floor effects were identified for DEP at baseline and follow-up and for PI at follow-up only. CONCLUSION PROMIS is feasible and time-efficient in BPCI patients undergoing primary THA. There were significant differences between BPCI and non-BPCI hips. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Charles M Lawrie
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Wahid Abu-Amer
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Robert L Barrack
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - John C Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
| |
Collapse
|
39
|
Bhatt S, Davis K, Manning DW, Barnard C, Peabody TD, Rothrock NE. Integration of Patient-reported Outcomes in a Total Joint Arthroplasty Program at a High-volume Academic Medical Center. J Am Acad Orthop Surg Glob Res Rev 2020; 4:e2000034. [PMID: 33970573 PMCID: PMC7434040 DOI: 10.5435/jaaosglobal-d-20-00034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 03/12/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Despite widely appreciated barriers to successful clinical implementation, the literature regarding how to operationalize electronic health record-integrated patient-reported outcomes (PROs) remains sparse. We offer a detailed summary of the implementation of PROs into the standard of care at a major tertiary academic medical center. METHODS Collection of four Patient-Reported Outcomes Measurement Information System computer adaptive tests was piloted in a large academic orthopaedic surgery ambulatory clinic starting in October 2016. The Patient-Reported Outcomes Measurement Information System computer adaptive tests (Physical Function, Pain Intensity, Pain Interference, and Ability to Return to Social Roles and Activities) were initially implemented as manual order sets to be administered before surgery through 2 years after surgery. Completion rate over time, mean time to completion for all PRO domains, and the overall distribution of symptom severity were used to evaluate the success of the pilot. A subsequent optimization and redesign of the pilot was conducted using tablets, automation of questionnaire deployment, and improved results review to address obstacles encountered during the pilot phase. RESULTS Two thousand nine distinct joint arthroplasty patients (mean age = 65) completed at least one set of PRO assessments, with overall completion rates reaching 68% and mean completion time of 3 minutes. Focal points during the implementation process included engagement and training of staff, selection of an appropriate patient population and outcome measures, and user friendly data displays for patients and providers. CONCLUSION Our pilot program successfully demonstrated that PROs can be administered, scored, and made immediately available within the electronic health record to patients and their providers with minimal disruption of clinical workflows. Although considerable operational and technological challenges remain, we found that the implementation of PROs in clinical care within an ambulatory practice at an academic medical center can be achieved through a constellation of several key factors.
Collapse
Affiliation(s)
- Surabhi Bhatt
- From the Department of Orthopaedic Surgery (Ms. Bhatt, Dr. Manning, Dr. Peabody), Northwestern University Feinberg School of Medicine; the Northwestern Memorial HealthCare (Ms. Davis, Dr. Barnard), Northwestern University Center for Healthcare Studies; the Department of Medical Social Sciences (Dr. Rothrock), Northwestern University Feinberg School of Medicine; and the Department of Surgery (Dr. Barnard), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | | | | | | | | |
Collapse
|
40
|
Voloshin I. Editorial Commentary: Patient-Reported Outcomes Measurement Information System (PROMIS) Is Important Part of Future Clinical Research. Arthroscopy 2020; 36:1429-1430. [PMID: 32370904 DOI: 10.1016/j.arthro.2020.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 02/13/2020] [Indexed: 02/02/2023]
Abstract
The Patient-Reported Outcomes Measurement Information System (PROMIS) is more efficient than legacy measures and is generalizable across all patients and diseases. Patient-reported outcome scores may eventually become related to physician reimbursement and give patients a voice in their care.
