The perils of PROMs: question 5 of the Oxford Hip Score is ambiguous to 10% of English-speaking patients: a survey of 135 patients

2018 ◽  
Vol 29 (3) ◽  
pp. 299-302 ◽  
Author(s):  
Pierre H M Péchon ◽  
Katherine Butler ◽  
George Murphy ◽  
Gian C Singer
Keyword(s):  
Incidental Finding ◽  
Hip Resurfacing ◽  
Patient Reported Outcome ◽  
Hospital Data ◽  
Surgical Interventions ◽  
Patient Reported ◽  
Great Scrutiny ◽  
Hip Function ◽  
Oxford Hip Score ◽  
English Speaking

Introduction: The Oxford Hip Score (OHS) is a commonly used patient-reported outcome measure (PROM), comprising 12 questions. We present the incidental finding that one of the 12 questions is ambiguous. Materials and methods: As part of a 10-year follow-up of patients treated with hip resurfacing the OHS was posted to 148 patients; 135 (91%) replied. Scores were read by 2 orthopaedic surgery trainees and entered into a database. It was noted that Question 5 was frequently mis-interpreted. Results: Thirteen patients’ questionnaires (10%) showed the same inconsistency: question 5 was scored as 0 points but the other 11 questions were scored as either 3 or 4 in 97% of cases. The ethnic group of all 13 patients was recorded in hospital data as being White-British. Conclusion: Question 5 of the OHS is ambiguous to 10% of native English-speakers. These patients rated their hip function highly, as reflected by the fact that 97% of the questions other than question 5 scored 3 or 4, indeed 87% of them scored 4. We hypothesise that the wording of the zero score option “Not at all” is being mis-interpreted as a response indicating that the patient does not suffer any pain at all. The effect is an error of 4 points out of 48 (8%); this may under-estimate the patient’s hip score. Surgeons are under great scrutiny to prove efficacy of surgical interventions; this is often provided by PROMs. We should strive to formulate the most accurate, reproducible and least ambiguous PROMs questionnaires.

scholarly journals Assessing responsiveness of the EQ-5D-3L, the Oxford Hip Score, and the Oxford Knee Score in the NHS patient-reported outcome measures

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Sujin Kang
Keyword(s):  
Outcome Measures ◽  
Knee Replacement ◽  
Oxford Knee Score ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Knee Score ◽  
Paired Data ◽  
Replacement Surgery ◽  
Patient Reported ◽  
Oxford Hip Score

Abstract Background The degree to which a validated instrument is able to detect clinically significant change over time is an important issue for the better management of hip or knee replacement surgery. This study examines the internal responsiveness of the EQ-5D-3L, the Oxford Hip Score (OHS), and the Oxford Knee Score (OKS) by various methods. Data from NHS patient-reported outcome measures (PROMs) linked to the Hospital Episodes Statistics (HES) dataset (2009–2015) was analysed for patients who underwent primary hip surgery (N = 181,424) and primary knee surgery (N = 191,379). Methods Paired data-specific univariate responsiveness was investigated using the standardized response mean (SRM), the standardized effect size (SES), and the responsiveness index (RI). Multivariate responsiveness was furthermore examined using the defined capacity of benefit score (i.e. paired data-specific MCID), adjusting baseline covariates such as age, gender, and comorbidities in the Box-Cox regression models. The observed and predicted percentages of patient improvement were examined both as a whole and by the patients' self-assessed transition level. Results The results showed that both the OHS and the OKS demonstrated great univariate and multivariate responsiveness. The percentages of the observed (predicted) total improvement were high: 51 (54)% in the OHS and 73 (58)% in OKS. The OHS and the OKS showed distinctive differences in improvement by the 3-level transition, i.e. a little better vs. about the same vs. a little worse. The univariate responsiveness of the EQ-5D-3L showed moderate effects in total by Cohen’s thresholds. The percentages of improvement in the EQ-5D-3L were moderate: 44 (48)% in the hip and 42 (44)% for the knee replacement population. Conclusions Distinctive percentage differences in patients’ perception of improvement were observed when the paired data-specific capacity of benefit score was applied to examine responsiveness. This is useful in clinical practice as rationale for access to surgery at the individual-patient level. This study shows the importance of analytic methods and instruments for investigation of the health status in hip and/or knee replacement surgery. The study finding also supports the idea of using a generic measure along with the disease-specific instruments in terms of cross-validation.

