1
|
Królikowska A, Reichert P, Senorski EH, Karlsson J, Becker R, Prill R. Scores and sores: Exploring patient-reported outcomes for knee evaluation in orthopaedics, sports medicine and rehabilitation. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39072858 DOI: 10.1002/ksa.12334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 06/09/2024] [Accepted: 06/10/2024] [Indexed: 07/30/2024]
Abstract
Recognizing and addressing the controversies surrounding using patient-reported outcome measures (PROMs) is crucial for enhancing evaluation standards in clinical studies in orthopedics, sports medicine, and rehabilitation. The article comprehensively described the challenges of using PROMs to evaluate knee conditions in these fields. Apart from defining and characterizing patient-reported outcomes and their measures, the article discussed controversies around them, such as using them as primary outcomes. It highlighted the importance of standardizing and validating PROMs. Several initiatives taken to improve the selection of appropriate outcomes for clinical research purposes were described. Additionally, the potential of technology, mainly digital health tools and mobile applications, was mentioned in the context of enhancing the collection and analysis of PROMs. The article also raised the issue of the readability of PROMs, defined as the ease with which they can be read and understood by patients. The article concluded that adopting a complementary approach to treatment evaluation by integrating subjective and objective measures is imperative for accurately assessing efficacy. This comprehensive approach provides a more holistic understanding of patient outcomes, forms the foundation for evidence-based medicine, and informs future healthcare policies. Proactive measures are urgently needed to address concerns and improve the reliability and validity of PROMs for clinical practice and research. LEVEL OF EVIDENCE: level V.
Collapse
Affiliation(s)
- Aleksandra Królikowska
- Ergonomics and Biomedical Monitoring Laboratory, Department of Physiotherapy, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Paweł Reichert
- Department of Orthopaedics, Traumatology and Hand Surgery, Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Eric Hamrin Senorski
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jon Karlsson
- Department of Orthopaedics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Roland Becker
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg a.d.H., Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg a.d.H., Germany
| | - Robert Prill
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg a.d.H., Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg a.d.H., Germany
| |
Collapse
|
2
|
Innocenti T, Salvioli S, Logullo P, Giagio S, Ostelo R, Chiarotto A. The Uptake of the Core Outcome Set for Non-Specific Low Back Pain Clinical Trials is Poor: A Meta-Epidemiological Study of Trial Registrations. THE JOURNAL OF PAIN 2024; 25:31-38. [PMID: 37604361 DOI: 10.1016/j.jpain.2023.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/03/2023] [Accepted: 08/12/2023] [Indexed: 08/23/2023]
Abstract
We conducted a meta-epidemiological study on all non-specific low back pain (NSLBP) trial registrations on the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov. We aimed to 1) assess the uptake of the core outcome set (COS) for NSLBP in clinical trials; 2) assess the uptake of the core outcome measurement set for NSLBP in clinical trials; and 3) determine whether specific study characteristics are associated with the COS uptake. After applying the relevant filters for the condition, study type, and phase of the trial, 240 registry entries were included in this study. Only 50 (20.8%) entries showed a full COS uptake, and this rate did not increase over time. Most registry entries that planned to measure physical functioning (n = 152) used the Roland-Morris Disability Questionnaire (n = 74; 48.7%); a small percentage used the numeric rating scale (n = 60; 27.3%) or Short Form-12 (n = 5; 8.3%) if they planned to measure pain intensity (n = 220) or health-related quality of life (n = 60), respectively. Only the planned sample size (OR = 1.02; 95% CI = 1.01, 1.03) showed a significant but small association with COS uptake. The uptake of the COS for NSLBP is poor. Only 21% of the randomized controlled trials aimed to measure all COS domains in their study registration and COS uptake is not increased over time. Great heterogeneity in measurement instruments was also observed, revealing poor core outcome measurement set uptake. PERSPECTIVE: The Core Outcome Set (COS) for non-specific low back pain was published more than 20 years ago. We evaluated whether trial registrations are using this set of outcomes when testing interventions for low back pain. Full uptake was found only in 21% of the sample, and this is not increasing over time. Researchers should use the COS to ensure that trials measure relevant outcomes consistently.
Collapse
Affiliation(s)
- Tiziano Innocenti
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, the Netherlands; GIMBE Foundation, Bologna, Italy
| | - Stefano Salvioli
- GIMBE Foundation, Bologna, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Patricia Logullo
- Centre for Statistics in Medicine (CSM), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Diseases (NDORMS), University of Oxford, Oxford, United Kingdom
| | - Silvia Giagio
- Division of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Raymond Ostelo
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, the Netherlands; Department of Epidemiology and Data Science, Amsterdam UMC, Location Vrije Universiteit, Amsterdam Movement Sciences research institute, the Netherlands
| | - Alessandro Chiarotto
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, the Netherlands; Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| |
Collapse
|
3
|
Paul E, George J, Ward S, Fitzgerald K, Jones G, Magana K, Modi J, Magee T, Hughes G, Ford AI, Vassar M. Assessing uptake of the core outcome set in randomized controlled trials for Parkinson's disease: A systematic review. Ageing Res Rev 2023; 91:102081. [PMID: 37774933 DOI: 10.1016/j.arr.2023.102081] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/20/2023] [Accepted: 09/25/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Parkinson's Disease (PD) affects more than 10 million individuals, with increasing incidence worldwide. As PD's incidence rises, research funding is increasing substantially. PD's core outcome set (COS) provides standardization for PD clinical trial outcomes, improves research quality, and study comparability. Our study aimed to analyze COS uptake rate before and after the PD COS publication. METHODS We searched ClinicalTrials.gov to retrieve phase III/IV adult PD trials published between 2013 and 2023. Screening for inclusion and data extraction occurred in a masked, duplicate fashion. Trial characteristics and COS uptake rate were extracted from this sample. RESULTS In our 111 included trials, the COS uptake rate was highest for the 'Walking and Balance' outcome and lowest for the 'Hospital Admissions' outcome. Overall, there was a non-significant monthly increase of 0.26 % (P = 0.266, CI = [-0.20, 0.72]) in "COS-defined outcome" measurement when comparing pre- and post-COS publication. CONCLUSION Our study found no significant increase in COS uptake in PD clinical trials. We found multiple outcomes to be vastly unmeasured and heterogeneity among the measurement instruments used. These findings complicate standardizing and comparing RCT outcomes. Overcoming these barriers is vital to improving the usefulness of PD research.
Collapse
Affiliation(s)
- Eli Paul
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, 1111 W. 17th St., Tulsa, OK 74017, United States.
