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John Charnley Award: Preoperative Patient-reported Outcome Measures Predict Clinically Meaningful Improvement in Function After THA.
Clin Orthop Relat Res 2016; 474(2):321-9CO

Abstract

BACKGROUND

Despite the overall effectiveness of total hip arthroplasty (THA), a subset of patients remain dissatisfied with their results because of persistent pain or functional limitations. It is therefore important to develop predictive tools capable of identifying patients at risk for poor outcomes before surgery.

QUESTIONS/PURPOSES

The purpose of this study was to use preoperative patient-reported outcome measure (PROM) scores to predict which patients undergoing THA are most likely to experience a clinically meaningful change in functional outcome 1 year after surgery.

METHODS

A retrospective cohort study design was used to evaluate preoperative and 1-year postoperative SF-12 version 2 (SF12v2) and Hip Disability and Osteoarthritis Outcome Score (HOOS) scores from 537 selected patients who underwent primary unilateral THA. Minimum clinically important differences (MCIDs) were calculated using a distribution-based method. A receiver operating characteristic analysis was used to calculate threshold values, defined as the levels at which substantial changes occurred, and their predictive ability. MCID values for HOOS and SF12v2 physical component summary (PCS) scores were calculated to be 9.1 and 4.6, respectively. We analyzed the effect of SF12v2 mental component summary (MCS) scores, which measure mental and emotional health, on SF12v2 PCS and HOOS threshold values.

RESULTS

Threshold values for preoperative HOOS and PCS scores were a maximum of 51.0 (area under the curve [AUC], 0.74; p < 0.001) and 32.5 (AUC, 0.62; p < 0.001), respectively. As preoperative mental and emotional health improved, which was reflected by a higher MCS score, HOOS and PCS threshold values also increased. When preoperative mental and emotional health were taken into account, both HOOS and PCS threshold values' predictive ability improved (AUCs increased to 0.77 and 0.69, respectively).

CONCLUSIONS

We identified PROM threshold values that predict clinically meaningful improvements in functional outcome after THA. Patients with a higher level of preoperative function, as suggested by HOOS or PCS scores above the defined threshold values, are less likely to obtain meaningful improvement after THA. Lower preoperative mental and emotional health decreases the likelihood of achieving a clinically meaningful improvement in function after THA. The results of this study may be used to facilitate discussion between physicians and patients regarding the expected benefit after THA and to support the development of patient-based informed decision-making tools. For example, despite significant disease, patients with high preoperative function, as measured by PROM scores, may choose to delay surgery given the low likelihood of experiencing a meaningful improvement postoperatively. Similarly, patients with notably low MCS scores might best be counseled to address mental health issues before embarking on surgery.

LEVEL OF EVIDENCE

Level III, prognostic study.

Authors+Show Affiliations

Department of Orthopaedic Surgery, University of California, San Francisco, 500 Parnassus Avenue, MU 320-W, San Francisco, CA, 94143, USA.Department of Orthopaedic Surgery, University of California, San Francisco, 500 Parnassus Avenue, MU 320-W, San Francisco, CA, 94143, USA.Department of Orthopaedic Surgery, University of California, San Francisco, 500 Parnassus Avenue, MU 320-W, San Francisco, CA, 94143, USA. Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA.Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, CA, USA.Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, 1400 Barbara Jordan Blvd, Suite 1.114, Austin, TX, 78723, USA. Kevin.bozic@austin.utexas.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26201420

