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Lewin AM, Cashman K, Harries D, Ackerman IN, Naylor JM, Harris IA. First knee for pain and function versus second knee for quality of life. Bone Jt Open 2024; 5:202-209. [PMID: 38461859 PMCID: PMC10924693 DOI: 10.1302/2633-1462.53.bjo-2023-0035.r1] [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: 03/12/2024] Open
Abstract
Aims The aim of this study was to describe and compare joint-specific and generic health-related quality of life outcomes of the first versus second knee in patients undergoing staged bilateral total knee arthroplasty (BTKA) for osteoarthritis. Methods This retrospective cohort study used Australian national arthroplasty registry data from January 2013 to January 2021 to identify participants who underwent elective staged BTKA with six to 24 months between procedures. The primary outcome was Oxford Knee Score (OKS) at six months postoperatively for the first TKA compared to the second TKA, adjusted for age and sex. Secondary outcomes compared six-month EuroQol five-dimension five-level (EQ-5D-5L) domain scores, EQ-5D index scores, and the EQ visual analogue scale (EQ-VAS) between knees at six months postoperatively. Results The cohort included 635 participants (1,270 primary procedures). Preoperative scores were worse in the first knee compared to the second for all instruments; however, comparing the first knee at six months postoperatively with the second knee at six months postoperatively, the mean between-knee difference was minimal for OKS (-0.8 points; 95% confidence interval (CI) -1.4 to -0.2), EQ-VAS (3.3; 95% CI 1.9 to 4.7), and EQ-5D index (0.09 points; 95% CI 0.07 to 0.12). Outcomes for the EQ-5D-5L domains 'mobility', 'usual activities', and 'pain/discomfort' were better following the second TKA. Conclusion At six months postoperatively, there were no clinically meaningful differences between the first and second TKA in either the joint-specific or overall generic health-related quality of life outcomes. However, individual domain scores assessing mobility, pain, and usual activities were notably higher after the second TKA, likely reflecting the cumulative improvement in quality of life after both knees have been replaced.
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Affiliation(s)
- Adriane M. Lewin
- South West Clinical Campuses, School of Clinical Medicine, UNSW Medicine & Health, Liverpool, Australia
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - Kara Cashman
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Dylan Harries
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Ilana N. Ackerman
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Justine M. Naylor
- South West Clinical Campuses, School of Clinical Medicine, UNSW Medicine & Health, Liverpool, Australia
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, Australia
- South West Sydney Local Health District, NSW Health, Sydney, Australia
| | - Ian A. Harris
- South West Clinical Campuses, School of Clinical Medicine, UNSW Medicine & Health, Liverpool, Australia
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, Australia
- South West Sydney Local Health District, NSW Health, Sydney, Australia
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, Australia
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Zhou Y, Shadbolt C, Thuraisingam S, Schilling C, Choong P, Dowsey M. Differences in Outcomes Between Initial Responders and Subsequent Responders to Health Questionnaires for Total Hip and Knee Arthroplasty: An Australian Tertiary Institutional Registry Study. J Arthroplasty 2023; 38:2561-2567. [PMID: 37286051 DOI: 10.1016/j.arth.2023.05.079] [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: 02/01/2023] [Revised: 05/16/2023] [Accepted: 05/29/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Patient-reported outcome measure (PROM) questionnaires in national arthroplasty registries often have low response rates leading to questions about data reliability. In Australia, the SMART (St. Vincent's Melbourne Arthroplasty Outcomes) registry captures all elective total hip (THA) and total knee (TKA) arthroplasty patients with an approximate 98% response rate for preoperative and 12-month PROM scores. This high response rate is due to dedicated registry staff following up patients who do not initially respond (subsequent responders). This study compared initial responders to subsequent responders to find differences in 12-month PROM outcomes for THA and TKA. METHODS All elective THA and TKA patients for osteoarthritis from 2012 to 2021 captured by the SMART registry were included. In total, 1,333 THA and 1,340 TKA patients were included. The PROM scores were assessed using the Veterans-RAND 12 (VR12) and Western Ontario and McMasters Universities Arthritis Index (WOMAC) questionnaires. The primary outcome was differences in mean 12-month PROM scores between initial and subsequent responders. RESULTS Baseline characteristics and PROM scores were similar between initial and subsequent responders. However, 12-month PROM scores varied significantly. The adjusted mean difference showed that for the WOMAC pain score, subsequent responders scored 3.4 points higher in the THA cohort and 7.4 points higher in the TKA cohort compared to initial responders. Significant differences were also found in other WOMAC and VR12 scores for both THA and TKA cohorts at the 12-month timepoint. CONCLUSION This study found that significant differences in PROM outcomes postsurgery occurred in THA and TKA patients based on response to PROM questionnaires, suggesting that loss to follow-up in PROM outcomes should not be treated as missing completely at random (MCAR).