| | - Joanna George
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, 1111 W. 17th St., Tulsa, OK 74017, United States
| | - Shaelyn Ward
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, 1111 W. 17th St., Tulsa, OK 74017, United States
| | - Kyle Fitzgerald
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, 1111 W. 17th St., Tulsa, OK 74017, United States
| | - Garrett Jones
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, 1111 W. 17th St., Tulsa, OK 74017, United States
| | - Kimberly Magana
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, 1111 W. 17th St., Tulsa, OK 74017, United States
| | - Jay Modi
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, 1111 W. 17th St., Tulsa, OK 74017, United States
| | - Trevor Magee
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, 1111 W. 17th St., Tulsa, OK 74017, United States
| | - Griffin Hughes
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, 1111 W. 17th St., Tulsa, OK 74017, United States
| | - Alicia Ito Ford
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, 1111 W. 17th St., Tulsa, OK 74017, United States; Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, 1111 W. 17th St., Tulsa, OK 74017, United States
| | - Matt Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, 1111 W. 17th St., Tulsa, OK 74017, United States; Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, 1111 W. 17th St., Tulsa, OK 74017, United States
| |
Collapse
|
4
|
Adriani M, Becker R, Milano G, Lachowski K, Prill R. High variation among clinical studies in the assessment of physical function after knee replacement: a systematic review. Knee Surg Sports Traumatol Arthrosc 2023; 31:3854-3860. [PMID: 36907938 PMCID: PMC10435639 DOI: 10.1007/s00167-023-07375-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/27/2023] [Indexed: 03/14/2023]
Abstract
PURPOSE The purpose of this study was to summarise the current use of outcome measures for the assessment of physical function after knee joint replacement. METHODS A systematic approach following the PRISMA guidelines was used. Literature search was performed on MEDLINE database via PubMed and on Epistemonikos. Clinical trials (level of evidence I-II) on knee joint replacement reporting data on the 'physical function' domain published between January 2017 and June 2022 were included. Descriptive statistics were used to summarise the evidence. RESULTS In the 181 articles that met the inclusion criteria, 49 different outcome measurements were used to evaluate clinical outcomes after knee joint replacement. The most frequently adopted patient-reported outcome measures (PROMs) were the Knee Society Score (KSS) (78 studies; 43.1%), the Western Ontario and McMaster Universities (WOMAC) Arthritis Index (62 studies; 34.3%), the Oxford Knee Score (OKS) (51 studies; 28.2%) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) (36 studies; 20%). The most frequently used performance-based outcome measures (PBOMs) were the Timed-Up-and-Go (TUG) test (30 studies; 16.6%) and the 6-min-walk test (6MWT) (21 studies; 11.6%). Among impairment-based outcome measures (IBOMs), range of motion (ROM) was the most used (74 studies; 40.9%). CONCLUSION There is considerable variation among clinical studies regarding the assessment of the physical function of patients after knee joint replacement. PROMs were found to be the most commonly adopted outcome measures; however, no single PROM was used in more than half of the papers analysed. LEVEL OF EVIDENCE Level II, systematic review of level I-II studies.
Collapse
Affiliation(s)
- Marco Adriani
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
| | - Roland Becker
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg a.d.H., Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg a.d.H., Germany
| | - Giuseppe Milano
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
- Department of Bone and Joint Surgery, Spedali Civili, Brescia, Italy
| | - Krzysztof Lachowski
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg a.d.H., Germany
| | - Robert Prill
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg a.d.H., Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg a.d.H., Germany
| |
Collapse
|
5
|
Wilson JM, Madden VJ, Pester BD, Yoon J, Papianou LN, Meints SM, Campbell CM, Smith MT, Haythornthwaite JA, Edwards RR, Schreiber KL. Change in Pain During Physical Activity Following Total Knee Arthroplasty: Associations With Improved Physical Function and Decreased Situational Pain Catastrophizing. Innov Aging 2023; 7:igad045. [PMID: 38094929 PMCID: PMC10714905 DOI: 10.1093/geroni/igad045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Indexed: 02/01/2024] Open
Abstract
Background and Objectives Knee osteoarthritis is one of the primary causes of chronic pain among older adults and because of the aging population, the number of total knee arthroplasties (TKAs) performed is exponentially increasing. While pain reduction is a goal of TKA, movement-evoked pain is rarely assessed pre- and post-TKA. We characterized the distributions of change in pain, function, and situational catastrophizing in patients from presurgery to 3 months postsurgery and explored associations among these pre-post changes. Research Design and Methods This prospective study longitudinally assessed movement-evoked pain, function, and situational catastrophizing in patients with knee osteoarthritis (N = 92) using in-person performance-based tests (6-min walk test [6MWT], stair-climb test [SCT]) prior to and 3 months after TKA. Patients also completed the Western Ontario McMaster Universities Scales (WOMAC) pain and function subscales, and Pain Catastrophizing Scale, presurgery and 3- and 6-months postsurgery. Results Movement-evoked pain and function on performance tests significantly improved from pre- to post-TKA. Improved SCT function was associated with reduced SCT pain and catastrophizing. Similarly, reduced pain during the SCT was associated with reduced catastrophizing during the SCT. However, 6MWT function was not associated with 6MWT pain or catastrophizing; yet reduced pain during the 6MWT was associated with reduced catastrophizing during the 6MWT. Reduced movement-evoked pain during both performance tests was consistently associated with improved WOMAC function and pain, whereas improved function on performance tests was inconsistently associated with WOMAC function and pain. Notably, greater movement-evoked pain on both performance tests at 3-month post-TKA was associated with worse WOMAC function and pain at 6 months, whereas better function on performance tests at 3 months was associated with better WOMAC function, but not related to WOMAC pain at 6 months. Discussion and Implications Findings highlight the importance of situation-specific and in vivo assessments of pain and catastrophizing during physical activity.
Collapse
Affiliation(s)
- Jenna M Wilson
- Department of Anesthesiology Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Victoria J Madden
- Pain Unit, Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Bethany D Pester
- Department of Anesthesiology Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - JiHee Yoon
- Department of Anesthesiology Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lauren N Papianou
- Department of Anesthesiology Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Samantha M Meints
- Department of Anesthesiology Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Claudia M Campbell
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael T Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jennifer A Haythornthwaite
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Robert R Edwards
- Department of Anesthesiology Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kristin L Schreiber
- Department of Anesthesiology Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
6
|
Prill R, Becker R, Schulz R, Michel S, Hommel H. No correlation between symmetry-based performance measures and patient-related outcome prior to and after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2022; 30:3155-3161. [PMID: 33881572 DOI: 10.1007/s00167-021-06570-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/06/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Standardized outcome measures are crucial for the evaluation of different treatment and rehabilitation regimes in patients after total knee arthroplasty (TKA). Performance-based measures are necessary to capture different aspects of physical function. High reliability and agreement of five performance-based measures were hypothesized to differentiate between measurement error and change in test performance. Secondary outcomes are the correlation of performance-based measurements to KSS and WOMAC prior to surgery (baseline) and 10 weeks thereafter (t3). METHODS The test-retest reliabilities and agreements of the 1-m walk test, the stair-climbing test, the timed-up-and-go test, the weight-balanced-chair-rising test and the isometric maximum knee extension force in patients undergoing total knee replacements were studied. The intraclass correlation coefficient was calculated and a Bland-Altman analysis performed. RESULTS The weight-balanced-chair-rising test showed a symmetry at baseline = 0.77, 5 ± 1 days after surgery (t1) = 0.50, 9 ± 1 days (t2) = 0.59 and (t3) = 0.80. All performance tests showed high intraclass correlation coefficients (ICC = 0.81-0.99). The 10-m walk test, stair climbing test, and the timed-up-and-go test showed high agreement in the Bland-Altman analysis. The Bland-Altman analysis for the weight-balanced-chair-rising test and isometric knee extension force indicated high agreement at 5 and 9 days postoperatively, but the relative measurement error increased pre- and 10 weeks postoperatively. CONCLUSION In conclusion, symmetry, as an important outcome after TKA, is a reliable and rather unique item that should unquestionably be added to established measurements like walking tests or survey-based function assessment. The implementation of standardized performance-based measures to assess physical function in rehabilitation procedures will help to improve the more objectively based assessment of different rehabilitation protocols. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
- Robert Prill
- Department of Orthopedics and Traumatology, Centre of Joint Replacement West Brandenburg, Brandenburg Medical School Theodor Fontane, Hochstraße 29, 14770, Brandenburg, Germany.
