The relationship between patient-reported outcomes and physical impairments in people with early hip osteoarthritis following hip arthroscopy

Introduction: Outcome assessment for hearing aids (HAs) is an essential part of HA fitting and validation. There is no consensus about the best or standard approach for evaluating HA outcomes. And, the relationship between objective and subjective measures is ambiguous. This study aimed to determine the outcomes after HA fitting, explore correlations between subjective benefit and acoustic gain improvement as well as objective audiologic tests, and investigate several variables that may improve patients’ perceived benefits. Methods: Eighty adults with bilateral symmetrical hearing loss using HAs for at least 1 month were included in this study. All subjects completed the pure tone average (PTA) threshold and word recognition score (WRS) tests in unaided and aided conditions. We also administered the Chinese version of International Outcome Inventory for Hearing Aids (IOI-HA), to measure participants’ subjective benefits. Objective HA benefit (acoustic gain improvement) was defined as the difference in thresholds or scores between aided and unaided conditions indicated with ΔPTA and ΔWRS. Thus, patients’ baseline hearing levels were taken into account. Correlations were assessed among objective audiologic tests (PTA and WRS), acoustic gain improvement (ΔPTA and ΔWRS), multiple potential factors, and IOI-HA overall scores. Results: PTA decreased significantly, but WRS did not increase when aided listening was compared to unaided listening. Negative correlations between PTAs and IOI-HA scores were significant but weak (r = −0.370 and r = −0.393, all p < 0.05). Significant weak positive correlations were found between WRSs and IOI-HA (r = 0.386 and r = 0.309, all p < 0.05). However, there was no correlation among ΔPTA, ΔWRS, and IOI-HA (r = 0.056 and r = −0.086, all p > 0.05). Moreover, 2 nonaudiological factors (age and daily use time) were significantly correlated with IOI-HA (r = −0.269 and r = 0.242, all p < 0.05). Conclusions: Correlations among objective audiologic tests, acoustic gain, and subjective patient-reported outcomes were weak or absent. Subjective questionnaires and objective tests do not reflect the same hearing capability. Therefore, it is advisable to evaluate both objective and subjective outcomes when analyzing HA benefits on a regular basis and pay equal attention to nonaudiological and audiological factors.

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Patient-Reported Disease-Modifying Therapy Adherence in the Clinic: A Reliable Metric?

Multiple Sclerosis Journal - Experimental Translational and Clinical ◽

10.1177/2055217318777894 ◽

2018 ◽

Vol 4 (2) ◽

pp. 205521731877789 ◽

Cited By ~ 1

Author(s):

Devon S Conway ◽

Maria Cecilia Vieira ◽

Nicolas R Thompson ◽

Kaila N Parker ◽

Xiangyi Meng ◽

...

Keyword(s):

Regression Models ◽

Patient Reported Outcomes ◽

Patient Reporting ◽

Lesion Formation ◽

Logistic Regression Models ◽

Disease Modifying Therapy ◽

Patient Reported ◽

Relapsing Remitting ◽

Disease Modifying ◽

The Relationship

Background Adherence to multiple sclerosis (MS) disease-modifying therapy (DMT) is commonly assessed through patient reporting, but patient-reported adherence is rarely studied. Objective To determine rates of DMT adherence reported from patient to clinician, reasons for nonadherence, and relationships between adherence and outcomes. Methods We identified relapsing–remitting MS patients on DMT for ≥3 months. DMT adherence was defined as taking ≥80% of doses. Linear and logistic regression models were created used to determine the association of baseline adherence with several patient reported outcomes and the timed 25-foot walk at 6 months, 1 year, 2 years, and 3 years after the index visit. Results The analysis included 1148 patients, of whom 501 had data at 6 months, 544 at 1 year, 331 at 2 years, and 247 at 3 years. Baseline adherence was 94.9% and overall adherence was 93.1%. Forgetting was the most common reason for missed doses. In the adjusted models, adherence was not associated with the outcomes. Conclusions Higher than expected adherence and a lack of association between adherence and outcomes suggests patient reported adherence may not be reliable. Further research is needed to clarify the relationship between patient-reported adherence and relapses or new lesion formation.

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Multi-centered Comparison of Patient Reported Outcomes After Hip Arthroscopy versus Combined Hip Arthroscopy Alone and Peri-acetabular Osteotomy in Patients with Acetabular Dysplasia

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117s00408 ◽

2017 ◽

Vol 5 (7_suppl6) ◽

pp. 2325967117S0040

Author(s):

Benjamin G. Domb ◽

Raymond James Kenney ◽

Christopher Cook ◽

Justin M. LaReau ◽

Sean Childs ◽

...