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Affiliation(s)
- Yushy Zhou
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, Victoria, Australia; Department of Orthopaedic Surgery, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Cade Shadbolt
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, Victoria, Australia
| | - Sharmala Thuraisingam
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, Victoria, Australia
| | - Chris Schilling
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, Victoria, Australia
| | - Peter Choong
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, Victoria, Australia
| | - Michelle Dowsey
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, Victoria, Australia
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Blackburn AZ, Homere A, Alpaugh K, Melnic CM, Bedair HS. Intersurgeon Variability of Minimal Clinically Important Difference for Worsening Achievement Rates After Total Joint Arthroplasty. J Arthroplasty 2023; 38:2573-2579.e2. [PMID: 37321518 DOI: 10.1016/j.arth.2023.06.006] [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: 02/15/2023] [Revised: 06/03/2023] [Accepted: 06/06/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Using the Patient-Reported Outcome Measurement Information System, we sought to evaluate surgeon performance variability via minimal clinically important difference for worsening (MCID-W) achievement rates in primary and revision total knee and hip arthroplasty. METHODS This retrospective study analyzed 3,496 primary total hip arthroplasty (THA), 4,622 primary total knee arthroplasty (TKA), 592 revision THA, and 569 revision TKA patients. Patient factors collected included demographics, comorbidities, and Patient-Reported Outcome Measurement Information System physical function short form 10a scores. Surgeon factors collected included caseload, years of experience, and fellowship training. The MCID-W rate was calculated as the percent of patients in each surgeon's cohort who achieved MCID-W. Distribution was presented via a histogram with associated average, standard deviation, range, and interquartile range (IQR). Linear regressions were performed to evaluate the potential correlation between surgeon- and patient-level factors with MCID-W rate. RESULTS The average MCID-W rates of the surgeons represented in the primary THA and TKA cohorts were 12.7 ± 9.2% (range, 0 to 35.3%; IQR, 6.7 to 15.5%) and 18.0 ± 8.2% (range, 0 to 36%; IQR, 14.3 to 22.0%). The average MCID-W rates among the revision THA and TKA surgeons were 36.0 ± 22.2% (range, 9.1 to 90%; IQR, 25.0 to 41.4%) and 21.2 ± 7.7% (range, 8.1 to 37.0%; IQR, 16.6 to 25.4%). Strong correlations were not found between patient- or surgeon-level factors and MCID-W rate of the surgeon. CONCLUSION We demonstrated variance in MCID-W achievement rates across surgeons in both primary and revision joint arthroplasty, independent of patient- or surgeon-level factors.
