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Ackerman IN, Cashman K, Lorimer M, Heath E, Harris IA. Hip-specific and generic patient-reported outcome measure scores after primary hip replacement are associated with early revision surgery: a national registry study. J Patient Rep Outcomes 2024; 8:34. [PMID: 38512535 PMCID: PMC10957851 DOI: 10.1186/s41687-024-00713-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 03/12/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND The ability to efficiently identify patients at higher risk of poor outcomes after joint replacement would enable limited resources for post-operative follow-up to be directed to those with the greatest clinical need. This is particularly important as joint replacement rates continue to grow internationally, stretching health system capabilities. Patient-reported outcome measures (PROMs) are routinely administered in many settings and offer an opportunity to detect suboptimal patient outcomes early. This study aimed to determine whether hip-specific and generic PROM scores are associated with early revision hip replacement within six to 24 months after the primary procedure. METHODS Pre-operative and six-month post-operative PROM scores for patients undergoing primary total hip replacement (THR) were obtained from the Australian Orthopaedic Association National Joint Replacement Registry and Arthroplasty Clinical Outcomes Registry National and linked to revision surgery data. Clinically important improvement was defined using anchor-based thresholds. Associations between PROM scores (hip pain, Oxford Hip Score, HOOS-12, EQ-5D-5L, EQ VAS, patient-perceived change, satisfaction) and revision surgery were evaluated using t-tests, chi-square tests and regression models. RESULTS Data were analysed for 21,236 primary THR procedures between 2013 and 2022. Eighty-eight revision procedures were performed at six to 24 months. Patients who were revised had more back pain and worse HOOS-12 scores pre-operatively but between-group differences were small. Worse post-operative PROM scores (hip pain, Oxford, HOOS-12, EQ-5D-5L, EQ VAS) were associated with early revision, after adjusting for age and sex (p < 0.001 for all analyses). Patient dissatisfaction (relative risk (RR) 10.18, 95%CI 6.01-17.25) and patient-perceived worsening (RR 19.62, 95%CI 11.33-33.98) were also associated with a higher likelihood of revision. Patients who did not achieve clinically important improvement in hip pain, function, or quality of life had a higher revision risk (RRs 2.54-5.64), compared with those who did (reference). CONCLUSION Six-month hip-specific and generic PROM scores can identify patients at higher risk of early revision surgery. Our data highlight the utility of routine post-operative PROM assessment for signaling suboptimal surgical outcomes.
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Affiliation(s)
- Ilana N Ackerman
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Kara Cashman
- South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia, 5000, Australia
| | - Michelle Lorimer
- South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia, 5000, Australia
| | - Emma Heath
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia, 5000, Australia
| | - Ian A Harris
- School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Sydney, NSW, 2052, Australia
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, NSW, 2170, Australia
- Australian Orthopaedic Association National Joint Replacement Registry, North Terrace, Adelaide, South Australia, 5000, Australia
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Levens B, Kim BS, Aksu N, Dorris CS, Svoboda S, Douoguih W, Dreese J. Young or Old Age and Non-White Race Are Associated With Poor Patient-Reported Outcome Measure Response Compliance After Orthopaedic Surgery. Arthrosc Sports Med Rehabil 2023; 5:100817. [PMID: 38023444 PMCID: PMC10661514 DOI: 10.1016/j.asmr.2023.100817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/28/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose To investigate orthopaedic patient compliance with patient-reported outcome measures (PROMs) and identify factors that improve response rates. Methods Our search strategy comprised a combination of key words and database-specific subject headings for the concepts of orthopaedic surgical procedures, compliance, and PROMs from several research databases from inception to October 11, 2022. Duplicates were removed. A total of 97 studies were included. A table was created for the remaining articles to be appraised and analyzed. The collected data included study characteristics, follow-up/compliance rate, factors that increase/decrease compliance, and type of PROM. Follow-up/compliance rate was determined to be any reported response rate. The range and average used for analysis was based on the highest or lowest number reported in the specific article. Results The range of compliance reported was 11.3% to 100%. The overall response rate was 68.6%. The average baseline (preoperative/previsit) response rate was 76.6%. Most studies (77%) had greater than 50% compliance. Intervention/reminder of any type (most commonly phone call or mail) resulted in improved compliance from 44.6% to 70.6%. Young and elderly non-White male patients had the lowest compliance rate. When directly compared, phone call (71.5%) resulted in a greater compliance rate than electronic-based (53.2%) or paper-based (57.6%) surveys. Conclusions The response rates for PROMs vary across the orthopaedic literature. Patient-specific factors, such as age (young or old) and race (non-White), may contribute to poor PROM response rate. Reminders and interventions significantly improve PROM response rates. Clinical Relevance PROMs are important tools in many aspects of medicine. The data generated from these tools not only provide information about individual patient outcomes but also make hypothesis-driven comparisons possible. Understanding the factors that affect patient compliance with PROMs is vital to our accurate understanding of patient outcomes and the overall advancement of medical care.
