scholarly journals 2017 IFFAS Award for Excellence Winner

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Adam Bennett ◽  
Malik Siddique ◽  
Jayasree Ramas Ramaskandhan
Keyword(s):  
Patient Satisfaction ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Pilon Fracture ◽  
Patient Satisfaction Scores ◽  
Ankle Replacement ◽  
Sf 36 ◽  
Patient Reported ◽  
Chi Squared ◽  
One Year

Category: Ankle Arthritis Introduction/Purpose: Pilon fractures of the distal tibia are high energy injuries often occurring in a young patient cohort. Despite optimal acute fracture management, post traumatic osteoarthritis of the tibiotalar joint is a common corollary. Standard treatment is by way of tibiotalar arthrodesis, however the lack of motion at the ankle afforded by this treatment is often poorly tolerated by patients and can lead to arthrosis of adjacent joints. Total ankle replacement (TAR) offers an attractive pain relieving and motion preserving option for this patient subgroup. Here we report the two-year patient reported outcome measures for a cohort of patients undergoing TAR for osteoarthritis secondary to tibial pilon fracture and compare them to the outcomes for other indications for total ankle replacement. Methods: The results of patient-reported outcome measures (PROMs) for TAR performed between March 2006 and November 2014 by a single surgeon at a single institution in the United Kingdom were reviewed. Data collected included Foot and Ankle Outcome Scores (FAOS) (WOMAC pain/stiffness/function); SF-36 General Health Questionnaire; number of comorbidities; self- reported BMI and patient satisfaction scores. Time points for data collection were pre-operatively and then at one and two years post-operatively. Clinical notes and radiographs were reviewed to highlight the indication for TAR and were categorised into the following sub-groups: osteoarthritis (OA); rheumatoid arthritis (RA); arthritis following pilon fracture; arthritis following ankle fracture; and post-traumatic arthritis without previous fracture (PTOA). FAOS and SF-36 were analysed using a general linear model to assess variance and by way of repeated measures ANOVA. Demographic data was assessed using student t-test and chi- squared analysis. Patient satisfaction scores were evaluated using cross-tabulation and chi-squared examination. Results: The pilon fracture group had the youngest average age and highest BMI (56.5 years; mean BMI 31.6). There was no statistically significant difference in number of reported comorbidities between subgroups (p>0.05). Significant improvement in FAOS pain, function and stiffness scores was seen in all subgroups from pre-operatively to one year post-operatively (p=0.01, 0.05 and 0.03 respectively). No further statistically significant improvement in the same scores was seen at two years. SF-36 analysis demonstrated similar results for all subgroups. There was general improvement in all parameters except for general health (p=0.890 at one year) and reduction in physical function in the RA group from first to second post-operative years (p=0.046). Patient satisfaction survey showed similar results for all subgroups. Conclusion: Our study has demonstrated that statistically significant improvement is seen in FAOS pain, function and stiffness scores in all subgroups of patients undergoing TAR by one year post surgery and that this improvement is maintained by two year follow up. There was no major difference in any of the reported outcomes between subgroups by two years post-operatively, suggesting that TAR performed for arthritis secondary to pilon fracture is a realistic alternative to tibio-talar arthrodesis.

Total Ankle Replacement for Osteoarthritis Following Pilon Fracture of the Tibia

2018 ◽  
Vol 39 (9) ◽  
pp. 1008-1018 ◽  
Author(s):  
Adam Bennett ◽  
Jayasree Ramaskandhan ◽  
Malik Siddique
Keyword(s):  
Patient Satisfaction ◽  
Total Ankle Replacement ◽  
Posttraumatic Arthritis ◽  
Pilon Fracture ◽  
Level Of Evidence ◽  
Fracture Group ◽  
Patient Satisfaction Scores ◽  
Ankle Replacement ◽  
Sf 36 ◽  
Patient Reported

