VALIDITY, MEANS, AND DISTRIBUTION OF THE HSS PEDI-FABS IN PEDIATRIC ATHLETES AND IN COMMON SPORTS

BACKGROUND: Patient reported outcome measures (PROMs) measuring activity level can be crucial to a musculoskeletal provider in both a clinical and research setting. The HSS Pedi-FABS was developed as a generalizable measure of activity in children ages 10-18. However, existing literature validating this scale is limited by small patient populations leading to underrepresentation of multiple sports. The purpose of this study is to assess the validity of the HSS Pedi-FABS when used in a large pediatric population participating in various sports and evaluate the means and distribution of Pedi-FABS amongst common sports. METHODS: A retrospective review of 517 subjects who completed the HSS Pedi-FABS while presenting for knee evaluation was performed. Subjects were seen by one of five providers at a pediatric sport medicine center between October 2016 and June 2017. Subjects were included in analysis if they completed the HSS Pedi-FABS and had reported status as an athlete. Patient demographics, primary sport, multi-sport involvement, level of competition, frequency of play, HSS Pedi-FABS and Tegner Activity Level Scale (Tegner) scores were reviewed. The Tegner asked subjects to classify their activity level prior to injury. To determine validity, the HSS Pedi-FABS was compared to the Tegner. S-correlations were calculated between the two activity scales. Each scale was then correlated with level of activity and frequency of play. A t-test was run between the HSS Pedi-FABS scores and multi-sport involvement. Distributions of the HSS Pedi-FABS scores were calculated across the eight most frequent primary sports reported by the sample population. ANOVA analyses were performed with the HSS Pedi-FABS and Tegner Before scores of the eight primary sports. The ANOVA analyses were followed by t-tests for multiple comparisons. RESULTS: Of the 424 athletes included in the study, 227 (53.5%) were female and 197 (46.5%) were male. The mean age was 14.29 years (range: 6.48-22.35). 207 (48.8%) were multi-sport athletes while 215 (50.7%) were considered single-sport athletes. 2 (0.5%) had an unknown status. There was a significant difference between HSS Pedi-FABS scores of multi-sport athletes versus single-sport athletes (22.0 versus 20.36, respectfully, p=.027). Correlations were found between the HSS Pedi-FABS and days per week playing a primary sport (r=0.273; p<0.001), hours per week playing primary sport (r=0.292, p<0.001), and weeks NOT engaged in sports (r=-0.112, p=0.039). In this data, there was no correlation with perceived level of competition and HSS Pedi-FABS. There was no statistical correlation found between the HSS Pedi-FABS and the Tegner with a similar mean HSS Pedi FABS scores seen in each Tegner group >5. The Tegner scale did not statistically correlate with hours per week or days per week. The HSS Pedi-FABS showed a significant difference in scores between the eight most frequent primary sports (p=0.001). Subjects whose primary sport was Soccer scored significantly higher (23.57 ± 6.27) than those of Dance/Drill Team/Ballet (17.45 ± 6.38) and Track and Field/Running/Cross Country (17.47 ± 5.74, p=.001, .024). Frequency distributions of each sports are seen in Figure 1. CONCLUSION: The HSS Pedi-FABS, as compared to the Tegner, has significant correlation with time spent while playing a primary sport. Normal distribution of the HSS Pedi FABS may be different based on sports. Further analysis of multiple joints could provide a more comprehensive understanding of Pedi-FABS scoring trends in pediatric athletes. [Figure: see text]

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An electronic patient-reported outcomes measurement system in paediatric orthopaedics

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.13.190053 ◽

2019 ◽

Vol 13 (4) ◽

pp. 431-437 ◽

Cited By ~ 7

Author(s):

M. J. Sabatino ◽

C. V. Gans ◽

A. J. Zynda ◽

J. S. Chung ◽

S. M. Miller ◽

...

