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Alfaro-Adrián J. Editorial Commentary: The Forgotten Joint Score Is Valid, But Should Not Be Used to Compare Heterogeneous Procedures. Arthroscopy 2023; 39:2096-2097. [PMID: 37543392 DOI: 10.1016/j.arthro.2023.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 08/07/2023]
Abstract
Patient-reported outcome measures are sometimes difficult to use. In contrast, the Forgotten Joint Score (FJS) is efficient and easy for patients to understand. FJS is used to assess patient awareness of joint symptoms or more specifically, as indicated by the word "forgotten," the lack thereof. Another advantage of the FJS is that it is quite discriminating compared with other patient-reported outcome measures, which may show low ceiling effects, meaning that a maximum score is easy to achieve. The FJS is valuable, but it should not be used to compare heterogeneous procedures.
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Kuhns BD, Harris WT, Domb BG. Low Ceiling Effects of the Forgotten Joint Score Compared With Legacy Measures After Joint-Preserving Procedures: A Systematic Review. Arthroscopy 2023; 39:2086-2095. [PMID: 36804458 DOI: 10.1016/j.arthro.2023.01.107] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 01/17/2023] [Accepted: 01/31/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE To determine, in patients undergoing joint preservation procedures, whether the Forgotten Joint Score (FJS) compares favorably with legacy measures. METHODS Medical databases (including PubMed/MEDLINE and Embase databases) were queried for publications with the terms "Forgotten Joint Score" and "hip," "knee," "arthroscopy," or "ACL." Fourteen studies met the inclusion criteria. Methodologic quality was assessed through the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist, and psychometric data were evaluated for ceiling or floor effects, convergent validity, internal consistency, reliability, responsiveness, measurement invariance, and measurement error by 2 fellowship-trained orthopaedic surgeons (B.D.K. and W.T.H.). RESULTS Data were collected from 14 studies using the FJS after joint-preserving procedures in 911 patients (959 joints). Four studies reported strong internal consistency with an average Cronbach α of 0.92. Two studies reported responsiveness with an effect size ranging from 0.6 to 1.16. One study reported reproducibility with an interclass correlation coefficient of 0.9 (95% confidence interval, 0.8-0.9). One study reported measurement error with an minimum detectable change (MDC)individual of 32% and MDCgroup of 4.5%. Studies reported moderate to very strong convergent validity across legacy measures for hip and knee preservation surgery. Ceiling effects were favorable compared with many legacy scores for hip and knee preservation. Three studies reported the minimal clinically important difference whereas 1 study reported the patient acceptable symptomatic state for the FJS. CONCLUSIONS The FJS is a methodologically sound outcome measure used to evaluate patient outcomes after hip and knee preservation surgery with overall low ceiling effects compared with legacy measures. LEVEL OF EVIDENCE Level IV, systematic review of Level III and IV studies.
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Affiliation(s)
- Benjamin D Kuhns
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A..
| | - W Taylor Harris
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
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Noguchi K, Yamaguchi S, Teramoto A, Amaha K, Kanzaki N, Tanaka H, Yasui T, Inaba Y. Reliability and validity of the Forgotten Joint Score-12 for total ankle replacement and ankle arthrodesis. PLoS One 2023; 18:e0286762. [PMID: 37315039 DOI: 10.1371/journal.pone.0286762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/22/2023] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVES This study evaluated the reliability and validity of the Forgotten Joint Score-12 (FJS-12)-a measure of patients' ability to forget their joints in daily life-in patients who underwent total ankle replacement (TAR) or ankle arthrodesis (AA). METHODS Patients who underwent TAR or AA were recruited from seven hospitals. The patients completed the Japanese version of FJS-12 twice, at an interval of two weeks, at a minimum of one year postoperatively. Additionally, they answered the Self-Administered Foot Evaluation Questionnaire and EuroQoL 5-Dimension 5-Level as comparators. The construct validity, internal consistency, test-retest reliability, measurement error, and floor and ceiling effects were evaluated. RESULTS A total of 115 patients (median age, 72 years), comprising 50 and 65 patients in the TAR and AA groups respectively, were evaluated. The mean FJS-12 scores were 65 and 58 for the TAR and AA groups, respectively, with no significant difference between groups (P = 0.20). Correlations between the FJS-12 and Self-Administered Foot Evaluation Questionnaire subscale scores were good to moderate. The correlation coefficient ranged from 0.39 to 0.71 and 0.55 to 0.79 in the TAR and AA groups, respectively. The correlation between the FJS-12 and EuroQoL 5-Dimension 5-Level scores was poor in both groups. The internal consistency was adequate, with Cronbach's α greater than 0.9 in both groups. The intraclass correlation coefficients of test-retest reliability was 0.77 and 0.98 in the TAR and AA groups, respectively. The 95% minimal detectable change values were 18.0 and 7.2 points in the TAR and AA groups, respectively. No floor or ceiling effect was observed in either group. CONCLUSIONS The Japanese version of FJS-12 is a valid and reliable questionnaire for measuring joint awareness in patients with TAR or AA. The FJS-12 can be a useful tool for the postoperative assessment of patients with end-stage ankle arthritis.