Collapse
|
41
|
Winebrake JP, Lovecchio F, Steinhaus M, Farmer J, Sama A. Wide Variability in Patient-Reported Outcomes Measures After Fusion for Lumbar Spinal Stenosis: A Systematic Review. Global Spine J 2020; 10:209-215. [PMID: 32206520 PMCID: PMC7076598 DOI: 10.1177/2192568219832853] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVES The purpose of this study is to review outcomes reporting methodology in studies evaluating fusion for lumbar spinal stenosis. METHODS A systematic review of PubMed and Embase databases was conducted from January 2007 to June 2017 for English language studies with minimum of 2 years postoperative follow-up reporting outcomes after fusion for lumbar spinal stenosis. Two reviewers assessed each study; those meeting inclusion criteria were examined for pertinent data. Outcome measures were categorized into relevant domains: pain/symptomatology, function/disability, and surgical satisfaction. Return to work reporting was also recorded. RESULTS Of 123 studies meeting inclusion criteria, 76% included posterior-only fusion, 32% included posterior/transforaminal interbody fusion, and 5% included anterior/lateral interbody fusion (non-mutually exclusive). There was significant variation in patient-reported outcomes (PROs) used-studies reported 31 unique PROs assessing at least one domain: 22 evaluating pain, 23 evaluating function, and 3 evaluating surgical satisfaction. Most commonly utilized PROs were the Oswestry Disability Index (73% of studies), Visual Analog Scale (55%), and 36-Item Short Form Survey (32%). The remaining 28 measures were used in 14% of studies or fewer. PROs specific to symptoms of lumbar spinal stenosis, such as the Zurich Claudication Questionnaire, were only used rarely (7/123 studies). Only 14% of studies reported on time to return to work. CONCLUSIONS The literature surrounding fusion in the setting of lumbar stenosis is characterized by substantial variability in outcomes reporting. Very few studies utilized measures specific to lumbar spinal stenosis. Efforts to standardize outcomes reporting would facilitate comparisons of surgical interventions.
Collapse
Affiliation(s)
- James P. Winebrake
- Weill Cornell Medicine, New York, NY, USA,James P. Winebrake, Cornell University Joan and Sanford I Weill Medical College, 420 East 70th Street, 13K-2, New York, NY 10021, USA.
| | | | | | - James Farmer
- The Hospital for Special Surgery, New York, NY, USA
| | - Andrew Sama
- The Hospital for Special Surgery, New York, NY, USA
| |
Collapse
|
42
|
Zuckerman SL, Devin CJ. Outcomes and value in elective cervical spine surgery: an introductory and practical narrative review. JOURNAL OF SPINE SURGERY 2020; 6:89-105. [PMID: 32309649 DOI: 10.21037/jss.2020.01.11] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
How we determine a successful clinical outcome and the value of a spine intervention are two major questions surrounding clinical spine research. Patient-reported outcomes (PROs), both LEGACY and Patient-Reported Outcomes Measurement Information System (PROMIS) measures, are becoming ubiquitous throughout the literature. Spine surgeons need a facile understanding of the financial landscape of their environment to influence change. In the current introductory, narrative review on outcomes and value in cervical spine surgery, we aim to: (I) define relevant outcome and cost terminology, (II) review recent cervical spine surgery literature, divided by specific pathology with a focus on LEGACY and PROMIS measures, and (III) discuss value and cost as they pertain to postoperative return to work and ambulatory surgery centers surgeries.