Keyword(s):

International Knee Documentation Committee ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Activity Level ◽

Level Of Evidence ◽

Assess Patient Satisfaction ◽

Patient Reported ◽

Group 2 ◽

Level Scale ◽

Tegner Activity Level

Purpose The purpose of the study was to evaluate the reliability, review differences and assess patient satisfaction of electronic patient-reported outcome measures (PROMs) compared with paper PROMs. Methods Participants between 12 and 19 years of age with a knee-related primary complaint were randomized into two groups. Group 1 completed paper PROMs followed by electronic, while Group 2 received the electronic followed by paper. PROMs included the Pediatric International Knee Documentation Committee (Pedi-IKDC), Hospital for Special Surgery (HSS) Pediatric Functional Activity Brief Scale (HSS Pedi-FABS), Tegner Activity Level Scale, Visual Analogue Scale (VAS), PedsQL Teen and a satisfaction survey. Results In all, 87 participants were enrolled with one excluded due to incomplete PROMs. Of the 86 participants, 54 were female and 32 were male with an average age of 14.3 years (12 to 18). A high degree of reliability was found when comparing the paper and electronic versions of the Pedi-IKDC (0.946; p < 0.001), HSS Pedi-FABS (0.923; p < 0.001), PedsQL Teen (0.894; p < 0.001), Tegner Activity Level Scale before injury (0.848; p < 0.001) and the Tegner Activity Level Scale after (0.930; p < 0.001). Differences were noted between the VAS scores, with paper scores being significantly higher than electronic (5.3 versus 4.6; p < 0.001). While not significant, a trend was noted in which electronic PROMs took, overall, less time than paper (10.0 mins versus 11.2 mins; p = 0.096). Of all participants, 69.8% preferred the electronic PROMs, 67.4% felt they were faster, 93.0% stated they would complete forms at home prior to appointments and 91.8% were not concerned about the safety/privacy of electronic forms. Conclusion PROMs captured electronically were reliable when compared with paper. Electronic PROMs may be quicker, will not require manual scoring and are preferred by patients. Level of Evidence II

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Conservative management acutely improves functional movement and clinical outcomes in patients with pre-arthritic hip pain

Journal of Hip Preservation Surgery ◽

10.1093/jhps/hnz075 ◽

2020 ◽

Vol 7 (1) ◽

pp. 95-102 ◽

Cited By ~ 2

Author(s):

Ryan P McGovern ◽

RobRoy L Martin ◽

Amy L Phelps ◽

Benjamin R Kivlan ◽

Beth Nickel ◽

...

Keyword(s):

Outcome Measures ◽

Conservative Management ◽

Movement Control ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Hip Pain ◽

Analysis Of Covariance ◽

Functional Movement ◽

Significant Difference ◽

Patient Reported

Abstract Conservative management for individuals with pre-arthritic hip pain is commonly prescribed prior to consideration of surgical management. The purpose of this study is to determine if patients with pre-arthritic hip pain will improve their functional movement control and clinical outcome measures following the implementation of physical therapy and a home-exercise programme. Information was retrospectively collected on consecutive patients and included: demographics, diagnosis, initial and follow-up evaluation of the single leg squat test (SLST) and step-down test (SDT), and patient-reported outcome measures. An independent t-test and one-way analysis of covariance were performed for continuous patient-reported outcome measures and a Fisher’s exact test was performed for patient satisfaction. Forty-six patients (31 female and 15 male) diagnosed with pre-arthritic hip pain were included. A total of 30 patients improved their functional movement control during performance of the SLST, whereas 31 patients improved performance of the SDT. There was a statistically significant difference between patients that improved and did not improve (P ≤ 0.017). Patients with pre-arthritic hip pain who improved their functional movement control following a prescribed rehabilitation intervention are likely to report less pain and greater functional ability in their daily and sports-related activities. This study supports conservative management to acutely improve outcomes for patients with pre-arthritic hip pain.

