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

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.

scholarly journals Comparison of Visual Analog Pain Score Reported to Physician vs. Nurse, Part II

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0033
Author(s):  
Kevin Martin ◽  
Trevor McBride ◽  
Jeffrey Wake ◽  
Jeffrey Van Buren ◽  
Cuyler Dewar
Keyword(s):  
Pain Score ◽  
Nursing Staff ◽  
Patient Reported Outcome Measures ◽  
Mean Difference ◽  
Surgical Patients ◽  
Vas Score ◽  
Pain Scores ◽  
Significant Difference ◽  
Patient Reported ◽  
The Mean

Category: Ankle Introduction/Purpose: Patient reported outcome measures (PROMs) are taking a more prominent role in Orthopedics as researchers and health care networks seek to define treatment outcomes. However, interpretation and clinical applications of PROMs are still under investigation. The visual analogue scale (VAS) is considered a reliable and validated measure of acute pain. In a previous study, it was found that in surgical candidates the VAS pain score was significantly higher when reporting to the surgeon as opposed to the nurse. The aim of this current study is to examine whether this phenomenon occurs in patients that do not ultimately go on to have a surgical procedure. We hypothesize that there will be no difference in patient reporting to the surgeon versus the nursing staff. Methods: This study is a retrospective cohort of 201 consecutive non-surgical foot and ankle patients treated by a single surgeon. The patients were asked to rate their pain intensity by the nursing staff and then by the surgeon using a standard horizontal VAS 0 to 10, from “no pain” to worst pain.” Differences in reported pain levels were analyzed. Results: The mean VAS score reported to the nurse was 3.2 whereas the mean VAS score reported to the Surgeon was 4.2 (p<.001). Contrary to our hypothesis, there was a statistically significant difference in pain scores reported to the surgeon compared to the nurse. We then analyzed the mean difference of pain scores reported to surgeon and nurse for surgical versus non-surgical patients. The mean difference in VAS scores reported to physician and nurse for surgical patients was 2.87 whereas the mean difference for non-surgical patients was 1.00 (p < .001). Conclusion: The current study found statistically significant differences between VAS pain scores reported to the surgeon versus the nurse in non-surgical patients. These results support the trend found in our previous study which demonstrated discrepancies in patient pain reporting, with surgical patients reporting significantly higher pain scores to the surgeon versus the nurse. However, the mean difference between reported pain scores, to the providers, is significantly higher for surgical patients as compared to non-surgical patients. The cause of this phenomenon remains unclear, however, this study provides more information regarding patient reported VAS pain scores in an outpatient clinical setting.

scholarly journals Comparison of Visual Analog Pain Score Reported to Physician vs Nurse in Postoperative Foot and Ankle Patients

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0005
Author(s):  
Trevor McBride ◽  
Kevin Martin ◽  
Aaron Joseph Wilke ◽  
Jamie Chisholm
Keyword(s):  
Outcome Measures ◽  
Nursing Staff ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Clinic Visit ◽  
Time Interval ◽  
Foot And Ankle ◽  
Pain Scores ◽  
Patient Reported ◽  
Vas Scores

Category: Patient Reported Outcome Measures Introduction/Purpose: The relativity of pain adds to the increasing ambiguity of deciding proper treatment procedures. Reliable and validated patient reported outcome measures have attempted to solve this problem, but there are still flaws due to the subjective nature of pain. This study is the third part to two previous studies that found both operative and new nonoperative patients overemphasize their pain scores when reporting to the treating physician as compared to a nurse. This current study aims to examine if this phenomenon holds true with orthopedic postoperative patients. The importance of this study is to observe this phenomenon, as to better understand subjective pain scores. We hypothesize there will be no differences in postoperative patients’ pain scores when reporting to a treating physician versus a nurse. Methods: This study is a retrospective cohort of consecutive postoperative foot and ankle patients treated by a single surgeon. The patients were asked to rate their pain intensity by the nursing staff and then by the surgeon using a standard horizontal visual analog scale (VAS) 0 to 10, from “no pain” to “worst pain” at 2, 6, and 12 weeks postoperatively. Differences in reported pain levels were analyzed within each clinic visit. Results: Two hundred and one patients each with 3 follow up encounters were included in our cohort. The mean 2, 6, and 12- week postoperative VAS scores reported to the physician were 2.85, 2.04, and 2.33 respectively; in comparison, the scores reported to the nurse were 2.52 (p=0.0005), 1.77 (p=0.002), and 2.02 (p=0.005) respectively. There was no significant relationship between time and type of provider. Conclusion: This study found that postoperative patients report their pain more consistently to physicians and nursing staff with no clinically significant differences noted. These findings stand in stark contrast to our two previous studies which noted new and preoperative patients reported significantly higher VAS scores to the physician. The reason for reporting inconstancies is unclear, but postoperatively patients no longer need to emphasize their impairments or injury. Postoperatively, they also have a defined time interval and more acute recollection of their pain potentially leading to more consistency in reporting.

