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Shibuya N, Agarwal MR, Jupiter DC. A New Paradigm in Foot and Ankle Outcomes?: Away From Radiographs and Toward Patient-Centered Outcomes. Clin Podiatr Med Surg 2024; 41:259-268. [PMID: 38388122 DOI: 10.1016/j.cpm.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
Having reasonable outcome measures is essential to unbiased research. For years, provider-measured outcomes have been valued as they are more objective and convenient for investigators. However, with the popularity of patient-centered medical care delivery, patient-reported outcome measures are appropriately becoming more popular in foot and ankle research.
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Affiliation(s)
- Naohiro Shibuya
- University of Texas Rio Grande Valley, School of Podiatric Medicine.
| | - Monica R Agarwal
- University of Texas Rio Grande Valley, School of Podiatric Medicine
| | - Daniel C Jupiter
- Department of Biostatistics and Data Science, Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, 2101 Treasure Hills Boulevard, Harlingen, TX 78550, USA
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Ziroglu N, Birinci T, Koluman A, Şahbaz Y, Çiftçi MU, Baca E, Duramaz A. Reliability and Validity of the Turkish Version of the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Joint Scale. Foot Ankle Spec 2023:19386400231214285. [PMID: 38018560 DOI: 10.1177/19386400231214285] [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] [Indexed: 11/30/2023]
Abstract
BACKGROUND The American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal (AOFAS Hallux MTP-IP) scale is one of the most widely used outcome measures to evaluate hallux pathologies. This study aimed to translate the AOFAS Hallux MTP-IP scale into Turkish and investigate its psychometric properties. METHODS The psychometric properties of the Turkish version of the AOFAS Hallux MTP-IP (AOFAS Hallux MTP-IP-T) scale were tested in 66 patients with hallux pathologies (52 women; mean age, 47.64 ± 12.75 years). Cronbach's alpha was used to assess internal consistency. The intraclass correlation coefficient (ICC) was used to estimate test-retest. Construct validity was analyzed with the Turkish version of the Manchester-Oxford Foot Questionnaire (MOXFQ), Visual Analogue Scale (VAS), and 12-item Short-Form Health Survey(SF-12). RESULTS The AOFAS Hallux MTP-IP-T scale had adequate internal consistency (α = 0.71) and test-retest reliability (ICC2,1 = 0.93 for pain, ICC2,1 = 0.97 for function, and ICC2,1 = 0.97 for total score). The AOFAS Hallux MTP-IP-T total score has a moderate to strong correlation with VAS-activity and MOXFQ (ρ = -0.77, P = .001; ρ = -0.69, P = .001, respectively). The weakest correlation was found between the AOFAS Hallux MTP-IP-T and the SF-12 mental component scale (ρ = 0.31, P = .01). CONCLUSION AOFAS Hallux MTP-IP-T has sufficient reliability and validity to evaluate Turkish-speaking individuals with a variety of forefoot pathologies including the hallux. LEVELS OF EVIDENCE Level II.
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Affiliation(s)
- Nezih Ziroglu
- Department of Orthopedics and Traumatology, Atakent Hospital, Acibadem University, Istanbul, Turkey
| | - Tansu Birinci
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Medeniyet University, Istanbul, Turkey
| | - Alican Koluman
- Department of Orthopedics and Traumatology, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Yasemin Şahbaz
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Beykent University, Istanbul, Turkey
| | - Mehmet Utku Çiftçi
- Department of Orthopedics and Traumatology, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Emre Baca
- Department of Orthopedics and Traumatology, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Altuğ Duramaz
- Department of Orthopedics and Traumatology, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
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Prat D, Sourugeon Y, Haghverdian BA, Pridgen EM, Lee W, Wapner KL, Farber DC. "In Situ" Joint Preparation Technique for First Metatarsophalangeal Arthrodesis: A Retrospective Comparative Review of 388 Cases. J Foot Ankle Surg 2023; 62:855-861. [PMID: 37220866 DOI: 10.1053/j.jfas.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 04/08/2023] [Accepted: 05/13/2023] [Indexed: 05/25/2023]
Abstract
"Cup-shaped power reamers" and "flat cuts" (FC) are common joint preparation techniques in first metatarsophalangeal (MTP) joint arthrodesis. However, the third option of an "in situ" (IS) technique has rarely been studied. This study aims to compare the clinical, radiographic, and patient-reported outcomes (PROMs) of the IS technique for various MTP pathologies with other MTP joint preparation techniques. A single-center retrospective review was performed for patients who underwent primary MTP joint arthrodesis between 2015 and 2019. In total, 388 cases were included in the study. We found higher nonunion rates in the IS group (11.1% vs 4.6%, p = .016). However, the revision rates were similar between the groups (7.1% vs 6.5%, p = .809). Multivariate analysis revealed that diabetes mellitus was associated with significantly higher overall complication rates (p < .001). The FC technique was associated with transfer metatarsalgia (p = .015) and a more first ray shortening (p < .001). Visual analog scale, PROMIS-10 physical, and PROMIS-CAT physical scores significantly improved in IS and FC groups (p < .001, p = .002, p = .001, respectively). The improvement was comparable between the joint preparation techniques (p = .806). In conclusion, the IS joint preparation technique is simple and effective for first MTP joint arthrodesis. In our series, the IS technique had a higher radiographic nonunion rate that did not correlate with a higher revision rate, and otherwise similar complication profile to the FC technique while providing similar PROMs. The IS technique resulted in significantly less first ray shortening when compared to the FC technique.
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Affiliation(s)
- Dan Prat
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA; Department of Orthopaedic Surgery, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
| | - Yosef Sourugeon
- Department of Orthopaedic Surgery, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | | | - Eric M Pridgen
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Wonyong Lee
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Keith L Wapner
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Daniel C Farber
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
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Martin RL, Harris JD, Ellis T, Kollmorgen R. Comparison of the PROMIS and iHOT-12 in Determining Satisfaction Levels After Hip Arthroscopy for FAIS. Orthop J Sports Med 2023; 11:23259671231168887. [PMID: 37197035 PMCID: PMC10184234 DOI: 10.1177/23259671231168887] [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: 01/21/2023] [Accepted: 01/30/2023] [Indexed: 05/19/2023] Open
Abstract
Background The Patient-Reported Outcomes Measurement Information System (PROMIS) has not been fully evaluated for outcomes assessment after hip arthroscopy to correct femoroacetabular impingement syndrome (FAIS). Purpose/Hypothesis The purpose of this study was to compare the accuracy of the PROMIS Physical Function (PF) and Pain Interference (PI) subscales with the 12-Item International Hip Outcome Tool (iHOT-12) to define patients with 3 unique substantial clinical benefit (SCB) scores-patients who reported ≥80%, ≥90%, and 100% satisfaction at 1 year after hip arthroscopy for FAIS. We hypothesized that the iHOT-12 would be more accurate than the PROMIS-PF and PROMIS-PI subscales in identifying these 3 patient groups. Study Design Cohort study (diagnosis); Level of evidence, 2. Methods We reviewed the records of patients who underwent hip arthroscopy for symptomatic FAIS at 3 centers from January 2019 through June 2021 and had 1-year clinical and radiographic follow-up data. Patients completed the iHOT-12, PROMIS-PF, and PROMIS-PI on initial assessment and at 1 year (±30 days) postoperatively. Postoperative satisfaction was reported on an 11-category scale with anchors defined as "0% satisfied" and "100% satisfied." Receiver operator characteristic analysis was performed to determine the absolute SCB values for the iHOT-12 and PROMIS subscales that would most accurately identify those patients who reported ≥80%, ≥90%, and 100% satisfaction. Area under the curve (AUC) values and 95% CIs for the 3 instruments were compared. Results Included were 163 patients (111 [68%] women and 52 [32%] men), with a mean age of 26.1 years. Corresponding absolute SCB scores for patients who reported ≥80%, ≥90%, and 100% satisfaction were as follows: iHOT-12, 68.4, 72.1, 74.7; PROMIS-PF, 45, 47.7, 49.9; and PROMIS-PI, 55.9, 52.4, 51.9. The AUC ranged between 0.67 and 0.82, with overlapping 95% CIs indicating a minimal difference in accuracy between the 3 instruments. Sensitivity and specificity values ranged between 0.61 and 0.82. Conclusion The PROMIS-PF and PROMIS-PI subscales were as accurate as the iHOT-12 in defining absolute SCB scores for patients reporting ≥80%, ≥90%, and 100% satisfaction at 1-year follow-up after hip arthroscopy for FAIS.