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Affiliation(s)
| | | | | | | | - Steven Svoboda
- Medstar Health at Lafayette Centre, Washington, DC, U.S.A
| | - Wiemi Douoguih
- Medstar Health at Lafayette Centre, Washington, DC, U.S.A
| | - James Dreese
- Medstar Union Memorial Hospital, Baltimore, Maryland, U.S.A
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Preston NJ, McHugh GA, Hensor EMA, Grainger AJ, O’Connor PJ, Conaghan PG, Stone MH, Kingsbury SR. Feasibility testing of a standardised virtual clinic for follow-up of patients after hip and knee arthroplasty. Ann R Coll Surg Engl 2023; 105:252-262. [PMID: 35975843 PMCID: PMC9974348 DOI: 10.1308/rcsann.2021.0356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Over 200,000 hip and knee total joint arthroplasties (TJAs) are performed annually in England and Wales. UK guidelines recommend regular follow-up because missed early failure can result in complex revision surgery, which places additional burden on overstretched orthopaedic services. This study evaluated the feasibility and acceptability of an expert, consensus-based, standardised virtual clinic (VC) approach for TJA follow-up. METHODS Five UK secondary care orthopaedic centres implemented a standardised VC. Feedback was obtained through patient satisfaction questionnaires and telephone interviews with arthroplasty care practitioners. Key stakeholders subsequently attended an expert discussion forum to achieve consensus on the final VC format and to address obstacles identified during testing. RESULTS From 19 June 2018 to 11 December 2018, 561 TJA patients [mean age (SD) 70 (9.4) years, 57.8% female, 69.0% hip TJA, 1-28 years postsurgery (median 5 years)] completed a VC. Of these 561 patients, 82.2% were discharged without attending an outpatient appointment and 46 (8.8%) required early face-to-face consultant review. Patient satisfaction with the VC was high (156/188; 83.0%); over 70% of patients indicated a preference for the VC. DISCUSSION This feasibility study suggested significant resource savings, including time spent by consultant orthopaedic surgeons in outpatient clinics, hospital transport and an estimated saving of up to two-thirds of usual clinic-allotted time. The expert discussion forum provided helpful feedback for supporting more efficient implementation of the VC. CONCLUSIONS A standardised VC is a feasible alternative to outpatient clinics for the follow-up of hip and knee TJA patients, and is acceptable to key stakeholders, including patients.
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Affiliation(s)
- NJ Preston
- Leeds Institute of Rheumatic and Musculoskeletal Medicine,UK
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Muacevic A, Adler JR, Bolland B. Virtual Arthroplasty Follow-Up: Better for the Trust, Patients, and the Planet. Cureus 2022; 14:e31978. [PMID: 36589176 PMCID: PMC9796862 DOI: 10.7759/cureus.31978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2022] [Indexed: 11/29/2022] Open
Abstract
Background The Virtual Arthroplasty Follow-Up (VARF) Quality Improvement Project was initiated in March 2020 with the aim of improving patient experience while reducing costs to the trust, the patient, and the planet. Methodology This retrospective study was conducted in a district general hospital. Patients were assessed based on their Oxford Hip Score (OHS), University of California, Los Angeles (UCLA) activity score, and an X-ray. A patient satisfaction survey was undertaken via phone call using a 10-point questionnaire. These responses were then correlated to age, distance travelled, and OHS/UCLA scores. The environmental impact was estimated using CO2 emissions for driving and outpatient clinics taken from relevant literature. Results A total of 132 patients were enrolled in the project. Overall, 75% demonstrated a good outcome from both their X-ray and OHS/UCLA scores. Further, 23% of patients required an additional phone call, of which a further 77% were re-enrolled in the VARF pathway. Only five of 132 (3.8%) patients required a face-to-face review. The patient satisfaction survey enrolled 52 patients, 90% of whom were satisfied with the service. Only one patient stated being dissatisfied with the service. Overall, 77% of patients felt that the service saved them time, money, or both. The strongest predictor of patient satisfaction was the OHS (r = 0.52) where a score of <35 was associated with a nine-fold increase in either responding neutral or dissatisfied with the service. Accounting for both travel and clinic space, approximately 8 tonnes of CO2 equivalent were saved. Once time and cost-saving from virtual clinics were included, this project saved the trust £21,408 and patients £948. Conclusions VARF has been shown to be an appropriate way to follow up arthroplasty patients which maintains high patient satisfaction while reducing the environmental impact, saving patients' time and money, and freeing up clinic space for other uses. A potential improvement of the process would be to triage those with low OHS to a more intensive follow-up.