scholarly journals Patient-led use of patient-reported outcome measure in self-Management of a Rotator Cuff Injury

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Maria J. Santana ◽  
Darrell J. Tomkins
Keyword(s):  
Rotator Cuff ◽  
Healthcare Providers ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Self Management ◽  
Care Organization ◽  
Surgical Interventions ◽  
Patient Reported ◽  
Rotator Cuff Injury ◽  
Dash Questionnaire

Abstract Introduction The patient is the person who experiences both the processes and the outcomes of care. Information held by the patient is vital for clinical and self-management, improving health outcomes, delivery of care, organization of health systems, and formulation of health policies. Patient-reported outcome measures (PROMs) play an important role in supporting patient’s self-management. This narrative describes a patient-led use of a PROM to self-manage after a rotator cuff injury. Methods This is a narrative of a patient who tore the supraspinatus tendon in her right shoulder in an accident. The Disabilities of the Arm, Shoulder and Hand, the DASH questionnaire, was used to monitor and self-manage recovery after the accident. The DASH questionnaire is a self-reported questionnaire that measures the difficulty in performing upper extremity activities and pain in the arm, shoulder or hand. It has been widely used in research studies, but here the patient initiated its use for self-management while waiting for and after rotator cuff surgery. The patient created separate sub-scale scores for function and for pain to answer questions from healthcare providers about her recovery. Results There was noticeable improvement over 3 months of conservative treatment, from a high level of disability of 56 to 39 (score changed 17); however, the scores were nowhere near the general population normative score of 10.1. Surgery improved the score from 39 pre-surgery to 28. Post-surgical interventions included physiotherapy, pain management and platelet-riched plasma treatment (PRP). The score was 14 4 weeks post-PRP. Conclusions The patient found the DASH useful in monitoring recovery from a rotator cuff injury (before and after surgery). The DASH contributed to communication with healthcare professionals and supported the clinical management. The DASH questionnaire was able to capture the patient’s experience with the injury and surgical recovery, corroborating an improvement in function while there was persistent post-surgical pain.

scholarly journals The Olympia anatomic polished cemented stem is associated with a high survivorship, excellent hip-specific functional outcome, and high satisfaction levels: follow-up of 239 consecutive patients beyond 15 years

2021 ◽  
Author(s):  
Gareth S. Turnbull ◽  
Claire Marshall ◽  
Jamie A. Nicholson ◽  
Deborah J. MacDonald ◽  
Nicholas D. Clement ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Femoral Stem ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
High Satisfaction ◽  
Age At Surgery ◽  
Patient Reported ◽  
Cemented Stem ◽  
Oxford Hip Score

Abstract Introduction The Olympia femoral stem is a stainless steel, anatomically shaped, polished and three-dimensionally tapered implant designed for use in cemented total hip arthroplasty (THA). The primary aim of this study was to determine the long-term survivorship, radiographic outcome, and patient-reported outcome measures (PROMs) of the Olympia stem. Patients and methods Between May 2003 and December 2005, 239 patients (264 THAs) underwent a THA with an Olympia stem in our institution. Patient-reported outcome measures were assessed using the Oxford Hip Score (OHS), EuroQol-5 dimensions (EQ-5D) score, and patient satisfaction at mean 10 years following THA. Patient records and radiographs were then reviewed at a mean of 16.5 years (SD 0.7, 15.3–17.8) following THA to identify occurrence of complications or revision surgery for any cause following surgery. Radiographs were assessed for lucent lines and lysis according to Gruen’s zones Results Mean patient age at surgery was 68.0 years (SD 10.9, 31–93 years). There were 156 women (65%, 176 THAs). Osteoarthritis was the indication for THA in 204 patients (85%). All cause stem survivorship at 10 years was 99.2% (95% confidence interval [CI], 97.9%–100%) and at 15 years was 97.5% (94.6%–100%). The 15-year stem survival for aseptic loosening was 100%. Analysis of all-cause THA failure demonstrated a survivorship of 98.5% (96.3%–100%) at 10 years and 95.9% (92.4%–99.4%) at 15 years. There were 9 THAs with non-progressive lucent lines in a single Gruen zone and 3 had lines in two zones, and no patient demonstrated signs for lysis. At a mean of 10-year (SD 0.8, 8.7–11.3) follow-up, mean OHS was 39 (SD 10.3, range 7–48) and 94% of patients reported being very satisfied or satisfied with their THA. Conclusions The Olympia stem demonstrated excellent 10-year PROMs and very high rates of stem survivorship at final follow-up beyond 15 years.