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Affiliation(s)
- RobRoy L. Martin
- Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, Pittsburgh, Pennsylvania, USA
- RobRoy L. Martin, PhD, PT, Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, 600 Forbes Avenue, Pittsburgh, PA 15282, USA ()
| | - Joshua D. Harris
- Department of Orthopaedic Surgery, Houston Methodist, Houston, Texas, USA
| | | | - Robert Kollmorgen
- Department of Orthopedic Surgery, UCSF Fresno, Fresno, California, USA
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Prat D, Haghverdian BA, Pridgen EM, Lee W, Wapner KL, Chao W, Farber DC. High complication rates following revision first metatarsophalangeal joint arthrodesis: a retrospective analysis of 79 cases. Arch Orthop Trauma Surg 2023; 143:1799-1807. [PMID: 35092466 DOI: 10.1007/s00402-022-04342-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 01/04/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND The most common indications for revision of first metatarsophalangeal joint (MTPJ) arthrodesis are symptomatic failures of prior arthrodesis, failed hallux valgus correction, and failed MTPJ arthroplasty implants. However, the outcomes of revision MTPJ arthrodesis have rarely been studied. The purpose of this study was to compare the clinical, radiographic, and patient-reported outcomes of revision MTPJ arthrodesis following different primary procedures. METHODS A retrospective review of revision MTPJ arthrodesis cases between January 2015 and December 2019 was performed. The radiographic results, patient-reported outcomes, and rates of complications, subsequent revisions, and nonunions, were analyzed and compared preoperatively and postoperatively. A multivariate analysis was utilized to determine risk factors for complications and reoperations. RESULTS This study yielded a total of 79 cases of revision MTPJ arthrodesis. The mean follow-up time was 365 days (SD ± 295). The overall complication rate was 40.5%, of which the overall nonunion rate was 19.0%. Seven cases (8.9%) required further revision surgery. The multivariate analysis revealed that Diabetes mellitus was associated with significantly higher overall complication rates (p = 0.016), and nonunion was associated with "in-situ" joint preparation techniques (p = 0.042). Visual Analog Scale (VAS) significantly improved postoperatively (p < 0.001); However, PROMIS-10 physical health and PROMIS-10 mental health did not change significantly during the study period. CONCLUSION Treatment of MTPJ surgery failures is a clinical challenge in orthopedic surgery. In our study, revision of first MTPJ surgery resulted in higher nonunion rates and overall complication rates compared to typical outcomes from primary MTPJ arthrodesis. Diabetes, Tobacco use, and "in-situ" joint preparation technique were found to be independent risk factors for complications and reoperations. LEVEL OF EVIDENCE III-Retrospective Cohort Study.
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Affiliation(s)
- Dan Prat
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Orthopaedic Surgery, Chaim Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel.
| | - Brandon A Haghverdian
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Eric M Pridgen
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Wonyong Lee
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Keith L Wapner
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Wen Chao
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel C Farber
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
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Chodaba Y, Andrews NA, Halstrom J, Sankey T, Sanchez T, Harrelson WM, Agarwal A, Shah A. First Metatarsophalangeal Arthrodesis for Hallux Rigidus and Hallux Valgus: A Comparison of Patient Reported and Clinical Outcomes. J Foot Ankle Surg 2023:S1067-2516(23)00036-4. [PMID: 36964117 DOI: 10.1053/j.jfas.2023.02.008] [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: 11/07/2022] [Revised: 02/07/2023] [Accepted: 02/12/2023] [Indexed: 03/26/2023]
Abstract
Few prior studies have compared the patient reported outcomes of first metatarsophalangeal arthrodesis between hallux rigidus and hallux valgus patients. Furthermore, we sought to examine the impact of postoperative radiographic hallux alignment on outcomes scores within each group. A retrospective review of 98 patients who a received primary metatarsophalangeal arthrodesis from January 2010 to March 2020. Clinical complications including nonunion were collected. Patient Reported Outcomes Measurement Information Systems (PROMIS) Physical Function, PROMIS Pain Interference, and the foot function index (FFI) revised short form scores were obtained via telephone. Patients were grouped based on review of preoperative radiographs of the foot and this grouping 37 hallux rigidus and 61 hallux valgus patients. Clinical and patient reported outcomes were compared between these pathologies. No differences in the rate of wound complications, radiographic union, and revision surgery were found between the 2 subgroups. At a median of 2.4 years (3.9 IQR) postoperatively, PROMIS and FFI scores did not vary by pathology group. For both groups, PROMIS scores were similar to the general population of the United States. The postoperative first MTP dorsiflexion angle in the hallux rigidus group was correlated with decreased FFI Pain, FFI Total, and PROMIS Pain Interference domain scores (|r| ≥ 0.40, p < .05 for all). When performing MTP arthrodesis in patients with hallux rigidus, increasing the first MTP dorsiflexion angle may correlate with improved intermediate term patient reported outcomes. However, further studies will need to be done to confirm this theoretical relationship.
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Affiliation(s)
- Yvonne Chodaba
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Nicholas A Andrews
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Jared Halstrom
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Turner Sankey
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Thomas Sanchez
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Whitt M Harrelson
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Abhinav Agarwal
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Ashish Shah
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL.