| | - Roland Becker
- Department of Orthopedics and Traumatology, Centre of Joint Replacement West Brandenburg, Brandenburg Medical School Theodor Fontane, Hochstraße 29, 14770, Brandenburg, Germany
| | - Robert Schulz
- Berlin Institute of Health Quest Center, Berlin, Germany
| | - Sven Michel
- Brandenburg University of Technology-CS, Senftenberg, Germany
| | - Hagen Hommel
- Department of Orthopedics and Traumatology, Centre of Joint Replacement West Brandenburg, Brandenburg Medical School Theodor Fontane, Hochstraße 29, 14770, Brandenburg, Germany
- District Hospital Märkisch Oderland GmbH, Wriezen, Germany
| |
Collapse
|
7
|
Lützner C, Postler AE, Druschke D, Riedel R, Günther KP, Lange T. Ask Patients What They Expect! A Survey Among Patients Awaiting Total Hip Arthroplasty in Germany. J Arthroplasty 2022; 37:1594-1601.e4. [PMID: 35341925 DOI: 10.1016/j.arth.2022.03.067] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/16/2022] [Accepted: 03/19/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) is an elective surgery. Therefore, patient satisfaction with the results of surgery is paramount. The association between fulfillment of patients' expectations and satisfaction is well known. The aim of this study was to identify key expectations of patients with hip osteoarthritis awaiting THA. METHODS A mixed-methods approach was used, consisting of two sequential parts. The questionnaire was developed based on literature review and focus group interviews. A nationwide survey was conducted in 21 orthopedic departments within Germany. RESULTS Out of 691 obtained questionnaires, 636 were analyzed (mean age = 65.7 years (±11.3), 56.1% female). A majority of patients (≥75%) reported more than 20 complaints as 'present' due to hip osteoarthritis. A total of 9 key expectations were identified, which were reported by more than 75% of the patients as 'mandatory' for a successful THA. The identified key expectations were related to pain, range of motion, walking abilities, gait pattern, transitions, leisure and sports activities, awareness of the affected hip, satisfaction with health or life, and compensatory posture. A consistently high correlation was found between the complaints and the corresponding expectations. CONCLUSION The expectations of patients have greatly expanded. In this study, a set of mandatory key expectations shared by the majority of patients was identified. The likelihood of fulfillment of key expectations should be assessed for weighing benefits and harms of available treatment options during the indication process. In addition, the results of this study might be used as a resource for shared decision-making.
Collapse
Affiliation(s)
- Cornelia Lützner
- University Center of Orthopedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Dresden, Germany
| | - Anne E Postler
- University Center of Orthopedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Dresden, Germany
| | - Diana Druschke
- Center for Evidence-based Healthcare, University Hospital Carl Gustav Carus and Faculty of Medicine Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Roman Riedel
- University Center of Orthopedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Dresden, Germany
| | - Klaus-Peter Günther
- University Center of Orthopedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Dresden, Germany
| | - Toni Lange
- Center for Evidence-based Healthcare, University Hospital Carl Gustav Carus and Faculty of Medicine Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| |
Collapse
|
8
|
The patient-reported outcomes measurement information systems (PROMIS®) physical function and its derivative measures in adults: a systematic review of content validity. Qual Life Res 2022; 31:3317-3330. [PMID: 35622294 DOI: 10.1007/s11136-022-03151-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE This study aims to systematically review and critically appraise the content validity of the adult versions of the Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF) item bank and its derivative measures in any adult population. METHODS MEDLINE and EMBASE were searched in October 2021 for studies on measurement properties of PROMIS-PF measures in an adult population. Studies were included if the study described the development of a PROMIS-PF measure or investigated its relevance, comprehensiveness, or comprehensibility. Assessment of the methodological quality of eligible studies, rating of results, and summarizing evidence was performed following the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology for assessing content validity. A modified GRADE approach was used to determine the level of evidence. RESULTS Three development studies and eight studies on the content validity of one or more of the PROMIS-PF measures were identified. The methodological quality of most studies was rated doubtful. There was low to high level evidence for sufficient relevance, comprehensiveness, and comprehensibility of most PROMIS-PF measures for healthy seniors and various disease populations. We found low to moderate level evidence for insufficient relevance of PROMIS-PF measures for patients with conditions that affected only one body part, and insufficient comprehensibility of the PROMIS-PF measures for minority elderly. CONCLUSION Most PROMIS-PF measures demonstrate sufficient content validity in healthy seniors and various disease populations. However, the quality of this evidence is generally low to moderate, due to limitations in the methodological quality of the studies.
Collapse
|
9
|
Pogatzki-Zahn EM, Liedgens H, Hummelshoj L, Meissner W, Weinmann C, Treede RD, Vincent K, Zahn P, Kaiser U. Developing consensus on core outcome domains for assessing effectiveness in perioperative pain management: results of the PROMPT/IMI-PainCare Delphi Meeting. Pain 2021; 162:2717-2736. [PMID: 34181367 DOI: 10.1097/j.pain.0000000000002254] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/24/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Postoperative pain management is still insufficient, leading to major deficits, including patient suffering, impaired surgical recovery, long-term opioid intake, and postsurgical chronic pain. Yet, identifying the best treatment options refers to a heterogeneous outcome assessment in clinical trials, not always reflecting relevant pain-related aspects after surgery and therefore hamper evidence synthesis. Establishing a core outcome set for perioperative pain management of acute pain after surgery may overcome such limitations. An international, stepwise consensus process on outcome domains ("what to measure") for pain management after surgery, eg, after total knee arthroplasty, sternotomy, breast surgery, and surgery related to endometriosis, was performed. The process, guided by a steering committee, involved 9 international stakeholder groups and patient representatives. The face-to-face meeting was prepared by systematic literature searches identifying common outcome domains for each of the 4 surgical procedures and included breakout group sessions, world-café formats, plenary panel discussions, and final voting. The panel finally suggested an overall core outcome set for perioperative pain management with 5 core outcome domains: physical function (for a condition-specific measurement), pain intensity at rest, pain intensity during activity, adverse events, and self-efficacy. Innovative aspects of this work were inclusion of the psychological domain self-efficacy, as well as the specific assessment of pain intensity during activity and physical function recommended to be assessed in a condition-specific manner. The IMI-PROMPT core outcome set seeks to improve assessing efficacy and effectiveness of perioperative pain management in any clinical and observational studies as well as in clinical practice.
Collapse
Affiliation(s)
- Esther M Pogatzki-Zahn
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | | | - Lone Hummelshoj
- Endometriosis.org, United Kingdom; World Endometriosis Society, Vancover, Canada; World Endometriosis Research Foundation, London, United Kingdom
| | - Winfried Meissner
- Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Claudia Weinmann
- Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Rolf-Detlef Treede
- Neurophysiology, Medical Faculty Mannheim, University Heidelberg, Heidelberg, Germany
| | - Katy Vincent
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Peter Zahn
- Department of Anaesthesiology and Intensive Care Medicine, Palliative Care Medicine and Pain Management, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH Bochum, Ruhr University Bochum, Bochum, Germany
| | - Ulrike Kaiser
- Comprehensive Pain Center, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| |
Collapse
|
10
|
De Rosis S, Pennucci F, Lungu DA, Manca M, Nuti S. A continuous PREMs and PROMs Observatory for elective hip and knee arthroplasty: study protocol. BMJ Open 2021; 11:e049826. [PMID: 34548358 PMCID: PMC8458328 DOI: 10.1136/bmjopen-2021-049826] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Scholars, healthcare practitioners and policymakers have increasingly focused their attention on patient-centredness. Patient-reported metrics support patient-driven improvement actions in healthcare systems. Despite the great interest, patient-reported outcome measures (PROMs) are still not extensively collected in many countries and not integrated with the collection of patient-reported experience measures (PREMs). This protocol describes the methodology behind an innovative observatory implemented in Tuscany, Italy, aiming at continuously and longitudinally collecting PROMs and PREMs for elective hip and knee total replacement. METHODS AND ANALYSIS The Observatory is digital. Enrolled patients are invited via SMS or email to online questionnaires, which include the Oxford Hip Score or the Oxford Knee Score. Data are real-time reported to healthcare professionals and managers in a raw format, anonymised and aggregated on a web platform. The data will be used to investigate the relationship between the PROMs trend and patients' characteristics, surgical procedure, hospital characteristics, and PREMs. Indicators using patient data will be computed, and they will integrate the healthcare performance evaluation system adopted in Tuscany. ETHICS AND DISSEMINATION The data protection officers of local healthcare organisations and the regional privacy office framed the initiative referring to the national and regional guidelines that regulate patient surveys. The findings will be reported both in real time and for publication in peer-reviewed journals.