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Affiliation(s)
- Amy Z Blackburn
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Andrew Homere
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Kyle Alpaugh
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Christopher M Melnic
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Hany S Bedair
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
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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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Pavetto C, Burla M, Lavallee DC, Levison TJ, DiGioia AM, Franklin PD. Optimizing PROM Implementation in Orthopedic Clinics for Longitudinal Outcome Monitoring: Lessons from a Multisite Study. Jt Comm J Qual Patient Saf 2023; 49:474-484. [PMID: 37455194 DOI: 10.1016/j.jcjq.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 05/31/2023] [Accepted: 05/31/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Systematic patient-reported outcome measure (PROM) collection is challenging for clinics, particularly when patients are not in the office. The Arthritis care through Shared Knowledge (ASK) study deployed multimodal approaches to collect PROMs using a clinical microsystem framework. CONCEPTUAL MODEL Informed by the clinical microsystem model, the authors coached 12 orthopedic practices to implement shared processes to support best practices for PROM collection and use. Orthopedic sites collected PROMs from new patients before the first office visit; patients completed the PROM from home via an online assessment in a personalized e-mail. Site staff placed follow-up phone reminders. At 6 and 12 months after the visit, PROMs were collected from home, prompted by an e-mail or phone call. PERFORMANCE OUTCOMES Of the 25,043 new patients identified by clinical sites during the study enrollment, approximately 60% completed a pre-visit PROM-36.6% completed the online PROM after receiving a single automated e-mail, and an additional 31.1% completed the PROM after receiving a text, an e-mail, or a phone call from the staff. The remaining 32.2% of PROMs were collected on arrival at the office. Of patients completing PROMs, 11,140 were eligible to participate in longitudinal collection, and 51.3% consented. Of these, approximately 84% completed a 6-month survey, more than 83% completed a 12-month survey, and more than 91% completed either a 6-month PROM, a 12-month PROM, or both. LEARNING This study illustrates that a multimodal approach to PROM collection using a clinical microsystem approach sustainably supports PROM completion rates. Further efforts are needed to define strategies to engage all patients in understanding and reporting PROMs to inform their care.
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Hoskins W, Bingham R, Corfield S, Harries D, Harris IA, Vince KG. Do the Revision Rates of Arthroplasty Surgeons Correlate With Postoperative Patient-reported Outcome Measure Scores? A Study From the Australian Orthopaedic Association National Joint Replacement Registry. Clin Orthop Relat Res 2023; 482:00003086-990000000-01237. [PMID: 37339166 PMCID: PMC10723865 DOI: 10.1097/corr.0000000000002737] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 03/29/2023] [Accepted: 05/22/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are a pragmatic and efficient means to evaluate the functional quality of arthroplasty beyond revision rates, which are used by most joint replacement registries to judge success. The relationship between these two measures of quality-revision rates and PROMs-is unknown, and not every procedure with a poor functional result is revised. It is logical-although still untested-that higher cumulative revision rates correlate inversely with PROMs for individual surgeons; more revisions are associated with lower PROM scores. QUESTIONS/PURPOSES We used data from a large national joint replacement registry to ask: (1) Does a surgeon's early THA cumulative percent revision (CPR) rate and (2) early TKA CPR rate correlate with the postoperative PROMs of patients undergoing primary THA and TKA, respectively, who have not undergone revision? METHODS Elective primary THA and TKA procedures in patients with a primary diagnosis of osteoarthritis that were performed between August 2018 and December 2020 and registered in the Australian Orthopaedic Association National Joint Replacement Registry PROMs program were eligible. THAs and TKAs were eligible for inclusion in the primary analysis if 6-month postoperative PROMs were available, the operating surgeon was clearly identified, and the surgeon had performed at least 50 primary THAs or TKAs. Based on the inclusion criteria, 17,668 THAs were performed at eligible sites. We excluded 8878 procedures that were not matched to the PROMs program, leaving 8790 procedures. A further 790 were excluded because they were performed by unknown or ineligible surgeons or were revised, leaving 8000 procedures performed by 235 eligible surgeons, including 4256 (53%; 3744 cases of missing data) patients who had postoperative Oxford Hip Scores and 4242 (53%; 3758 cases of missing data) patients who had a postoperative EQ-VAS score recorded. Complete covariate data were available for 3939 procedures for the Oxford Hip Score and for 3941 procedures for the EQ-VAS. A total of 26,624 TKAs were performed at eligible sites. We excluded 12,685 procedures that were not matched to the PROMs program, leaving 13,939 procedures. A further 920 were excluded because they were performed by unknown or ineligible surgeons, or