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Mid-term Prospective Follow-up of Ankle Fracture Fixation Using Patient Reported Outcome Measures

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00393 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0039

Author(s):

Paul Rai ◽

Jitendra Mangwani

Keyword(s):

Outcome Measures ◽

Ankle Fracture ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Ankle Fractures ◽

Anatomical Reduction ◽

Clear Space ◽

Significant Difference ◽

Patient Reported

Category: Trauma Introduction/Purpose: Open reduction and internal fixation (ORIF) is a common procedure to stabilise unstable ankle fractures. Anatomical reduction and stable fixation is desirable to achieve good clinical and radiological outcome after this injury. This prospective study examines the correlation between mid-term patient reported outcome measures (PROMs) and quality of fracture reduction of adult patients with ankle fractures treated with ORIF. Methods: A total of 100 patients with unstable ankle fracture who underwent ORIF were prospectively entered into the study between Nov 2013 to Oct 2014. Exclusion criteria were: age <18 years, pathological or open fractures and patients with cognitive impairment. Two independent observers assessed fracture patterns and quality of reduction. Fixations were analysed using Pettrone’s criteria including assessment of fracture displacement, medial clear space and tibiofibular overlap. Patients were followed up at two years post-operatively with postal questionnaires. Validated PROMs, Olerud-Molander Score (OMAS) and the Lower Extremity Functional Scale (LEFS) were used. For both scores a higher number indicated a better result. Co-morbidities and infection data were collated from Hospital records. Results: At 2 years post-op there were 5 deceased patients,17 did not have accessible radiographs and there was a 65% response rate to questionnaires. 46 patients were included in the final study group with a mean age of 45 (16-90). There was 1 Weber A fracture, 26 Weber B, 16 Weber C and 3 Medial malleolus fractures. 7% had Diabetes Mellitus, 22% were smokers. The mean OMAS score was 71.4(SD26.9) and LEFS score 56.7(SD25.9). There was no significant difference in PROM scores when fracture fragment reduction was optimised. There was a significant improvement in PROMs with low medial clear space and high tibiofibular overlap. Conclusion: This study reports a good correlation between quality of reduction and favourable PROMs at 2 years post ORIF ankle fracture. Reduced medial clear space and increased tibiofibular overlap were most associated with good outcome scores. Anatomical reduction of fracture fragments did not appear to affect PROMs on its own. There was very little infection in this cohort to confound the results. We would advise careful consideration of medial clear space and tibiofibular overlap in particular at time of fixation of unstable ankle fractures.

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Lisfranc injuries: fix or fuse?

Bone & Joint Open ◽

10.1302/2633-1462.210.bjo-2021-0127.r1 ◽

2021 ◽

Vol 2 (10) ◽

pp. 842-849

Author(s):

Noortje Anna Clasina van den Boom ◽

Guido A. N. L. Stollenwerck ◽

Laureanne Lodewijks ◽

Jeroen Bransen ◽

Silvia M. A. A. Evers ◽

...

Keyword(s):

Meta Analysis ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Risk Of Bias ◽

Level Of Evidence ◽

Assessment Development ◽

Significant Difference ◽

Patient Reported ◽

Mean Differences ◽

Lisfranc Injuries

Aims This systematic review and meta-analysis was conducted to compare open reduction and internal fixation (ORIF) with primary arthrodesis (PA) in the treatment of Lisfranc injuries, regarding patient-reported outcome measures (PROMs), and risk of secondary surgery. The aim was to conclusively determine the best available treatment based on the most complete and recent evidence available. Methods A systematic search was conducted in PubMed, Cochrane Controlled Register of Trials (CENTRAL), EMBASE, CINAHL, PEDro, and SPORTDiscus. Additionally, ongoing trial registers and reference lists of included articles were screened. Risk of bias (RoB) and level of evidence were assessed using the Cochrane risk of bias tools and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. The random and fixed-effect models were used for the statistical analysis. Results A total of 20 studies were selected for this review, of which 12 were comparative studies fit for meta-analysis, including three randomized controlled trials (RCTs). This resulted in a total analyzed population of 392 patients treated with ORIF and 249 patients treated with PA. The mean differences between the two groups in American Orthopedic Foot and Ankle Society (AOFAS), VAS, and SF-36 scores were -7.41 (95% confidence interval (CI) -13.31 to -1.51), 0.77 (95% CI -0.85 to 2.39), and -1.20 (95% CI -3.86 to 1.46), respectively. Conclusion This is the first study to find a statistically significant difference in PROMs, as measured by the AOFAS score, in favour of PA for the treatment of Lisfranc injuries. However, this difference may not be clinically relevant, and therefore drawing a definitive conclusion requires confirmation by a large prospective high-quality RCT. Such a study should also assess cost-effectiveness, as cost considerations might be decisive in decision-making. Level of Evidence: I Cite this article: Bone Jt Open 2021;2(10):842–849.