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Rizzi SA, Torre M, Bunch TJ, Fang J, Hess R, Rodriguez-Correa C, Spertus JA, Stehlik J, Zhang M, Zhang Y, Steinberg BA. Ejection Fraction Improvement Does Not Reflect Changes in Quality of Life Following Cardiac Resynchronization Therapy. Crit Pathw Cardiol 2022; 21:201-205. [PMID: 36413400 PMCID: PMC9720911 DOI: 10.1097/hpc.0000000000000299] [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: 11/29/2022]
Abstract
OBJECTIVE To determine if health-related quality of life (HRQoL) improvement after cardiac resynchronization therapy (CRT) correlates with improved left-ventricular ejection fraction (EF). BACKGROUND CRT was reported to improve EF and HRQoL in clinical trials of heart failure with reduced EF (HFrEF). It is unknown if improvements in HRQoL reflect EF response to CRT. METHODS We included HFrEF patients who underwent CRT and had both pre- and post-CRT HRQoL assessment. EF response was categorized as absent (0% change or decrease), modest (0%-19% increase), or significant ( > 20% increase). We examined the associations between EF response and generic (PROMIS) and HF-specific (KCCQ-12) HRQoL. RESULTS The group included 115 patients with mean age of 65 years and baseline EF of 31%; 39% were female (n = 45). Nineteen percent (n = 22) had significant, 57% (n = 66) modest, and 23% (n = 27) absent EF responses. AF burden across significant (8.9%), modest (4.8%), and absent EF responders (1.4%) was similar ( P = 0.20). Significant improvements in KCCQ-12 (43.4-57.5, P = 0.003), current health visual analog scale (49.1-55.9, P = 0.042), PROMIS fatigue (58.9-55.1, P = 0.026), and PROMIS satisfaction (42.7-46.4, P = 0.020) resulted following CRT across all groups. There was no association between significant EF improvement and HRQoL by KCCQ-12 (nonresponse, 44.4%; modest response, 33.3%; and significant response, 22.2%) at 1 year ( P = 0.52 across all groups). CONCLUSION CRT was associated with a modest to significant EF response in a majority of patients. However, EF response did not significantly correlate with generic or HF-specific HRQoL measures. Further investigations are warranted into determinants of improved HRQoL following CRT.
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Affiliation(s)
- Scott A. Rizzi
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Michael Torre
- Department of Population Health, University of Utah School of Medicine, Salt Lake City, UT
| | - T. Jared Bunch
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - James Fang
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Rachel Hess
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT
- University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | | | - John A. Spertus
- University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Josef Stehlik
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Mingyuan Zhang
- Department of Population Health, University of Utah School of Medicine, Salt Lake City, UT
| | - Yue Zhang
- Department of Population Health, University of Utah School of Medicine, Salt Lake City, UT
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Neville C, Baumhauer J, Houck J. Are Patient Reported Outcome Measurement Information System scales responsive in patients attending physical therapy with foot and ankle diagnoses? Physiother Theory Pract 2022:1-11. [PMID: 35139745 DOI: 10.1080/09593985.2022.2037116] [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: 10/19/2022]
Abstract
BACKGROUND Patient-reported outcomes (PROs) have been used to provide insight into the patient experience while uncovering an opportunity to improve patient care. Current studies document responsiveness of outcomes using the Patient Reported Outcome Measurement Information System (PROMIS) for a variety of orthopedic problems but are not specific to a physical therapy interval of care. PURPOSE The main purpose of this study was to examine responsiveness of the PROMIS Physical Function (PF) and Pain Interference (PI) scales across an interval of care for physical therapy in patients with foot and ankle conditions. METHODS Adult records (299 records, averaged 45.1 ± 15.4 years; 61% female) were assessed. Comparisons between pre- and post-physical therapy intervals of care were evaluated using a repeated-measures ANOVA, and the effect size was reported using Cohen's d. RESULTS PROMIS PF scores significantly improved from 38.5 ± 8.8 to 45.2 ± 9.1 (6.6; p < .001; Cohen's d = 1.0). PROMIS PI scores significantly improved from 56.8 ± 8.8 to 53.0 ± 9.8 (-3.8; p < .001; Cohen's d = 0.52). CONCLUSIONS The person-centered PROMIS PF and PI outcome measures were responsive to change following an interval of care in physical therapy for a large sample of orthopedic patients with foot and ankle diagnoses. The magnitude of change was dependent on starting score and diagnosis.
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Affiliation(s)
| | - Judith Baumhauer
- Department of Orthopedic Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Jeff Houck
- Program of Physical Therapy, George Fox University, Newberg, OR, USA
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Shlykov MA, Savage-Elliott I, Lonergan TM, Klein SE, Backus JD, Johnson JE, McCormick JJ. Does the Canadian Orthopaedic Foot and Ankle Society Postoperative COFAS End-Stage Ankle Arthritis Classification System Correlate With Pre- and Postoperative PROMIS Scores for Total Ankle Arthroplasty? FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221084635. [PMID: 35321001 PMCID: PMC8935569 DOI: 10.1177/24730114221084635] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Recently, the Canadian Orthopaedic Foot and Ankle Society (COFAS) proposed a classification system addressing adjunct procedures in the treatment for end-stage ankle arthritis. We reviewed Patient-Reported Outcome Measures Information System (PROMIS) data to determine if outcomes of total ankle arthroplasty (TAA) correlated with postoperative COFAS classification. We hypothesize that as COFAS classification increases, patients will demonstrate greater improvement in the change between pre- and postoperative PROMIS scores. Methods: From June 2015 to December 2018, a total of 127 patients underwent 132 TAA. Demographic factors and preoperative and most recent postoperative PROMIS scores were collected. Univariate, multivariate and post hoc analyses with a significance threshold of P <.05 were performed. Results: Eighty-seven patients with a mean follow-up of 13.6±7.3 months and complete PROMIS scores were classified into COFAS types 1-4. Significant differences were identified in the PROMIS Pain Interference domain comparing COFAS types 2 and 4 and COFAS types 3 and 4. These results demonstrate that more complex ankles with a higher COFAS score had worse interval improvement in PROMIS scores. Additionally, multivariate linear regression showed that age and BMI were associated with worse physical function and depression, whereas diabetes and a history of prior surgeries were associated with improved postoperative function. Conclusion: The COFAS postoperative classification system is useful for categorizing end-stage ankle arthritis. Further research into the ideal timing of surgery and higher-level studies to better determine TAA efficacy with different classification systems is warranted. This information can be helpful with preoperative counseling about treatment outcomes. Level of Evidence: Level IV, retrospective analysis of prospectively collected data.