because they were revisions, leaving 13,019 procedures performed by 276 eligible surgeons, including 6730 (52%; 6289 cases of missing data) patients who had had postoperative Oxford Knee Scores and 6728 (52%; 6291 cases of missing data) patients who had a postoperative EQ-VAS score recorded. Complete covariate data were available for 6228 procedures for the Oxford Knee Score and for 6241 procedures for the EQ-VAS. The Spearman correlation between the operating surgeon's 2-year CPR and 6-month postoperative EQ-VAS Health and Oxford Hip or Oxford Knee Score was evaluated for THA and TKA procedures where a revision had not been performed. Associations between postoperative Oxford and EQ-VAS scores and a surgeon's 2-year CPR were estimated based on multivariate Tobit regressions and a cumulative link model with a probit link, adjusting for patient age, gender, ASA score, BMI category, preoperative PROMs, as well as surgical approach for THA. Missing data were accounted for using multiple imputation, with models assuming they were missing at random and a worst-case scenario. RESULTS Of the eligible THA procedures, postoperative Oxford Hip Score and surgeon 2-year CPR were correlated so weakly as to be clinically irrelevant (Spearman correlation ρ = -0.09; p < 0.001), and the correlation with postoperative EQ-VAS was close to zero (ρ = -0.02; p = 0.25). Of the eligible TKA procedures, postoperative Oxford Knee Score and EQ-VAS and surgeon 2-year CPR were correlated so weakly as to be clinically irrelevant (ρ = -0.04; p = 0.004 and ρ = 0.03; p = 0.006, respectively). All models accounting for missing data found the same result. CONCLUSION A surgeon's 2-year CPR did not exhibit a clinically relevant correlation with PROMs after THA or TKA, and all surgeons had similar postoperative Oxford scores. PROMs, revision rates, or both may be inaccurate or imperfect indicators of successful arthroplasty. Missing data may limit the findings of this study, although the results were consistent under a variety of different missing data scenarios. Innumerable factors contribute to arthroplasty results, including patient-related variables, differences in implant design, and the technical quality of the procedure. PROMs and revision rates may be analyzing two different facets of function after arthroplasty. Although surgeon variables are associated with revision rates, patient factors may exert a stronger influence on functional outcomes. Future research should identify variables that correlate with functional outcome. Additionally, given the gross level of function that Oxford scores record, outcome measures that can identify clinically meaningful functional differences are required. The use of Oxford scores in national arthroplasty registries may rightfully be questioned. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Wayne Hoskins
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Australia
- Traumaplasty Melbourne, East Melbourne, Australia
- Department of Orthopaedics, Whangarei Hospital, Northland District Health Board, Whangarei, New Zealand
| | | | - Sophia Corfield
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, Australia
| | - Dylan Harries
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Ian A. Harris
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, Australia
- Ingham Institute for Applied Medical Research, School of Clinical Medicine, UNSW Sydney, Australia
| | - Kelly G. Vince
- Department of Orthopaedics, Whangarei Hospital, Northland District Health Board, Whangarei, New Zealand
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Gumbie M, Costa M, Erb M, Dissanayake G. Innovative technologies for reverse total shoulder arthroplasty in Australia: Market access challenges and implications for patients, decision-makers, and manufacturers. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2022; 11:2154420. [PMID: 36506841 PMCID: PMC9731581 DOI: 10.1080/20016689.2022.2154420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/24/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE The success of reverse total shoulder arthroplasty (RTSA) has expanded its use for a broader range of shoulder indications worldwide. Evidence regarding the relative efficacy and long-term safety of medical technologies used in RTSA is subjected to rigorous assessment. Nonetheless, substantial challenges impede market access for innovative shoulder implant technologies for RTSA in Australia, resulting in delayed patient access. APPROACH This paper addresses the key challenges associated with generating evidence for the health technology assessments of innovative medical technologies for RTSA that are required for access to the Australian market. The transition to value-based care requires establishing a benchmarking reference that incorporates patient-reported outcome measures (PROMs) and combines revision outcomes with additional clinical outcomes to increase patient cohort sizes. Establishing the benchmark would require agreement on the outcome measures to be collected for each indication, and investment in reporting patient-reported outcomes for RTSA to the national orthopaedic registry. IMPLICATIONS FOR PRACTICE The need for increased flexibility in developing evidence for health technology assessment of RTSA medical technologies is required. Optimised approaches for benchmarking RTSA require extensive stakeholder discussions, including the agreement on evidence requirements and follow-up periods, selection of clinical outcomes, as well as pre-operative and post-operative PROMs as a value assessment.