Collapse
Affiliation(s)
- Sabina De Rosis
- Management and Healthcare Laboratory, Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Francesca Pennucci
- Management and Healthcare Laboratory, Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Daniel Adrian Lungu
- Management and Healthcare Laboratory, Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Mario Manca
- Department of Orthopaedic Surgery, Versilia Hospital, Lido di Camaiore, Italy
| | - Sabina Nuti
- Management and Healthcare Laboratory, Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Pisa, Italy
| |
Collapse
|
11
|
Pahlplatz TMJ, Schafroth MU, Krijger C, Hylkema TH, van Dijk CN, Frings-Dresen MHW, Kuijer PPFM. Beneficial and limiting factors in return to work after primary total knee replacement: Patients' perspective. Work 2021; 69:895-902. [PMID: 34180460 PMCID: PMC8385499 DOI: 10.3233/wor-213522] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND: Return to work (RTW) is an important outcome in Total Knee Arthroplasty (TKA). At present, 70–80%of TKA patients return to work within three to six months. OBJECTIVE: What are patients’ perspectives regarding beneficial and limiting factors in RTW after TKA? METHODS: Focus groups were formed in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Three major topics were explored: 1. What was beneficial for RTW after TKA; 2. What was limiting for RTW after TKA; and 3. What additional care would benefit RTW after TKA? RESULTS: Data saturation was reached after four focus groups, comprising 17 participants—nine men and eight women (median age 58, range 52–65). The focus group study identified four main themes that contributed to a successful RTW namely rehabilitation (medical) like post-operative physical therapy, patient characteristics (personal), like motivation to RTW, occupational characteristics (work-related) like build-up in work tasks and medical support (medical) like availability of a walker or crutches. CONCLUSION: According to participants, factors within the following four themes can contribute to a successful return to work: occupational, patient, rehabilitation and medical care. Incorporating these factors into the integrated care pathway for the “young” TKA patients may increase the chances of a successful RTW.
Collapse
Affiliation(s)
- T M J Pahlplatz
- Amsterdam UMC, University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam, the Netherlands.,University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - M U Schafroth
- Amsterdam UMC, University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam, the Netherlands.,University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - C Krijger
- Amsterdam UMC, University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam, the Netherlands.,University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - T H Hylkema
- University Medical Center Groningen, Department of Orthopaedic Surgery and Department of Community and Occupational Medicine, Groningen, the Netherlands
| | - C N van Dijk
- Amsterdam UMC, University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam, the Netherlands.,University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - M H W Frings-Dresen
- Amsterdam UMC, University of Amsterdam, Department Public and Occupational Health, Amsterdam Public Health research institute Amsterdam, Amsterdam Movement Sciences, the Netherlands
| | - P P F M Kuijer
- Amsterdam UMC, University of Amsterdam, Department Public and Occupational Health, Amsterdam Public Health research institute Amsterdam, Amsterdam Movement Sciences, the Netherlands
| |
Collapse
|
12
|
Bigalke S, Maeßen TV, Schnabel K, Kaiser U, Segelcke D, Meyer-Frießem CH, Liedgens H, Macháček PA, Zahn PK, Pogatzki-Zahn EM. Assessing outcome in postoperative pain trials: are we missing the point? A systematic review of pain-related outcome domains reported in studies early after total knee arthroplasty. Pain 2021; 162:1914-1934. [PMID: 33492036 DOI: 10.1097/j.pain.0000000000002209] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/21/2020] [Indexed: 01/04/2023]
Abstract
ABSTRACT The management of acute postoperative pain remains suboptimal. Systematic reviews and Cochrane analysis can assist with collating evidence about treatment efficacy, but the results are limited in part by heterogeneity of endpoints in clinical trials. In addition, the chosen endpoints may not be entirely clinically relevant. To investigate the endpoints assessed in perioperative pain trials, we performed a systematic literature review on outcome domains assessing effectiveness of acute pain interventions in trials after total knee arthroplasty. We followed the Cochrane recommendations for systematic reviews, searching PubMed, Cochrane, and Embase, resulting in the screening of 1590 potentially eligible studies. After final inclusion of 295 studies, we identified 11 outcome domains and 45 subdomains/descriptors with the domain "pain"/"pain intensity" most commonly assessed (98.3%), followed by "analgesic consumption" (88.8%) and "side effects" (75.3%). By contrast, "physical function" (53.5%), "satisfaction" (28.8%), and "psychological function" (11.9%) were given much less consideration. The combinations of outcome domains were inhomogeneous throughout the studies, regardless of the type of pain management investigated. In conclusion, we found that there was high variability in outcome domains and inhomogeneous combinations, as well as inconsistent subdomain descriptions and utilization in trials comparing for effectiveness of pain interventions after total knee arthroplasty. This points towards the need for harmonizing outcome domains, eg, by consenting on a core outcome set of domains which are relevant for both stakeholders and patients. Such a core outcome set should include at least 3 domains from 3 different health core areas such as pain intensity, physical function, and one psychological domain.
Collapse
Affiliation(s)
- Stephan Bigalke
- Clinic for Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Münster, Münster, Germany
- Clinic for Anaesthesiology, Intensive and Pain Medicine, Ruhr-University Bochum, BG-University Hospital Bergmannsheil gGmbH, Bochum, Germany
| | - Timo V Maeßen
- Clinic for Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Münster, Münster, Germany
| | - Kathrin Schnabel
- Clinic for Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Münster, Münster, Germany
| | - Ulrike Kaiser
- University Pain Centre, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Daniel Segelcke
- Clinic for Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Münster, Münster, Germany
| | - Christine H Meyer-Frießem
- Clinic for Anaesthesiology, Intensive and Pain Medicine, Ruhr-University Bochum, BG-University Hospital Bergmannsheil gGmbH, Bochum, Germany
| | | | - Philipp A Macháček
- Faculty of Electrical Engineering and Information Technology, Ruhr-University Bochum, Bochum, Germany
| | - Peter K Zahn
- Clinic for Anaesthesiology, Intensive and Pain Medicine, Ruhr-University Bochum, BG-University Hospital Bergmannsheil gGmbH, Bochum, Germany
| | - Esther M Pogatzki-Zahn
- Clinic for Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Münster, Münster, Germany
| |
Collapse
|
13
|
Hughes KL, Clarke M, Williamson PR. A systematic review finds Core Outcome Set uptake varies widely across different areas of health. J Clin Epidemiol 2021; 129:114-123. [PMID: 32987162 PMCID: PMC7815247 DOI: 10.1016/j.jclinepi.2020.09.029] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/11/2020] [Accepted: 09/09/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aim of our review was to bring together studies that had assessed the uptake of core outcome sets (COS) to explore the level of uptake across different COS and areas of health. STUDY DESIGN AND SETTING We examined the citations of 337 COS reports to identify studies that had assessed the uptake of a particular COS in randomized controlled trials (RCTs) or systematic reviews (SRs). RESULTS We identified 24 studies that had assessed uptake in RCTs and two studies that had assessed uptake in SRs. The studies covered a total of 17/337 (5%) COS. Uptake rates reported for RCTs varied from 0% of RCTs (gout) to 82% RCTs (rheumatoid arthritis) measuring the full COS. Studies that assessed uptake of individual core outcomes showed a wide variation in uptake between the outcomes. Suggested barriers to uptake included lack of validated measures, lack of patient and other key stakeholder involvement in COS development, and lack of awareness of the COS. CONCLUSIONS Few studies have been undertaken to assess the uptake of COS in RCTs and SRs. Further studies are needed to assess whether COS have been implemented across a wider range of disease categories and to explore the barriers and facilitators to COS uptake.