Keyword(s):

Hip Arthroscopy ◽

Patient Reported Outcomes ◽

Acetabular Dysplasia ◽

Patient Reported

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Does improved radiographic alignment truly enhance dynamic functional balance?

Studies in Health Technology and Informatics - Research into Spinal Deformities 9 ◽

10.3233/shti210433 ◽

2021 ◽

Author(s):

R Haddas ◽

S Kisinde ◽

D Mar ◽

I Lieberman

Keyword(s):

Patient Reported Outcomes ◽

Added Value ◽

Functional Balance ◽

Radiographic Measurements ◽

Patient Reported ◽

Before And After ◽

Gait Abnormalities ◽

The Relationship ◽

Radiographic Alignment

Prospective, concurrent-cohort study. To establish the relationship between radiographic alignment parameters and functional CoE measurements at one week before and at three months after realignment surgery in ADS patients. Adult degenerative scoliosis (ADS) represents a significant healthcare burden with exceedingly high and increasing prevalence, particularly among the elderly. Radiographic alignment measures and patient-reported outcomes currently serve as the standard means to assess spinal alignment, deformity, and stability. Neurological examinations have served as qualitative measures for indicating muscle strength, motor deficits, and gait abnormalities. Three-Dimensional motion analysis is increasingly being used to identify and measure gait and balance instability. Recently, techniques have been established to quantify balance characteristics described by Dubousset as the “cone of economy” (CoE). The relationship between radiographic alignment parameters and CoE balance measures of ADS patients before and after realignment surgery is currently unknown. 29 ADS patients treated with realignment surgery. Patients were evaluated at one week before realignment surgery and at their three-month follow-up examination. During each evaluation, patients completed self-reported outcomes (visual analog scales for pain, Oswestry Disability Index, SRS22r) and a functional balance test. Mean changes in dependent measures from before to after surgery were compared using paired t-tests. Pearson correlations were used to test for significant correlations between changes in radiographic and CoE measures. Significant improvements were found for all patient-reported outcomes, in several radiographic measures, and in CoE measures. Improvements of scoliosis Cobb angle, coronal pelvic tilt, lumbar lordosis, and thoracic kyphosis showed significant correlations with CoE sway and total distance measures at both the center of mass and center of the head. Improved radiographic alignment measures significantly correlated with improved CoE balance measures among ADS patients treated with realignment surgery at their three-month follow-up. These findings indicate that functional balance evaluations when used in conjunction with radiographic measurements, may provide a more robust and improved patient-specific sensitivity for postoperative assessments. CoE balance may represent a new measure of added value for surgical intervention of ADS.

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Patient-Reported Outcomes Measurement Information System (PROMIS) in Femoroacetabular Impingement (FAI)

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00266 ◽

2019 ◽

Vol 7 (7_suppl5) ◽

pp. 2325967119S0026

Author(s):

Anas Minkara ◽

Michaela O’Connor ◽

Robert W. Westermann ◽

James T. Rosneck ◽

Thomas Sean Lynch

Keyword(s):