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Lim R, Du J, Calligeros K. Virtual arthroplasty clinic: a single centre experience: commentary on progress, cost savings and patient retention. ANZ J Surg 2022; 92:2242-2246. [PMID: 35727065 DOI: 10.1111/ans.17854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 05/04/2022] [Accepted: 05/31/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The COVID pandemic highlights utility of remote patient follow-up. We observe a Virtual Clinic (VC) follow-up model for arthroplasty used at a metropolitan hospital. Patients aged <70 that exhibit no issues in face-to-face review (F2F) progress to VC. We aimed to review VC's cost-effectiveness, and identify potential improvements to patient allocation and retention. METHOD A retrospective database was collated of all hip and knee joint arthroplasties performed at Frankston Hospital over a 12-month period in 2017-2018. Patient encounters were followed from operation to discharge from F2F and, if appropriate, VC (involving imaging and a paper-based qualitative questionnaire). VC attendance was compared to that of the year in which it was introduced (2014). The Clinical Costings Department provided average hospital spending for each of these modes of follow-up. RESULTS Of 516 joint arthroplasties performed, 500 attended outpatient clinic (OPC). There were 884 F2F appointments (average 1.7 per person, range 0-12). One-hundred-and-fifty-four arthroplasties were correctly assigned to subsequent VC as per protocol (30%). Completed VC responses were received for 86 arthroplasties (56% response rate). In the period studied, VC attendance increased significantly compared to the year following introduction (36-56%, p < 0.05), with the questionnaire revealing a high-level of patient satisfaction for this method of follow-up. Over the period studied, we estimate VC has saved $250 000 and 300 review hours from OPC. CONCLUSION Implementing VC for follow-up of arthroplasty may demonstrate a method of saving hospital resources. Appropriate early enrolment of patients to reduce F2F burden, and VC retention, should be encouraged.
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Affiliation(s)
- Reuben Lim
- Department of Surgery, Frankston Hospital, Peninsula Health, Melbourne, Victoria, Australia
| | - John Du
- Department of Surgery, Frankston Hospital, Peninsula Health, Melbourne, Victoria, Australia
| | - Kosta Calligeros
- Department of Surgery, Frankston Hospital, Peninsula Health, Melbourne, Victoria, Australia
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El Ashmawy AAH, Dowson K, El-Bakoury A, Hosny HAH, Yarlagadda R, Keenan J. Effectiveness, Patient Satisfaction, and Cost Reduction of Virtual Joint Replacement Clinic Follow-Up of Hip and Knee Arthroplasty. J Arthroplasty 2021; 36:816-822.e1. [PMID: 32893060 PMCID: PMC7428443 DOI: 10.1016/j.arth.2020.08.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/28/2020] [Accepted: 08/10/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Total hip and knee arthroplasties are increasingly performed operations, and routine follow-up places huge demands on orthopedic services. This study investigates the effectiveness, patients' satisfaction, and cost reduction of Virtual Joint Replacement Clinic (VJRC) follow-up of total hip arthroplasty and total knee arthroplasty patients in a university hospital. VJRC is especially valuable when in-person appointments are not advised or feasible such as during the COVID-19 pandemic. METHODS A total of 1749 patients who were invited for VJRC follow-up for knee or hip arthroplasty from January 2017 to December 2018 were included in this retrospective study. Patients were referred to VJRC after their 6-week postoperative review. Routine VJRC postoperative review was undertaken at 1 and 7 years and then 3-yearly thereafter. We evaluated the VJRC patient response rate, acceptability, and outcome. Patient satisfaction was measured in a subgroup of patients using a satisfaction survey. VJRC costs were calculated compared to face-to-face follow-up. RESULTS The VJRC had a 92.05% overall response rate. Only 7.22% required further in-person appointments with only 3% being reviewed by an orthopedic consultant. VJRC resulted in an estimated saving of £42,644 per year at our institution. The patients' satisfaction survey showed that 89.29% of the patients were either satisfied or very satisfied with VJRC follow-up. CONCLUSION VJRC follow-up for hip and knee arthroplasty patients is an effective alternative to in-person clinic assessment which is accepted by patients, has high patient satisfaction, and can reduce the cost to both health services and patients.