Collapse
Affiliation(s)
- Karen L Hughes
- MRC North West Hub for Trials Methodology Research, Department of Health Data Science, University of Liverpool, Block F Waterhouse Building, 1-5 Brownlow Street, Liverpool L69 3GL, United Kingdom.
| | - Mike Clarke
- Centre for Public Health, Institute of Clinical Sciences, Block B, Queen's University Belfast, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, United Kingdom
| | - Paula R Williamson
- MRC North West Hub for Trials Methodology Research, Department of Health Data Science, University of Liverpool, Block F Waterhouse Building, 1-5 Brownlow Street, Liverpool L69 3GL, United Kingdom
| |
Collapse
|
14
|
Kaiser U, Liedgens H, Meissner W, Weinmann C, Zahn P, Pogatzki-Zahn E. Developing consensus on core outcome domains and measurement instruments for assessing effectiveness in perioperative pain management after sternotomy, breast cancer surgery, total knee arthroplasty, and surgery related to endometriosis : The IMI-PainCare PROMPT protocol for achieving a consensus on core outcome domains. Trials 2020; 21:773. [PMID: 32912288 PMCID: PMC7488037 DOI: 10.1186/s13063-020-04665-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 08/09/2020] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Evidence synthesis of clinical trials requires consistent outcome assessment. For pain management after surgery, inconsistency of effectiveness assessment is still observed. A subproject of IMI-PainCare (Innovative Medicine Initiatives, www.imi-paincare.eu ) aims for identifying core outcome domains and measurement instruments for postoperative pain in four surgical fields (sternotomy, breast cancer surgery, total knee arthroplasty, and surgery related to endometriosis) in order to harmonize outcome assessment for perioperative pain management. METHODS A multifaceted process will be performed according to existing guidelines (Core Outcome Measures in Effectiveness Trials (COMET), COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN)). In a first step, outcome domains will be identified via systematic literature review and consented on during a 1-day consensus meeting by 10 stakeholder groups, including patient representatives, forming an IMI PROMPT consensus panel. In a second step, outcome measurement instruments regarding the beforehand consented core outcome domains and their psychometric properties will be searched for via systematic literature review and approved by COSMIN checklist for study quality and scale quality separately. In a three-step online survey, the IMI PROMPT consensus panel will vote for most suitable measurement instruments. The process is planned to be conducted between 11/2017 (systematic literature review on common outcome domains) and 3/2022 (final voting on core outcome measurement).
Collapse
Affiliation(s)
- Ulrike Kaiser
- Comprehensive Pain Center, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | | | - Winfried Meissner
- Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Claudia Weinmann
- Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Peter Zahn
- Department of Anaesthesiology and Intensive Care Medicine, Palliative Care Medicine and Pain Management, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH Bochum, Ruhr University Bochum, Bochum, Germany
| | - Esther Pogatzki-Zahn
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Germany.
| |
Collapse
|
15
|
Liu H, Cong H, Chen L, Wu H, Yang X, Cao Y. Efficacy and Safety of Lower Limb Progressive Resistance Exercise for Patients With Total Knee Arthroplasty: A Meta-analysis of Randomized Controlled Trials. Arch Phys Med Rehabil 2020; 102:488-501. [PMID: 32569586 DOI: 10.1016/j.apmr.2020.05.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 05/21/2020] [Accepted: 05/26/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of progressive resistance exercise (PRE) for patients with total knee arthroplasty (TKA) in a meta-analysis. DATA SOURCES PubMed, MEDLINE, Cochrane's Library, and EMBASE databases. STUDY SELECTION Randomized controlled trials evaluating the effect of PRE on mobility and function in patients with TKA. DATA EXTRACTION A random-effects model was applied if significant heterogeneity was detected; otherwise, a fixed-effects model was applied. DATA SYNTHESIS Seven randomized controlled trials. Compared with a rehabilitation program without PRE, physiotherapy including PRE was associated with improvements in the 6-minute walking test (weighed mean difference [WMD], 19.22m; P=.04) with a wide confidence interval (CI, 0.48∼37.95). However, sensitivity analysis by omitting 1 study with preoperative rehabilitation revealed nonsignificant results (WMD, 15.15m; P=.16). Moreover, PRE did not significantly improve the maximal walking speed (WMD, 0.05m/s, 95% CI, 0.00∼0.11; P=.05). However, PRE was associated with improved knee strength of extension (standardized mean difference [SMD], 0.72; 95% CI, 0.47∼0.96; P<.001) and flexion (SMD, 0.47; 95% CI, 0.19∼0.74; P<.001) but not self-reported physical function (SMD, -0.17; 95% CI, -0.37∼0.03; P=.10) or changes in pain score (SMD, 0.11; 95% CI, -0.15∼0.37; P=.40). PRE did not increase the risk of adverse events (risk ratio, 1.19; 95% CI, 0.52∼2.71; P=.68). CONCLUSIONS PRE may lead to improvements in physical function among patients receiving a TKA. PRE leads to higher ultimate strength in the surgical knee and is safe to perform.
Collapse
Affiliation(s)
- Heng Liu
- Department of Orthopedics, Peking University First Hospital, Beijing
| | - Hui Cong
- Department of Rehabilitation, Peking Union Medical College Hospital, Beijing, China
| | - Lixia Chen
- Department of Rehabilitation, Peking Union Medical College Hospital, Beijing, China
| | - Hao Wu
- Department of Orthopedics, Peking University First Hospital, Beijing
| | - Xin Yang
- Department of Orthopedics, Peking University First Hospital, Beijing
| | - Yongping Cao
- Department of Orthopedics, Peking University First Hospital, Beijing.
| |
Collapse
|
16
|
Lange T, Kopkow C, Lützner J, Günther KP, Gravius S, Scharf HP, Stöve J, Wagner R, Schmitt J. Comparison of different rating scales for the use in Delphi studies: different scales lead to different consensus and show different test-retest reliability. BMC Med Res Methodol 2020; 20:28. [PMID: 32041541 PMCID: PMC7011537 DOI: 10.1186/s12874-020-0912-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 01/24/2020] [Indexed: 12/12/2022] Open
Abstract
Background Consensus-orientated Delphi studies are increasingly used in various areas of medical research using a variety of different rating scales and criteria for reaching consensus. We explored the influence of using three different rating scales and different consensus criteria on the results for reaching consensus and assessed the test-retest reliability of these scales within a study aimed at identification of global treatment goals for total knee arthroplasty (TKA). Methods We conducted a two-stage study consisting of two surveys and consecutively included patients scheduled for TKA from five German hospitals. Patients were asked to rate 19 potential treatment goals on different rating scales (three-point, five-point, nine-point). Surveys were conducted within a 2 week period prior to TKA, order of questions (scales and treatment goals) was randomized. Results Eighty patients (mean age 68 ± 10 years; 70% females) completed both surveys. Different rating scales (three-point, five-point and nine-point rating scale) lead to different consensus despite moderate to high correlation between rating scales (r = 0.65 to 0.74). Final consensus was highly influenced by the choice of rating scale with 14 (three-point), 6 (five-point), 15 (nine-point) out of 19 treatment goals reaching the pre-defined 75% consensus threshold. The number of goals reaching consensus also highly varied between rating scales for other consensus thresholds. Overall, concordance differed between the three-point (percent agreement [p] = 88.5%, weighted kappa [k] = 0.63), five-point (p = 75.3%, k = 0.47) and nine-point scale (p = 67.8%, k = 0.78). Conclusion This study provides evidence that consensus depends on the rating scale and consensus threshold within one population. The test-retest reliability of the three rating scales investigated differs substantially between individual treatment goals. This variation in reliability can become a potential source of bias in consensus studies. In our setting aimed at capturing patients’ treatment goals for TKA, the three-point scale proves to be the most reasonable choice, as its translation into the clinical context is the most straightforward among the scales. Researchers conducting Delphi studies should be aware that final consensus is substantially influenced by the choice of rating scale and consensus criteria.