Background: Outcomes for total ankle replacement (TAR) performed for osteoarthritis following pilon fracture are underreported. We compared the outcomes between different indications for TAR. Methods: Patient-reported outcome measures (PROMs) for TAR performed from 2006 to 2014 by a single surgeon were reviewed. Foot and Ankle Outcome Score (FAOS), SF-36, comorbidities, self-reported body mass index (BMI), and patient satisfaction scores were reviewed. Data were collected preoperatively and at 1 and 2 years postoperatively. Clinical notes and radiographs highlighted the indication for TAR. The following subgroups were created: osteoarthritis (OA), rheumatoid arthritis (RA), pilon fracture (PF), ankle fracture (AF), and posttraumatic arthritis without previous fracture (PTOA). PROMs were available for 173 TARs: 89 (51.4%) for OA, 36 (20.8%) for AF, 21 (12.1%) for RA, 15 (8.7%) for PF, and 12 (6.9%) for PTOA. The pilon fracture group were the youngest and had the highest BMI (mean, 56.5 years; mean BMI, 31.6 kg/m2). No difference was found in number of reported comorbidities ( P > .05). Results: Significant improvement in FAOS scores was seen in all subgroups from preoperatively to 1 year ( P = .01, .05, and .03). SF-36 had similar results for all subgroups with improvement in all parameters by 2 years. Significant improvement in role physical and role emotional domains was seen by 1 year following TAR ( P = .018 and P = .042). Patient satisfaction scores were similar in each group. There was no major difference in any of the reported outcomes between subgroups by 2 years postoperatively. Conclusion: We found similar outcomes for patients who underwent TAR after pilon fracture compared to other indications. Level of Evidence: Level III, comparative study.

Longitudinal changes in patient-reported outcome measures following total hip arthroplasty and predictors of deterioration during follow-up

2019 ◽  
Vol 101-B (7) ◽  
pp. 768-778 ◽  
Author(s):  
V. P. Galea ◽  
P. Rojanasopondist ◽  
L. H. Ingelsrud ◽  
H. E. Rubash ◽  
C. Bragdon ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Significant Deterioration ◽  
Sf 36 ◽  
Patient Reported ◽  
Clinically Significant ◽  
One Year ◽  
Anxiety Depression

AimsThe primary aim of this study was to quantify the improvement in patient-reported outcome measures (PROMs) following total hip arthroplasty (THA), as well as the extent of any deterioration through the seven-year follow-up. The secondary aim was to identify predictors of PROM improvement and deterioration.Patients and MethodsA total of 976 patients were enrolled into a prospective, international, multicentre study. Patients completed a battery of PROMs prior to THA, at three months post-THA, and at one, three, five, and seven-years post-THA. The Harris Hip Score (HHS), the 36-Item Short-Form Health Survey (SF-36) Physical Component Summary (PCS), the SF-36 Mental Component Summary (MCS), and the EuroQol five-dimension three-level (EQ-5D) index were the primary outcomes. Longitudinal changes in each PROM were investigated by piece-wise linear mixed effects models. Clinically significant deterioration was defined for each patient as a decrease of one half of a standard deviation (group baseline).ResultsImprovements were noted in each PROM between the preoperative and one-year visits, with one-year values exceeding age-matched population norms. Patients with difficulty in self-care experienced less improvement in HHS (odds ratio (OR) 2.2; p = 0.003). Those with anxiety/depression experienced less improvement in PCS (OR -3.3; p = 0.002) and EQ-5D (OR -0.07; p = 0.005). Between one and seven years, obesity was associated with deterioration in HHS (1.5 points/year; p = 0.006), PCS (0.8 points/year; p < 0.001), and EQ-5D (0.02 points/year; p < 0.001). Preoperative difficulty in self-care was associated with deterioration in HHS (2.2 points/year; p < 0.001). Preoperative pain from other joints was associated with deterioration in MCS (0.8 points/year; p < 0.001). All aforementioned factors were associated with clinically significant deterioration in PROMs (p < 0.035), except anxiety/depression with regard to PCS (p = 0.060).ConclusionThe present study finds that patient factors affect the improvement and deterioration in PROMs over the medium term following THA. Special attention should be given to patients with risk factors for decreased PROMs, both preoperatively and during follow-up. Cite this article: Bone Joint J 2019;101-B:768–778.

