Do commonly reported outcome measures reflect patient satisfaction after revision hip arthroplasty?

Net Promoter Score: a prospective, single-centre observational study assessing if a single question determined treatment success after primary or revision hip arthroplasty

BACKGROUND

Our study aimed to identify the relationship between treatment outcome assessed by patient-reported outcomes (PROMs) and satisfaction measured by calculation of the Net Promoter Score (NPS), which identifies promoters, following total hip arthroplasty (THA). The aim was to evaluate this association separately in primary and revision THA and to determine thresholds based on PROMs that identify detractors of the surgical procedure or the centre.

METHODS

A total of 1,243 patients who underwent primary or revision THA at our hospital were asked to complete questionnaires of the Oxford Hip Score (OHS), Euroquol-5D (EQ-5D) and information on pain intensity preoperatively, three and 12 months after surgery. Postoperatively, the patients were additionally asked about their satisfaction with the procedure and the hospital by using three different NPS questions. The association between PROMs and NPS was evaluated based on group comparisons of primary or revision THA and receiver operating characteristics analysis (ROC) to determine threshold values.

RESULTS

At 12 months the NPS of all three questions were invariably linked to treatment outcome in patients after primary THA and patients with a single revision. In these two treatment groups, promoters always showed significantly better PROM scores than detractors. The NPS score was always higher in the primary group in comparison to the single revision group, e.g. 66.4% would undergo the procedure again in the first group, while only 33.0% would opt for this in the latter group. The high thresholds for the PROMs at 12 months, that were calculated by ROC analysis to identify promoter/detractors, indicate that patients` satisfaction required very good joint function and pain relief. However, the NPS was not a suitable tool to identify patients who need further care in an early phase after surgery.

CONCLUSIONS

With NPS already a single question or a single parameter provides the desired information regarding patient satisfaction and also treatment success.

TRIAL REGISTRATION

The study was approved by the Ethics Committee at the Medical Faculty of the University Rostock: "Ethikkommission an der Medizinischen Fakultät der Universität Rostock", Address: St.-Georg Str. 108 18055 Rostock, Germany, reference number: A2015-0055.

Psychological status affects postoperative quality of life, function, and pain after periacetabular osteotomy

Aims

Psychological status may be an important predictor of outcome after periacetabular osteotomy (PAO). The aim of this study was to investigate the influence of psychological distress on postoperative health-related quality of life, joint function, self-assessed pain, and sports ability in patients undergoing PAO.

Methods

In all, 202 consecutive patients who underwent PAO for developmental dysplasia of the hip (DDH) at our institution from 2015 to 2017 were included and followed up at 63 months (SD 10) postoperatively. Of these, 101 with complete data sets entered final analysis. Patients were assessed by questionnaire. Psychological status was measured by Brief Symptom Inventory (BSI-18), health-related quality of life was raised with 36-Item Short Form Survey (SF-36), hip functionality was measured by the short version 0f the International Hip Outcome Tool (iHOT-12), Subjective Hip Value (SHV), and Hip Disability and Outcome Score (HOS). Surgery satisfaction and pain were assessed. Dependent variables (endpoints) were postoperative quality of life (SF-36, HOS quality of life (QoL)), joint function (iHOT-12, SHV, HOS), patient satisfaction, and pain. Psychological distress was assessed by the Global Severity Index (GSI), somatization (BSI Soma), depression (BSI Depr), and anxiety (BSI Anx). Influence of psychological status was assessed by means of univariate and multiple multivariate regression analysis.

Results

In multiple multivariate regression, postoperative GSI, BSI Soma, and BSI Depr had a negative effect on postoperative SF-36 (e -2.07, -3.05, and -2.67, respectively; p < 0.001), iHOT-12 (e -1.35 and -4.65, respectively; p < 0.001), SHV (e -1.20 and -2.71, respectively; p < 0.001), HOS QoL (e -2.09 and -4.79, respectively; p < 0.001), HOS Function (e -1.00 and -3.94, respectively; p < 0.001), and HOS Sport (e -1.44 and -5.29, respectively; p < 0.001), and had an effect on postoperative pain (e 0.13 and 0.37, respectively; p < 0.001).

Conclusion

Psychological distress, depression, and somatization disorders affect health-related quality of life, perceived joint function, and sports ability. Pain perception is significantly increased by somatization. However, patient satisfaction with surgery is not affected.

Clinical and Radiological Outcomes of Revision Total Hip Arthroplasty for Patients with Prior Hartofilakidis Type C Hip Dysplasia

OBJECTIVE

To investigate the clinical and radiological results of revision total hip arthroplasty (THA) for patients with previously diagnosed Hartofilakidis type C hip dysplasia, which is technically challenging and lacks literature.