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Affiliation(s)
- Mutsa Gumbie
- Macquarie University Centre for the Health Economy, Sydney, NSW, Australia
- Johnson & Johnson MedTech, North Ryde, NSW, Australia
| | | | | | - Gnanadarsha Dissanayake
- New South Wales Ministry of Health, St Leonards, NSW, Australia
- School of Mathematics and Statistics, University of Sydney, Sydney, NSW, Australia
- Statistical Society of Australia, Belconnen, NSW, Australia
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Schleicher O, Horndasch A, Krumbholz M, Sembill S, Bremensdorfer C, Grabow D, Erdmann F, Karow A, Metzler M, Suttorp M. Patient-reported long-term outcome following allogeneic hematopoietic stem cell transplantation in pediatric chronic myeloid leukemia. Front Oncol 2022; 12:963223. [PMID: 36276159 PMCID: PMC9580018 DOI: 10.3389/fonc.2022.963223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/26/2022] [Indexed: 01/03/2023] Open
Abstract
Background Pediatric CML is very rare. Before the introduction of tyrosine kinase inhibitors (TKIs), allogeneic hematopoietic stem cell transplantation (HSCT) from a donor -if available- was the standard cure attempt. Data on the long-term outcome and health-related quality of life (HRQOL) in former pediatric CML patients undergoing HSCT are lacking. Study question We investigated long-term survivors' self-reporting to a questionnaire sent out to patients formerly enrolled in pediatric CML-HSCT trials. Methods Individuals with CML transplanted at age <18 years were identified from the German Childhood Cancer Registry database. Long-term survivors received a questionnaire based on the SF-36 and FACT-BMT asking them to self-report HRQOL issues. (Ethical vote #541_20 B, Medical Faculty, University of Erlangen-Nürnberg). Results 111/171 (64.9%) individuals survived HSCT long-term and 86/111 (77.5%) fulfilled all inclusion criteria and received the questionnaire. 37/86 (43%) participants (24 female, 13 male, median age at HSCT 12 years [range 2-18], median age at the time of the survey 29 years [range 18-43]) responded after a median follow-up period of 19 years (range 4-27) after HSCT. 10/37 (27%) participants underwent no regular medical follow-up examinations. Self-reported symptoms like chronic graft-versus-host disease (cGvHD)-associated organ impairments and conditioning regimen consequences could causatively not sharply be separated in each case. Complains comprised hypothyroidism (N=11, 30%), infertility (N=9, 24%), lung problems, dry eyes (each N=7, 19%), skin alterations (N=6, 17%), hair problems (N=4, 11%), and sexual dysfunction (N=3, 9%). 10 (27%) participants experienced 13 CML relapses after a median interval from HSCT of 31 months (range 2-93). Only one patient underwent 2nd SCT after failure of relapse treatment with TKIs. Six secondary malignancies (dysplastic melanocytic nevus and ALL, basal cell carcinoma (N=2), rhabdomyosarcoma, and thyroid carcinoma developed in 5 (13%) participants. As assessed by the SF-36 questionnaire, impaired physical health was mainly associated with cGvHD. The mental component summary score showed that also participants without cGvHD scored significantly lower than the general population. When assessed by the FACT-BMT, participants with cGvHD scored significantly lower while participants without cGvHD scored even 5 points higher than the data from controls. 18 (49%) participants considered the sequelae of HSCT an obstacle to education. Out of the total cohort, N=20 (54%), N=7 (19%), N=5 (14%), and N=4 (11%) participants worked full time, part-time, were unemployed, or had not yet finalized their education, respectively. 20 (54%) participants lived as singles, 8 (22%) lived in a partnership, 6 (16%) were married, and 3 (8%) had been divorced. Four (11%) participants reported a total number of 7 children. Conclusion This first assessment of HRQOL in former pediatric patients with CML surviving HSCT for more than two decades demonstrates self-reported satisfactory well-being only in the absence of cGvHD. Research-based on self-reported outcomes sheds light on former patients' perspectives and provides an additional layer of valuable knowledge for pediatric and adult hematologists. Regular follow-up examinations are mandatory helping to avoid that late secondary neoplasias, CML-relapse, and disorders forming the broad range of possible long-term consequences of HSCT are not detected too late.