Collapse
Affiliation(s)
- Toni Lange
- Center for Evidence-based Healthcare, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Germany. .,University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Germany.
| | - Christian Kopkow
- Center for Evidence-based Healthcare, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Germany.,Department of Therapy Science I, Brandenburg Technical University Cottbus, Senftenberg, Germany
| | - Jörg Lützner
- University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Germany
| | - Klaus-Peter Günther
- University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Germany
| | - Sascha Gravius
- Orthopaedic and Trauma Surgery Centre (OUZ), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Hanns-Peter Scharf
- Orthopaedic and Trauma Surgery Centre (OUZ), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Johannes Stöve
- Department of Orthopaedic and Trauma Surgery, St. Marien- und St. Annastiftskrankenhaus, Ludwigshafen, Germany
| | - Richard Wagner
- Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Jochen Schmitt
- Center for Evidence-based Healthcare, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Germany
| |
Collapse
|
17
|
|
18
|
Assessing the impact of a research funder's recommendation to consider core outcome sets. PLoS One 2019; 14:e0222418. [PMID: 31518375 PMCID: PMC6743767 DOI: 10.1371/journal.pone.0222418] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 08/28/2019] [Indexed: 02/08/2023] Open
Abstract
Background Core outcome sets (COS) have the potential to reduce waste in research by improving the consistency of outcomes measured in trials of the same health condition. However, this reduction in waste will only be realised through the uptake of COS by clinical trialists. Without uptake, the continued development of COS that are not implemented may add to waste in research. Funders of clinical trials have the potential to have an impact on COS uptake by recommending their use to those applying for funding. The aim of our study was to assess the extent to which applicants followed the National Institute for Health Research Health Technology Assessment (NIHR HTA) programme’s recommendation to search for a COS to include in their clinical trial. Methods and findings We examined the outcomes section and detailed project descriptions of all 95 researcher-led primary research applications submitted to the NIHR HTA between January 2012, when the recommendation to search for a COS was included in the guidance for applicants, and December 2015 for evidence that a search for a COS had taken place and rationale for outcome choice in the absence of COS. A survey of applicants was conducted to further explore their use of COS and choice of outcomes with a response rate of 49%. Nine out of 95 applicants (10%) stated in their application that they had searched the COMET (Core Outcome Measures for Effectiveness Trials) Initiative database for a COS and another nine referred to searching for a COS using another method, e.g. a review of the literature. Of the 77 (81%) applicants that did not mention COMET or COS in their application, eight stated in the survey that they had searched the COMET database and ten carried out a search using another method. Some applicants who did not search for a COS gave reasons for their choice of outcomes including taking advice from patients and the public and choosing outcomes used in previous trials. Conclusion A funding body can have an impact on COS uptake by encouraging trialists to search for a COS. Funders could take further steps by putting processes in place to prompt applicants to be explicit about searching for COS in their application and notifying the funding board if a search has not taken place. The sources of information used by trialists to make decisions about outcomes in the absence of COS may suggest methods of dissemination for COS.
Collapse
|
19
|
Bansback N, Trenaman L, MacDonald KV, Hawker G, Johnson JA, Stacey D, Marshall DA. An individualized patient-reported outcome measure (PROM) based patient decision aid and surgeon report for patients considering total knee arthroplasty: protocol for a pragmatic randomized controlled trial. BMC Musculoskelet Disord 2019; 20:89. [PMID: 30797238 PMCID: PMC6387514 DOI: 10.1186/s12891-019-2434-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 01/28/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While the rates of total knee arthroplasty (TKA) continue to rise worldwide, there are concerns about whether all surgeries are appropriate. Guidelines for appropriateness suggest that patients should have realistic expectations for total knee arthroplasty (TKA), and that the patient and their surgeon should agree that the potential benefits outweigh the potential harms. The objective of this study is to evaluate whether routinely collected pre- and post-TKA patient-reported outcome measures (PROMs) could be integrated into a patient decision aid to better inform these appropriateness criteria. This randomised trial will evaluate the preliminary efficacy of a tailored PROM-based patient decision aid and surgeon report (compared to usual care) for patients considering TKA on decision quality. METHODS This is a pragmatic, randomised controlled trial conducted at one site in Alberta, Canada. Adults over the age of 30 years, who have been scheduled for a TKA consultation at the Edmonton Bone and Joint Centre with a participating surgeon, who understand, speak, and read English, and can provide informed consent, are eligible to participate. Participants will be randomised to receive a PROM-based patient decision aid and surgeon report before their surgical consultation or usual care. The decision aid will provide patients with information on their expected outcomes based on the EQ-5D-5L PROM, and these estimates are individualized based on clinical and demographic characteristics. The primary outcome of this trial is decision quality. Analysis will consider outcomes intention to treat, and feasibility outcomes for implementing the trial to routine practise. DISCUSSION This patient decision aid and surgeon report intervention could contribute to improved treatment decision-making for patients considering total knee arthroplasty. TRIAL REGISTRATION (REGISTRY AND NUMBER) ClinicalTrials.gov : NCT03240913. Registered on August 1, 2017.
Collapse
Affiliation(s)
- Nick Bansback
- School of Population and Public Health, University of British Columbia, Vancouver, BC Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC Canada
- Arthritis Research Canada, Richmond, BC Canada
| | - Logan Trenaman
- School of Population and Public Health, University of British Columbia, Vancouver, BC Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC Canada
- Arthritis Research Canada, Richmond, BC Canada
| | - Karen V. MacDonald
- Department of Community Health Sciences, University of Calgary, Calgary, AB Canada
| | - Gillian Hawker
- Department of Medicine, University of Toronto, Toronto, ON Canada
| | | | - Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, ON Canada
- Centre for Practice Changing Research, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Deborah A. Marshall
- Arthritis Research Canada, Richmond, BC Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB Canada
| |
Collapse
|
20
|
Psychologische Faktoren im Kontext perioperativer Knie- und Gelenkschmerzen: die Rolle der Behandlungserwartungen für den Schmerzverlauf. Schmerz 2018; 33:13-21. [DOI: 10.1007/s00482-018-0350-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
21
|
Price AJ, Alvand A, Troelsen A, Katz JN, Hooper G, Gray A, Carr A, Beard D. Knee replacement. Lancet 2018; 392:1672-1682. [PMID: 30496082 DOI: 10.1016/s0140-6736(18)32344-4] [Citation(s) in RCA: 387] [Impact Index Per Article: 64.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 09/13/2018] [Accepted: 09/19/2018] [Indexed: 12/13/2022]
Abstract
Knee replacement surgery is one of the most commonly done and cost-effective musculoskeletal surgical procedures. The numbers of cases done continue to grow worldwide, with substantial variation in utilisation rates across regions and countries. The main indication for surgery remains painful knee osteoarthritis with reduced function and quality of life. The threshold for intervention is not well defined, and is influenced by many factors including patient and surgeon preference. Most patients have a very good clinical outcome after knee replacement, but multiple studies have reported that 20% or more of patients do not. So despite excellent long-term survivorship, more work is required to enhance this procedure and development is rightly focused on increasing the proportion of patients who have successful pain relief after surgery. Changing implant design has historically been a target for improving outcome, but there is greater recognition that improvements can be achieved by better implantation methods, avoiding complications, and improving perioperative care for patients, such as enhanced recovery programmes. New technologies are likely to advance future knee replacement care further, but their introduction must be regulated and monitored with greater rigour to ensure patient safety.