Collapse
Affiliation(s)
- Scott L Zuckerman
- Vanderbilt Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA.,Steamboat Orthopaedic and Spine Institute, Steamboat Springs, CO, USA
| | - Clinton J Devin
- Vanderbilt Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA.,Steamboat Orthopaedic and Spine Institute, Steamboat Springs, CO, USA
| |
Collapse
|
43
|
Li DJ, Clohisy JC, Schwabe MT, Yanik EL, Pascual-Garrido C. PROMIS Versus Legacy Patient-Reported Outcome Measures in Patients Undergoing Surgical Treatment for Symptomatic Acetabular Dysplasia. Am J Sports Med 2020; 48:385-394. [PMID: 31910042 DOI: 10.1177/0363546519894323] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND No previous study has investigated how the Patient-Reported Outcomes Measurement Information System (PROMIS) performs compared with legacy patient-reported outcome measures in patients with symptomatic acetabular dysplasia treated with periacetabular osteotomy (PAO). PURPOSE To (1) measure the strength of correlation between the PROMIS and legacy outcome measures and (2) assess floor and ceiling effects of the PROMIS and legacy outcome measures in patients treated with PAO for symptomatic acetabular dysplasia. STUDY DESIGN Cohort study (Diagnosis); Level of evidence, 2. METHODS This study included 220 patients who underwent PAO for the treatment of symptomatic acetabular dysplasia. Outcome measures included the Hip disability and Osteoarthritis Outcome Score (HOOS) pain, HOOS activities of daily living (ADL), modified Harris Hip Score (mHHS), PROMIS pain, and PROMIS physical function subsets, with scores collected preoperatively and/or postoperatively at a minimum 12-month follow-up. The change in mean scores from preoperatively to postoperatively was calculated only in a subgroup of 57 patients with scores at both time points. Distributions of the PROMIS and legacy scores were compared to evaluate floor and ceiling effects, and Pearson correlation coefficients were calculated to evaluate agreement. RESULTS The mean age at the time of surgery was 27.7 years, and 83.6% were female. The mean follow-up time was 1.5 years. Preoperatively, neither the PROMIS nor the legacy measures showed significant floor or ceiling effects. Postoperatively, all legacy measures showed significant ceiling effects, with 15% of patients with a maximum HOOS pain score of 100, 29% with a HOOS ADL score of 100, and 21% with an mHHS score of 100. The PROMIS and legacy instruments showed good agreement preoperatively and postoperatively. The PROMIS pain had a moderate to strong negative correlation with the HOOS pain (r = -0.66; P < .0001) and mHHS (r = -0.60; P < .0001) preoperatively and the HOOS pain (r = -0.64; P < .0001) and mHHS (r = -0.64; P < .0001) postoperatively. The PROMIS physical function had a moderate positive correlation with the HOOS ADL (r = 0.51; P < .0001) and mHHS (r = 0.49; P < .0001) preoperatively and a stronger correlation postoperatively with the HOOS ADL (r = 0.56; P < .0001) and mHHS (r = 0.56; P < .0001). CONCLUSION We found good agreement between PROMIS and legacy scores preoperatively and postoperatively. PROMIS scores were largely normally distributed, demonstrating an expanded ability to capture variability in patients with improved outcomes after treatment.
Collapse
Affiliation(s)
- Deborah J Li
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - John C Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Maria T Schwabe
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Elizabeth L Yanik
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Cecilia Pascual-Garrido
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| |
Collapse
|
44
|
Tennekoon RL, Smith-Forbes EV, Woods Y. A Mixed Methods Analysis of Acute Upper Extremity Pain as Measured by the Patient Reported Outcomes Measurement Information System. Mil Med 2019. [DOI: 10.1093/milmed/usz396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Chronic pain affects U.S. service member’s (SMs) more disproportionately than individuals in the general public. SMs have unique cultural pressures to ignore or deny acute pain; therefore, the beliefs and behaviors of this group may cause them to self-report their acute pain in a specific manner. This study evaluated the strength of the relationship of the patient reported outcomes measurement information system (PROMIS) upper extremity computer adaptive test (CAT) and assessed U.S. active duty SMs experience of acute pain and function compared to the quick disabilities of the arm, shoulder, and hand (QuickDASH). In addition, the PROMIS pain interference CAT, PROMIS pain behavior CAT, and PROMIS anxiety CAT were correlated to the PROMIS upper extremity CAT and QuickDASH questionnaires.
Materials and Methods
This mixed methods, sequential, explanatory study included a convenience sample of 26 participants from two occupational therapy clinics. Participants were administered five self-report questionnaires at initial evaluation and at follow up (30–90 day). At follow up, 12 participants completed a semi-structured interview. Categorical variables were summarized using percentages and analyzed using a chi-square goodness of fit test. A Pearson correlation coefficient was used to analyze the linear relationship between the QuickDASH and specified PROMIS questionnaires. This study was approved by the Institutional Review Board at Brooke Army Medical Center, reference number C.2017.173d.