METHODS

We enrolled 20 patients with previously diagnosed Hartofilakidis type C hip dysplasia who underwent revision THA between November 2008 and July 2015 at our hospital. Patients were followed up for an average of 87 months. Data pertaining to the Harris hip score (HHS), modified Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), general satisfaction, and the level of satisfaction related to 16 hip functions or issues experienced after revision THA were collected. The vertical and horizontal center of rotation (COR) of the hips were measured bilaterally based on preoperative and postoperative anteroposterior radiographs. Categorical variables were analyzed by the chi-square test. Continuous variables were analyzed using the student's t test or non-parametric Wilcoxon Rank Sum test.

RESULTS

There were significant postoperative improvements in the HHS (47.4 ± 31.6 vs 70.1 ± 39.0), modified WOMAC (48.5 ± 27.9 vs 75.7 ± 36.8), and the vertical (45.7 ± 33.7 mm vs 21.6 ± 21.8 mm) and horizontal (41.8 ± 17.0 mm vs 31.4 ± 14.7 mm) offset of the COR after revision THA (P < 0.05). Fifteen (75.0%) patients were satisfied with the procedure. The satisfaction rate for each of the 16 items ranged from 45% to 100%. The top three dissatisfactory items were squatting, getting into/out of cars, and leg-length discrepancy. Postoperatively, dissatisfied patients had a significantly higher visual analogue scale pain score and lower WOMAC pain, HHS pain, WOMAC total, and HHS total scores, a lower satisfaction rate for pain relief, and a higher vertical COR.

CONCLUSION

There is a high rate (25%) of dissatisfaction with the outcome after revision THA for patients with prior Hartofilakidis type C hip dysplasia. The most likely reasons for dissatisfaction were inadequate pain relief and a higher vertical COR measured on radiography.

Patient Satisfaction with Virtual-Based Prenatal Care: Implications after the COVID-19 Pandemic

OBJECTIVE

The objective of this study was to identify factors related to satisfaction with virtual visits during pregnancy in an effort to prioritize intervention targets for pregnant women during the COVID-19 pandemic.

METHODS

The study relied on data obtained from pregnant women (N = 416) who participated in the Perinatal Experiences and COVID-19 Effects (PEACE) Study from May 21 to November 22, 2020. Using a cross-sectional design, this study examined factors including COVID-19 related experiences and prenatal care changes in association with patient satisfaction of virtual prenatal care.

RESULTS

Overall, women reported being very or extremely satisfied (27.9%) or moderately satisfied (43.5%) with their virtual prenatal experiences, however, 89.9% indicated a preference for in-person care under non-pandemic conditions. Those who completed the survey further into the pandemic were less satisfied with virtual prenatal care (β =  - 0.127, p < 0.01). After accounting for this and other sociodemographic characteristics, COVID-19 pregnancy worries (β =  - 0.226, p < 0.001) and the number of prenatal care changes due to the pandemic (β =  - 0.137, p < 0.01) were associated with lower satisfaction.

CONCLUSION

Our findings demonstrate general satisfaction with virtual visits among pregnant women in this study although in general women would prefer in-person care if it weren't for a pandemic. Women worried about the impact of pandemic on their pregnancy, as well as those experiencing transitions in their prenatal care may need more information and reassurance. Additional studies are needed to understand the unmet needs through virtual care compared to in-person care.

Are Oxford Hip Score and Western Ontario and McMaster Universities Osteoarthritis Index Useful Predictors of Clinical Meaningful Improvement and Satisfaction After Total Hip Arthroplasty?

BACKGROUND

Up to 15% of patients express dissatisfaction after total hip arthroplasty (THA). Preoperative patient-report outcome measures (PROMs) scores can potentially mitigate this by predicting postoperative satisfaction, identifying patients that will benefit most from surgery. The aim of this study was to (1) calculate the minimal clinically important difference (MCID) thresholds for Oxford Hip Score (OHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Short Form-36 (SF-36) mental component summary (MCS) and physical component summary (PCS) scores and (2) identify the threshold values of these PROMs that could be used to predict patient satisfaction and expectation fulfilment.

METHODS

Prospectively collected registry data of 1334 primary THA patients who returned for 2-year follow-up from 1998 to 2016 were reviewed. All patients were assessed preoperatively and postoperatively at 2 years using the OHS, WOMAC, and SF-36 PCS/MCS scores. The MCID for each PROMs was calculated, and the proportion of patients that attained MCID was recorded. The relationship between satisfaction, expectation fulfilment, and MCID attainment was analyzed using Spearman rank correlation. Optimal threshold scores for each PROM that predicted MCID attainment and satisfaction/expectation fulfilment at 2 years were calculated using receiver operating curve analysis.