Collapse
Affiliation(s)
- Andrew J Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, Nuffield Orthopaedic Centre, Oxford, UK.
| | - Abtin Alvand
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, Nuffield Orthopaedic Centre, Oxford, UK
| | - Anders Troelsen
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Jeffrey N Katz
- Department of Orthopedic Surgery and Division of Rheumatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gary Hooper
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Alastair Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Andrew Carr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, Nuffield Orthopaedic Centre, Oxford, UK
| | - David Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, Nuffield Orthopaedic Centre, Oxford, UK
| |
Collapse
|
22
|
Implementing core outcomes in kidney disease: report of the Standardized Outcomes in Nephrology (SONG) implementation workshop. Kidney Int 2018; 94:1053-1068. [PMID: 30360959 DOI: 10.1016/j.kint.2018.08.018] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 08/22/2018] [Accepted: 08/30/2018] [Indexed: 02/08/2023]
Abstract
There are an estimated 14,000 randomized trials published in chronic kidney disease. The most frequently reported outcomes are biochemical endpoints, rather than clinical and patient-reported outcomes including cardiovascular disease, mortality, and quality of life. While many trials have focused on optimizing kidney health, the heterogeneity and uncertain relevance of outcomes reported across trials may limit their policy and practice impact. The international Standardized Outcomes in Nephrology (SONG) Initiative was formed to identify core outcomes that are critically important to patients and health professionals, to be reported consistently across trials. We convened a SONG Implementation Workshop to discuss the implementation of core outcomes. Eighty-two patients/caregivers and health professionals participated in plenary and breakout discussions. In this report, we summarize the findings of the workshop in two main themes: socializing the concept of core outcomes, and demonstrating feasibility and usability. We outline implementation strategies and pathways to be established through partnership with stakeholders, which may bolster acceptance and reporting of core outcomes in trials, and encourage their use by end-users such as guideline producers and policymakers to help improve patient-important outcomes.
Collapse
|
23
|
Efficacy and Safety Outcome Domains and Outcome Measures in Systematic Reviews of Neuropathic Pain Conditions. Clin J Pain 2018; 34:674-684. [DOI: 10.1097/ajp.0000000000000574] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
24
|
Tong A, Crowe S, Gill JS, Harris T, Hemmelgarn BR, Manns B, Pecoits-Filho R, Tugwell P, van Biesen W, Wang AYM, Wheeler DC, Winkelmayer WC, Gutman T, Ju A, O’Lone E, Sautenet B, Viecelli A, Craig JC. Clinicians' and researchers' perspectives on establishing and implementing core outcomes in haemodialysis: semistructured interview study. BMJ Open 2018; 8:e021198. [PMID: 29678992 PMCID: PMC5914778 DOI: 10.1136/bmjopen-2017-021198] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To describe the perspectives of clinicians and researchers on identifying, establishing and implementing core outcomes in haemodialysis and their expected impact. DESIGN Face-to-face, semistructured interviews; thematic analysis. STETTING Twenty-seven centres across nine countries. PARTICIPANTS Fifty-eight nephrologists (42 (72%) who were also triallists). RESULTS We identified six themes: reflecting direct patient relevance and impact (survival as the primary goal of dialysis, enabling well-being and functioning, severe consequences of comorbidities and complications, indicators of treatment success, universal relevance, stakeholder consensus); amenable and responsive to interventions (realistic and possible to intervene on, differentiating between treatments); reflective of economic burden on healthcare; feasibility of implementation (clarity and consistency in definition, easily measurable, requiring minimal resources, creating a cultural shift, aversion to intensifying bureaucracy, allowing justifiable exceptions); authoritative inducement and directive (endorsement for legitimacy, necessity of buy-in from dialysis providers, incentivising uptake); instituting patient-centredness (explicitly addressing patient-important outcomes, reciprocating trial participation, improving comparability of interventions for decision-making, driving quality improvement and compelling a focus on quality of life). CONCLUSIONS Nephrologists emphasised that core outcomes should be relevant to patients, amenable to change, feasible to implement and supported by stakeholder organisations. They expected core outcomes would improve patient-centred care and outcomes.
Collapse
Affiliation(s)
- Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | | | - John S Gill
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Brenda R Hemmelgarn
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Braden Manns
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Roberto Pecoits-Filho
- Department of Internal Medicine, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | - Peter Tugwell
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Wim van Biesen
- Renal Division, Ghent University Hospital, Ghent, Belgium
| | | | - David C Wheeler
- Centre for Nephrology, University College London, London, UK
| | - Wolfgang C Winkelmayer
- Selzman Institute for Kidney Health, Section of Nephrology, Baylor College of Medicine, Houston, Texas, USA
| | - Talia Gutman
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - Angela Ju
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - Emma O’Lone
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - Benedicte Sautenet
- Department of Nephrology and Clinical Immunology, Tours Hospital, Tours, France
- University Francois Rabelais, Tours, France
- INSERM, U1246, Tours, France
| | - Andrea Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Jonathan C Craig
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| |
Collapse
|
25
|
Li X, Tang C, Wang J, Guo P, Wang C, Wang Y, Zhang Z, Wu H. Methylene blue relieves the development of osteoarthritis by upregulating lncRNA MEG3. Exp Ther Med 2018; 15:3856-3864. [PMID: 29581742 PMCID: PMC5863598 DOI: 10.3892/etm.2018.5918] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 11/03/2017] [Indexed: 12/23/2022] Open
Abstract
Methylene blue (MB) is a long-term inhibitor of peripheral nerve axons, thereby alleviating or permanently eliminating pain. However, it remains unknown whether MB is safe and effective method of treating osteoarthritis (OA). MB was injected into the knee joints of rabbits and they were monitored for any histological structural changes. The results revealed no evident changes in the histological structure of the normal knee joint following injection of 1 mg/kg MB at 1, 4, 8 and 24 weeks post-injection. Compared with the vehicle control, MB treatment significantly enhanced the weight distribution and significantly decreased the swelling ratio of the rabbits. Additionally, levels of long non-coding RNA (lncRNA) maternally expressed 3 (MEG3) mRNA were significantly increased following treatment with MB, but the protein expression of P2X purinoceptor 3 (P2X3) was significantly suppressed compared with the vehicle control. The levels of interleukin (IL) 6, tumor necrosis factor (TNF)α, IL-1β and IL-8 were significantly suppressed following MB treatment, indicating that MB protects against OA progression. It was also revealed that MEG3 overexpression significantly suppresses levels of P2X3 protein. ELISA indicated that the MEG3-induced reduction of IL-6, TNFα, IL-1β and IL-8 expression was significantly reversed following P2X3 overexpression. Therefore, the results of the present study demonstrated that MB is an effective method of treating OA-associated pain by upregulating lncRNA MEG3 levels. Additionally, lncRNA MEG3 relieves the OA-associated pain and inflammation in a rabbit model of OA by inhibiting P2X3 expression.