Results
The initial and follow up scores from the self-report questionnaires demonstrated a good to excellent correlation between the PROMIS upper extremity CAT and the QuickDASH (r = –0.65; r = –0.81; p < 0.001). Qualitative data were gathered during a semi-structured interview of 12 participants after the follow up and were analyzed using thematic analysis. Three themes emerged from qualitative analysis of data: (1) impact of military culture, (2) psychosocial effects of acute pain, and (3) therapist contributions to disability awareness.
Conclusions
This study demonstrates several cultural and psychosocial influences concerning the experience of SMs with acute UE disability and pain, which were not previously reported for this population.
Collapse
Affiliation(s)
- Robin L Tennekoon
- Blanchfield Army Community Hospital, Department of Occupational Therapy, 650 Joel Drive, Fort Campbell, KY 42223
| | - Enrique V Smith-Forbes
- Brooke Army Medical Center JBSA, Department of Occupational Therapy, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234
| | - Yvette Woods
- Brooke Army Medical Center JBSA, Department of Occupational Therapy, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234
| |
Collapse
|
45
|
Pierce KE, Alas H, Brown AE, Bortz CA, O'Connell B, Vasquez-Montes D, Diebo BG, Lafage R, Lafage V, Buckland AJ, Passias PG. PROMIS physical health domain scores are related to cervical deformity severity. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2019; 10:179-183. [PMID: 31772431 PMCID: PMC6868545 DOI: 10.4103/jcvjs.jcvjs_52_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction The aim of this study was to evaluate the association of available cervical alignment components through the Ames cervical deformity (CD) classification parameters with the Patient-Reported Outcomes Measurement Information System (PROMIS) physical health domain metrics. Methods Surgical CD patients (C2-C7 Cobb >10° or C2-C7 sagittal vertical axis [cSVA] >4 cm or T1 slope minus cervical lordosis (TS-CL) >15°) ≥18 years with available baseline (BL) radiographic and PROMIS were isolated in a single-center spine database. Patients were classified according to the Ames CD modifiers for cSVA and TS-CL (low deformity [Low], moderate deformity [Mod], and severe deformity [Sev]). Descriptives and univariate analyses compared population-weighted PROMIS scores for Pain Intensity (PI), Physical Function (PF), and Pain Interference (Int) across CD modifiers. Conditional tree analysis with logistic regression sampling determined the threshold of PROMIS scores for which the correlation with Ames radiographic cutoffs was most significant. Reported cutoff values for Mod (cSVA: 4-8 cm; TS-CL: 15-20°) and Sev (cSVA: >8 cm; TS-CL: >20°) disabilities were used. Results Two hundred and eight patients (58.8 years, female: 51%, 29.6 kg/m2, Charlson Comorbidity Index: 1.19). BL cSVA modifier by severity: 83.2% Low, 16.8% Mod. No patients met criteria for severe cSVA. BL TS-CL modifier by severity: 18.8% Low, 22.1% Mod, 59.1% Sev. Mean baseline PROMIS scores were as follows: PI score: 89.6 ± 15.4, PF score: 11.9 ± 13.1, Int score: 56.9 ± 6.8. PI did not differ between cSVA and TS-CL severity. Mod cSVA patients and Mod/Sev TS-CL modifier groups trended toward lower PF scores and higher Int scores. A PI score of >96 (odds ratio [OR]: 0.658 [0.303-1.430]), a PF score of <14 (OR: 1.864 [0.767-4.531]), and an Int score of > 57.4 (OR: 1.878 [0.889-3.967]) were predictors of Mod cSVA. A PI score of >87 (OR: 1.428 [0.767-2.659]), a PF score of <14 (OR: 1.551 [0.851-2.827]), and an Int score of >56.5 (OR: 1.689 [0.967-2.949]) were predictors of Sev TS-CL. Conclusions PROMIS physical health domains were related to the Ames CD classification. Certain BL PROMIS thresholds can be connected to the severity of CD.