The Value of Motion: Patient-Reported Outcome Measures Are Correlated With Range of Motion in Total Ankle Replacement

2017 ◽  
Vol 11 (5) ◽  
pp. 451-456 ◽  
Author(s):  
Travis J. Dekker ◽  
Kamran S. Hamid ◽  
Andrew E. Federer ◽  
John R. Steele ◽  
Mark E. Easley ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Outcome Measures ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Ankle Motion ◽  
Ankle Replacement ◽  
Sf 36 ◽  
Patient Reported ◽  
And Function

Background: The proposed benefit of total ankle replacement (TAR) over ankle fusion is preserved ankle motion, thus we hypothesized that an increase in range of motion (ROM) is positively correlated with validated patient-reported outcome measures (PROMs) in individuals receiving TAR. Methods: Patients undergoing TAR at a single academic medical center between 2007 and 2013 were evaluated in this study. In addition to a minimum of 2-year follow-up, complete preoperative and postoperative outcome measures for the Foot and Ankle Disability Index (FADI), Short Musculoskeletal Function Assessment (SMFA) Bother and Function Indices, Visual Analog Scale (VAS), and 36-Item Short Form Health Survey (SF-36) were requisite for inclusion. Standardized weightbearing maximum dorsiflexion and plantarflexion sagittal radiographs were obtained and previously described ankle and foot measurements were performed to determine ankle ROM. Results: Eighty-eight patients met inclusion criteria (33 INBONE, 18 Salto-Talaris, 37 STAR). Mean time to final ROM radiographs was 43.8 months (range 24-89 months). All aforementioned PROMs improved between preoperative evaluation and most recent follow-up (  P < .01). Final ankle ROM was significantly correlated with postoperative FADI, SF-36 Mental Component Summary (MCS), SMFA Bother and Function Indices, and VAS. Additionally, dorsiflexion was positively associated with FADI, SF-36 MCS, and SMFA Function (  P < .05) but plantarflexion had no such influence on outcomes. No differences were identified with subset stratification by prosthesis type, fixed versus mobile-bearing design or etiology. Conclusion: In this TAR cohort with prospectively collected outcomes data, radiographic sagittal plane ankle motion was positively correlated with multiple PROMs. Disease-specific and generic health-related quality of life PROMs demonstrated improvement postoperatively in all domains when evaluating final total range of motion. Patients who undergo TAR for end-stage osteoarthritis with improvement in ROM demonstrate a direct correlation with improved patient-centric metrics and outcome scores. Levels of Evidence: Level III: Retrospective comparative study

scholarly journals Preoperative Patient-reported Outcome Measures (PROMs) Predict Postoperative Success in Patients With End-Stage Ankle Arthritis

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0004
Author(s):  
Feras Waly ◽  
Kevin Wing ◽  
Murray Penner ◽  
Andrea Veljkovic ◽  
Alastair Younger
Keyword(s):  
Surgical Treatment ◽  
Area Under The Curve ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Ankle Arthritis ◽  
Meaningful Improvement ◽  
Ankle Replacement ◽  
Sf 36 ◽  
Patient Reported ◽  
End Stage