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Affiliation(s)
- Koji Noguchi
- Department of Orthopaedic Surgery, Kurume University School of Medicine, Kurume-shi, Fukuoka, Japan
- Japan Community Health care Organization Kurume General Hospital, Kurume-shi, Fukuoka, Japan
| | - Satoshi Yamaguchi
- Graduate School of Global and Transdisciplinary Studies, Chiba University, Chiba-shi, Chiba, Japan
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba-shi, Chiba, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo-shi, Hokkaido, Japan
| | - Kentaro Amaha
- Department of Orthopaedic Surgery, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan
| | - Noriyuki Kanzaki
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe-shi, Hyogo, Japan
| | - Hirofumi Tanaka
- Hyakutake Orthopedic Surgery and Sports Clinic, Saga-shi, Saga, Japan
| | - Tetsuro Yasui
- Department of Orthopaedic Surgery, Teikyo University Mizonokuchi Hospital, Kawasaki-shi, Kanagawa, Japan
| | - Yosuke Inaba
- Biostatistics Section, Chiba University Hospital Clinical Research Center, Chiba-shi, Chiba, Japan
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Karakaş G, Özçadırcı A, Topuz S. A Modified Version of the Forgotten Joint Score-12 in Lower Limb Amputees: Validity and Reliability Study. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2023; 43:288-295. [PMID: 36125052 DOI: 10.1177/15394492221123521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Adaptation to prosthesis is important for occupation, quality of life, and participation in social life, so it needs to be evaluated. The aim of this study was to determine the validity and reliability of the Forgotten Joint Score-12 (FJS-12) in lower limb amputees. The FJS-12 was applied to 80 amputees. Criterion-referenced validity was assessed using the activity restriction subparameter of Trinity Amputation and Prosthesis Experience Scale (TAPES). The internal consistency of the FJS-12 was high (Cronbach's α = .943). A statistically significant very good negative correlation was determined between the FJS-12 and the activity restriction subparameter of TAPES (r = -.641; p < .001). The results of this study showed that FJS-12 is a valid and reliable measurement tool that can be used to assess the adaptation to prosthesis in amputees. Evaluation of prosthesis awareness in daily living activities of amputees is important in terms of establishing occupational therapy and rehabilitation programs.
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Lee JY, Yeo WW, Chia ZY, Chang P. Normative FJS-12 scores for the knee in an Asian population: a cross-sectional study. Knee Surg Relat Res 2021; 33:40. [PMID: 34717774 PMCID: PMC8557544 DOI: 10.1186/s43019-021-00122-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/19/2021] [Indexed: 11/28/2022] Open
Abstract
Background The Forgotten Joint Score is a patient-reported outcome measure validated in assessing patients post knee arthroplasty, anterior cruciate ligament (ACL) reconstruction surgery and patellar dislocation. A previous study had established the normative scores of a population in the USA but included knees with pathology. The aim of our study is to obtain normative Forgotten Joint Scores in young Asian adults without any pre-existing knee pathologies to increase the interpretability of the Forgotten Joint Score-12 (FJS-12) score. Methods We conducted a cross-sectional study across young healthy Asian adults via electronic platforms. Participants who had sought either Western medical consultation, physiotherapy or traditional medical therapies were excluded. Demographic data, occupation, type of sport played, and FJS-12 scores were collected. Scores were stratified into subgroups and analysed. Results There were 172 participants who met our inclusion criteria for this study. The average age of participants in our study was 28.1 ± 10.5 years (range 14–70 years), with 83 (47.7%) participants falling into the ages 21–25 years. Average body mass index (BMI) was 21.9 ± 3.3 kg/m2 (range 14.7–36.3 kg/m2). The average FJS-12 score was 62.8 ± 25.6. The median FJS-12 was 63.5 with a range of 4.2–100. Nine participants (5.2%) scored the maximum score possible, and 56 (32.6%) participants scored below the midpoint score of 50. The percentiles for each subgroup of participants were tabulated and reported. Notably, males aged 46–70 years old scored the highest average FJS-12 score of 73.4 ± 5.5, and females aged 31–45 years old scored the lowest FJS-12 score of 57.1 ± 25.1. Females scored lower than males, although the difference was not statistically significant (p = 0.157). There were no significant correlations between BMI, age, or type of sport played with FJS-12; however, interestingly, we observed that women reported similar FJS-12 scores across all age groups, while men reported better scores with increasing age.Interestingly,
we observed that women reported similar FJS-12 scores across all age groups,
while men reported better scores with increasing age. Conclusion Having normative values provides opportunities for benchmarking and comparing individuals against age- and gender-matched peers in the general population. Knowledge of normative values for FJS-12 scores would aid evaluating and tracking progress in patients recovering from injuries or undergoing post-surgery rehabilitation. This would help clinicians determine if they return to ‘normal’ post intervention. Supplementary Information The online version contains supplementary material available at 10.1186/s43019-021-00122-2.
