A One-Question Patient-Reported Outcome Measure Is Comparable to Multiple-Question Measures in Total Knee Arthroplasty Patients (original) (raw)
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Clinimetric quality of the new 2011 Knee Society Score: High validity, low completion rate
The Knee, 2014
Background: The demands of the younger and more active current total knee arthroplasty (TKA) patients are not in line with the current outcome assessments. Therefore, new questionnaires are developed or adjusted, as with the popular 1989 Knee Society Score (KSS). This study is the first to investigate the clinimetric parameters of the patient-reported outcome measurement (PROM) part of the 2011 KSS. Methods: Four-hundred-fifteen primary Dutch TKA patients were scored using the PROM part of the 2011 KSS. The scale is subdivided into an Objective (not evaluated), Satisfaction, Expectation and Function subscales. Clinimetric quality was evaluated by response and completion rate, test-retest reliability (n = 29, intraclass correlation coefficient), internal consistency (n = 172, Cronbach's alpha), construct validity (Pearson's correlations with 1989 KSS (n = 75) and KOOS-PS (n = 139)) and responsiveness (n = 20, paired-samples t-test, effect sizes and floor and ceiling effects). Results: A response rate of 96% and completion rate of 43% were found. Reliability and internal consistency proved excellent with ICCs ≥ 0.79 and Cronbach's alpha ≥ 0.76 for all subscales. Strong correlations were found between the Function subscales of the 2011 KSS and KOOS-PS (r = −0.60 to −0.83). All subscales improved significantly after intervention, with exception of Walking & Standing and Discretionary Activities. 23% reached the maximum score postoperatively in Walking & Standing, indicating a ceiling effect. Conclusions: The 2011 KSS is a reliable, internal consistent, construct valid and responsive questionnaire to assess the outcome of the Dutch TKA patients. Optimizations (e.g. shortening the scale, simplified design) are recommended to increase the disappointing completion rate. Clinical relevance: The 2011 KSS is a reliable, internal consistent, construct valid and responsive questionnaire to assess the outcome of the Dutch TKA patients.
Knee Surgery & Related Research
Purpose The aim of this article was to highlight various terminologies and methods of calculation of minimal clinically important difference (MCID) and summarize MCID values of frequently used patient-reported outcome measures (PROMs) evaluating total knee arthroplasty (TKA). Materials and methods PubMed and EMBASE databases were searched through May 2019. Of 71 articles identified, 18 articles matched and underwent a comprehensive analysis for terminologies used to indicate clinical significance, method of calculation, and reported MCID values. Results MCID was the most common terminology (67% studies) and anchor-based methods were most commonly employed (67% studies) to calculate it. The analytical methods used to calculate and the estimated values of MCID for clinical use are highly variable. MCID values reported for WOMAC scores are 20.5 to 36.0, 17.6 to 33.0 and 12.9 to 25.0 for pain, function and stiffness sub-scales, respectively, and 4.7 to 10.0 for OKS. Conclusion There was...