Category: Ankle, Ankle Arthritis Introduction/Purpose: Ankle arthritis is a leading cause of pain and disability. Total ankle replacement and Ankle fusion are two common surgical treatments with successful outcomes. Despite the effectiveness of those treatments, a subset of patients remains with persistent pain and functional limitations. This has prompted the search for predictive tools capable of identifying patients who are likely to benefit from surgery which allows surgeons to provide valuable prognostic information, implement, and direct appropriate treatment programs. The purpose of this study is to use preoperative patient-reported outcome measures (PROMs) to predict which patients with end-stage ankle arthritis undergoing surgical treatment are most likely to experience postoperative improvements (a clinically meaningful change) in functional outcomes at an average follow-up of five years after surgical treatment. Methods: A prospective cohort design used to evaluate 427 Patients with end-stage ankle arthritis at preoperative baseline and an average of five years after undergoing total ankle replacement or ankle fusion at a single academic institution. Data on demographics, comorbidities, Ankle Osteoarthritis Score (AOS), and Physical components (PCS) of SF-36 were collected. The Canadian Orthopaedic Foot and Ankle Society Ankle Arthritis Score (COFAS-AAS) was calculated from the AOS. The Minimal clinically important difference (MCID) was then determined using a distribution-based method. A multivariable logistic regression analysis examined the variables affecting the change in PROM scores. Receiver operating characteristic (ROC) analysis was used to calculate threshold values, defined as the levels at which substantial changes occurred, and their predictive ability to determine whether preoperative PROM scores were predictive of achieving MCID. Results: Patients who scored worst at preoperative baseline made the greatest gains in function and pain relief following surgical treatment. ROC curves demonstrated that preoperative AOS, COFAS-AAS, SF-36 PCS physical function scores were predictive of postoperative improvements in physical function. Patients with preoperative AOS score above 45.7 had an 83% probability of achieving a clinically meaningful improvement in function as defined by MCID (area under the curve [AUC] 0.67). Similarly, Patients with preoperative COFAS-AAS score above 25.70 had a 78% probability of achieving MCID (area under the curve [AUC] 0.63). Patients with preoperative SF-36 PCS score below 31 had a 62% probability of achieving MCID (area under the curve [AUC] 0.64). MCIDs for AOS, COFAS-AAS and SF3-36 PCS score changes were 12.35, 9.99 and 6.43, respectively. Conclusion: In the present study, we identified PROM threshold values that predict clinically meaningful improvements in functional outcome in patients with end-stage ankle OA. Patients with a higher level of preoperative function are less likely to obtain meaningful improvement after surgical treatment. The results of this study may be used to facilitate discussion between physicians and patients regarding the expected functional benefit after surgery and to support the development of patient-based informed decision-making tools.

Comparability of Patient-reported Outcome Measures and Clinical Assessment Tools for Shoulder Function in Patients with Proximal Humeral Fracture

2020 ◽  
Author(s):  
Elke Maurer ◽  
Christian Bahrs ◽  
Luise Kühle ◽  
Patrick Ziegler ◽  
Christoph Gonser ◽  
...  
Keyword(s):  
Strong Correlation ◽  
Proximal Humeral Fracture ◽  
Humeral Fracture ◽  
Patient Reported Outcome Measures ◽  
Shoulder Function ◽  
Patient Reported Outcome ◽  
Sf 36 ◽  
Patient Reported ◽  
Scoring Tools

Abstract Background Patient-reported outcome measures (PROMs) are gaining increasing importance in the context of quality management. Different PROMs and scoring tools are available to assess shoulder function after proximal humeral fracture (PHFx). In Europe, these include the Constant-Murley Score (CS), Neer Score (NS), Oxford Shoulder Score (OSS), University of California at Los Angeles Score (UCLA) and Disabilities of the Arm, Shoulder and Hands Score (DASH). In addition, the health-related quality of life can be assessed by the PROMs Short Form 36 (SF-36) and EuroQol (EQ-5D). Although all these test instruments assess shoulder function, the components to be answered objectively and subjectively vary and thus the possibility of independent assessment. The aim of the present study is to compare the correlation between the results of the different PROMs and the clinical screening tools in patients with PHFx. Methods 76 patients who were treated with angular stable plate osteosynthesis for a proximal humeral fracture between 01/2001 and 12/2005 were included in this trial. The outcome was measured with PROMs or clinical scoring tools such as CS, NS, OSS, UCLA, DASH, SF-36 and EQ-5D and a correlation coefficient between those evaluation tools was calculated. In addition, a distinction was made between the two force measurement methods (wrist [HG] vs. deltoid muscle [DM]) for CS. Results The correlation of the results of CS and NS (HG: r = 0.85; p < 0.001/DM: r = 0.93; p < 0.001), CS and UCLA (HG: r = 0.83; p < 0.001/DM: r = 0.86; p < 0.001), NS and UCLA (r = 0.91; p < 0.001) as well as DASH and OSS (r = 0.88; p < 0.001) was strongly expressed. A good comparability of the results was demonstrated between CS and OSS (HG: r = 0.63; p < 0.001/DM: r = 0.66; p < 0.001) and between CS and DASH (HG: r = 0.62; p < 0.001/DM: r = 0.61; p < 0.001). The correlation of CS (HG/DM) and UCLA with the EQ-5D index was also good. Assessment of the physical components of SF-36 with CS, NS, OSS, UCLA and DASH showed a moderate to good association, while the mental components of SF-36 showed a low correlation (p > 0.05). Conclusion The assessment of shoulder function after proximal humerus fracture showed a very strong correlation within the clinical questionnaires (CS/NS/UCLA) and the PROMs (OSS/DASH). A strong correlation also exists between the clinical questionnaires and the PROMs. There was only a moderate correlation with the EQ-5D. The moderate to strong correlation between the physical components of SF-36, with almost no correlation between the mental components of SF-36, indicates that the quality of life restriction is based on a physical, but not on a mental impairment.