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Affiliation(s)
- Maksim A. Shlykov
- Department of Orthopaedic Surgery, Washington University in St Louis, St Louis, MO, USA
| | - Ian Savage-Elliott
- Department of Orthopaedic Surgery, Washington University in St Louis, St Louis, MO, USA
| | | | - Sandra E. Klein
- Department of Orthopaedic Surgery, Washington University in St Louis, St Louis, MO, USA
| | - Jonathon D. Backus
- Department of Orthopaedic Surgery, Washington University in St Louis, St Louis, MO, USA
| | - Jeffrey E. Johnson
- Department of Orthopaedic Surgery, Washington University in St Louis, St Louis, MO, USA
| | - Jeremy J. McCormick
- Department of Orthopaedic Surgery, Washington University in St Louis, St Louis, MO, USA
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Steinberg BA, Zhang M, Bensch J, Lyons A, Bunch TJ, Piccini JP, Siu A, Spertus JA, Stehlik J, Wohlfahrt P, Greene T, Hess R, Fang JC. Quantifying the Impact of Atrial Fibrillation on Heart Failure-Related Patient-Reported Outcomes in the Utah mEVAL Program. J Card Fail 2022; 28:13-20. [PMID: 34324927 PMCID: PMC8748275 DOI: 10.1016/j.cardfail.2021.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) frequently complicates heart failure (HF), and each is associated with lower overall health-related quality of life. We aimed to quantify the incremental burden of AF on the health-related quality of life of patients with HF in clinical practice. METHODS AND RESULTS We used data from the Utah mEVAL program to analyze patient-reported outcomes (PROs) among patients with HF with and without AF. The primary outcome was the HF-specific Kansas City Cardiomyopathy Questionnaire, with generic PROs as secondary outcomes. Among 1707 patients with HF, 36% had AF (n = 616). Those with HF and AF were older (mean age 69 years vs 58 years, P < .001), more likely to have prior stroke (29% vs 17%, P < .001) and ischemic cardiomyopathy (28% vs 23%, P = .01), but had similar ejection fractions (mean 44% each, P = .6). After adjustment, and compared with HF alone, HF with AF was associated with worse Kansas City Cardiomyopathy Questionnaire scores (adjusted mean difference -3.45, 95% confidence interval [CI] -6.24 to -0.65), and worse Patient-Reported Outcomes Measurement Information System physical function scores (adjusted mean difference -1.63, 95% CI -2.59 to -0.67). The difference in visual analog scale general health was borderline (adjusted mean difference -2.01, 95% CI -4.51 to 0.49), and Patient-Reported Outcomes Measurement Information System depression scores were similar (adjusted mean difference 0.54, 95% CI -0.48 to 1.57). CONCLUSIONS AF complicates nearly one-third of HF cases, and patients with HF and AF are substantially older and sicker. After adjustment, AF was independently associated with worse disease-specific and overall health-related quality of life than HF alone. Whether maintaining sinus rhythm can improve the HF-related health status of patients with HF in clinical practice should be explored further.
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Affiliation(s)
| | - Mingyuan Zhang
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Jason Bensch
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Ann Lyons
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | - T Jared Bunch
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Jonathan P Piccini
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina
| | - Alfonso Siu
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | - John A Spertus
- Saint Luke's Mid America Heart Institute/UMKC, Kansas City MO
| | - Josef Stehlik
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Peter Wohlfahrt
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Tom Greene
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Rachel Hess
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | - James C Fang
- University of Utah Health Sciences Center, Salt Lake City, Utah
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Obey MR, Goldfarb CA, Broughton JS, Gebhart SS, Smith MV. Early Improvement in Patient-Reported Outcome Scores After Operative Treatment of Osteochondritis Dissecans of the Humeral Capitellum. J Hand Surg Am 2021; 46:1120.e1-1120.e7. [PMID: 33931273 DOI: 10.1016/j.jhsa.2021.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 12/14/2020] [Accepted: 03/02/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Outcome measures that lack sensitivity for the detection of clinical changes early after surgery for capitellar osteochondritis dissecans (OCD) make it difficult to determine the optimal treatment for these defects. We sought to evaluate the early responsiveness of patient-reported outcomes measurement information system (PROMIS) scores in a cohort of patients operatively treated for capitellar OCD. METHODS Four PROMIS questionnaires (mobility, upper extremity [UE], pain interference, and peer relations) were electronically administered to patients treated for capitellar OCD at a single tertiary academic medical center between January 1, 2015, and July 1, 2018. The questionnaires were administered at the initial preoperative outpatient clinic visit as well as at the 2-week, 6-week, and final return-to-play (RTP) visits. RESULTS Twenty-nine patients (31 elbows, mean age 12.9 years) with available preoperative and postoperative PROMIS data were included. The mean final follow-up period was 26 weeks. Compared with that before surgery, there was a significant improvement in the mobility, pain interference, and UE scores at 6 weeks following surgery. The scores improved most significantly by 6 weeks, reached a relative plateau, and remained significantly improved through the RTP visit thereafter. Patients with preoperative, intra-articular loose bodies scored significantly better than those without them during the 6-week and RTP visits. Patients with lesions >1 cm2, compared with those with lesions ≤1 cm2, demonstrated greater improvement in the UE scores during the RTP visit. CONCLUSIONS In patients undergoing operative treatment for capitellar OCD, a significant improvement in the PROMIS domains of mobility, pain interference, and UE can be expected early in the postoperative period, with majority of patients reaching their greatest improvement in scores by 6 weeks following surgery. CLINICAL RELEVANCE This is important information for preoperative counseling. In addition, this information is helpful in confirming that PROMIS scores are responsive in the detection of changes in outcomes during the early postoperative period in this population.
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Affiliation(s)
- Mitchel R Obey
- Department of Orthopedic Surgery, Washington University, St. Louis, MO
| | | | - J Sam Broughton
- Department of Orthopedic Surgery, Washington University, St. Louis, MO
| | - Sandra S Gebhart
- Department of Orthopedic Surgery, Washington University, St. Louis, MO
| | - Matthew V Smith
- Department of Orthopedic Surgery, Washington University, St. Louis, MO.
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12
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Verbeek DO, Terwee CB, Haverman L. How to use the patient-reported outcomes measurement information system (PROMIS) in international orthopaedic trauma research: a practical approach. Injury 2021; 52:3537-3539. [PMID: 33752876 DOI: 10.1016/j.injury.2021.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 03/09/2021] [Indexed: 02/02/2023]
Affiliation(s)
- Diederik O Verbeek
- Department of Surgery, Division of Trauma, Maastricht University Medical Center +, P Debyelaan 25, 6202 AZ, Maastricht, The Netherlands.
| | - Caroline B Terwee
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | - Lotte Haverman
- Department of Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam Reproduction and Development, Amsterdam Public Health, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands; Department of Strategy and Policy, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
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13
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Ochen Y, Guss D, Houwert RM, Smith JT, DiGiovanni CW, Groenwold RHH, Heng M. Validation of PROMIS Physical Function for Evaluating Outcome After Acute Achilles Tendon Rupture. Orthop J Sports Med 2021; 9:23259671211022686. [PMID: 34692874 PMCID: PMC8527582 DOI: 10.1177/23259671211022686] [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: 01/10/2021] [Accepted: 02/12/2021] [Indexed: 11/30/2022] Open
Abstract
Background: There is increased demand for valid, reliable, and responsive
patient-reported outcome measures (PROMs) to evaluate treatment for Achilles
tendon rupture, but not all PROMs currently in use are reliable and
responsive for this condition. Purpose: To evaluate the measurement properties of the Patient-Reported Outcomes
Measurement Information System Physical Function (PROMIS PF) compared with
other PROMs used after treatment for acute Achilles tendon rupture. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A retrospective cohort study with a follow-up questionnaire was performed.
All adult patients with an acute Achilles tendon rupture between June 2016
and June 2018 with a minimum 12-month follow-up were eligible for inclusion.
