Correlation of patient questionnaire responses and physician history in grading clinical outcome following hip and knee arthroplasty

McGrory, Brian J.; Morrey, B.F.; Rand, James A.; Ilstrup, Duane M.

doi:10.1016/s0883-5403(96)80160-4

Cited by 111 publications

(73 citation statements)

References 28 publications

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“…23 In a study by Lattig et al, 10 the comparability of surgeon-patient outcome ratings at the first follow-up (up to 3 months after surgery) was examined. Generally, the findings were similar to those reported for total joint arthroplasty, 2,[19][20][21]25 that is, a tendency for overestimation on the part of the surgeon, and particularly so in senior surgeons and for patients who declared a poor outcome. However, the authors conceded that a possible limitation of the study was that, at this early stage after surgery, the patients may not have been in a position to fully appreciate the success or otherwise of the surgery.…”

supporting

confidence: 84%

“…10 However, because similar results have now been found 12 months after surgery, especially with regard to factors influencing the surgeon-patient discrepancy in ratings, it would appear that the follow-up period, by itself, is not of great relevance, confirming the findings of other studies. 19,21 The proportion of perfect agreements (51% in the study of Lattig et al, 10 53% in the present study) was almost identical at the 2 time points. Surgeon overrating appeared to be slightly more prevalent at 3 months (26% of cases 10 ) than at 12 months (17%), but this was likely as much the result of the greater proportion of junior surgeons participating in the 12-month investigation, as the effect of a difference in the length of followup.…”

Section: Discussionsupporting

confidence: 58%

“…Studies in the area of total joint arthroplasty have mostly shown a good degree of agreement between patient and physician assessments of outcome, 2,20,21,25 although not without exception. 22 Generally, in cases of disagreement, it has been the clinician that has typically overrated outcome or underrated symptoms compared with the perspective of the patient.…”

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confidence: 99%

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Comparison of patient and surgeon ratings of outcome 12 months after spine surgery

Porchet¹,

Lattig

Grob

et al. 2010

SPI

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ObjectThe contemporary assessment of spine surgical outcome primarily relies on patient-centered reports of symptoms and function. Such measures are considered to reduce bias compared with traditional surgeon-based outcome ratings. This study examined the agreement between patients' and surgeons' ratings of outcome 1 year after spine surgery.MethodsThe study involved 404 patients (mean age 56.6 ± 16.4 years; 259 women, 145 men) and their treating surgeons. At baseline and 12 months postoperatively patients completed the Core Outcome Measures Index (COMI) rating pain, function, quality of life, and disability. At 12 months postoperatively, they also rated the global outcome of surgery and their satisfaction with treatment. The surgeon, blinded to the patient's evaluation, rated the global outcome of surgery as excellent, good, fair, or poor.ResultsSeventy-six percent of the patients who were considered by the surgeon to have an excellent or good outcome achieved the minimum clinically important difference (MCID) of a 2.2-point reduction on the COMI; 24% achieved less than the MCID. There was a significant correlation between the surgeons' and patients' global outcome ratings (Spearman ρ = 0.56; p < 0.0001). The degree of absolute agreement between them was significantly influenced by surgeon seniority: senior surgeons “overrated” the outcome in 24.5% of cases (compared with patients' ratings) and “underrated” it in 17.5% of cases. Junior surgeons overrated in 7.8% of cases and underrated in 43.8% of cases (p < 0.0001). Surgeon overrating occurred significantly more frequently for patients with a poor self-rated outcome (measured as global outcome, COMI score, or satisfaction with treatment). In a multivariate model, the independent variables “senior surgeon” and “patient dissatisfaction with care” were the most significant unique predictors of surgeon overrating of the global outcome (p < 0.0001; adjusted R2for the model = 0.16).ConclusionsOverall, agreement between surgeon and patient was reasonably good. The majority of patients who were rated as excellent/good by the surgeons had achieved the MCID in the prospectively measured COMI score. Discrepancies in outcome ratings were influenced by surgeon seniority and patient satisfaction. For a balanced view of the surgical result, outcomes should be assessed from the perspectives of both the patient and the surgeon.

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confidence: 84%

Section: Discussionsupporting

confidence: 58%

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Comparison of patient and surgeon ratings of outcome 12 months after spine surgery

Porchet¹,

Lattig

Grob

et al. 2010

SPI

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“…Additionally, some patients were lost before 5 years followup and radiographic followup was incomplete in several patients. Followup frequently was limited to telephone questionnaires; however, their usefulness has been correlated with physician assessments (but not standardized outcome measures) [15]. Nonetheless, the relatively large patient population, length of followup, and survival data provide important insights into the potential advantages and disadvantages of this tool in reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Limitations of Structural Allograft in Revision Total Knee Arthroplasty

Bauman¹,

Lewallen

Hanssen³

2009

Clinical Orthopaedics &Amp; Related Research

129

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Management of large bone defects in total knee arthroplasty (TKA) usually has involved modular prostheses with metal augments, structural allografts, and megaprostheses. We retrospectively reviewed the outcome of treatment of major bone defects for 74 patients (79 knees) who had revision TKAs with structural allografts; nine patients were lost to followup before 5 years, leaving 65 patients (70 knees, or 88%) followed for a minimum of 5 years or until revision or death. Medical records, radiographs, patient surveys, and correspondence were used for all data. Sixteen patients (22.8%) had failed reconstructions and underwent additional revision surgery; eight of the 16 were secondary to allograft failure, three were secondary to failure of a component not supported by allograft, and five were secondary to infection. In patients not requiring revision surgery, the Knee Society score improved from 49 preoperatively to 87 postoperatively. We observed revision-free survival of 80.7% (95% confidence interval, 71.7-90.8) at 5 years and 75.9% (95% confidence interval, 65.6-87.8) at 10 years. Our data support the selective use of structural allograft for large cavitary defects encountered during TKA. However, the rates of complications and reoperations suggest efforts to improve results or develop more durable alternative methods are warranted for these challenging reconstructions.

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“…Despite this, a number of studies in the area of hip, knee and shoulder arthroplasty have shown a substantial degree of agreement between patient and physician assessments of outcome [1,12,13,16], although not without fail [14]. Smith et al [16] reported a high level of agreement between patients' and surgeons' ratings of pain, function and satisfaction in a group of patients who were followedup at least 6 months after shoulder arthroplasty.…”

Section: Introductionmentioning

confidence: 99%

Ratings of global outcome at the first post-operative assessment after spinal surgery: how often do the surgeon and patient agree?

et al. 2009

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Correlation of patient questionnaire responses and physician history in grading clinical outcome following hip and knee arthroplasty

Cited by 111 publications

References 28 publications

Comparison of patient and surgeon ratings of outcome 12 months after spine surgery

Comparison of patient and surgeon ratings of outcome 12 months after spine surgery

Limitations of Structural Allograft in Revision Total Knee Arthroplasty

Ratings of global outcome at the first post-operative assessment after spinal surgery: how often do the surgeon and patient agree?

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