Hip Arthroscopy ◽

Patient Reported Outcomes ◽

Pain Interference ◽

Measurement Information ◽

Retest Reliability ◽

Pearson Coefficient ◽

Patient Reported ◽

Ceiling Effects ◽

Measurement Information System ◽

Test Retest Reliability

Objectives: Patient-Reported Outcomes Measurement Information System (PROMIS) is an NIH-funded computerized adaptive test (CAT) developed to effectively assess patient outcomes in multiple domains, including physical function (PF), pain severity, and quality of life while minimizing patient burden. The purpose of this study is to validate PROMIS in patients undergoing hip arthroscopy for Femoroacetabular Impingement (FAI), including test-retest reliability and correlation with validated hip outcome measures. Methods: Patients undergoing elective hip arthroscopy for FAI were consecutively enrolled at a major academic center. Patients with chronic comorbidities, bilateral FAI with a staged approach, and lack of postoperative follow-up were excluded. Eligible patients completed the modified Hip Harris Score (mHHS), Hip Outcome Score Activities of Daily Living (HOS-ADL), International Hip Outcome Tool (iHOT-12), and PROMIS including PF, pain interference, and activity satisfaction. Questionnaires were completed preoperatively, two, and six weeks postoperatively. Ceiling effects were determined to be present if greater than 15% of patients scored the highest possible score on one of the patient reported outcome measurement tools in this study. The correlation of preoperative values with postoperative function were assessed utilizing the Pearson coefficient. Normality was evaluated using the Shapiro-Wilk test. Dependent sample t-tests were utilized to compare means in test-retest reliability. Results: There were 38 patients with a mean age of 29.3 ± 8.9 years (54% female) identified for the study. PROMIS demonstrated excellent correlation with HOS-ADL (Pearson coefficient of 0.81, Figure 1), as well as mHHS (0.80) and iHOT-12 (0.73). Patients with higher PROMIS-pain interference and pain intensity scores demonstrated a negative linear correlation with mHHS (r=-0.86, p<0.05), HOS-ADL (r=-0.71, p<0.05), and iHOT-12 (-0.71, p<0.01). PROMIS scores exhibited significant responsiveness to hip arthroscopy. Patients with higher activity satisfaction demonstrated excellent-good correlation with mHHS scores (r=0.66, p<0.05) and HOS-ADL (0.66, p<0.05). PROMIS also demonstrated excellent test-retest reliability with no variability in scores, including PF (55.5 ± 8.6 vs. 54.2 ± 10.5, p=0.74). No floor or ceiling effects were exhibited by PROMIS including the physical function, pain interference, pain intensity, social participation, and role satisfaction domain scores. Conclusion: PROMIS is a valid and efficient PRO in hip arthroscopy for FAI demonstrating excellent test-retest reliability and correlation with established hip outcome measures. No floor or ceiling effects were demonstrated by PROMIS. Subdomains also exhibit excellent prognostic ability in the clinical setting.

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Effect of alcohol consumption on patient-reported outcomes in hip arthroscopy: a matched controlled study with minimum 2-year follow-up

Hip International ◽

10.1177/1120700019853554 ◽

2019 ◽

Vol 30 (4) ◽

pp. 457-468

Author(s):

Ajay C Lall ◽

Erwin Secretov ◽

Muriel R Battaglia ◽

David R Maldonado ◽

Itay Perets ◽

...

Keyword(s):

Alcohol Consumption ◽

Total Hip Arthroplasty ◽

Hip Arthroscopy ◽

Patient Reported Outcomes ◽

Heavy Drinking ◽

Controlled Study ◽

Patient Reported ◽

Heavy Drinkers ◽

Outerbridge Grade

Introduction:There is a paucity of literature examining the effects of alcohol consumption on patient-reported outcomes (PROs) after hip arthroscopy. The purpose of this study was to report 2-year outcomes of hip arthroscopy in patients who consume alcohol compared to patients who abstain.Methods:Registry data were prospectively collected and retrospectively reviewed to identify heavy drinkers at the time of primary hip arthroscopy. Patients were matched 1:1 (heavy drinkers:non-drinkers) based on age, sex, BMI, acetabular Outerbridge grade, and capsular treatment. All patients were assessed with 4 validated PROs: mHHS, NAHS, HOS-SSS, and iHOT-12. Pain was estimated with VAS.Results:42 patients were pair matched in each group (heavy drinkers:non-drinkers). Both groups demonstrated significant improvement for all PROs and VAS. Heavy drinkers reported lesser improvement in HOS-SSS ( p = 0.0169), smaller decrease in VAS ( p = 0.0157), and lower final scores on iHOT-12 ( p = 0.0302), SF-12 mental ( p = 0.0086), and VR-12 mental ( p = 0.0151). Significantly fewer patients in the heavy-drinking group reached PASS for mHHS ( p = 0.0464). Odds of achieving PASS for mHHS was 2.5 times higher for patients who abstain from alcohol. The rates of revision hip arthroscopy and conversion to total hip arthroplasty were not statistically different between groups.Conclusion:While hip arthroscopy may still yield clinical benefit in drinkers, patients who consume heavy amounts of alcohol may ultimately achieve an inferior functional status and should be counselled on drinking cessation to optimise their results.

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Fast Starters and Slow Starters After Hip Arthroscopy for Femoroacetabular Impingement: Correlation of Early Postoperative Pain and 2-Year Outcomes

The American Journal of Sports Medicine ◽

10.1177/0363546520952406 ◽

2020 ◽

Vol 48 (12) ◽

pp. 2903-2909

Author(s):

Thu Quynh Nguyen ◽

James M. Friedman ◽

Sergio E. Flores ◽

Alan L. Zhang

Keyword(s):