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Affiliation(s)
- Jia Ying Lee
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia Level 4, Singapore, 169856, Singapore.
| | - Wai Weng Yeo
- University of New South Wales, Sydney, Australia
| | - Zi Yang Chia
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia Level 4, Singapore, 169856, Singapore
| | - Paul Chang
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia Level 4, Singapore, 169856, Singapore
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Itoh M, Itou J, Kuwashima U, Okazaki K. Good Validity and High Internal Consistency of the Forgotten Joint Score-12 in Patients After Medial Opening Wedge High Tibial Osteotomy. J Arthroplasty 2021; 36:2691-2697. [PMID: 33812712 DOI: 10.1016/j.arth.2021.03.028] [Citation(s) in RCA: 3] [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: 12/25/2020] [Revised: 03/04/2021] [Accepted: 03/08/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The Forgotten Joint Score-12 (FJS-12) was originally developed to assess awareness of an artificial joint. Medial opening wedge high tibial osteotomy (MOWHTO), an alternative surgical method of knee replacement, is a joint-preservation surgery; therefore, joint awareness should be used to evaluate its clinical results. However, FJS-12 has not been validated as a tool to evaluate the postoperative results of MOWHTO. This study aimed to validate FJS-12 in MOWHTO. METHODS Patients with bilateral knee surgery, previous knee surgery, flexion contracture >15°, varus alignment >20°, and patients without plate removal surgery were excluded. Finally, 71 knees of 71 patients were analyzed, with a mean follow-up of 34.5 months. The FJS-12 score and Knee Injury and Osteoarthritis Outcome Score (KOOS) were obtained, and the floor and ceiling effect of each score was investigated. Cronbach's α was calculated to determine the internal consistency of FJS-12. Spearman's correlation coefficients between FJS-12 and KOOS were calculated to assess convergent validity. RESULTS There were ceiling effects in 3 KOOS subscales (symptoms [25.4%], pain [15.5%], and activities of daily living [25.4%]) but not in FJS-12 (8.5%). No floor effect was noted in any patient-reported outcome measures. The total Cronbach's α was 0.9457 in FJS-12. FJS-12 showed moderate-to-strong positive correlations with all KOOS subscales (r = 0.64-0.72). CONCLUSION FJS-12 showed a lower ceiling effect than KOOS and high internal consistency and convergent validity in patients following MOWHTO. With its low ceiling effect, FJS-12 was found to be useful for evaluating patients following MOWHTO.
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Affiliation(s)
- Masafumi Itoh
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Junya Itou
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Umito Kuwashima
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Ken Okazaki
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
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Abstract
Aims As our population ages, the number of octogenarians who will require a total hip arthroplasty (THA) rises. In a value-based system where operative outcomes are linked to hospital payments, it is necessary to assess the outcomes in this population. The purpose of this study was to compare outcomes of elective, primary THA in patients ≥ 80 years old to those aged < 80. Methods A retrospective review of 10,251 consecutive THA cases from 2011 to 2019 was conducted. Patient-reported outcome (PRO) scores (Hip disability and Osteoarthritis Outcome Score (HOOS)), as well as demographic, readmission, and complication data, were collected. Results On average, the younger cohort (YC, n = 10,251) was a mean 61.60 years old (SD 10.71), while the older cohort (OC, n = 609) was 84.25 years old (SD 3.02) (p < 0.001). The OC had greater surgical risk based on their higher mean American Society of Anesthesiologists (ASA) scores (2.74 (SD 0.63) vs 2.30 (SD 0.63); p < 0.001) and Charlson Comorbidity Index (CCI) scores (6.26 (SD 1.71) vs 3.87 (SD 1.98); p < 0.001). While the OC stayed in the hospital longer than the YC (mean 3.5 vs 2.5 days; p < 0.001), there were no differences in 90-day emergency visits (p = 0.083), myocardial infarctions (p = 0.993), periprosthetic joint infections (p = 0.214), dislocations (p = 0.993), or aseptic failure (p = 0.993). The YC was more likely to be readmitted within 90 days (3.88% vs 2.18%, Β = 0.57; p = 0.048). There were no observed differences in 12-week (p = 0.518) or one-year (p = 0.511) HOOS scores. Conclusion Although patients ≥ 80 years old have a greater number of comorbidities than younger patients, they had equivalent perioperative complication rates and PRO scores. This study demonstrates the safety and success of elective THA in octogenarians. Cite this article: Bone Jt Open 2021;2(7):535–539.