Patient-Reported Outcome following Metal-On-Metal Resurfacing of the Hip and Total Hip Replacement

2009 ◽  
Vol 19 (3) ◽  
pp. 245-250 ◽  
Author(s):  
David P. Hall ◽  
Del Srikantharajah ◽  
Raimond E. Anakwe ◽  
Paul Gaston ◽  
Colin R. Howie
Keyword(s):  
Total Hip Replacement ◽  
Hip Replacement ◽  
Short Form ◽  
Length Of Hospital Stay ◽  
Multivariate Regression Analysis ◽  
Hip Resurfacing ◽  
Patient Reported Outcome ◽  
Additional Patient ◽  
Total Hip ◽  
Patient Reported

Patient-reported outcome and satisfaction scores have become increasingly important in evaluating successful surgery. This case-matched control study compared patient-reported outcome and satisfaction data following hip resurfacing and total hip arthroplasty. Thirty-three consecutive patients selected for hip resurfacing were compared with 99 patients undergoing cemented total hip replacement (THR), matched for age, sex and pathology. Participants completed a Short-Form 12 Health Survey (SF-12) and Oxford Hip Score questionnaire preoperatively and 6 months post operatively with an additional patient satisfaction questionnaire. There was no difference in length of hospital stay. While both groups reported improved outcome scores, multivariate regression analysis did not demonstrate any significant benefit for one group over the other. Both groups reported high levels of satisfaction, which tended to be better in patients undergoing hip resurfacing.

Functionally Crippled Nose

2020 ◽  
Vol 36 (01) ◽  
pp. 066-071
Author(s):  
Priyesh Patel ◽  
Sam P. Most
Keyword(s):  
Nasal Obstruction ◽  
Primary Care Physicians ◽  
Diagnostic Testing ◽  
Treatment Strategies ◽  
Objective Measure ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Surgical Interventions ◽  
Patient Reported ◽  
Facial Plastic

AbstractNasal obstruction is a common presenting symptom of patients seen by primary care physicians, otolaryngologists, and facial plastic surgeons. A variety of treatment strategies, both surgical and nonsurgical, have been used with success in improving nasal obstruction and quality of life. In a subset of patients, many of whom have either attempted these common treatment strategies or are intolerant of them, nasal obstruction remains a significant symptom. In these patients, there may be an identifiable problem, but it is simply not repairable or there is no identifiable anatomic issue. The management of these patients is discussed in this article, with an emphasis on a sensitive approach that takes into consideration a patient's mental health. While the need for diagnostic testing is generally not necessary for most cases of nasal obstruction, endoscopy and imaging should be considered in these patients. Validated patient-reported outcome measures are particularly helpful in providing an objective measure to a patient's frustrating symptoms. A variety of medications can be either contributory to the patient's symptoms or therapeutic if used appropriately. A variety of surgical interventions can also result in a functionally crippled nose and diagnoses including nasal valve stenosis, septal perforations, and empty nose syndrome are discussed. Importantly, further surgical interventions may not be appropriate if a deformity is minimal, and a surgeon should resist the temptation to proceed with surgery in those situations.