Collapse
Affiliation(s)
- Katherine E Pierce
- Departments of Orthopaedic and Neurosurgery, Division of Spinal Surgery, NYU Medical Center, NY Spine Institute, New York, NY, USA
| | - Haddy Alas
- Departments of Orthopaedic and Neurosurgery, Division of Spinal Surgery, NYU Medical Center, NY Spine Institute, New York, NY, USA
| | - Avery E Brown
- Departments of Orthopaedic and Neurosurgery, Division of Spinal Surgery, NYU Medical Center, NY Spine Institute, New York, NY, USA
| | - Cole A Bortz
- Departments of Orthopaedic and Neurosurgery, Division of Spinal Surgery, NYU Medical Center, NY Spine Institute, New York, NY, USA
| | - Brooke O'Connell
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Dennis Vasquez-Montes
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Bassel G Diebo
- Department of Orthopedic Surgery, SUNY Downstate, New York, NY, USA
| | - Renaud Lafage
- Department of Orthopaedics, Hospital for Special Surgery, New York, NY, USA
| | - Virginie Lafage
- Department of Orthopaedics, Hospital for Special Surgery, New York, NY, USA
| | - Aaron J Buckland
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Peter G Passias
- Departments of Orthopaedic and Neurosurgery, Division of Spinal Surgery, NYU Medical Center, NY Spine Institute, New York, NY, USA
| |
Collapse
|
46
|
Kaat AJ, Buckenmaier CT, Cook KF, Rothrock NE, Schalet BD, Gershon RC, Vrahas MS. The expansion and validation of a new upper extremity item bank for the Patient-Reported Outcomes Measurement Information System® (PROMIS). J Patient Rep Outcomes 2019; 3:69. [PMID: 31773413 PMCID: PMC6879697 DOI: 10.1186/s41687-019-0158-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 10/25/2019] [Indexed: 12/27/2022] Open
Abstract
Background The Patient-Reported Outcomes Measurement Information System® (PROMIS) includes a Physical Function (PF) item bank and an Upper Extremity (UE) item bank, which is composed of a subset of items from the PF bank. The UE item bank has few items and known ceiling effects. Therefore, this study aimed to expand the item bank to assess a wider range of functioning. With the additional content, other psychometric properties—improved content validity, item bank depth, range of measurement, and score reliability—were also evaluated. We convened an expert panel to review potential items, and then conducted psychometric analyses on both extant and newly-collected data. Results Expert focus groups reviewed the PF item bank for items that were “sufficiently” related to upper extremity functioning for inclusion in the expanded UE item bank. The candidate item bank was quantitatively evaluated in a new sample of 600 people. The final items were calibrated in an aggregated dataset (n = 11,635) from two existing datasets, and the newly collected sample. The original UE item bank included 15 items. After expert review and quantitative evaluation, 31 items were added. The combined 46 items were calibrated using item response theory (IRT). Then computer adaptive tests (CATs) were simulated based off of the psychometric results. These indicated that the new UE item bank has an extended measurement range compared to the original version. Conclusions The expanded PROMIS UE item bank assesses a wider range of upper extremity functioning compared to the initial UE item bank. However, ceiling effects remain a concern for unimpaired groups. The new UE item bank is recommended for individuals with known or suspected upper extremity limitations.
Collapse
Affiliation(s)
- Aaron J Kaat
- Department of Medical Social Sciences, Northwestern University, 625 N Michigan Ave Suite 2700, Chicago, IL, 60611, USA.