Postoperative Pain ◽

Femoroacetabular Impingement ◽

Hip Arthroscopy ◽

Harris Hip Score ◽

Physical Component Score ◽

Pain Level ◽

Component Score ◽

Pain Scores ◽

Patient Reported ◽

The Relationship

Background: Patients experience varying degrees of pain and symptoms during the early recovery period after hip arthroscopy for femoroacetabular impingement (FAI). Some “fast starters” report minimal discomfort and are eager to advance activities, while “slow starters” describe severe pain and limitations. The relationship between these early postoperative symptoms and 2-year outcomes after hip arthroscopy is unknown. Purpose: To analyze the relationship between early postoperative pain and 2-year patient-reported outcomes (PROs) after hip arthroscopy for FAI. Study Design: Cohort study; Level of evidence, 2. Methods: Patients without arthritis or dysplasia who were undergoing primary hip arthroscopy for FAI were prospectively enrolled and completed validated PROs. Scores for visual analog scale (VAS) for pain were collected preoperatively and at 1 week, 6 weeks, and 2 years postoperatively. Scores for the modified Harris Hip Score (mHHS), Hip disability and Osteoarthritis Outcome Score (HOOS), and 12-Item Short Form Health Survey (SF-12) were collected preoperatively and 2 years postoperatively. Paired t tests were used to evaluate PRO score changes, and correlation analyses were used to assess relationships between early postoperative pain and 2-year postoperative outcomes. Results: A total of 166 patients were included (55% female; mean ± SD age, 35.29 ± 9.6 years; mean body mass index, 25.07 ± 3.98 kg/m2). Patients demonstrated significant improvements in PRO scores (VAS, SF-12 Physical Component Score, mHHS, and all HOOS subscales) at 2 years after hip arthroscopy for FAI ( P < .001). There was a significant correlation between lower 1-week VAS pain level (fast starters) and lower 2-year VAS pain level ( R = 0.31; P < .001) as well as higher 2-year PRO scores (SF-12 Physical Component Score, mHHS, and all HOOS subscales: R = −0.21 to −0.3; P < .001). There was no correlation between 1-week VAS pain and 2-year SF-12 Mental Component Score ( P = .17). Preoperative VAS pain levels showed positive correlations with 1-week postoperative pain scores ( R = 0.39; P < .001) and negative correlations with 2-year patient outcomes ( R = −0.15 to −0.33, P < .01). There was no correlation between 6-week postoperative pain scores and 2-year PRO scores. Conclusion: Fast starters after hip arthroscopy for FAI experience sustained improvements in outcomes at 2 years after surgery. Patient pain levels before surgery may delineate potential fast starters and slow starters.

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Importance of Retaining Sufficient Acetabular Depth: Successful 2-Year Outcomes of Hip Arthroscopy for Patients With Pincer Morphology as Compared With Matched Controls

The American Journal of Sports Medicine ◽

10.1177/0363546520937301 ◽

2020 ◽

Vol 48 (10) ◽

pp. 2471-2480 ◽

Cited By ~ 1

Author(s):

Claudia R. Brick ◽

Catherine J. Bacon ◽

Matthew J. Brick

Keyword(s):

Total Hip Arthroplasty ◽

Femoroacetabular Impingement ◽

Hip Arthroplasty ◽

Hip Arthroscopy ◽

Patient Reported Outcomes ◽

Control Group ◽

Total Hip ◽

Patient Reported ◽

Acetabular Overcoverage

Background: Patients with pincer-type femoroacetabular impingement are commonly treated with arthroscopic reduction of acetabular depth as measured by the lateral center-edge angle (LCEA). The optimal amount of rim reduction has not been established, although large resections may increase contact pressures through the hip. A recent publication demonstrated inferior surgical outcomes in patients with acetabular overcoverage as compared with normal acetabular coverage. Casual observation of our database suggested equivalent improvements, prompting a similar analysis. Purpose: To analyze patient-reported outcomes after hip arthroscopy for femoroacetabular impingement in patients with acetabular overcoverage who were matched with controls with normal coverage, as well as to analyze associations with reduction in LCEA. Study Design: Cohort study; Level of evidence, 3. Methods: Data were collected prospectively from patients with a minimum 2-year follow-up after receiving hip arthroscopy for femoroacetabular impingement by a single surgeon. Cases were reviewed to identify those with pincer-type morphology (LCEA >40°) and matched according to sex, age, chondral damage, and surgery date in a 1:1 ratio with controls with an LCEA of 25° to 40°. The surgical goal was to reduce the LCEA to the upper end of the normal range with minimal rim resection, usually 35° to 37°. Radiographic measurements of coverage, intraoperative findings, procedures, and patient-reported outcomes were recorded, including the 12-Item International Hip Outcome Tool, Non-arthritic Hip Score, Hip Disability and Osteoarthritis Outcome Score, visual analog scale for pain, rates of revision or reoperation, and conversion to total hip arthroplasty. Results: A total of 114 hips (93 patients) for the pincer group were matched 1:1 from 616 hips (541 patients) for the control group. The pincer group (mean ± SD age, 34.5 ± 12.2 years) did not differ in age, body mass index, or follow-up from controls. LCEA was reduced in both groups pre- to postoperatively: the pincer group from 44.0° ± 2.8° to 34.2° ± 3.5° and the controls from 32.9° ± 3.9° to 31.0° ± 3.0°. No differences in improvement were observed: iHOT-12 improved by 35.7 points in both groups ( P = .9 for analysis of variance interaction) and Nonarthritic Hip Score by 22.3 points ( P = .6). From all eligible surgical procedures, 2-year follow up rates were 2.5% and 2.6% for the pincer and control cohorts, respectively, and 1.2% and 0.3% for conversion to total hip arthroplasty. Conclusion: Arthroscopic management of acetabular overcoverage can achieve excellent results, equivalent to arthroscopy for other causes of symptomatic femoroacetabular impingement. A key finding was smaller rim resections producing a mean postoperative LCEA of 34.2° with a small standard deviation.

