Patient-reported outcome measures are a cornerstone of outcome assessment in orthopaedics. However, completing the pencil and paper questionnaires in clinic is something of a burden to the individual patient and the health care institution. We do not provide much in the way of incentives to collect PRO data. Lengthy questionnaires and hidden data analysis offer no direct benefit to the individual patient nor the clinician. Employing ePRO, utilising tablet PCs for questionnaire completion, can improve this situation considerably. Swift and cost-effective data management and instant availability of results using intuitive graphical display make questionnaire completion more rewarding. Direct feedback of PRO data during the consultation can inform the individual's care. Completing electronic questionnaires also makes computer-adaptive testing (CAT) possible. CAT creates dynamic questionnaires, adapting to the individual symptom burden of the individual patient. CAT both increases measurement precision and reduces the number of questions required. As such, ePRO assessment may help to maximise the efficiency and the utilisation of PRO data.
To investigate the validity of threshold values for the Oxford Hip and Knee Score (OHS and OKS) for treatment success 12 months after total knee or hip replacement. Questionnaires were administered to patients undergoing total hip (THA) or knee (TKA) replacement before and 12 months after surgery alongside questions assessing key accepted aspects of treatment success (satisfaction, pain relief, functional improvement) to form a composite criterion of success and assessed using receiver operator characteristic (ROC) analysis. Thresholds providing maximum sensitivity and specificity for predicting treatment success were determined for the total sample and subgroups defined by pre-surgery scores.Aim
Methods
To evaluate the association of BMI and improvement in patient-reported outcomes after TKA. Knee replacement outcome data for procedures carried out over an eight month period was extracted from a regional arthroplasty register in the UK. Data was available before surgery and 12 months after. We analysed the impact of overweight on post-operative change in the Forgotten Joint Score − 12 (FJS-12) measuring joint awareness and the Oxford Knee Score (OKS) measuring pain and function using five BMI categories (A: <25, B: 25–29.9, C: 30–34.9, D: 35–39.9 and E: >40).Aim
Methods
Obese patients undergoing total knee arthroplasty (TKA) face increased risks of complications such as joint infection and early revision. However, the influence of obesity on measures of patient function following TKA is poorly defined. Knee arthroplasty outcome data for procedures carried out over an eight month period was extracted from a regional database in the UK. We analysed the impact of weight categories (BMI<30, BMI=30–34.9, and BMI≥35) on the Forgotten Joint Score – 12 (FJS-12) and Oxford Knee Score (OKS). Data was available preoperatively and 12 months postoperatively. Physical and mental health was assessed with the SF-12 one year after surgery. Data from 256 patients were available. 49.6% had a BMI<30, 27.4% had a BMI 30–34.9 and 23.1% had a BMI≥35. Mean FJS-12 results at 1-year were 48.7 points for patients with a BMI<30, 40.7 points for patients with a BMI=30–34.9 and 34.0 points for patients with a BMI≥35. Effect sizes for change from baseline to 12-month post-op were 3.0 (Cohen's d) in patients with BMI<30 and d=2.2 in patients with BMI≥35. Mean OKS results at 1 year were 36.9 (BMI<30), 33.7 (BMI=30–34.9) and 32.0 (BMI≥35) respectively. Effect sizes for change from baseline to 12-month was d=2.1 (BMI<30) and d=1.9 (BMI≥35). Differences between BMI groups with regard to post-operative change were statistically significant for the FJS-12 (p=0.038) but not for the OKS (p=0.229). This study highlights that outcome scores may differ in their ability to capture the impact of obesity on patient function following TKA. The FJS-12 showed significant differences in outcome based on patient obesity category, whereas the OKS did not detect between group differences.