scholarly journals The role of response domain and scale label in the quantitative interpretation of patient-reported outcome measure response options

2021 ◽  
Author(s):  
Tessa Peasgood ◽  
Jen-Yu Chang ◽  
Robina Mir ◽  
Clara Mukuria ◽  
Philip A. Powell
Keyword(s):  
First Language ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Response Options ◽  
The Public ◽  
Online Panel ◽  
Patient Reported ◽  
Common Response ◽  
Chi Squared

Abstract Purpose Uncertainties exist in how respondents interpret response options in patient-reported outcome measures (PROMs), particularly across different domains and for different scale labels. The current study assessed how respondents quantitatively interpret common response options. Methods Members of the general public were recruited to this study via an online panel, stratified by age, gender, and having English as a first language. Participants completed background questions and were randomised to answer questions on one of three domains (i.e. loneliness (negatively phrased), happiness or activities (positively phrased)). Participants were asked to provide quantitative interpretations of response options (e.g. how many times per week is equal to “often”) and to order several common response options (e.g. occasionally, sometimes) on a 0–100 slider scale. Chi-squared tests and regression analyses were used to assess whether response options were interpreted consistently across domains and respondent characteristics. Results Data from 1377 participants were analysed. There was general consistency in quantifying the number of times over the last 7 days to which each response option referred. Response options were consistently assigned a lower value in the loneliness than happiness and activities domains. Individual differences, such as age and English as a second language, explained some significant variation in responses, but less than domain. Conclusion Members of the public quantify common response options in a similar way, but their quantification is not equivalent across domains or every type of respondent. Recommendations for the use of certain scale labels over others in PROM development are provided.

Assessment of computer adaptive testing version of the Neuro-QOL for people with multiple sclerosis

2018 ◽  
Vol 25 (13) ◽  
pp. 1791-1799 ◽  
Author(s):  
Brian C Healy ◽  
Jonathan Zurawski ◽  
Cindy T Gonzalez ◽  
Tanuja Chitnis ◽  
Howard L Weiner ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Outcome Measures ◽  
Computerized Adaptive Testing ◽  
Short Form ◽  
Patient Reported Outcome Measures ◽  
Adaptive Testing ◽  
Patient Reported Outcome ◽  
Longitudinal Change ◽  
Sf 36 ◽  
Patient Reported