RESULTS

The calculated MCID for OHS, WOMAC, SF-36 PCS, and SF-36 MCS were 5.2, 10.8, 6.7, and 6.2, respectively. A threshold value of 24.5 for the preoperative OHS was predictive of achieving WOMAC MCID at 2 years after THA (area under the curve 0.80, P < .001). 93.1% of patients were satisfied, and 95.5% had expectations fulfilled at 2 years. None of the PROMs were able to predict satisfaction.

CONCLUSION

OHS and WOMAC scores can be used to determine clinical meaningful improvement but are limited in their ability to predict patient satisfaction after THA.

Tobacco use predicts a more difficult episode of care after anatomic total shoulder arthroplasty

BACKGROUND

In the current health care environment, it is becoming increasingly important to recognize risks factors that may affect a patient's postoperative outcome. To determine the potential impact of tobacco as a risk factor, we evaluated postoperative pain, narcotic use, length of stay, reoperations, and complications in the global 90-day episode of care for patients undergoing anatomic total shoulder arthroplasty (TSA) who were current tobacco users, former users, or nonusers.

METHODS

Database search identified 163 patients with primary anatomic TSA done for glenohumeral arthritis; these were divided into 3 groups: current tobacco users (28), nonusers (88), and former users (47). All surgeries were done with the same technique and implants.

RESULTS

Patients in the current tobacco use group had significantly higher visual analog scale scores preoperatively and at 12 weeks postoperatively than nonusers and former users. Mean improvement in visual analog scale scores was significantly less in current tobacco users. Cumulative oral morphine equivalent use at 12 weeks was significantly higher in current tobacco users than in nonusers and former users. The average oral morphine equivalent per day was also significantly higher in the current tobacco users than in nonusers and former users. There were no significant differences in length of stay or complications.

CONCLUSIONS

Although length of stay, complication rates, hospital readmissions, and reoperation rates were not significantly different, tobacco users reported increased postoperative pain and narcotic use in the global period after TSA. Former tobacco users were found to have a postoperative course similar to that of nonusers, suggesting that discontinuation of tobacco use can improve a patient's episode of care performance after TSA.

Acetabulum-Only Revision Total Hip Arthroplasty Is Associated With Good Functional Outcomes and Survivorship

BACKGROUND

The coexistence of a stable femoral and a loose acetabular component may pose a clinical dilemma for the surgeon. Our study aims at comparing the intermediate functional outcomes and survivorship of acetabulum-only revision total hip arthroplasty (ArTHA) with an age-matched and gender-matched total revision THA (TrTHA) group.

METHODS

We retrospectively reviewed prospectively collected data on the pain, function, and total Harris Hip Scores (HHS) and complication profile for ArTHA and TrTHA cohorts from our regional arthroplasty database. Kaplan-Meier survivorship, with the need for repeat revision surgery as the end point, was used for survival analysis.

RESULTS

Among 538 cases, there were fewer acute medical complications in ArTHA and a similar dislocation rate for both cohorts. Preoperative HHS for pain, function, and total were better in the ArTHA cohort, but only the function score reached statistical significance. No significant differences in subsequent years for all aspects of HHS, except the function score was significantly better in the ArTHA cohort at year 1. And 10.0% of ArTHAs and 7.8% of TrTHAs had required rerevision. The 5-year survivorship was 90.3% (95% confidence interval ± 2.1%) for the ArTHA cohort and 92.7% (95% confidence interval ± 1.8%) for the TrTHA cohort (P = .394). The ArTHA with posterior approach (n = 118) group had the lowest dislocation rate and the best trend of functional outcomes.

CONCLUSION

ArTHA can provide similar functional outcomes and dislocation rate to TrTHA, with an acceptable rerevision rate. The posterior approach in this study was not associated with a significant dislocation rate.

Development and validation of a questionnaire assessing discrepancy between patients' pre-surgery expectations and abilities and post-surgical outcomes following knee replacement surgery

PURPOSE

The discrepancy between patient-desired outcomes and achievable functional outcomes is a source of patient dissatisfaction. This paper reports development and validation of a questionnaire to assess this discrepancy in patients undergoing knee replacement surgery.