scholarly journals A protocol for a nationwide multicentre, prospective surveillance cohort and nested-consented cohort to determine the incidence and clinical outcomes of slipped capital femoral epiphysis

2020 ◽  
Vol 1 (3) ◽  
pp. 35-40 ◽  
Author(s):  
Daniel C Perry ◽  
Barbara Arch ◽  
Duncan Appelbe ◽  
Priya Francis ◽  
Catherine Spowart ◽  
...  
Keyword(s):  
Cohort Study ◽  
Intervention Studies ◽  
Slipped Capital Femoral Epiphysis ◽  
Treatment Strategies ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Surgical Interventions ◽  
Patient Reported ◽  
Hip Diseases ◽  
External Sources

Aims Slipped capital femoral epiphysis (SCFE) is one of the most common hip diseases of adolescence that can cause marked disability, yet there is little robust evidence to guide treatment. Fundamental aspects of the disease, such as frequency, are unknown and consequently the desire of clinicians to undertake robust intervention studies is somewhat prohibited by a lack of fundamental knowledge. Methods The study is an anonymized nationwide comprehensive cohort study with nested consented within the mechanism of the British Orthopaedic Surgery Surveillance (BOSS) Study. All relevant hospitals treating SCFE in England, Scotland, and Wales will contribute anonymized case details. Potential missing cases will be cross-checked against two independent external sources of data (the national administrative data and independent trainee data). Patients will be invited to enrich the data collected by supplementing anonymized case data with patient-reported outcome measures. In line with recommendations of the IDEAL Collaboration, the study will primarily seek to determine incidence, describe case mix and variations in surgical interventions, and explore the relationships between baseline factors (patients and types of interventions) and two-year outcomes. Discussion This is the first disease to be investigated using the BOSS Study infrastructure. It provides a robust method to determine the disease frequency, and a large unbiased sample of cases from which treatment strategies can be investigated. It may form the basis for definitive robust intervention studies or, where these are demonstrated not to be feasible, this may be the most robust cohort study.

scholarly journals Orthopaedic registries: the Australian experience

2019 ◽  
Vol 4 (6) ◽  
pp. 409-415 ◽  
Author(s):  
Richard N. de Steiger ◽  
Stephen E. Graves
Keyword(s):  
Joint Replacement ◽  
Patient Reported Outcome Measures ◽  
Hip Resurfacing ◽  
Patient Reported Outcome ◽  
Annual Reports ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Patient Reported ◽  
Australian Experience

The Australian Orthopaedic Association National Joint Replacement Registry first began data collection on 1 September 1999 and full nationwide implementation commenced in January 2003. The purpose of the Registry is to improve the quality of care for individuals receiving joint replacement surgery. The Registry enables surgeons, academic institutions, governments and industry to request specific data that are not available in published annual reports. There is an established system for identifying prostheses with a higher than anticipated rate of revision (HTARR) which was introduced in 2004. The higher rate of revision for the ASR Hip Resurfacing System was first identified by this process in 2007. There has been a reduction in revision hip and knee replacement over the years that the Registry has been in operation, and the addition of Patient Reported Outcome Measures (PROMs) and data linkage will enable more extensive analysis of joint replacement surgery in the future. Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180071

scholarly journals Surgical Treatments of Talar Osteochondral Lesion: A Long-term Follow-up of Return to Sport and Patient-Reported Outcome Measures

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0037
Author(s):  
Andrew Schwartz ◽  
Shuo Niu ◽  
Faris Mirza ◽  
Ashley Thomas ◽  
Sameh Labib
Keyword(s):  
Outcome Measures ◽  
Osteochondral Lesion ◽  
Return To Sport ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Surgical Interventions ◽  
Patient Reported ◽  
Long Term Follow Up ◽  
And Function