| | - Chester Trip Buckenmaier
- Uniformed Services University, Defense & Veterans Center for Integrative Pain Management, 11300 Rockville Pike #709, Rockville, MD, 20852, USA
| | - Karon F Cook
- Department of Medical Social Sciences, Northwestern University, 625 N Michigan Ave Suite 2700, Chicago, IL, 60611, USA
| | - Nan E Rothrock
- Department of Medical Social Sciences, Northwestern University, 625 N Michigan Ave Suite 2700, Chicago, IL, 60611, USA
| | - Benjamin D Schalet
- Department of Medical Social Sciences, Northwestern University, 625 N Michigan Ave Suite 2700, Chicago, IL, 60611, USA
| | - Richard C Gershon
- Department of Medical Social Sciences, Northwestern University, 625 N Michigan Ave Suite 2700, Chicago, IL, 60611, USA
| | - Mark S Vrahas
- Department of Orthopaedics, Cedars-Sinai Medical Center, Mark Goodson Building, 444 S. San Vicente Blvd., #603, Los Angeles, CA, 90048, USA
| |
Collapse
|
47
|
A Prospective, Psychometric Validation of National Institutes of Health Patient-Reported Outcomes Measurement Information System Physical Function, Pain Interference, and Upper Extremity Computer Adaptive Testing in Cervical Spine Patients: Successes and Key Limitations. Spine (Phila Pa 1976) 2019; 44:1539-1549. [PMID: 31689249 DOI: 10.1097/brs.0000000000003133] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective Cohort Study OBJECTIVE.: The aim of this study was to validate the Patient Reported Outcomes Measurement Information System (PROMIS) against existing patient-reported outcomes in the cervical spine. SUMMARY OF BACKGROUND DATA Current patient-reported outcomes in cervical spine have substantial limitations. PROMIS offers the potential for improved psychometric properties with reduced questionnaire burden. METHODS Adult patients undergoing cervical spine surgery at a single institution between 2016 and 2018 were prospectively enrolled. Patients completed questionnaires (36-Item Short Form Health Survey [SF-36], Neck Disability Index (NDI), Visual Analog Scale arm/neck, and PROMIS pain Interference [PI], physical Function [PF], and Upper Extremity [UE]) preoperatively and at 6 months postoperatively. Demographic data, diagnosis, and procedural data were recorded. Validation of the instruments was completed with a Rasch Model as well as measurement of coverage, efficiency, test-retest reliability, responsiveness, and convergent validity. RESULTS Of 197 patients who completed the preoperative survey, 164 were eligible for 6-month follow-up and 139 completed 6-month postoperative surveys. The most common diagnoses were radiculopathy (37.6%), myeloradiculopathy (30.5%), and myelopathy (28.4%). All studied instruments had acceptable fit to a Rasch model. PROMIS computer adaptive testings (CATs) demonstrated improved average time to completion for PI (39 seconds), PF (47 seconds), and UE (54 seconds), compared to NDI (117 s) and SF-36 PCS (175 seconds). Responsiveness for PROMIS CATs was similar to NDI and SF-36, test-retest reliability was lower for PI (intraclass correlation: 0.68), PF (0.70), and UE (0.59), compared to NDI (0.86) and PCS (0.85). For convergent validity, PI was strongly correlated to NDI and PF to SF-36 PCS. There were no significant floor or ceiling effects for the PROMIS domains, although UE had preoperative clustering (n = 18) at a high score (56.4) and PI had postoperative clustering (n = 27) at a low score (38.7). CONCLUSION PROMIS CATs demonstrate several advantages, including efficiency and responsiveness, while demonstrating good convergent validity with legacy instruments. Nevertheless, CATs had lower test-retest reliability and had significant clustering at higher levels of function for the PI and UE CATs. These limitations must be considered before broad adoption of CATs in cervical spine patients. LEVEL OF EVIDENCE 3.