PM&R, 2011
To characterize patient outcomes after total knee arthroplasty (TKA) by (1) examining changes in self-report measures (Knee Injury and Osteoarthritis Outcome Score [KOOS]) and performance measures over the first 6 months after TKA, (2) evaluating correlations between changes in KOOS self-report function (activities of daily living [ADL] subscale) and functional performance (6-minute walk [6MW]), and (3) exploring how changes in pain correlate with KOOS ADL and 6MW outcomes. Retrospective cohort evaluation. Clinical research laboratory. Thirty-nine patients scheduled for a unilateral, primary TKA for end-stage unilateral knee osteoarthritis. Patients were evaluated 2 weeks before surgery and 1, 3, and 6 months after surgery. KOOS, 6MW, timed-up-and-go (TUG), and stair climbing tests (SCT), quadriceps strength. Three of 5 KOOS subscales significantly improved by 1 month after TKA. All 5 KOOS subscales significantly improved by 3 and 6 months after TKA. In contrast, performance measures (6MW, TUG, SCT, and quadriceps strength) all significantly declined from preoperative values by 1 month after TKA and significantly improved from preoperative values by 3 and 6 months after TKA; yet, improvements from preoperative values were not clinically meaningful. Pearson correlations between changes in the KOOS ADL subscale and 6MW from before surgery were not statistically significant at 1, 3, or 6 months after TKA. In addition, KOOS Pain was strongly correlated with KOOS ADL scores at all times, but KOOS Pain was not correlated with 6MW distance at any time. Patient self-report by using the KOOS did not reflect the magnitude of performance deficits present after surgery, especially 1 month after TKA. Self-report KOOS outcomes closely paralleled pain relief after surgery, whereas performance measures were not correlated with pain. These results emphasize the importance of including performance measures when tracking recovery after TKA as opposed to solely relying on self-reported measures.
Journal of Patient-Reported Outcomes, 2023
Background While there are a few studies on measurement properties of PROMIS short forms for pain and function in patients with knee osteoarthritis, nothing is known about the measurement properties in patients with knee arthroplasty. Therefore, this study examined the measurement properties of the German Patient-Reported Outcomes Measurement Information System (PROMIS) short forms for pain intensity (PAIN), pain interference (PI) and physical function (PF) in knee arthroplasty patients. Methods Short forms were collected from consecutive patients of our clinic's knee arthroplasty registry before and 12 months post-surgery. Oxford Knee Score (OKS) was the reference measure. A subsample completed the short forms twice to test reliability. Construct validity and responsiveness were assessed using scale-specific hypothesis testing. For reliability, Cronbach's alpha, intraclass correlation coefficients, and agreement using standard error of measurement (SEM agr) were used. Agreement was used to determine standardised effect sizes and smallest detectable changes (SDC90). Individual-level minimal important change (MIC) was calculated using a method of adjusted prediction. Results Of 213 eligible patients, 155 received questionnaires, 143 returned baseline questionnaires and 119, 12-month questionnaires. Correlations of short forms with OKS were large (│r│ ≥ 0.7) with slightly lower values for PAIN, and specifically for men. Cronbach's alpha values were ≥ 0.84 and intraclass correlation coefficients ≥ 0.90. SEM agr were around 3.5 for PAIN and PI and 1.7 for PF. SDC90 were around 8 for PAIN and PI and 4 for PF. Follow-up showed a relevant ceiling effect for PF. Correlations with OKS change scores of around 0.5 to 0.6 were moderate. Adjusted MICs were 7.2 for PAIN, 3.5 for PI and 5.7 for PF. Conclusion Our results partly support the use of the investigated short forms for knee arthroplasty patients. The ability of PF to differentiate between patients with high perceived recovery is limited. Therefore, the advantages and disadvantages should be strongly considered within the context of the intended use.
The use of outcome measures relating to the knee
Orthopaedics and Trauma, 2010
Accurate outcomes assessment is one of the fundamental aspects of any reliable research. There are a vast number of outcome instruments currently available in orthopaedics. This plethora and diversity can lead to frustration when it comes to choosing the appropriate option. In this article we address the essential properties an outcome measure must possess, aiming to allow an informed selection of the most suitable instrument. We describe and illustrate key psychometric properties that are to be assessed when judging suitability of an instrument, such as validity, reliability and responsiveness. We also review some of the most commonly used and recommended outcome measures available in regard to different knee pathologies. With no intention of recommending a specific option, we briefly outline advances and shortcomings of named instruments.
The Oxford Knee Score; problems and pitfalls
The Knee, 2005
The Oxford Knee Score is a self-completed patient based outcome score. We audited the outcome of total knee arthroplasty at our unit using the Oxford Knee Score. The hypothesis of this study is that the OKS can be easily and accurately completed by unassisted patients.