A SANE Approach to Outcome Collection? Comparing the Performance of Single- Versus Multiple-Question Patient-Reported Outcome Measures After Total Hip Arthroplasty

Abstract

Background: Several patient-reported outcome measures (PROMs) exist to measure outcomes after total hip arthroplasty (THA) but can be limited by patient-perceived burden and completion rates. We analyzed whether the modified single assessment numerical evaluation (M-SANE), a one-question PROM, would perform similarly to multiple-question PROMs among patients undergoing primary THA. Methods: Patients undergoing THA completed the Patient-Reported Outcomes Measurement Information System-10 (PROMIS-10), the Hip Disability and Osteoarthritis Outcomes Score Junior (HOOS-Jr), and M-SANE questionnaires both preoperatively and postoperatively. The M-SANE assessment asked patients to assess their hip on a scale from 0 to 10, with 10 being the best possible score. Validity of M-SANE compared with other PROMs was determined by Spearman's correlation and floor and ceiling effects. Responsiveness was analyzed using standardized response mean (SRM). Results: One hundred and thirty six patients with at least 1-year follow-up were reviewed. The average M-SANE score improved from 3.3 preoperatively to 7.1 at one year postoperatively. There was moderate to strong correlation at one-year follow-up between the M-SANE and HOOS-Jr (r ¼ 0.75, P < .001) and PROMIS-10 physical component summary (r ¼ 0.63, P < .001). Floor and ceiling effects of the M-SANE (floor 2.0%, ceiling 21.3%) were comparable to the HOOS-Jr (floor 0.0%, ceiling 20.8%). The responsiveness of the M-SANE after THA (SRM ¼ 1.06, 95% CI: 0.79-1.33) was comparable to HOOS-Jr (SRM ¼ 1.33, 95% CI: 1.08-1.59) and superior to PROMIS-10 physical component summary (SRM ¼ 0.65, 95% CI: 0.55-0.74). Conclusion:The M-SANE has performed similarly across multiple psychometric properties compared with more burdensome PROMs in assessing longitudinal patient-reported outcomes after THA.

Patient Perceptions of COVID-19-Related Surgical Delay: An Analysis of Patients Awaiting Total Hip and Knee Arthroplasty

“…The survey we used attempted to quantify patient-reported disease severity, perceptions related to surgical delays, and the implications that this may have with regard to their willingness and eagerness to reengage the healthcare system. Some of our questions were derived from prior, similar studies [34, 35], while others were aimed at addressing potential provider concerns [30, 39]. While some patients reported multiple pain generators, we explicitly asked that they attempt to isolate perceptions of their pre-surgical joint.…”

“…While some patients reported multiple pain generators, we explicitly asked that they attempt to isolate perceptions of their pre-surgical joint. For each participant, we collected quantitative data including age, current pain level (numerical rating scale (NRS) from 0 to 10), Single Assessment Numerical Evaluation (SANE) scores [7, 35], the number of months they were willing to wait for surgery, and multiple qualitative assessments (open-ended questions). Additionally, we collected an abbreviated, binary version of the validated daily pain catastrophizing scale (PCS).…”

The Oxford Elbow Score demonstrated good measurement properties when used with a shortened 7-day recall period

“…A potential selective reduction in the construct validity of SANE-F for greater degrees of impairment might contribute to these findings. A reduction of this kind is indicated by previous studies 2 , 38 , 46 and the low correlation between SANE-F values and OES scores at T2, a time point when function was notably impaired. Poor construct validity of SANE-F at T2 would be expected to affect responsiveness negatively, as T2 values are included in calculations for assessing responsiveness.…”

Examining the Relationship Between Value and Patient Satisfaction With Treatment in Total Joint Arthroplasty

“…Individual patient direct cost was benchmarked against the institutional average direct cost across all TJA-treated patients. Treatment outcome included both clinical and patient-reported health outcomes [PROMIS-10 global physical functioning measure (PROMIS) [ 13 , 15 ], Knee or Hip Injury and Osteoarthritis Outcome Scores (KOOS Jr./HOOS Jr.) [ 15 ], modified Single Assessment Numeric Evaluation measure [ 16 , 17 ], 90-day complication, primary joint infection (PJI), and readmission [ Eq. (B.1) ].…”