Citation

Berliner, Jonathan L., et al. "John Charnley Award: Preoperative Patient-reported Outcome Measures Predict Clinically Meaningful Improvement in Function After THA." Clinical Orthopaedics and Related Research, vol. 474, no. 2, 2016, pp. 321-9.
Berliner JL, Brodke DJ, Chan V, et al. John Charnley Award: Preoperative Patient-reported Outcome Measures Predict Clinically Meaningful Improvement in Function After THA. Clin Orthop Relat Res. 2016;474(2):321-9.
Berliner, J. L., Brodke, D. J., Chan, V., SooHoo, N. F., & Bozic, K. J. (2016). John Charnley Award: Preoperative Patient-reported Outcome Measures Predict Clinically Meaningful Improvement in Function After THA. Clinical Orthopaedics and Related Research, 474(2), pp. 321-9. doi:10.1007/s11999-015-4350-6.
Berliner JL, et al. John Charnley Award: Preoperative Patient-reported Outcome Measures Predict Clinically Meaningful Improvement in Function After THA. Clin Orthop Relat Res. 2016;474(2):321-9. PubMed PMID: 26201420.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - John Charnley Award: Preoperative Patient-reported Outcome Measures Predict Clinically Meaningful Improvement in Function After THA. AU - Berliner,Jonathan L, AU - Brodke,Dane J, AU - Chan,Vanessa, AU - SooHoo,Nelson F, AU - Bozic,Kevin J, PY - 2015/7/24/entrez PY - 2015/7/24/pubmed PY - 2016/5/21/medline SP - 321 EP - 9 JF - Clinical orthopaedics and related research JO - Clin. Orthop. Relat. Res. VL - 474 IS - 2 N2 - BACKGROUND: Despite the overall effectiveness of total hip arthroplasty (THA), a subset of patients remain dissatisfied with their results because of persistent pain or functional limitations. It is therefore important to develop predictive tools capable of identifying patients at risk for poor outcomes before surgery. QUESTIONS/PURPOSES: The purpose of this study was to use preoperative patient-reported outcome measure (PROM) scores to predict which patients undergoing THA are most likely to experience a clinically meaningful change in functional outcome 1 year after surgery. METHODS: A retrospective cohort study design was used to evaluate preoperative and 1-year postoperative SF-12 version 2 (SF12v2) and Hip Disability and Osteoarthritis Outcome Score (HOOS) scores from 537 selected patients who underwent primary unilateral THA. Minimum clinically important differences (MCIDs) were calculated using a distribution-based method. A receiver operating characteristic analysis was used to calculate threshold values, defined as the levels at which substantial changes occurred, and their predictive ability. MCID values for HOOS and SF12v2 physical component summary (PCS) scores were calculated to be 9.1 and 4.6, respectively. We analyzed the effect of SF12v2 mental component summary (MCS) scores, which measure mental and emotional health, on SF12v2 PCS and HOOS threshold values. RESULTS: Threshold values for preoperative HOOS and PCS scores were a maximum of 51.0 (area under the curve [AUC], 0.74; p < 0.001) and 32.5 (AUC, 0.62; p < 0.001), respectively. As preoperative mental and emotional health improved, which was reflected by a higher MCS score, HOOS and PCS threshold values also increased. When preoperative mental and emotional health were taken into account, both HOOS and PCS threshold values' predictive ability improved (AUCs increased to 0.77 and 0.69, respectively). CONCLUSIONS: We identified PROM threshold values that predict clinically meaningful improvements in functional outcome after THA. Patients with a higher level of preoperative function, as suggested by HOOS or PCS scores above the defined threshold values, are less likely to obtain meaningful improvement after THA. Lower preoperative mental and emotional health decreases the likelihood of achieving a clinically meaningful improvement in function after THA. The results of this study may be used to facilitate discussion between physicians and patients regarding the expected benefit after THA and to support the development of patient-based informed decision-making tools. For example, despite significant disease, patients with high preoperative function, as measured by PROM scores, may choose to delay surgery given the low likelihood of experiencing a meaningful improvement postoperatively. Similarly, patients with notably low MCS scores might best be counseled to address mental health issues before embarking on surgery. LEVEL OF EVIDENCE: Level III, prognostic study. SN - 1528-1132 UR - https://www.unboundmedicine.com/medline/citation/26201420/John_Charnley_Award:_Preoperative_Patient_reported_Outcome_Measures_Predict_Clinically_Meaningful_Improvement_in_Function_After_THA_ L2 - https://link.springer.com/article/10.1007/s11999-015-4350-6 DB - PRIME DP - Unbound Medicine ER -