Collapse
Affiliation(s)
- Xinyi Li
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Chaoliang Tang
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Jin Wang
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Peipei Guo
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Chengyao Wang
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Yanlin Wang
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Zongze Zhang
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Huisheng Wu
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
| |
Collapse
|
26
|
Lange T, Schmitt J, Kopkow C, Rataj E, Günther KP, Lützner J. What Do Patients Expect From Total Knee Arthroplasty? A Delphi Consensus Study on Patient Treatment Goals. J Arthroplasty 2017; 32:2093-2099.e1. [PMID: 28259490 DOI: 10.1016/j.arth.2017.01.053] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 01/13/2017] [Accepted: 01/30/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Although total knee arthroplasty (TKA) is among the most frequent orthopedic procedures for end-stage knee osteoarthritis (OA), systematically developed patient treatment goals for this elective intervention are missing. This constitutes a relevant barrier toward patient-centered healthcare. METHODS A Delphi consensus study was conducted. Patients who were candidates for TKA were recruited through 11 outpatient orthopedic surgeons, 4 physiotherapists, and a patient organization in Germany. The initial questionnaire included 20 potential treatment goals derived from a systematic review on outcomes assessed in TKA trials. Patients were asked to rate these potential treatment goals as "main goal," "secondary goal," or "no goal." It was specified that a main goal must be met to consider TKA as successful. Patients could add further goals which were included in the next questionnaire together with a feedback on their own and the group's previous rating. Patients could then confirm or revise their responses to find group consensus, which was defined as ≥70% of participants rating a treatment goal as main goal. RESULTS From initial 108 participants, 93 (86%) completed the study. Consensus was achieved that symptom reduction ("pain reduction," "improvement of stability"), functional improvements (improvement of "physical function," "range of motion," "walking distance," "walking stairs," "physical activity"), "improvement of quality of life," and prevention and safety concerns ("prevention from secondary impairments," "long implant survival") are the main treatment goals of patients who are candidates for TKA. CONCLUSION Physicians should consider patient treatment goals in routine clinical decision making to meet the requirements of patient-centered healthcare. Researchers should consider those treatment goals in effectiveness studies on TKA.
Collapse
Affiliation(s)
- Toni Lange
- Center for Evidence-Based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany; University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Christian Kopkow
- Center for Evidence-Based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Elisabeth Rataj
- Center for Evidence-Based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany; University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - Klaus-Peter Günther
- University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - Jörg Lützner
- University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| |
Collapse
|
27
|
Singh JA, Dowsey M, Choong PF. Patient Endorsement of the Outcome Measures in Rheumatology (OMERACT) Total Joint Replacement (TJR) clinical trial draft core domain set. BMC Musculoskelet Disord 2017; 18:111. [PMID: 28298194 PMCID: PMC5353795 DOI: 10.1186/s12891-017-1464-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 02/28/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND A patient- and surgeon-Delphi-derived Outcome Measures in Rheumatology (OMERACT) draft core domain set for total joint arthroplasty (TJR) trials was recently developed. Our objective was to obtain further patient stakeholder endorsement of draft core domain set for TJR clinical trials. METHODS We surveyed two patient groups: (1) OMERACT patient partners; and (2) patients who had undergone hip or knee TJR. Patients received an introductory email with explanations about the core domain set and instructions to rate the core domains, i.e., important aspects, of OMERACT TJR clinical trial draft core domain set. Rating was on a nominal scale, where 1-3 indicated a domain of limited importance, 4-6 an important, but not critical domain, and 7-9 a critical domain. We used Mann-Whitney test (a non-parametric test) to compare the distribution of ratings between the two groups. RESULTS Thirty one survey participants from the OMERACT patient partner group and 118 knee/hip TJR patients responded with response rates of 66 and 80%, respectively. Majority of the survey respondents were female, 87 vs. 53%, and were 55 years or older, 57 vs. 94%. Median (interquartile range [IQR]) scores for six core domains by OMERACT and knee/hip TJR patient groups were, respectively: pain, 8 [8, 9] and 9 [8, 9]; function, 9 [8, 9] and 9 [8, 9]; patient satisfaction, 8 [8, 9] and 8 [7, 9]; revision surgery, 7 [7, 8] and 7 [5, 9]; adverse events, 8 [7, 9] and 8 [6, 9]; and death, 9 [6, 9] and 9 [4, 9]. No statistically significant differences in rating were noted for any of the six core domains between the two groups (p ≥ 0.31). Among the additional domains, ratings for patient participation did not differ by group (p = 0.98), but ratings for cost were significantly different (p = 0.005). Patients provided qualitative feedback regarding core domains, and did not propose any modifications to the draft core domain set. CONCLUSIONS Two separate patient stakeholder groups endorsed the OMERACT TJR draft core domain set for TJR trials.
Collapse
Affiliation(s)
- Jasvinder A Singh
- University of Alabama at Birmingham, 510 20th Street S, Faculty Office Tower 805B, Birmingham, AL, 35294, USA. .,Birmingham Veterans Affairs Medical Center, 700 19th St S, Birmingham, AL, 35233, USA.
| | - Michelle Dowsey
- Department of Surgery, University of Melbourne, St. Vincent's Hospital, Melbourne, Australia
| | - Peter F Choong
- Department of Surgery, University of Melbourne, St. Vincent's Hospital, Melbourne, Australia
| |
Collapse
|
28
|
Chiarotto A, Ostelo RW, Turk DC, Buchbinder R, Boers M. Core outcome sets for research and clinical practice. Braz J Phys Ther 2017; 21:77-84. [PMID: 28460714 PMCID: PMC5537457 DOI: 10.1016/j.bjpt.2017.03.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 12/05/2016] [Accepted: 12/05/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND This masterclass introduces the topic of core outcome sets, describing rationale and methods for developing them, and providing some examples that are relevant for clinical research and practice. METHOD A core outcome set is a minimum consensus-based set of outcomes that should be measured and reported in all clinical trials for a specific health condition and/or intervention. Issues surrounding outcome assessment, such as selective reporting and inconsistency across studies, can be addressed by the development of a core set. As suggested by key initiatives in this field (i.e. OMERACT and COMET), the development requires achieving consensus on: (1) core outcome domains and (2) core outcome measurement instruments. Different methods can be used to reach consensus, including: literature systematic reviews to inform the process, qualitative research with clinicians and patients, group discussions (e.g. nominal group technique), and structured surveys (e.g. Delphi technique). Various stakeholders should be involved in the process, with particular attention to patients. RESULTS AND CONCLUSIONS Several COSs have been developed for musculoskeletal conditions including a longstanding one for low back pain, IMMPACT recommendations on outcomes for chronic pain, and OMERACT COSs for hip, knee and hand osteoarthritis. There is a lack of COSs for neurological, geriatric, cardio-respiratory and pediatric conditions, therefore, future research could determine the value of developing COSs for these conditions.
Collapse
Affiliation(s)
- Alessandro Chiarotto
- Department of Health Sciences, Faculty of Earth and Life Sciences, EMGO(+) Institute for Health and Care Research, Vrije Universiteit, Amsterdam, Netherlands; Department of Epidemiology and Biostatistics, EMGO(+) Institute for Health and Care Research, VU Medical Center, Amsterdam, Netherlands.
| | - Raymond W Ostelo
- Department of Health Sciences, Faculty of Earth and Life Sciences, EMGO(+) Institute for Health and Care Research, Vrije Universiteit, Amsterdam, Netherlands; Department of Epidemiology and Biostatistics, EMGO(+) Institute for Health and Care Research, VU Medical Center, Amsterdam, Netherlands
| | - Dennis C Turk
- Department of Anesthesiology and Pain Medicine, Center for Pain Research in Impact, Measurement and Effectiveness, University of Washington, Seattle, USA
| | - Rachelle Buchbinder
- Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Maarten Boers
- Department of Health Sciences, Faculty of Earth and Life Sciences, EMGO(+) Institute for Health and Care Research, Vrije Universiteit, Amsterdam, Netherlands; Amsterdam Rheumatology and Immunology Center, VU Medical Center, Amsterdam, Netherlands
| |
Collapse
|