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Affiliation(s)
- Stephen Gerard Zak
- Orthopedic Surgery, NYU Langone Orthopedic Center, New York, New York, USA
| | - Katherine Lygrisse
- Orthopedic Surgery, NYU Langone Orthopedic Center, New York, New York, USA
| | - Alex Tang
- Orthopedic Surgery, NYU Langone Orthopedic Center, New York, New York, USA
| | - Morteza Meftah
- Orthopedic Surgery, NYU Langone Orthopedic Center, New York, New York, USA
| | - William J Long
- Orthopedic Surgery, NYU Langone Orthopedic Center, New York, New York, USA
| | - Ran Schwarzkopf
- Orthopedic Surgery, NYU Langone Orthopedic Center, New York, New York, USA
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Robinson PG, Rankin CS, Murray IR, Maempel JF, Gaston P, Hamilton DF. The forgotten joint score-12 is a valid and responsive outcome tool for measuring success following hip arthroscopy for femoroacetabular impingement syndrome. Knee Surg Sports Traumatol Arthrosc 2021; 29:1378-1384. [PMID: 32691092 PMCID: PMC8038977 DOI: 10.1007/s00167-020-06138-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/26/2020] [Indexed: 11/13/2022]
Abstract
PURPOSE The forgotten joint score-12 (FJS-12) is an outcome questionnaire designed to evaluate joint awareness. The responsiveness and validity of the English language version of the FJS-12 in patients undergoing hip arthroscopy for femoroacetabular impingement (FAI) is not known. METHODS Consecutive patients undergoing hip arthroscopy for a diagnosis of FAI were prospectively followed up over a 1 year period. Patients completed preoperative and postoperative FJS-12, EuroQol 5 Dimension (EQ-5D-5L), and the 12-item international hip outcome tool (iHOT-12). We evaluated construct validity with Spearman correlation coefficients for the FJS-12, and responsiveness by way of effect size and ceiling effects. RESULTS Forty-six patients underwent hip arthroscopy, of which 42 (91%) completed post-operative PROMs at 1 year follow-up. Construct validity was strong with the iHOT-12 (r = 0.87) and also the EQ-5D-5L (r = 0.83). The median postoperative FJS score was 50.2 (IQR 64). The mean change in score for the FJS-12 was 31 points (SD 31) (p < 0.001), with an effect size (Cohen's d) of 1.16. Preoperatively, three patients scored the lowest possible value resulting in a floor effect of 7.1%. Similarly, only three patients (7.1%) scored the best possible score post-operatively. CONCLUSION This is the first evaluation of the joint awareness concept in the English language version of the FJS-12 following hip arthroscopy for FAI. The FJS-12 is a valid and responsive tool for the assessment of this cohort of patients. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Patrick G. Robinson
- grid.4305.20000 0004 1936 7988Trauma and Orthopaedic Department, University of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA UK
| | - C. S. Rankin
- grid.4305.20000 0004 1936 7988Trauma and Orthopaedic Department, University of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA UK
| | - I. R. Murray
- grid.4305.20000 0004 1936 7988Trauma and Orthopaedic Department, University of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA UK
| | - J. F. Maempel
- grid.413249.90000 0004 0385 0051Department of Trauma and Orthopaedics, Royal Prince Alfred Hospital, Camperdown, NSW Australia
| | - P. Gaston
- grid.4305.20000 0004 1936 7988Trauma and Orthopaedic Department, University of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA UK
| | - D. F. Hamilton
- grid.4305.20000 0004 1936 7988Trauma and Orthopaedic Department, University of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA UK
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