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

2020 ◽  
Vol 7 (1) ◽  
pp. 95-102 ◽  
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.

scholarly journals Perceptions of Patients, Caregivers, and Healthcare Providers of Idiopathic Inflammatory Myopathies: An International OMERACT Study

2018 ◽  
Vol 46 (1) ◽  
pp. 106-111 ◽  
Author(s):  
Christopher A. Mecoli ◽  
Jin Kyun Park ◽  
Helene Alexanderson ◽  
Malin Regardt ◽  
Merrilee Needham ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Qualitative Content Analysis ◽  
Healthcare Providers ◽  
The United States ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Idiopathic Inflammatory Myopathies ◽  
Inflammatory Myopathies ◽  
Patient Reported ◽  
Initial List

Objective.Patient-reported outcome measures (PROM) that incorporate the patient perspective have not been well established in idiopathic inflammatory myopathies (IIM). As part of our goal to develop IIM-specific PROM, the Outcome Measures in Rheumatology (OMERACT) Myositis special interest group sought to determine which aspects of disease and its effects are important to patients and healthcare providers (HCP).Methods.Based on a prior qualitative content analysis of focus groups, an initial list of 24 candidate domains was constructed. We subsequently conducted an international survey to identify the importance of each of the 24 domains to be assessed in clinical research. Patients with IIM, their caregivers, and HCP treating IIM completed the survey.Results.In this survey, a total of 638 respondents completed the survey, consisting of 510 patients, 101 HCP, and 27 caregivers from 48 countries. Overall, patients were more likely to rank “fatigue,” “cognitive impact,” and “difficulty sleeping” higher compared with HCP, who ranked “joint symptoms,” “lung symptoms,” and “dysphagia” higher. Both patients and providers rated muscle symptoms as their top domain. In general, patients from different countries were in agreement on which domains were most important. One notable exception was that patients from Sweden and the Netherlands ranked lung symptoms significantly higher compared to other countries including the United States and Australia (mean weighted rankings of 2.86 and 2.04 vs 0.76 and 0.80, respectively; p < 0.0001).Conclusion.Substantial differences exist in how IIM is perceived by patients compared to HCP, with different domains prioritized. In contrast, patients’ ratings across the world were largely similar.

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

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.

scholarly journals Patient Reported Outcome Measures (PROMs) for quality of care assessment: a pilot study protocol

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A J Fauci ◽  
A Acampora ◽  
C Cadeddu ◽  
C Angioletti ◽  
A G De Belvis ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Performance Evaluation ◽  
Cancer Patients ◽  
Outcome Measures ◽  
Healthcare Providers ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Patient Centered ◽  
Patient Reported ◽  
Colorectal Cancer Patients