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Affiliation(s)
- Abd-Allah H El Ashmawy
- Department of Orthopaedic surgery, Nuffield Orthopaedic centre, Oxford, United Kingdom; Department of Trauma and Orthopaedic surgery and Trauma, University of Alexandria, Alexandria, Egypt
| | - Kathleen Dowson
- Department of Orthopaedic surgery, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - Ahmed El-Bakoury
- Department of Trauma and Orthopaedic surgery and Trauma, University of Alexandria, Alexandria, Egypt; Department of Orthopaedic surgery, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - Hazem A H Hosny
- Department of Trauma and Orthopaedic surgery and Trauma, University of Alexandria, Alexandria, Egypt; Department of Orthopaedic surgery, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - Rathan Yarlagadda
- Department of Orthopaedic surgery, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - Jonathan Keenan
- Department of Orthopaedic surgery, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
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Erivan R, Villatte G, Chaput T, Mulliez A, Ollivier M, Descamps S, Boisgard S. French translation and cultural adaptation of a questionnaire for patients with hip or knee prosthesis. Orthop Traumatol Surg Res 2019; 105:435-440. [PMID: 30858043 DOI: 10.1016/j.otsr.2019.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/08/2019] [Accepted: 01/11/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The Kingsbury questionnaire offers the possibility of follow-up by means of an X-ray and a simple questionnaire sent to the home address of the patient, who will not need to come in consultation if there are no problems. The questionnaire detects any anomaly in follow-up. In case of anomaly in the questionnaire or radiograph, the patient is contacted and/or seen again, as appropriate. The Kingsbury questionnaire has had no transcultural validation, and we therefore conducted a prospective study in order to 1) translate into French the questionnaire, previously validated in English; 2) adapt it for good understanding according to cultural habits; and 3) assess the translated version on a test-retest procedure. HYPOTHESIS The study hypothesis was that the translated questionnaire would show good test-retest reproducibility. MATERIAL AND METHODS The exact English version of the questionnaire was obtained directly from the authors of the index publication. A methodology of translation, back-translation and test-retest enabled assessment of the translation and of the reproducibility of the French version. The reference method of cultural adaptation of self-administered questionnaires and patient information documents was used. The questionnaire was tested prospectively. RESULTS One hundred patients were contacted, providing 73 clinical tests with radiographic validation and 48 complete test-retests in a representative population of total hip and total knee arthroplasty (THA, TKA). Internal coherence showed a KR-20 coefficient of 0.71 and Cronbach alpha of 0.76: e.g., good internal coherence. Item difficulty, requiring renewed contact, was low for all questions. Mean variance was low on the first 7 questions: 0.08 (range, 0.02-0.16). Correlation was close to 0.5 for each question. Analysis of reproducibility found excellent agreement (>90%) for the first 7 questions, which were binary; for question 8, agreement was good (83.3%) considering that there were 5 possible responses. For 19 of the 73 respondents, the questionnaire results indicated a need for further contact. After analysis of their radiographs, 4 needed to be seen in consultation again. The other 15 had unfavorable responses but without deterioration since the last classical consultation or any radiologic abnormality consultation, and were not called back for consultation. CONCLUSION The French version of the Kingsbury questionnaire provided reproducible assessment, avoiding the need to call the patient back for consultation unnecessarily. The questionnaire needs validating in a larger sample before being widely used: the present study was just a first step. LEVEL OF EVIDENCE IV, Prospective without control group.
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Affiliation(s)
- Roger Erivan
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France.
| | - Guillaume Villatte
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France
| | - Thibault Chaput
- Université Clermont Auvergne, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Aurélien Mulliez
- Délégation à la Recherche Clinique et aux Innovations (DRCI) - CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Matthieu Ollivier
- Aix-Marseille Université, CNRS, ISM UMR 7287, 13288, Marseille cedex 09, France Institute for Locomotion, Department of Orthopedics and Traumatology, St. Marguerite Hospital, 270, boulevard Sainte-Marguerite, BP 29, 13274 Marseille, France
| | - Stéphane Descamps
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France
| | - Stéphane Boisgard
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France
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