Background: To date, the computerized adaptive testing (CAT) version of the Neuro-quality of life (QOL) has not been assessed in a large sample of people with multiple sclerosis (MS). Objective: The aim of this study was to assess the associations between the CAT version of Neuro-QOL and other clinical and patient-reported outcome measures. Methods: Subjects ( n = 364) enrolled in SysteMS completed the CAT version of the Neuro-QOL and the 36-Item Short Form Survey (SF-36) within 4 weeks of a clinical exam that included the Multiple Sclerosis Functional Composite-4 (MSFC-4). The correlations between the Neuro-QOL domains and the MSFC-4 subscores and the SF-36 scores were calculated. The changes over time in the Neuro-QOL and other measures were also examined. Results: The lower extremity functioning score of the Neuro-QOL showed the highest correlations with MSFC-4 components including Timed 25-Foot Walk, 9-Hole Peg Test, and cognitive score. The expected domains of the Neuro-QOL showed high correlations with the SF-36 subscores, and some Neuro-QOL domains were associated with many SF-36 subscores. There was limited longitudinal change on the Neuro-QOL domains over 12 months, and the change was not associated with change on other measures. Conclusion: The CAT version of the Neuro-QOL shows many of the expected associations with clinical and patient-reported outcome measures.

scholarly journals Patient Satisfaction in Medicine and Dentistry: A Need to Advance to a Patient-Reported Outcome Measures (PROMs) Culture in Surgical Sciences

2020 ◽  
Author(s):  
Kelvin I. Afrashtehfar ◽  
Mansour K. A. Assery
Keyword(s):  
Patient Satisfaction ◽  
Dental Treatment ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Review Of The Literature ◽  
Participant Satisfaction ◽  
Patient Reported ◽  
Current Article ◽  
Negative Feelings ◽  
Perceived Reasons

There is little understanding of patients' experiences and perceptions with satisfaction by health professionals such as medical and dental clinicians. Furthermore, patient satisfaction is not well understood. The objective of this article is to better understand patients' satisfaction with their medical and dental care. The methods of the current article are based on a narrative review of the literature strategy. Patient satisfaction's multidimensional nature has been established since the perceived reasons for satisfaction varied widely among patients. Many aspects of the treatment influence participant satisfaction at different stages of the intervention's process. An improved understanding of the basis for managing patients' expectations with information reiteratively and efficiently may ultimately reduce patients' potential for negative feelings toward the medical and dental treatment experience. The consumerist method may misrepresent the concept of satisfaction in health service.

scholarly journals Oxford Video Informed Consent Tool (OxVIC): a pilot study of informed video consent in spinal surgery and preoperative patient satisfaction

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e027712 ◽  
Author(s):  
Gerard Mawhinney ◽  
Chrishan Thakar ◽  
Victoria Williamson ◽  
Dominique A Rothenfluh ◽  
Jeremy Reynolds
Keyword(s):  
Patient Satisfaction ◽  
Pilot Study ◽  
Spinal Surgery ◽  
Median Number ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Controlled Study ◽  
Patient Reported ◽  
Service To Others ◽  
Preoperative Patient

ObjectivesThe British Association of Spinal Surgeons recently called for updates in consenting practice. This study investigates the utility and acceptability of a personalised video consent tool to enhance patient satisfaction in the preoperative consent giving process.DesignA single-centre, prospective pilot study using questionnaires to assess acceptability of video consent and its impacts on preoperative patient satisfaction.SettingA single National Health Service centre with individuals undergoing surgery at a regional spinal centre in the UK.Outcome measureAs part of preoperative planning, study participants completed a self-administered questionnaire (CSQ-8), which measured their satisfaction with the use of a video consent tool as an adjunct to traditional consenting methods.Participants20 participants with a mean age of 56 years (SD=16.26) undergoing spinal surgery.ResultsMean patient satisfaction (CSQ-8) score was 30.2/32. Median number of video views were 2–3 times. Eighty-five per cent of patients watched the video with family and friends. Eighty per cent of participants reported that the video consent tool helped to their address preoperative concerns. All participants stated they would use the video consent service again. All would recommend the service to others requiring surgery. Implementing the video consent tool did not endure any significant time or costs.ConclusionsIntroduction of a video consent tool was found to be a positive adjunct to traditional consenting methods. Patient–clinician consent dialogue can now be documented. A randomised controlled study to further evaluate the effects of video consent on patients’ retention of information, preoperative and postoperative anxiety, patient reported outcome measures as well as length of stay may be beneficial.

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