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Clinical and Radiographic Presentation of Capsular Iatrogenic Hip Instability After Previous Hip Arthroscopy

The American Journal of Sports Medicine ◽

10.1177/0363546520949821 ◽

2020 ◽

Vol 48 (12) ◽

pp. 2927-2932

Author(s):

Dillon C. O’Neill ◽

Alexander J. Mortensen ◽

Peter C. Cannamela ◽

Stephen K. Aoki

Keyword(s):

Hip Arthroscopy ◽

Daily Living ◽

Patient Reported Outcomes ◽

Harris Hip Score ◽

Hip Instability ◽

Computer Adaptive Test ◽

Adaptive Test ◽

Patient Reported ◽

Modified Harris Hip Score

Background: The clinical and radiographic features of iatrogenic hip instability following hip arthroscopy have been described. However, the prevalence of presenting symptoms and associated imaging findings in patients with hip instability has not been reported. Purpose: To detail the prevalence of clinical and magnetic resonance arthrogram (MRA) findings in a cohort of patients with isolated hip instability and to determine midterm patient-reported outcomes in this patient population. Study Design: Case series; Level of evidence, 4. Methods: We retrospectively reviewed patients from 2014 to 2016 who underwent an isolated capsular repair in the revision hip arthroscopy setting. Patients were excluded if they underwent any concomitant procedures, such as labral repair, reconstruction, femoral osteoplasty, or any other related procedure. Several clinical data points were reviewed, including painful activities, mechanical symptoms, subjective instability, Beighton scores, axial distraction testing (pain, toggle, and apprehension), and distractibility under anesthesia. Patient-reported outcomes—including modified Harris Hip Score, Hip Outcome Score–Sports Subscale, Patient-Reported Outcome Measurement Information System (PROMIS) Physical Function Computer Adaptive Test, and a return patient hip questionnaire—were collected pre- and postoperatively. Pre-revision radiographs were obtained, and lateral center-edge angle and alpha angle were measured on anteroposterior and frog-leg lateral views, respectively. Pre-revision MRAs were reviewed and evaluated for capsular changes. Capsular changes were defined as follows: 0, normal; 1, capsular redundancy; 2, focal capsular rent; and 3, gross extravasation of fluid from the capsule. Results: A total of 31 patients met inclusion criteria (5 male, 26 female; 14 right and 17 left hips). The mean age of patients was 36 years (range, 20-58 years). Overall, 27 (87%) reported hip pain with activities of daily living, and 31 (100%) experienced pain with sports or exercise. In addition, 24 (77%) had at least 1 positive finding on axial distraction testing. All patients had evidence of capsular changes on review of pre-revision MRAs. Out of 31 patients, 23 (74%) were available for follow-up at a minimum of 3.3 years and a mean ± SD of 4.6 ± 0.8 years. On average, modified Harris Hip Score improved by 20.3, Hip Outcome Score–Sports Subscale by 25.1, and PROMIS Physical Function Computer Adaptive Test by 6.4. Additionally, 20 (87%) patients reported improved or much improved physical ability, and 18 (78%) reported improved or much improved pain. Conclusion: The current study suggests that patients with hip instability demonstrate high rates of pain with activities of daily living and exercise, positive findings on axial distraction testing, and evidence of capsular changes on magnetic resonance imaging. Furthermore, these patients improve with revision surgery for capsular repair at midterm follow-up.

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