METHODS

The initial questionnaire (Knee Surgery Perception Questionnaire, KSPQ) comprised two parts. Part A, assessed patients' perception of their current level of function and pain, and Part B, assessed patients' desired outcomes of the surgery. Validation was carried out for Part A and then applied to Part B using a one-factor congeneric model and was tested in 185 patients preceding surgery. A discrepancy score between patients' expectations and desired outcome (Part B) and their perception of current function (Part A) was also calculated. Pearson correlations were used between the KSPQ total score and subscales and other knee-specific questionnaires to determine construct validity.

RESULTS

The final best set of models included four items for each subscale with a Chi-square value of 7.3 (n.s). The subscales and the total KSPQ showed significant strong to moderate correlations with knee-specific questionnaires. The discrepancy score in each subscale and the overall score showed relatively large discrepancy between patients' expectations and their perception of current function; with higher discrepancy score reported for pain and walking.

CONCLUSION

The KSPQ is a valid questionnaire to assess patients' expected and desired outcomes of knee replacement surgery and their perception of their current abilities and function, and discrepancy between these. The KSPQ now requires further investigation at different stages of recovery following surgery.

LEVEL OF EVIDENCE

III.

Is satisfaction among orthopaedic trauma patients predicted by depression and activation levels?

OBJECTIVES

Among orthopaedic trauma patients, little is known regarding the relationship between patient satisfaction and patient levels of depression and "activation" (level of involvement of patient in his or her own care). Our hypothesis was that satisfaction is correlated to levels of depression and activation.

DESIGN

Patient questionnaires.

SETTING

Level 1 trauma center.

PATIENTS

One hundred twenty-four patients with at least one fracture.

INTERVENTION

Patients were evaluated at orthopaedic trauma clinics 6 weeks or longer after injury.

MAIN OUTCOME MEASURES

Patient Satisfaction Questionnaire (PSQ), Patient Activation Measure, and Patient Health Questionnaire, a screening and evaluation tool for the presence and severity of depression. Spearman correlation coefficients assessed the relationship between activation level and depression severity with PSQ domains. Bivariate and multivariate linear regression models determined independent effects of depression and activation on general satisfaction.

RESULTS

Patient satisfaction was moderate to high in general (mean score, 4.17). Spearman correlation coefficients were high for patient activation and all PSQ domains (generally >0.3, P < 0.05). Correlation coefficients were weaker for depression and PSQ domains (rho range, 0.16-0.33). Final multivariate linear regression model indicated improvement in general satisfaction of 0.14 with increasing patient activation. A decrease in general satisfaction of -0.03 was noted with increasing Patient Health Questionnaire depression score.

CONCLUSIONS

Patient satisfaction is strongly correlated with patient activation but less correlated with the presence of depression. Patient satisfaction after orthopaedic trauma might be improved by encouraging and coaching patients on how to be more involved in their own health care.

LEVEL OF EVIDENCE

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Chinese patients' satisfaction with total hip arthroplasty: what is important and dissatisfactory?

Through validated self-administered questionnaires, we conducted a retrospective investigation in 818 patients (1009 hips) who underwent primary THA, to collect data on overall satisfaction plus satisfaction and importance rating for 16 specific functions and issues. Overall, 8.1% patients were dissatisfied with the surgery. The top 3 important items are pain relief, squatting, and walking. The top 3 dissatisfactory items are jogging, squatting, and rising after squatting. The strongest risk factors for dissatisfaction with walking were pain (6.1×), muscle weakness(3.7×), and LLD (3.3×). The strongest risk factors for dissatisfaction with squatting were low postoperative HHS ROM (3.7×) and muscle weakness (2.6×). For Chinese patients, ROM, muscle strength and LLD are very important.

Predictive outcomes of revision total hip replacement--a consecutive series of 1176 patients with a minimum 10-year follow-up

The burden of revision total hip replacement (THR) surgery is increasing. With an increasing life expectancy and younger age of primary surgery this trend is set to continue. There are few data on the long-term outcome of revision THR. This retrospective study of 1176 consecutive revision THRs with a minimum 10-year follow-up from a University Teaching Hospital was undertaken to review implant survival and patient reported outcomes. Mean follow-up was 11 years with implant survival at 10 years of 82% (CI: 80-85). Implant survival varied between 58% (unexplained pain) to 84% (aseptic loosening) depending on the indication for revision surgery. Positive predictors of survival were age greater than 70 at the time of surgery (p=0.011), revision for aseptic loosening (p<0.01) and revision of both components or just the acetabular component (p<0.01). At the last review, mean Oxford Hip Score (OHS) was 34 (SD: 11.3) and 92% of the living patients with unrevised hips were satisfied with the outcome of revision surgery. This long term study has demonstrated that positive predictors of survival and outcome of revision THR surgery are age greater than 70 years, revision for aseptic loosening and component revision. This should aid surgeons in their counselling of patients prior to surgery.