Collapse
|
48
|
PROMIS Physical Function Short Forms Display Item- and Scale-Level Characteristics at Least as Good as the Roland Morris Disability Questionnaire in Patients With Chronic Low Back Pain. Arch Phys Med Rehabil 2019; 101:297-308. [PMID: 31689418 DOI: 10.1016/j.apmr.2019.09.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 07/19/2019] [Accepted: 09/16/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To compare dimensionality, item-level characteristics, scale-level reliability, and construct validity of PROMIS Physical Function short forms (PROMIS-PF) and 24-item Roland Morris Disability Questionnaire (RMDQ-24) in patients with chronic low back pain (LBP). DESIGN Cross-sectional study. SETTING Secondary care center for rehabilitation and rheumatology. PARTICIPANTS Patients with nonspecific LBP ≥3 months (N=768). Mean age was 49±13 years, 77% were female, and 54% displayed pain for more than 5 years. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Dutch versions of the 4-, 6-, 8-, 10-, and 20-item PROMIS-PF and of the RMDQ-24. RESULTS PROMIS-PF-6, PROMIS-PF-8, and RMDQ-24 exhibited sufficient unidimensionality (confirmatory factor analysis: comparative fit index>0.950, Tucker-Lewis index>0.950, root means square error of approximation<0.060), whereas the other instruments did not. All instruments were free of local dependence except PROMIS-PF-20 with 4 item pairs with clear residual correlations. Mokken scale analysis found 1 nonmonotone item for PROMIS-PF-20 and 8 for RMDQ-24 (ie, the probability of endorsing these items was not increasing with increasing level on the underlying construct). PROMIS-PF-20 displayed 2 misfitting items (S-χ2P value>.001). Two-parameter item response theory models found 2 items with low discrimination for RMDQ-24. All other instruments had adequate fit statistics and item parameters. PROMIS-PF-20 displayed the best scale-level reliability. Construct validity was sufficient for all instruments as all hypotheses on expected correlations with other instruments and differences between relevant subgroups were met. CONCLUSIONS PROMIS-PF-6, PROMIS-PF-8, and RMDQ-24 exhibited better unidimensionality, whereas PROMIS-PF-4, PROMIS-PF-6, PROMIS-PF-8, and PROMIS-PF-10 showed superior item-level characteristics. PROMIS-PF-20 was the instrument with the best scale-level reliability. This study warrants assessment of other measurement properties of PROMIS-PF short forms in comparison with disease-specific physical functioning instruments in LBP.
Collapse
|
49
|
Construct Validity and Precision of Different Patient-reported Outcome Measures During Recovery After Upper Extremity Fractures. Clin Orthop Relat Res 2019; 477:2521-2530. [PMID: 31490347 PMCID: PMC6903842 DOI: 10.1097/corr.0000000000000928] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patient perceptions of their limitations after illness and injury can be quantified using patient-reported outcome measures (PROMs). Few studies have assessed construct validity (using correlations and factor analysis) and precision (floor and ceiling effects) of a range of frequently used PROMs longitudinally in a population of patients recovering from common upper extremity fractures according to area (general health, region-specific, or joint-specific measures) and mode of administration (fixed-scale or computer adaptive test). QUESTIONS/PURPOSES (1) What is the strength of the correlation between different PROMs within 1 week, 2 to 4 weeks and 6 to 9 months after shoulder, elbow, and wrist fractures? (2) Using a factor analysis, what underlying constructs are being measured by these PROMs? (3) Are there strong floor and ceiling effects with these instruments? METHODS Between January 2016 and August 2016, 734 patients recovering from an isolated shoulder, elbow, or wrist fracture completed physical-limitation PROMs at baseline (the initial office visit after diagnosis in the emergency department), 2 to 4 weeks after injury, and at the final assessment 6 to 9 months after injury. In all, 775 patients were originally approached; 31 patients (4%) declined to participate due to time constraints, four patients died of unrelated illness, and six patients were lost to follow-up. The PROMs included the PROMIS Physical Function (PF, a computer adaptive, general measure of physical function), the PROMIS Upper Extremity (UE, a computer adaptive measure of upper extremity physical function), the QuickDASH (a fixed-scale, region-specific measure), the Oxford Shoulder Score (OSS), the Oxford Elbow Score (OES) and the Patient-rated Wrist Evaluation (PRWE) (a fixed-scale, joint-specific measure), and the EQ-5D-3L (a fixed-scale measure of general health). PROMs were evaluated during recovery for construct validity (using correlations and factor analysis) and precision (using floor and ceiling effects). RESULTS Physical-limitation PROMs were intercorrelated at all time points, and the correlation strengthened over time (for example, PROMIS UE and QuickDASH at 1 week, r = -0.4665; at 2 to 4 weeks, r = -0.7763; at 6 to 9 months, r = -0.8326; p < 0.001). Factor analysis generated two factors or groupings of PROMs that could be described as capability (perceived ability to perform or engage in activities), and quality of life (an overall sense of health and wellbeing) that varied by time point and fracture type, Joint-specific and general-health PROMs demonstrated high ceiling effects 6 to 9 months after injury and PROMIS PF, PROMIS UE and QuickDASH had no floor or ceiling effects at any time points. CONCLUSIONS There is a substantial correlation between PROMs that assess physical limitations (based on anatomic region) and general health after upper extremity fractures, and these relationships strengthen during recovery. Regardless of the delivery mode or area of focus, PROMs largely appear to represent two underlying constructs: capability and quality of life. Computer adaptive tests may be favored over fixed-scale measures for their efficiency and limited censoring. LEVEL OF EVIDENCE Level II, therapeutic study.