Abstract Background There is emerging interest in integrating Patient Reported Outcome Measures (PROMs) into the assessment of care quality. This study protocol aims at testing the collection and use of PROMs for evaluating and comparing health outcomes by patients with colorectal cancer. This is part of a project of the Istituto Superiore di Sanità and Gruppo Italiano di Reti Oncologiche (GIRO) aimed at promoting Value-Based Healthcare (VBHC) for performance evaluation of oncological healthcare providers. Methods A multicentric prospective observational study will be conducted at the seven GIRO oncological hospitals. For each hospital, 40 colorectal cancer patients undergoing either surgery or surgery plus neoadjuvant therapy, will be recruited (20 colon; 20 rectum) over 12 months. The data will be collected twice (before and after surgery) or three times for patients undergoing neoadjuvant therapy, by using EORTC-C30, a generic module for cancer patients and EORTC-CR29, a specific module for colorectal cancer patients. Collected data will be analyzed descriptively and the scores of each hospital will be compared to the overall scores of all the centers. Additional medical information will be used to adjust for the center casemix. Feedback from health professionals and patients will be collected through structured questionnaires and focus groups. Results The results will be interpreted to assess and compare the health outcomes reported by the patients among the GIRO hospitals. Feedback from health professionals and patients will help identify barriers and facilitators of implementation of PROs collection. Conclusions PROMs have the potential to systematically incorporate the patient perspective into the health outcome measurements for performance evaluation and benchmarking, which is essential to delivering high-value patient-centered care. The PROMs collected in this study will be integrated in a set of process and outcome indicators previously defined within same project. Key messages Patient-Reported Outcome Measures (PROMs) have the potential to systematically incorporate the patient perspective, which is essential to delivering high-value patient-centered care. It is critical to integrate PROMs in performance evaluation and comparison among oncological healthcare providers for improving the quality of care in a Value-Based Healthcare perspective.

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

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.

scholarly journals 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 ◽  
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.

Der IBD-Control-Fragebogen: Deutsche Übertragung und Validierung des standardisierten Fragebogens zur Messung des Outcomes aus Patientensicht bei chronisch entzündlichen Darmerkrankungen

2021 ◽  
Author(s):  
Annabell Müller ◽  
Selina Simone Bilger ◽  
Andreas Göldi ◽  
Gunther Meinlschmidt ◽  
Florian Rueter ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Colitis Ulcerosa ◽  
Morbus Crohn ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Vas Score ◽  
Mayo Score ◽  
Patient Reported

Zusammenfassung Hintergrund Auf dem Weg zu einer wertebasierten und patientenzentrierten medizinischen Versorgung rückt das subjektiv vom Patienten empfundene Ergebnis einer Behandlung zunehmend in den Fokus. Als Messinstrument dienen dabei Patient-reported Outcome Measures (PROMs). Bei chronisch entzündlichen Darmerkrankungen hat sich der englischsprachig validierte Fragebogen IBD-Control zur Messung des Behandlungserfolgs aus Patientensicht etabliert. Da dieser bisher nicht auf Deutsch vorliegt, machte sein Einsatz in der deutschsprachigen Schweiz im Vorfeld eine Übersetzung sowie Validierung notwendig. Methoden Die englischsprachige Originalversion des IBD-Control-Fragebogens wurde mittels „forward-backward translation“ ins Deutsche übertragen und anschließend an 154 Patienten mit Morbus Crohn oder Colitis ulcerosa validiert. Resultat Die Übersetzung des IBD-Control erfolgte durch eine multidisziplinäre Expertengruppe sowie Fachübersetzer. Der IBD-Control-D zeigte eine große Akzeptanz. Eine starke Korrelation zwischen dem IBD-Control-8-Subscore mit der visuellen Analogskala des IBD-Control-D (r=0,632) zeigt die Validität des Instruments. Die Konstruktvalidität zeigt sich in der starken Korrelation zwischen der Krankheitsaktivität der letzten 6 Monate und dem IBD-Control-8-Subscore (r=0,640) sowie dem IBD-Control-VAS-Score (r=0,622) sowie zwischen dem IBD-Control-8-Subscore und dem Harvey Bradshaw Index (r=–0,620) und dem partiellen Mayo Score (r=–0,679) wie auch zwischen dem IBD-Control-VAS-Score und dem Harvey Bradshaw Index (r=–0,484) sowie dem Mayo Score (r=–0,435). Die interne Konsistenz ist gegeben (Cronbachs α = 0,840). Schlussfolgerung Mit der hier vorgestellten deutschen Version des IBD-Control, dem IBD-Control-D, liegt nun auch im deutschsprachigen Raum ein valides, benutzerfreundliches und geeignetes Instrument vor, um das subjektive Krankheitsempfinden und das Behandlungsoutcome im Kontext chronisch entzündlicher Darmerkrankungen zu erfassen.

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