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Affiliation(s)
- Oliver Schleicher
- Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Annkathrin Horndasch
- Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Manuela Krumbholz
- Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Stephanie Sembill
- Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Claudia Bremensdorfer
- German Childhood Cancer Registry, Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Desiree Grabow
- German Childhood Cancer Registry, Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Friederike Erdmann
- German Childhood Cancer Registry, Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Axel Karow
- Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Markus Metzler
- Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Meinolf Suttorp
- Pediatric Hemato-Oncology, Medical Faculty Carl Gustav Carus, Technical University, Dresden, Germany,*Correspondence: Meinolf Suttorp,
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Harris IA, Peng Y, Ackerman I, Graves SE. The association between pre-operative patient-reported health status and post-operative survey completion following arthroplasty: a registry-based cohort study. (Preprint). JMIR Perioper Med 2021; 5:e33414. [PMID: 35771616 PMCID: PMC9284355 DOI: 10.2196/33414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 11/18/2022] Open
Abstract
Background Patient-reported outcome measures (PROMs) are commonly used to report outcomes after hip and knee arthroplasty, but response rates are rarely complete. Given that preoperative health status (as measured by PROMs) is a strong predictor of outcomes (using the same measures) and that these outcomes may influence the response rate, it is possible that postoperative response rates (the proportion of patients providing preoperative PROMs who also provide postoperative PROMs) may be influenced by preoperative health status. Objective This study aims to test the association between preoperative PROMs and postoperative response status following hip and knee arthroplasty. Methods Data from the PROMs program of the Australian national joint registry were used. The preoperative PROMs were the Oxford Hip Score or Oxford Knee Score, The EQ-5D Utility Index, and the EQ visual analog scale (VAS) for overall health. Logistic regression, adjusting for age, sex, BMI, and the American Society of Anesthesiologists (ASA) Physical Status Classification System, was used to test the association between each preoperative PROM and response status for the 6-month postsurgery survey. Results Data from 9499 and 16,539 patients undergoing elective total hip arthroplasty (THA) and total knee arthroplasty (TKA) for osteoarthritis, respectively, were included in the analysis. Adjusting for age, sex, BMI, and ASA, there was no significant difference in response status at the postoperative follow-up based on the preoperative Oxford Hip or Knee Scores (odds ratio [OR] 1.00, 95% CI 0.99-1.01 for both; P=.70 for THA and P=.85 for TKA). Healthier patients (based on the EQ VAS scores) preoperatively were more likely to respond postoperatively, but this difference was negligible (OR 1.00, 95% CI 1.00-1.01 for THA and TKA; P=.004 for THA and P<.001 for TKA). The preoperative EQ Utility Index was not associated with the postoperative response rate for THA (OR 1.14, 95% CI 0.96-1.36; P=.13) or TKA patients (OR 1.05, 95% CI 0.91-1.22; P=.49). Conclusions The likelihood of responding to a postoperative PROMs survey for patients undergoing hip or knee arthroplasty was not associated with clinically important differences in preoperative patient-reported joint pain, function, or health-related quality of life. This suggests that the assessment of postoperative outcomes in hip and knee arthroplasty is not biased by differences in preoperative health measures between responders and nonresponders.
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Affiliation(s)
- Ian A Harris
- Ingham Institute for Applied Medical Research, School of Clinical Medicine, University of New South Wales, Medicine and Health, Liverpool, Australia
- Australian Orthopaedic Association National Joint Replacement Registry, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Yi Peng
- Australian Orthopaedic Association National Joint Replacement Registry, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Ilana Ackerman
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Stephen E Graves
- Australian Orthopaedic Association National Joint Replacement Registry, South Australian Health and Medical Research Institute, Adelaide, Australia
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