Pain management and satisfaction in postsurgical patients

AIMS AND OBJECTIVES

To examine the relationship between patient satisfaction and the incidence of severe and enduring pain through a health board wide hospital satisfaction questionnaire.

BACKGROUND

The incidence and management of acute postoperative pain and its relationship to patient satisfaction have been of great interest to clinicians over the last 20 years. Evidence suggests that despite many moves to address this problem with the advent of acute pain nurse specialists and dedicated pain teams, severe and enduring pain continues to be a problem. However, patients appear to report high satisfaction levels.

DESIGN

The study design was a postal questionnaire the results of which were analysed statistically.

METHODS

The postal questionnaire was sent to patients who had been discharged from acute hospitals in one health board in the previous two weeks. A total of three large acute hospitals were included. The data were analysed to produce descriptive statistics for all patients on the pain questions and then for patients with severe and enduring pain on the variables of age, gender, ethnic group, responses to pain questions and type of admission.

RESULTS

Twenty-six percent of patients reported having pain all or most of the time. Patients suffering from severe and enduring pain were younger females.

CONCLUSION

Acute postoperative pain continues to be a problem, although patients continue reporting moderate satisfaction levels.

RELEVANCE TO CLINICAL PRACTICE

Acute postoperative pain is an ongoing issue for postsurgical patients. It is crucial to understand and recognise issues that can adversely contribute to increased pain severity.

Is total hip arthroplasty after hip arthrodesis as good as primary arthroplasty?

BACKGROUND

Conversion of hip arthrodesis to a THA reportedly provides a reasonable solution, improving function, reducing back and knee pain, and slowing degeneration of neighboring joints associated with a hip fusion. Patients generally are satisfied with conversion despite the fact that range of mobility, muscle strength, leg-length discrepancy (LLD), persistence of limp, and need for assistive walking aids generally are worse than those for conventional primary THA.

QUESTIONS/PURPOSES

We compared THA after hip arthrodesis and primary THA to determine whether these procedures would be associated with similar functional scores, maintenance of scores with time, complications and failures, survivorship of the arthroplasty, and patient satisfaction.

PATIENTS AND METHODS

We retrospectively matched 48 patients undergoing conversion of a fused hip to a THA between January 1980 and January 2000, with 50 patients receiving a primary THA during the same period. We prospectively followed all patients between January 2000 and January 2010. The changes in function and pain after THA were compared between the two cohorts using the Harris hip score (HHS) and the Rosser Index Matrix (RIM). The Oxford hip score (OHS) and the SF-36 also were used to assess quality of life (QOL) during followup. Complications were collected and survivorship of the THA was evaluated. Patient satisfaction was assessed using the Robertsson and Dunbar questionnaire. The minimum followup was 10 years (mean, 17 years; range, 10-29 years).

RESULTS

At last followup, hip function and health-related QOL were similar for patients having conversion of hip arthrodesis to THA and for patients having a routine THA. Scores diminished overall in the two groups between 2000 and 2010, but without a difference for the HHS, RIM QOL, and OHS in the study cohort. The rate of complications, THA survival, and patient satisfaction were similar in both groups.

CONCLUSIONS

Conversion of hip arthrodesis to a THA provides substantial improvement of hip function and health-related QOL, with an acceptable rate of complications, good expectancy of survival for the arthroplasty, and high level of patient satisfaction comparable to those of primary THA.

LEVEL OF EVIDENCE

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

The relationship between patient satisfaction with physical therapy care and global rating of change reported by patients receiving worker's compensation

This study examined relationships between patient satisfaction with physical therapy care and global rating of change; 1,944 respondents completed the Medrisk Instrument for Measuring Patient Satisfaction with Physical Therapy Care (MR-12) and a nine-point Global Rating of Change Scale (GROC) following a course of physical therapy for a work-related musculoskeletal problem. Ninety percent of all respondents reported being satisfied or very satisfied with their overall care, whereas 70.1% of all respondents indicated they improved following treatment. Respondents who reported improvement had significantly higher scores for all measures of satisfaction (p<0.01) than did those who reported failure to improve; however, both of these groups had mean scores of greater than 4.0 on the MR-12, indicating that respondents were likely to be satisfied or very satisfied with care regardless of perceived change following treatment. Scores>4.0 from the MR-12 had high sensitivity to detect those respondents classified as "improved" (0.87-0.95), but low specificity to differentiate between those who were classified as "improved" and those who were classified as "did not improve" (0.22-0.30). Our findings support the hypothesis that patient satisfaction with care is primarily independent of perceived clinical change.