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No clinically meaningful difference in 1-year patient-reported outcomes among major approaches for primary total hip arthroplasty

Hip International ◽

10.1177/1120700021992013 ◽

2021 ◽

pp. 112070002199201

Author(s):

◽

James B Bircher ◽

Atul F Kamath ◽

Nicolas S Piuzzi ◽

Wael K Barsoum ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Consecutive Series ◽

Total Hip ◽

Pain Scores ◽

Significant Difference ◽

Patient Reported ◽

Primary Total Hip Arthroplasty

Background: Debate continues around the most effective surgical approach for primary total hip arthroplasty (THA). This study’s purpose was to compare 1-year patient-reported outcome measures (PROMs) of patients who underwent direct anterior (DA), transgluteal anterolateral (AL)/direct lateral (DL), and posterolateral (PL) approaches. Methods: A prospective consecutive series of primary THA for osteoarthritis ( n = 2,390) were performed at 5 sites within a single institution with standardised care pathways (20 surgeons). Patients were categorised by approach: DA ( n = 913; 38%), AL/DL ( n = 505; 21%), or PL ( n = 972; 41%). Primary outcomes were pain, function, and activity assessed by 1-year postoperative PROMs. Multivariable regression modeling was used to control for differences among the groups. Wald tests were performed to test the significance of select patient factors and simultaneous 95% confidence intervals were constructed. Results: At 1-year postoperative, PROMs were successfully collected from 1842 (77.1%) patients. Approach was a statistically significant factor for 1-year HOOS pain ( p = 0.002). Approach was not a significant factor for 1-year HOOS-PS ( p = 0.16) or 1-year UCLA activity ( p = 0.382). Pairwise comparisons showed no significant difference in 1-year HOOS pain scores between DA and PL approach ( p > 0.05). AL/DL approach had lower (worse) pain scores than DA or PL approaches with differences in adjusted median score of 3.47 and 2.43, respectively ( p < 0.05). Conclusions: Patients receiving the AL/DL approach had a small statistical difference in pain scores at 1 year, but no clinically meaningful differences in pain, activity, or function exist at 1-year postoperative.

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Are responders to patient health surveys representative of those invited to participate? An analysis of the Patient-Reported Outcome Measures Pilot from the Australian Orthopaedic Association National Joint Replacement Registry

PLoS ONE ◽

10.1371/journal.pone.0254196 ◽

2021 ◽

Vol 16 (7) ◽

pp. e0254196

Author(s):

Ian A. Harris ◽

Kara Cashman ◽

Michelle Lorimer ◽

Yi Peng ◽

Ilana Ackerman ◽

...

Keyword(s):

Outcome Measures ◽

Joint Replacement ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Telephone Call ◽