Functional outcome was assessed using the PROMIS PF computerized adaptive
test (CAT), Foot and Ankle Ability Measure (FAAM) Activities of Daily Living
(ADL), FAAM–Sports, and Achilles Tendon Total Rupture Score (ATRS). Pearson
correlation (r) was used to assess the correlations between
PROMs. Absolute and relative floor and ceiling effects were calculated. Results: In total, 103 patients were included (mean age, 44.7 years; 74% male); 82
patients (79.6%) underwent operative repair, while 21 patients (20.4%)
underwent nonoperative management. The mean time between treatment and
collection of PROMs was 25.3 months (range, 15-36 months). The mean scores
were 55.4 ± 9.2 (PROMIS PF), 92.9 ± 12.2 (FAAM-ADL), 77.7 ± 22.9
(FAAM–Sports), and 83.0 ± 19.4 (ATRS). The ATRS was correlated with FAAM-ADL
(r = 0.80; 95% CI, 0.72-0.86; P <
.001) and FAAM–Sports (r = 0.86; 95% CI, 0.80-0.90;
P < .001). The PROMIS PF was correlated with the
FAAM-ADL (r = 0.66; 95% CI, 0.53-0.75; P
< .001), FAAM–Sports (r = 0.65; 95% CI, 0.53-0.75;
P < .001), and ATRS (r = 0.69; 95%
CI, 0.58-0.78; P < .001). The PROMIS PF did not show
absolute floor or ceiling effects (0%). The FAAM-ADL (35.9%), FAAM–Sports
(15.8%), and ATRS (20.4%) had substantial absolute ceiling effects. Conclusion: The PROMIS PF, FAAM-ADL, and FAAM–Sports all showed a moderate to high mutual
correlation with the ATRS. Only the PROMIS PF avoided substantial floor and
ceiling effects. The results suggest that the PROMIS PF CAT is a valid,
reliable, and perhaps the most responsive tool to evaluate patient outcomes
after treatment for an Achilles tendon rupture.
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Affiliation(s)
- Yassine Ochen
- Department of Orthopedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Daniel Guss
- Department of Orthopedic Surgery, Foot and Ankle Service, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Orthopedic Surgery, Foot and Ankle Service, Newton-Wellesley Hospital, Newton, Massachusetts, USA
| | - R Marijn Houwert
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jeremy T Smith
- Department of Orthopedic Surgery, Division of Foot and Ankle Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher W DiGiovanni
- Department of Orthopedic Surgery, Foot and Ankle Service, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Orthopedic Surgery, Foot and Ankle Service, Newton-Wellesley Hospital, Newton, Massachusetts, USA
| | - Rolf H H Groenwold
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Marilyn Heng
- Department of Orthopedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital, Boston, Massachusetts, USA
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14
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Arunakul M, Pholsawatchai W, Arunakul P, Pitakveerakul A. Conventional vs Accelerated Rehabilitation Protocol Following Reattachment of Achilles Tendon for Insertional Achilles Tendinopathy. Foot Ankle Int 2021; 42:1121-1129. [PMID: 34024153 DOI: 10.1177/10711007211003871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND No studies have compared early vs conventional postoperative weightbearing following suture bridge Achilles tendon reattachment. We, therefore, evaluated postoperative functional outcomes in these patients. METHODS We collected data on 49 patients who underwent surgical treatment of insertional Achilles tendinopathy using a central Achilles tendon-splitting approach and reattachment with suture bridge technique by a single surgeon. Functional outcomes were measured by a visual analog scale (VAS) for pain, Foot and Ankle Ability Measure (FAAM), and Short Form Health Survey (SF-36) at 3, 6, and 12 months postoperatively. The differences in outcomes were analyzed using multiple linear regression. RESULTS Eighteen and 31 patients underwent the conventional and accelerated protocols, respectively; their corresponding mean ages were similar, 53 and 57 years, as were all other baseline characteristics. The mean scores (conventional vs accelerated group) for VAS for pain, FAAM, and SF-36 in the conventional group at 3 months postoperatively were 4 ± 1 vs 3 ± 1 points, 53 ± 8 vs 68 ± 3 points, and 57 ± 15 vs 67 ± 10 points (P < .05 for each comparison). There were no statistically significant differences between the groups at 6 and 12 months postoperatively. All patients could perform the single heel raise test at 6 months, and none experienced complications. CONCLUSION In this small study, short-term functional outcomes were better in the accelerated group. More data are needed before the accelerated program can be recommended. LEVEL OF EVIDENCE Level II, prospective comparative study.
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Affiliation(s)
- Marut Arunakul
- Department of Orthopaedics, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Waroot Pholsawatchai
- Chulabhorn International College of Medicine, Thammasat University, Pathumthani, Thailand
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15
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Steinberg BA, Turner J, Lyons A, Biber J, Chelu MG, Fang JC, Freedman RA, Han FT, Hardisty B, Marrouche NF, Ranjan R, Shah RU, Spertus JA, Stehlik J, Zenger B, Piccini JP, Hess R. Systematic collection of patient-reported outcomes in atrial fibrillation: feasibility and initial results of the Utah mEVAL AF programme. Europace 2021; 22:368-374. [PMID: 31702780 DOI: 10.1093/europace/euz293] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 10/02/2019] [Indexed: 11/13/2022] Open
Abstract
AIMS Incorporating patient-reported outcomes (PROs) into routine care of atrial fibrillation (AF) enables direct integration of symptoms, function, and health-related quality of life (HRQoL) into practice. We report our initial experience with a system-wide PRO initiative among AF patients. METHODS AND RESULTS All patients with AF in our practice undergo PRO assessment with the Toronto AF Severity Scale (AFSS), and generic PROs, prior to electrophysiology clinic visits. We describe the implementation, feasibility, and results of clinic-based, electronic AF PRO collection, and compare AF-specific and generic HRQoL assessments. From October 2016 to February 2019, 1586 unique AF patients initiated 2379 PRO assessments, 2145 of which had all PRO measures completed (90%). The median completion time for all PRO measures per visit was 7.3 min (1st, 3rd quartiles: 6, 10). Overall, 38% of patients were female (n = 589), mean age was 68 (SD 12) years, and mean CHA2DS2-VASc score was 3.8 (SD 2.0). The mean AFSS symptom score was 8.6 (SD 6.6, 1st, 3rd quartiles: 3, 13), and the full range of values was observed (0, 35). Generic PROs of physical function, general health, and depression were impacted at the most severe quartiles of AF symptom score (P < 0.0001 for each vs. AFSS quartile). CONCLUSION Routine clinic-based, PRO collection for AF is feasible in clinical practice and patient time investment was acceptable. Disease-specific AF PROs add value to generic HRQoL instruments. Further research into the relationship between PROs, heart rhythm, and AF burden, as well as PRO-guided management, is necessary to optimize PRO utilization.