Collapse
|
50
|
Shazadeh Safavi P, Janney C, Jupiter D, Kunzler D, Bui R, Panchbhavi VK. A Systematic Review of the Outcome Evaluation Tools for the Foot and Ankle. Foot Ankle Spec 2019; 12:461-470. [PMID: 30338697 DOI: 10.1177/1938640018803747] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. The goal of this systematic review is to determine the most commonly used outcome measurement tools used by foot and ankle specialists and determine their limitations, such as whether they are validated, have floor/ceiling effects, and so on. Methods. A literature search was conducted to identify primary publications between January 1, 2012 and July 1, 2017 that concern care of the foot and ankle and use any established grading criteria to evaluate patients. Results. In 669 publications, 76 scoring systems were used. The 10 most common were American Orthopaedic Foot and Ankle Score (AOFAS), visual analog scale (VAS), Short Form-36 (SF-36), Foot Function Index (FFI), Foot and Ankle Outcome Score (FAOS), Foot and Ankle Ability Measure (FAAM), SF-12, Short Musculoskeletal Function Assessment (SMFA), Ankle Osteoarthritis Scale (AOS), and Foot and Ankle Disability Index (FADI). AOFAS was used in 393 articles, VAS in 308, and SF-36 in 133 publications. AOFAS, VAS, and SF-36 were used to evaluate 23,352, 20,759, and 13,184 patients respectively. AOFAS and VAS were used simultaneously in 172 publications. Conclusion. While there are many different scoring systems available for foot and ankle specialists to use to assess or demonstrate the effectiveness of treatments, the AOFAS, while it is an unvalidated scoring system, is the most commonly used scoring system in this review. Clinical Relevance. This review presents data about commonly used patient reported outcomes systems in foot and ankle surgery. Levels of Evidence: Level III: Systematic review.
Collapse
Affiliation(s)
- Pejma Shazadeh Safavi
- University of Texas Medical Branch at Galveston, Galveston, Texas (PSS, CJ, DJ, DK, VKB).,United States Navy (CJ)
| | - Cory Janney
- University of Texas Medical Branch at Galveston, Galveston, Texas (PSS, CJ, DJ, DK, VKB).,United States Navy (CJ)
| | - Daniel Jupiter
- University of Texas Medical Branch at Galveston, Galveston, Texas (PSS, CJ, DJ, DK, VKB).,United States Navy (CJ)
| | - Daniel Kunzler
- University of Texas Medical Branch at Galveston, Galveston, Texas (PSS, CJ, DJ, DK, VKB).,United States Navy (CJ)
| | - Roger Bui
- University of Texas Medical Branch at Galveston, Galveston, Texas (PSS, CJ, DJ, DK, VKB).,United States Navy (CJ)
| | - Vinod K Panchbhavi
- University of Texas Medical Branch at Galveston, Galveston, Texas (PSS, CJ, DJ, DK, VKB).,United States Navy (CJ)
| |
Collapse
|