Joint Replacement Registry ◽

Asa Score ◽

Significant Difference ◽

Patient Reported

Background Patient-reported outcome measures (PROMs) are commonly used to evaluate surgical outcome in patients undergoing joint replacement surgery, however routine collection from the target population is often incomplete. Representative samples are required to allow inference from the sample to the population. Although higher capture rates are desired, the extent to which this improves the representativeness of the sample is not known. We aimed to measure the representativeness of data collected using an electronic PROMs capture system with or without telephone call follow up, and any differences in PROMS reporting between electronic and telephone call follow up. Methods Data from a pilot PROMs program within a large national joint replacement registry were examined. Telephone call follow up was used for people that failed to respond electronically. Data were collected pre-operatively and at 6 months post-operatively. Responding groups (either electronic only or electronic plus telephone call follow up) were compared to non-responders based on patient characteristics (joint replaced, bilaterality, age, sex, American Society of Anesthesiologist (ASA) score and Body Mass Index (BMI)) using chi squared test or ANOVA, and PROMs for the two responder groups were compared using generalised linear models adjusted for age and sex. The analysis was restricted to those undergoing primary elective hip, knee or shoulder replacement for osteoarthritis. Results Pre-operatively, 73.2% of patients responded electronically and telephone follow-up of non-responders increased this to 91.4%. Pre-operatively, patients responding electronically, compared to all others, were on average younger, more likely to be female, and healthier (lower ASA score). Similar differences were found when telephone follow up was included in the responding group. There were little (if any) differences in the post-operative comparisons, where electronic responders were on average one year younger and were more likely to have a lower ASA score compared to those not responding electronically, but there was no significant difference in sex or BMI. PROMs were similar between those reporting electronically and those reporting by telephone. Conclusion Patients undergoing total joint replacement who provide direct electronic PROMs data are younger, healthier and more likely to be female than non-responders, but these differences are small, particularly for post-operative data collection. The addition of telephone call follow up to electronic contact does not provide a more representative sample. Electronic-only follow up of patients undergoing joint replacement provides a satisfactory representation of the population invited to participate.

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Minimum ten-year follow-up of a randomized trial comparing acetabular component fixation of two porous in-growth surfaces using radiosteriometric analysis

Bone & Joint Open ◽

10.1302/2633-1462.110.bjo-2020-0118.r1 ◽

2020 ◽

Vol 1 (10) ◽

pp. 653-662

Author(s):

Luthfur Rahman ◽

Mazin S. Ibrahim ◽

Lyndsay Somerville ◽

Matthew G. Teeter ◽

Douglas D. Naudie ◽

...

Keyword(s):

Randomized Trial ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

P Value ◽

Significant Difference ◽

Patient Reported ◽

Acetabular Components

Aims To compare the in vivo long-term fixation achieved by two acetabular components with different porous ingrowth surfaces using radiostereometric analysis (RSA). Methods This was a minimum ten-year follow-up of a prospective randomized trial of 62 hips with two different porous ingrowth acetabular components. RSA exams had previously been acquired through two years of follow-up. Patients returned for RSA examination at a minimum of ten years. In addition, radiological appearance of these acetabular components was analyzed, and patient-reported outcome measures (PROMs) obtained. Results In all, 15 hips were available at ten years. There was no statistically significant difference in PROMS between the two groups; PROMs were improved at ten years compared to preoperative scores. Conventional radiological assessment revealed well-fixed components. There was minimal movement for both porous surfaces in translation (X, Y, Z, 3D translation in mm (median and interquartile range (IQR)), StikTite (Smith and Nephew, Memphis, Tennessee, USA): 0.03 (1.08), 0.12 (0.7), 0.003 (2.3), 0.37 (0.30), and Roughcoat (Smith and Nephew): -0.6 (0.59),–0.1 (0.49), 0.1 (1.12), 0.48 (0.38)), and rotation (X, Y, Z rotation in degrees (median and IQR), (Stiktite: -0.4 (3), 0.28 (2), -0.2 (1), and Roughcoat: - 0.4 (1),–0.1 (1), 0.2 (2)). There was no statistically significant difference between the two cohorts (p-value for X, Y, Z, 3D translation - 0.54, 0.46, 0.87, 0.55 and for X, Y, Z rotation - 0.41, 0.23, 0.23 respectively) at ten years. There was significant correlation between two years and ten years 3D translation for all components ( r = 0.81(p =< 0.001)). Conclusion Both porous ingrowth surfaces demonstrated excellent fixation on plain radiographs and with RSA at ten years. Short-term RSA data are good predictors for long-term migration data.