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Affiliation(s)
- Benjamin A Steinberg
- University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132, USA
| | - Jeffrey Turner
- University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132, USA
| | - Ann Lyons
- University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132, USA
| | - Joshua Biber
- University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132, USA
| | - Mihail G Chelu
- University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132, USA
| | - James C Fang
- University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132, USA
| | - Roger A Freedman
- University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132, USA
| | - Frederick T Han
- University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132, USA
| | - Benjamin Hardisty
- University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132, USA
| | - Nassir F Marrouche
- University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132, USA
| | - Ravi Ranjan
- University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132, USA
| | - Rashmee U Shah
- University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132, USA
| | | | - Josef Stehlik
- University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132, USA
| | - Brian Zenger
- University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132, USA
| | | | - Rachel Hess
- University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132, USA
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16
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Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision 2021. J Orthop Sports Phys Ther 2021; 51:CPG1-CPG80. [PMID: 33789434 DOI: 10.2519/jospt.2021.0302] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This revised clinical practice guideline (CPG) addresses the distinct but related lower extremity impairments of those with a first-time lateral ankle sprain (LAS) and those with chronic ankle instability (CAI). Depending on many factors, impairments may continue following injury. While most individuals experience resolution of symptoms, complaints of instability may continue and are defined as CAI. The aims of the revision were to provide a concise summary of the contemporary evidence since publication of the original guideline and to develop new recommendations or revise previously published recommendations to support evidence-based practice. J Orthop Sports Phys Ther 2021;51(4):CPG1-CPG80. doi:10.2519/jospt.2021.0302.
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17
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Smit EB, Bouwstra H, Roorda LD, van der Wouden JHC, Wattel ELM, Hertogh CMPM, Terwee CB. A Patient-Reported Outcomes Measurement Information System Short Form for Measuring Physical Function During Geriatric Rehabilitation: Test-Retest Reliability, Construct Validity, Responsiveness, and Interpretability. J Am Med Dir Assoc 2021; 22:1627-1632.e1. [PMID: 33640312 DOI: 10.1016/j.jamda.2021.01.079] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 01/20/2021] [Accepted: 01/24/2021] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To study the test-retest reliability and measurement error, construct validity, responsiveness, interpretability, and floor/ceiling effects of a Patient-Reported Outcomes Measurement Information System (PROMIS) short form designed to measure physical function in geriatric rehabilitation patients (PROMIS-PF-GR). DESIGN Prospective cohort. SETTING AND PARTICIPANTS Inpatient geriatric rehabilitation patients. METHODS We evaluated the test-retest reliability by re-administering PROMIS-PF-GR 3 to 5 days after the admission measurement. The intraclass correlation coefficient (ICC) was calculated to determine test-retest reliability; an ICC of ≥0.70 was considered sufficient. Measurement error was established by calculating the standard error of measurement and smallest detectable change. Construct validity and responsiveness were determined by testing a priori formulated hypotheses (criterion: ≥75% hypothesis not rejected). Interpretability was evaluated by calculating the minimal important change using predictive modeling and a global rating as criterion for change. Floor/ceiling effects were established by calculating the percentage patients with the minimum/maximum raw score (criterion: ≤15%) at admission and discharge. RESULTS A total of 207 patients participated in the study [mean ± standard deviation age (80 ± 8.3 years), 58% female]. More than one-half of patients (56%) reported to be improved during rehabilitation. The ICC was 0.79 (95% confidence interval 0.70-0.84), the standardized error of measurement was 3.8, and the smallest detectable change 10.6. None of the 4 hypotheses for construct validity were rejected; 2 out of 5 hypotheses for responsiveness were rejected. The minimal important change was 8.0 (95% confidence interval 4.1-12.5). No floor/ceiling effects were found. CONCLUSIONS AND IMPLICATIONS The PROMIS-PG-GR showed sufficient test-retest reliability, measurement error, and construct validity. We did not find sufficient evidence for responsiveness, which may be due to the unexplained weak correlation between the PROMIS change score and the Global Rating Scale. We still recommend the use the PROMIS-PG-GR for measuring self-reported physical function in geriatric rehabilitation.
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Affiliation(s)
- Ewout B Smit
- Department of Medicine for Older People, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Hylco Bouwstra
- Department of Medicine for Older People, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Leo D Roorda
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, the Netherlands
| | - Johannes Hans C van der Wouden
- Department of Medicine for Older People, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Elizabeth Lizette M Wattel
- Department of Medicine for Older People, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Cees M P M Hertogh
- Department of Medicine for Older People, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Caroline B Terwee
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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18
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Horn ME, Reinke EK, Couce LJ, Reeve BB, Ledbetter L, George SZ. Reporting and utilization of Patient-Reported Outcomes Measurement Information System® (PROMIS®) measures in orthopedic research and practice: a systematic review. J Orthop Surg Res 2020; 15:553. [PMID: 33228699 PMCID: PMC7684926 DOI: 10.1186/s13018-020-02068-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 11/04/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The Patient-Reported Outcomes Measurement Information SystemⓇ (PROMISⓇ) is a dynamic system of psychometrically sound patient-reported outcome (PRO) measures. There has been a recent increase in the use of PROMIS measures, yet little has been written about the reporting of these measures in the field of orthopedics. The purpose of this study was to conduct a systematic review to determine the uptake of PROMIS measures across orthopedics and to identify the type of PROMIS measures and domains that are most commonly used in orthopedic research and practice. METHODS We searched PubMed, Embase, and Scopus using keywords and database-specific subject headings to capture orthopedic studies reporting PROMIS measures through November 2018. Our inclusion criteria were use of PROMIS measures as an outcome or used to describe a population of patients in an orthopedic setting in patients ≥ 18 years of age. We excluded non-quantitative studies, reviews, and case reports. RESULTS Our final search yielded 88 studies published from 2013 through 2018, with 57% (50 studies) published in 2018 alone. By body region, 28% (25 studies) reported PROMIS measures in the upper extremity (shoulder, elbow, hand), 36% (32 studies) reported PROMIS measures in the lower extremity (hip, knee, ankle, foot), 19% (17 studies) reported PROMIS measures in the spine, 10% (9 studies) reported PROMIS measures in trauma patients, and 6% (5 studies) reported PROMIS measures in general orthopedic patients. The majority of studies reported between one and three PROMIS domains (82%, 73 studies). The PROMIS Computerized Adaptive Test (CAT) approach was most commonly used (81%, 72 studies). The most frequently reported PROMIS domains were physical function (81%, 71 studies) and pain interference (61%, 54 studies). CONCLUSION Our review found an increase in the reporting of PROMIS measures over the recent years. Utilization of PROMIS measures in orthopedic populations is clinically appropriate and can facilitate communication of outcomes across different provider types and with reduced respondent burden. REGISTRATION The protocol for this systematic review was designed in accordance with the PRISMA guidelines and is registered with the PROSPERO database (CRD42018088260).
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Affiliation(s)
- Maggie E Horn
- Duke Clinical Research Institute, Duke University, Durham, NC, USA.
