Establishing minimum clinically important difference values for the Patient-Reported Outcomes Measurement Information System Physical Function, hip disability and osteoarthritis outcome score for joint reconstruction, and knee injury and osteoarthritis outcome score for joint reconstruction in orthopaedics

PROMIS Physical and Emotional Health Scores Are Worse in Musculoskeletal Patients Presenting to Physiatrists than to Other Orthopedic Specialists

BACKGROUND

Physiatrists' unique training in person-centered biopsychosocial management of complex problems may influence musculoskeletal patients' expectations and self- and/or physician-referral patterns to physiatrists. Consequently, average patient complexity and need for multi-disciplinary services may be increased in physiatric patients.

OBJECTIVE

To compare musculoskeletal patients' self-reported physical and emotional health according to provider specialty. Researchers tested the null hypothesis that there is no significant difference in Patient-Reported Outcomes Measurement Information System (PROMIS) scores between patients who present to physiatrists in comparison to other musculoskeletal specialists.

DESIGN

Cross-sectional study.

SETTING

Orthopedic department of a tertiary academic medical center.

PATIENTS

Participants included 31 791 new adult patients (mean age 52.6 ± 16.2 years) who presented for initial elective evaluation of a musculoskeletal problem by an orthopedic surgeon or sports medicine trained emergency medicine, family medicine, pediatric, or physiatric physician.

METHODS

Patients completed the PROMIS computer adaptive test (CAT) Physical Function, Pain Interference, Anxiety, and Depression domains at department check-in prior to the physician encounter. Score differences by provider type were assessed using Wilcoxon rank-sum tests.

MAIN OUTCOME MEASUREMENTS

Mean PROMIS score in each domain subdivided by physiatric, surgical, and other nonsurgical provider type.

RESULTS

In total, 2081 patients presented to physiatrists, 28 267 presented to surgeons, and 1443 presented to other nonsurgical providers. For each respective provider type, average PROMIS scores were Physical Function 38.9 ± 8.2, 41.5 ± 9.5, and 43.5 ± 8.2; Pain Interference 62.6 ± 7.2, 60.9 ± 7.7, and 59.2 ± 6.8; Anxiety 54.5 ± 10.4, 51.9 ± 10.6, and 49.8 ± 9.8; and Depression 49.3 ± 10.4, 47.0 ± 10.0, and 44.2 ± 8.7. Physiatric patients had significantly worse average scores for all domains compared to surgical (P < .001) and other nonsurgical patients (P < .001).

CONCLUSIONS

Average PROMIS Physical Function, Pain Interference, Anxiety, and Depression scores were worse in musculoskeletal patients who presented to physiatrists in comparison to surgical or other nonsurgical providers. This suggests that some patients who choose to see or are referred to see physiatrists may have more or be more willing to endorse having biopsychosocial impairments.

LEVEL OF EVIDENCE

III.

Effectiveness of therapeutic inflatable ball self-exercises for improving shoulder function and quality of life in breast cancer survivors after sentinel lymph node dissection

BACKGROUND

The survival rate of breast cancer survivors (BCSs) is > 90%. Particular issues are upper arm dysfunction caused by surgery and treatments. Physical activity has been recommended to improve shoulder function and quality of life (QoL) in BCSs. However, rehabilitation programs tend not to be continuous.

PURPOSE

To explore the effectiveness of therapeutic inflatable ball self-exercise for improving shoulder function and QoL in breast cancer survivors (BCSs) following breast cancer surgery.

PATIENTS AND METHODS

Seventy-two BCSs were allocated to two groups, conventional self-exercise (CSE; n = 34; age, 48.9 ± 7.2 years) and therapeutic inflatable ball self-exercise (IBE; n = 38; age, 47.7 ± 8.9 years); 22 in the CSE and 23 in the IBE group completed the interventions. Both groups performed intervention for 12 weeks, three times per week and 15 min a day at least. Measurement was performed three times for shoulder range of motion (ROM), handgrip strength, Shoulder Pain and Disability Index (SPADI), and Functional Assessment of Cancer Therapy-Breast (FACT-B).

RESULT

Flexion and extension of shoulder ROM showed significant differences between the two groups at 12 weeks. Flexion and extension of shoulder ROM showed significant differences for t1-t2 (p = 0.02) and t0-t1 (p = 0.04). Abduction showed a significant difference for t0-t1 (p = 0.03), t1-t2 (p = 0.02), and t0-t2 (p = 0.01). CSE (7 points) and IBE (20 points) satisfied the MDC in FACT-B total score. The MDC of the SPADI total score was 13 points in the CSE group and 9 points in the IBE group.

CONCLUSION

IBE would be more appropriate to start the rehabilitation for BCSs and CSE would be effective after the pain has improved.

Web-Based, Self-Directed Physical Therapy After Total Hip Arthroplasty Is Safe and Effective for Most, but Not All, Patients

BACKGROUND

Recent data suggested that unsupervised, self-directed physical therapy (SDPT) is both safe and efficacious for patients undergoing total hip arthroplasty (THA) and that formal outpatient physical therapy (OPPT) may not be routinely required. The purpose of this study was to evaluate the routine use of an SDPT program in a nonselect patient population.

METHODS

This is a multi-surgeon, single-institution, retrospective study of 941 consecutive patients discharged home, from January 2016 to December 2016, after primary, unilateral THA and enrolled in a web-based SDPT program. Patients were seen 4 weeks after surgery and OPPT was prescribed for perceived need, patient request, or if unable to use the web-based program. Patient-reported outcomes, medical comorbidities, and assessment of home environment were prospectively recorded.

RESULTS

Overall, 646 of 941 patients (68.7%) were not prescribed OPPT (SDPT-only group) while 295 of 941 patients (31.3%) were prescribed OPPT (SDPT + OPPT group). In the SDPT + OPPT group, 88.2% were for perceived need, 10.8% for patient request, and 1.0% due to inability to use the web-based platform. Multivariate analysis identified male sex (odds ratio, 0.64; 0.45-0.90; P = .012) and a higher preoperative Short Form-12 physical component (odds ratio, 0.98; 0.96-0.99; P = .036) as independent variables protective against requiring OPPT. At a minimum 6-month follow-up, the SDPT-only group had statistically higher hip disability and osteoarthritis outcome score junior compared to the SDPT + OPPT cohort (85.0 vs 80.9; P = .012).

CONCLUSION

Web-based SDPT is safe and effective for most, but not all, patients eligible for home discharge after THA. It is critical to preserve OPPT services for the one-third of patients who require them.

LEVEL OF EVIDENCE

Level III.

Update on the epidemiology, risk factors and disease outcomes of osteoarthritis

Osteoarthritis (OA) is the most frequent form of arthritis and a leading cause of pain and disability worldwide. OA can affect any synovial joint, although the hip, knee, hand, foot and spine are the most commonly affected sites. Knowledge about the occurrence and risk factors for OA is important to define the clinical and public health burden of the disease to understand mechanisms of disease occurrence and may also help to inform the development of population-wide prevention strategies. In this article, we review the occurrence and risk factors for OA and also consider patient-reported outcome measures that have been used for the assessment of the disease.