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Relationship Between Sports Participation After Revision Anterior Cruciate Ligament Reconstruction and 2-Year Patient-Reported Outcome Measures

The American Journal of Sports Medicine ◽

10.1177/0363546519856348 ◽

2019 ◽

Vol 47 (9) ◽

pp. 2056-2066

Author(s):

◽

John P. Bigouette ◽

Erin C. Owen ◽

Brett (Brick) A. Lantz ◽

Rudolf G. Hoellrich ◽

...

Keyword(s):

Revision Surgery ◽

Cruciate Ligament ◽

Sports Participation ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Activity Level ◽

Acl Revision ◽

Patient Reported ◽

Anterior Cruciate

Background: Anterior cruciate ligament (ACL) revision cohorts continually report lower outcome scores on validated knee questionnaires than primary ACL cohorts at similar time points after surgery. It is unclear how these outcomes are associated with physical activity after physician clearance for return to recreational or competitive sports after ACL revision surgery. Hypotheses: Participants who return to either multiple sports or a singular sport after revision ACL surgery will report decreased knee symptoms, increased activity level, and improved knee function as measured by validated patient-reported outcome measures (PROMs) and compared with no sports participation. Multisport participation as compared with singular sport participation will result in similar increased PROMs and activity level. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 1205 patients who underwent revision ACL reconstruction were enrolled by 83 surgeons at 52 clinical sites. At the time of revision, baseline data collected included the following: demographics, surgical characteristics, previous knee treatment and PROMs, the International Knee Documentation Committee (IKDC) questionnaire, Marx activity score, Knee injury and Osteoarthritis Outcome Score (KOOS), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). A series of multivariate regression models were used to evaluate the association of IKDC, KOOS, WOMAC, and Marx Activity Rating Scale scores at 2 years after revision surgery by sports participation category, controlling for known significant covariates. Results: Two-year follow-up was obtained on 82% (986 of 1205) of the original cohort. Patients who reported not participating in sports after revision surgery had lower median PROMs both at baseline and at 2 years as compared with patients who participated in either a single sport or multiple sports. Significant differences were found in the change of scores among groups on the IKDC ( P < .0001), KOOS-Symptoms ( P = .01), KOOS–Sports and Recreation ( P = .04), and KOOS–Quality of Life ( P < .0001). Patients with no sports participation were 2.0 to 5.7 times more likely than multiple-sport participants to report significantly lower PROMs, depending on the specific outcome measure assessed, and 1.8 to 3.8 times more likely than single-sport participants (except for WOMAC-Stiffness, P = .18), after controlling for known covariates. Conclusion: Participation in either a single sport or multiple sports in the 2 years after ACL revision surgery was found to be significantly associated with higher PROMs across multiple validated self-reported assessment tools. During follow-up appointments, surgeons should continue to expect that patients who report returning to physical activity after surgery will self-report better functional outcomes, regardless of baseline activity levels.

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Operative repair of acute Achilles tendon rupture does not give superior patient-reported outcomes to nonoperative management

The Bone & Joint Journal ◽

10.1302/0301-620x.102b7.bjj-2019-0783.r3 ◽

2020 ◽

Vol 102-B (7) ◽

pp. 933-940 ◽

Cited By ~ 1

Author(s):

Julian F. Maempel ◽

Nicholas D. Clement ◽

Neil R. Wickramasinghe ◽

Andrew D. Duckworth ◽

John F. Keating

Keyword(s):

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Patient Reported Outcome Measures ◽