- Department of Orthopaedic Surgery, Duke University, Box 10042, Durham, NC, 27710, USA.
| | - Emily K Reinke
- Department of Orthopaedic Surgery, Duke University, Box 10042, Durham, NC, 27710, USA
| | - Logan J Couce
- University of Utah Orthopaedic Center, University of Utah Health, Salt Lake City, UT, USA
| | - Bryce B Reeve
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Leila Ledbetter
- Duke University Medical Center Library, Duke University, Durham, NC, USA
| | - Steven Z George
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
- Department of Orthopaedic Surgery, Duke University, Box 10042, Durham, NC, 27710, USA
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Abstract
OBJECTIVE To investigate the immediate impact of removing symptomatic syndesmotic screws on PROMIS outcomes and ankle range of motion (ROM) in patients who had previously undergone ankle fracture open reduction and internal fixation (ORIF) and syndesmotic fixation and later experienced functional limitations. DESIGN Prospective cohort study. SETTING Level 1-trauma center. PATIENTS/PARTICIPANTS Fifty-eight patients with ankle fractures with syndesmotic instability that required ORIF with syndesmotic fixation who underwent syndesmotic screw removal (SSR) and 71 patients who underwent ankle ORIF with syndesmotic fixation, but without screw removal during the same study period. INTERVENTION Symptomatic SSR for patients with functional limitations and decreased ankle ROM. MAIN OUTCOME MEASUREMENTS PROMIS physical function (PF) and pain interference T-scores and ankle ROM before and after screw removal. RESULTS Patients who underwent SSR had a statistically significant improvement in the PF T-score to 44.5 (P < 0.01) in the early postoperative period (mean 48 days) after screw removal. The screw removal occurred an average of 184 days after initial ORIF. This PF T-score change also met the minimally clinically important difference. There was a trend toward a significant improvement in PF T-scores for the SSR group as compared to the cohort group (44.5 vs. 41.6; P = 0.06) after screw removal. Removal of symptomatic implants resulted in an early mean improvement of total arc ankle ROM by 17 degrees (P < 0.01). CONCLUSIONS Patients experienced an immediate and significant improvement in PF outcomes and ankle ROM after symptomatic SSR for ankle fracture ORIF with syndesmotic fixation. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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20
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Kohring JM, Houck JR, Oh I, Flemister AS, Ketz JP, Baumhauer JF. Pattern of recovery and outcomes of patient reported physical function and pain interference after ankle fusion: a retrospective cohort study. J Patient Rep Outcomes 2020; 4:40. [PMID: 32462241 PMCID: PMC7253567 DOI: 10.1186/s41687-020-00203-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 05/03/2020] [Indexed: 12/26/2022] Open
Abstract
Background Research on outcomes after ankle fusion focuses on basic activities of daily living, fusion rates, and gait parameters. Little has been reported on the patient’s perspective after surgery. The purpose of this study was to determine the change in patient reported physical function and pain interference after ankle fusion surgery to guide patient expectations and improve provider communication. Methods This was a retrospective review of prospectively collected patient reported outcome measurement information system (PROMIS) data in 88 ankle arthrodesis procedures performed from May 2015 to March 2018. The PROMIS Physical function (PF) and pain interference (PI) measures were collected as routine care. Linear mixed models were used to assess differences at each follow-up point for PF and PI. Preoperative to last follow-up in the 120–365 day interval was assessed using analysis of variance. Outcomes included T-scores, z-scores, and PROMIS-Preference (PROPr) utility scores for PF and PI and the percentage of patients improving by at least 4 T-score points. Results The linear mixed model analysis for PF after the 120–149 days, and for PI, after 90–119 days, indicated recovery plateaued at 39–40 for PF and 57–59 for PI T-scores. The change in the PI T-score was the greatest with a mean T-score improvement of − 5.4 (95% CI − 7.7 to − 3.1). The proportion of patients improving more than 4 points was 66.2% for either PF or PI or both. The change in utility T-scores for both PF (0.06, 95% CI 0.02 to 0.11) and PI (0.15, 95% CI 0.09 to 0.20) was significantly improved, however, only PI approached clinical significance. Conclusion Average patients undergoing ankle fusion experience clinically meaningful improvement in pain more so than physical function. Average patient recovery showed progressive improvement in pain and function until the four-month postoperative time point. Traditional dogma states that recovery after an ankle fusion maximizes at a year, however based on the findings in this study, 4 months is a more accurate marker of recovery. A decline in function or an increase in pain after 4 months from surgery may help to predict nonunion and other complications after ankle arthrodesis. Level of evidence Level II, prospective single cohort study.
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Affiliation(s)
- Jessica M Kohring
- Department of Orthopaedics, University of Rochester, 601 Elmwood Avenue, Box 665, Rochester, NY, 14642, USA
| | - Jeffrey R Houck
- Department of Physical Therapy, George Fox University, Newberg, OR, USA
| | - Irvin Oh
- Department of Orthopaedics, University of Rochester, 601 Elmwood Avenue, Box 665, Rochester, NY, 14642, USA
| | - Adolf S Flemister
- Department of Orthopaedics, University of Rochester, 601 Elmwood Avenue, Box 665, Rochester, NY, 14642, USA
| | - John P Ketz
- Department of Orthopaedics, University of Rochester, 601 Elmwood Avenue, Box 665, Rochester, NY, 14642, USA
| | - Judith F Baumhauer
- Department of Orthopaedics, University of Rochester, 601 Elmwood Avenue, Box 665, Rochester, NY, 14642, USA.
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21
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Daniels TR, Wilson IR, Fu JM. What's New in Foot and Ankle Surgery. J Bone Joint Surg Am 2020; 102:856-865. [PMID: 32187125 DOI: 10.2106/jbjs.20.00068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Timothy R Daniels
- Division of Orthopaedic Surgery, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
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22
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Waldman OV, Hao SP, Houck JR, Lee NJ, Baumhauer JF, Oh I. Operative Intervention Does Not Change Pain Perception in Patients With Diabetic Foot Ulcers. Clin Diabetes 2020; 38:132-140. [PMID: 32327885 PMCID: PMC7164984 DOI: 10.2337/cd19-0031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Researchers investigated pain perception in patients with diabetic foot ulcers (DFUs) by analyzing pre- and postoperative physical function (PF), pain interference (PI), and depression domains of the Patient-Reported Outcome Measurement Information System (PROMIS). They hypothesized that 1) because of painful diabetic peripheral neuropathy (DPN), a majority of patients with DFUs would have high PROMIS PI scores unchanged by operative intervention, and 2) the initially assessed PI, PF, and depression levels would be correlated with final outcomes. Seventy-five percent of patients with DFUs reported pain, most likely because of painful DPN. Those who reported high PI and low PF were likely to report depression. PF, PI, and depression levels were unchanged after operative intervention or healing of DFUs.