Category: Ankle, Arthroscopy, Sports, Trauma Introduction/Purpose: Talar osteochondral lesion (TOCL) is a common problem in the young athletic population, mostly related to trauma. TOCL surgical treatment algorithm remains controversial, though results are improving as we gain experience. The results of TOCL surgical treatment on function and return to sport are promising, but quantified return to sport metrics remain largely unknown. Methods: A total of 156 consecutive patients following TOCL chondroplasty (10/1/2000-5/31/2018) by a single practice were retrospectively reviewed and included in this study. There were 54.5% female with a mean age 38.2 years, and mean follow-up 40.2 months following the index surgery. Patients were divided into four groups according to the type of chondroplasty performed: Antegrade arthroscopic drilling and/or microfracture (antegrade, 83 patients), retrograde arthroscopic drilling (retrograde, 35 patients), osteochondral autograft transfer (OATS, 26 patients), and allograft cartilage implantation (allograft, 12 patients). VAS scores for pain and function at the final clinic visit were collected. Patient-reported outcome measures including the short form-12 (SF-12), The Foot and Ankle Disability Index Sports Module (FADI-sports), Tegner score, Marx scale, Naal’s Sports inventory are also actively being collected. Results: Nearly 75% of patients are satisfied with surgical intervention of TOCLs. Allograft transplant was the least satisfying (71.4%), while OATS was the most satisfying (90%). Each surgical intervention yielded significantly decreased pain and increased function postoperatively (all p<0.001). Currently, 57 patients (36%) provided patient-reported outcome measures, with an average follow up of 79.8 months (Table 1). All surgical interventions trended toward decreased Tegner score, though only antegrade drilling showed a significant decrease (p<0.001). Based on Naal’s sports inventory, 85.7% of surgically treated patients reported participating in sport activities, on average 3 times/week and 50.6 minutes/session. Conclusion: Traditionally, TOCLs presented a difficult problem that is marred by unsatisfactory surgical outcomes in typically active patients. As our surgical understanding has evolved, we’ve continued to improve on outcomes. Our patients demonstrated a 74.5% satisfaction rate, a statistically significant improvement in pain and function, and a high rate of return to sport with little difference between surgical interventions at a long-term follow-up.

scholarly journals Assessing the Attitudes, Awareness, and Behavioral Alterations of Patients Awaiting Total Hip Arthroplasty During the COVID-19 Crisis

2020 ◽  
Vol 11 ◽  
pp. 215145932096937
Author(s):  
Stephen Fahy ◽  
Joss Moore ◽  
Michael Kelly ◽  
Shane Irwin ◽  
Paddy Kenny
Keyword(s):  
Mental Health ◽  
Short Form ◽  
Hip Osteoarthritis ◽  
Surgical Care ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Harris Hip Score ◽  
Physical And Mental Health ◽  
Patient Reported ◽  
Hip Function

Background: COVID-19 has placed a huge burden on healthcare systems which has led to widespread cancellation elective surgical care. Ireland is recovering from the first wave of COVID-19 and as such the expeditious return of elective surgical care is important. This is the first study to examine the attitudes of patients to undergoing total joint arthroplasty during the COVID-19 crisis. Methods: A prospective qualitative study was undertaken in our institution during the week 13/05/2020-20/05/2020. 65 patients completed a questionnaire assessing attitudes, awareness, and behavioral changes associated with COVID-19, a Charlson Comorbidity Index, modified-Harris Hip Score, and a Short Form-12 score. Results: 86% of patients felt that they were at little to no risk of COVID-19 infection. The majority of patients were happy to proceed with surgery at the current level of COVID-19 related threat (86%). Patients with higher mHHS were more likely to postpone their operation than those with lower mHHS scores. Our cohort had low patient reported outcome measures in both mHHS and SF-12, indicating the significant burden of hip osteoarthritis on both physical and mental health. Conclusion: Patients reported a significant disease-related impairment of physical function and subsequent deterioration in mental health as a result of hip osteoarthritis. Patients with worse hip function, as measured by the mHHS are more willing to proceed with surgery than those with superior hip function. This offers a potential mechanism by which to triage patients once elective surgical pathways reopen in the coming months.

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