Nonoperative Treatment ◽

Patient Reported Outcome ◽

Significant Difference ◽

Patient Reported ◽

Long Term Follow Up

Aims The aim was to compare long-term patient-reported outcome measures (PROMs) after operative and nonoperative treatment of acute Achilles tendon rupture in the context of a randomized controlled trial. Methods PROMs including the Short Musculoskeletal Function Assessment (SMFA), Achilles Tendon Total Rupture Score (ATRS), EuroQol five-dimension (EQ-5D), satisfaction, net promoter score and data regarding re-rupture, and venous thromboembolic rates were collected for patients randomized to receive either operative or nonoperative treatment for acute Achilles tendon rupture in a previous study. Of the 80 patients originally randomized, 64 (33 treated surgically, 31 nonoperatively) patients were followed up at a mean of 15.7 years (13.4 to 17.7). Results There was no statistically significant difference between operatively and nonoperatively treated patients, in SMFA Dysfunction Index (median 1.56 (interquartile range (IQR) 0 to 5.51) vs 1.47 (IQR 0 to 5.15); p = 0.289), SMFA Bother Index (2.08 (IQR 0 to 12.50) vs 0.00 (IQR 0 to 6.25); p = 0.074), ATRS (94 (IQR 86 to 100) vs 95 (IQR 81 to 100); p = 0.313), EQ-5D-5L (1 (IQR 0.75 to 1) vs 1 (IQR 0.84 to 1); p = 0.137) or EQ-5D health today visual analogue score (85 (IQR 72.5 to 95) vs 85 (IQR 8 to 95); p = 0.367). There was no statistically significant difference between operative and nonoperative groups in terms of satisfaction (84% vs 100%; p = 0.119) or willingness to recommend treatment to friends or family (79% vs 87%; p = 0.255). Four nonoperative patients and two in the operative group sustained a re-rupture (p = 0.306). Conclusion Both patient groups reported good results at long-term follow-up. The findings give no evidence of superior long-term patient reported outcomes (as measured by the SMFA) for surgical treatment over nonoperative treatment. There was no demonstrable difference in other patient reported outcome measures, satisfaction, or re-rupture rates at long-term follow-up. Cite this article: Bone Joint J 2020;102-B(7):933–940.

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Exaggerated Pre-Operative Patient Reported Visual Analog Pain Scale, A Retrospective review of 201 consecutive surgical patients

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000283 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0002

Author(s):

Kevin Martin ◽

Laura Dawson ◽

Kenneth Cameron ◽

Jeffrey Van Buren

Keyword(s):

Outcome Measures ◽

Nursing Staff ◽

Healthcare Providers ◽

Office Visit ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Vas Score ◽

Pain Scores ◽

Significant Difference ◽

Patient Reported

Category: Patient Reported Outcomes Introduction/Purpose: The visual analog scale (VAS) is a reliable and validated measure of patient reported acute pain. The clinical implications of the VAS in patients with chronic pain or postoperative pain is less clear. As patient reported outcome measures are becoming the standard of care throughout the orthopaedic community, interpretation and clinical applications are still under investigation. The aim of the current study was to evaluate preoperative patient reported VAS score reported to nursing staff as compared to the surgeon at the same clinical visit. Our hypothesis was that there would be no difference in the scores reported by a single patient to two different healthcare providers during the same clinic visit. Methods: The current study was a retrospective cohort of 201 consecutive foot and ankle patients treated by a signal surgeon. The patients were asked by the nursing staff to rate their pain intensity using a standard horizontal VAS 0-10, from “no pain” to the “worst possible pain”. At the same office visit the patients were asked by the treating surgeon to rate their pain using the same VAS. Dependent t-tests were calculated to evaluate mean differences in VAS pain reported by each patient to two different healthcare professional. All data were analyzed using STATA v10.1 with an alpha level of p<0.05. Results: The results demonstrate that patients reported higher pain scores to the surgeon within 81% of the encounters, nursing staff 8% and equal 11%. On average the VAS score reported to the surgeon (6.17 ±2.12) was significantly higher higher than that reported to the nursing staff (3.30 ±2.26), respectively. The mean difference between the scores was 2.87 ±2.46 (p=<0.001). Conclusion: The current study demonstrates a clear and significant difference in patient reported pain scores between that given to nursing staff verses the treating surgeon. The cause for the exaggerated pain scores is unclear, but does lead surgeons to consider patients may have a predetermined desire for surgery. The findings of this study may also have implications for comparing patient reported outcome measures prior to surgery to post-surgical outcomes depending on who administers the instrument.

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