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Affiliation(s)
- Olivia V Waldman
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY
| | - Stephanie P Hao
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY
| | - Jeff R Houck
- Department of Physical Therapy, George Fox University, Newburg, OR
| | - Nicolette J Lee
- Sydney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Judith F Baumhauer
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY
| | - Irvin Oh
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY
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An TW, Cassinelli S, Charlton TP, Pfeffer GB, Thordarson DB. Radiographic and Magnetic Resonance Imaging of the Symptomatic Synthetic Cartilage Implant. Foot Ankle Int 2020; 41:25-30. [PMID: 31538827 DOI: 10.1177/1071100719877147] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Synthetic Cartilage Implantation (SCI; Cartiva) is a treatment of hallux rigidus associated with mixed clinical outcomes in the United States. Patients with persistent pain typically undergo diagnostic imaging for evaluation. We aimed to characterize the radiologic findings of SCI and surrounding tissues. METHODS This is a retrospective review of patients treated using SCI who underwent magnetic resonance imaging (MRI) for persistent pain. Metatarsophalangeal (MTP) joint spaces were compared on plain radiographs of the foot immediately postoperatively and at most recent follow-up. MRI of the foot were assessed for dimensions of the implant, bony channel, and presence of peri-implant fluid. Clinical follow-up, including Patient-Reported Outcome Measures Informational System (PROMIS) scores, satisfaction rating, and revision surgery, was collected. Eighteen cases of symptomatic SCI from 16 patients (13 females, 3 males) were included. All but 1 case involved a 10-mm implant. RESULTS Mean satisfaction rating was 2.25 (1-5 Likert scale). PROMIS scores indicated moderate physical dysfunction (41) and moderate pain interference (63). Six of 16 patients (37.5%) underwent revision surgery at average 20.9 months of follow-up. Plain radiographs over a 13.3-month interval showed joint space narrowing of 2 mm medially and 1.6 mm laterally (P < .001). One hundred percent of cases had radiographic evidence of osteoarthritis (OA) progression. MRI studies were obtained on average 11.5 months postoperatively. The implant diameter averaged 9.7 mm, which mismatched the bony channel diameter of 11.2 mm (P < .001). Fourteen of 18 cases had peri-implant fluid. All cases had edema in the metatarsal, proximal phalanx, and soft tissues. CONCLUSION Radiographic loss of MTP joint space and progression of arthritis were present for all cases studied. MRI revealed bony channel widening and a smaller implant, with peri-implant fluid suggesting instability at the implant-bone interface. Persistent edema was observed in soft tissues and bone. Diagnostic imaging of SCI in symptomatic patients demonstrated concerning findings that merit further correlation with patient outcomes. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Tonya W An
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Franovic S, Gulledge CM, Kuhlmann NA, Williford TH, Chen C, Makhni EC. Establishing "Normal" Patient-Reported Outcomes Measurement Information System Physical Function and Pain Interference Scores: A True Reference Score According to Adults Free of Joint Pain and Disability. JB JS Open Access 2019; 4:e0019. [PMID: 32043056 PMCID: PMC6959908 DOI: 10.2106/jbjs.oa.19.00019] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Numerous recent studies have demonstrated the validity and efficiency of the National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS) forms in patients undergoing orthopaedic surgical procedures. It is assumed that a score of 50 in each domain represents the health state of a “reference” population, but this threshold has not been definitively proven. In order to truly assess whether a given orthopaedic intervention is successful, the comparative scores of healthy individuals must be known for any given health domain measured. Therefore, the purpose of this study was to determine baseline scores for the PROMIS general physical function (PROMIS-PF), pain interference (PROMIS-PI), and upper-extremity physical function (PROMIS-UE) domains in physically healthy, asymptomatic adult individuals. We hypothesized that, in individuals <40 years old, the mean PROMIS-PF and PROMIS-UE scores would be >50 and PROMIS-PI scores would be <50. We further hypothesized that these scores would be impacted by participant age.
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Affiliation(s)
- Sreten Franovic
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan
| | - Caleb M Gulledge
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan
| | - Noah A Kuhlmann
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan
| | - Tyler H Williford
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan
| | - Chaoyang Chen
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan
| | - Eric C Makhni
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan
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Responsiveness of the PROMIS and its Concurrent Validity with Other Region- and Condition-specific PROMs in Patients Undergoing Carpal Tunnel Release. Clin Orthop Relat Res 2019; 477:2544-2551. [PMID: 31107341 PMCID: PMC6903856 DOI: 10.1097/corr.0000000000000773] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Patient-reported Outcome Measurement Information System (PROMIS) continues to be an important universal patient-reported outcomes measure (PROM) in orthopaedic surgery. However, there is concern about the performance of the PROMIS as a general health questionnaire in hand surgery compared with the performance of region- and condition-specific PROMs such as the Michigan Hand Questionnaire (MHQ) and the Boston Carpal Tunnel Questionnaire (BCTQ), respectively. To ensure that PROMIS domains capture patient-reported outcomes to the same degree as region- and condition-specific PROMs do, comparing PROM performance is necessary. QUESTIONS/PURPOSES (1) Which PROMs demonstrate high responsiveness among patients undergoing carpal tunnel release (CTR)? (2) Which of the PROMIS domains (Physical Function [PF], Upper Extremity [UE], and Pain Interference [PI]) demonstrate concurrent validity with the HHQ and BCTQ domains? METHODS In this prospective study, between November 2014 and October 2016, patients with carpal tunnel syndrome visiting a single surgeon who elected to undergo CTR completed the BCTQ, MHQ, and PROMIS UE, PF, and PI domains at each visit. A total of 101 patients agreed to participate. Of these, 31 patients (31%) did not return for a followup visit at least 6 weeks after CTR and were excluded, leaving a final sample of 70 patients (69%). We compared the PROMIS against region- and condition-specific PROMs in terms of responsiveness and concurrent validity. Responsiveness was determined using Cohen's d or the effect-size index (ESI). The larger the absolute value of the ESI, the greater the effect size. Using the ESI allows surgeons to better quantify the impact of CTR, with a medium ESI (that is, 0.5) representing a visible clinical change to a careful observer. Concurrent validity was determined using Spearman's correlation coefficient with correlation strengths categorized as excellent (> 0.7), excellent-good (0.61-0.70), good (0.4-0.6), and poor (< 0.4). Significance was set a priori at p < 0.05. RESULTS Among PROMIS domains, the PI demonstrated the best responsiveness (ESI = 0.74; 95% CI, 0.39-1.08), followed by the UE (ESI = -0.66; 95% CI, -1.00 to -0.31). For the MHQ, the Satisfaction domain had the largest effect size (ESI = -1.48; 95% CI, -1.85 to -1.09), while for the BCTQ, the Symptom Severity domain had the best responsiveness (ESI = 1.54; 95% CI, 1.14-1.91). The PROMIS UE and PI domains demonstrated excellent-good to excellent correlations to the total MHQ and BCTQ-Functional Status scores (preoperative UE to MHQ: ρ = 0.68; PI to MHQ: ρ = 0.74; UE to BCTQ-Functional Status: ρ = 0.74; PI to BCTQ-Functional Status: ρ = 0.67; all p < 0.001), while the PROMIS PF demonstrated poor correlations with the same domains (preoperative PF to MHQ; ρ = 0.33; UE to BCTQ-Functional Status: ρ = 0.39; both p < 0.01). CONCLUSIONS The PROMIS UE and PI domains demonstrated slightly worse responsiveness than the MHQ and BCTQ domains that was nonetheless acceptable. The PROMIS PF domain was unresponsive. All three PROMIS domains correlated with the MHQ and BCTQ, but the PROMIS UE and PI domains had notably stronger correlations to the MHQ and BCTQ domains than the PF domain did. We feel that the PROMIS UE and PI can be used to evaluate the clinical outcomes of patients undergoing CTR, while also providing more robust insight into overall health status because they are general PROMs. However, we do not recommend the PROMIS PF for evaluating patients undergoing CTR. LEVEL OF EVIDENCE Level II, diagnostic study.
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Cheung EC, Moore LK, Flores SE, Lansdown DA, Feeley BT, Zhang AL. Correlation of PROMIS with Orthopaedic Patient-Reported Outcome Measures. JBJS Rev 2019; 7:e9. [DOI: 10.2106/jbjs.rvw.18.00190] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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