External Validation of Achieving the Patient Acceptable Symptom State for the EuroQol-5 Dimension 1 Year After Total Hip Arthroplasty

Abstract

Background: Patient acceptable symptom state (PASS) thresholds for the EuroQol-5 Dimension-3 Level (EQ-5D-3L) questionnaire have been established for patients being evaluated 1 year following total hip arthroplasty (THA) but with varying derivation cohorts and methods. The aim of this study was to (1) generate an EQ-5D PASS threshold 1 year following THA on the basis of an international patient cohort, (2) validate preexisting and newly generated PASS thresholds 1 year following THA using the institutional registry of an academic care center, and (3) assess whether THA PASS thresholds vary by patient age and sex. Methods: The derivation cohort for the THA PASS threshold consisted of 774 patients (after exclusions) who were enrolled in an international, multicenter study from 2007 to 2012 and who completed the EQ-5D and a numerical rating scale (NRS) for satisfaction 1 year postoperatively. With the NRS dichotomized at 2.5 as the anchor, a PASS cutoff for the EQ-5D was generated using the 80% specificity method. The Youden method and 75th percentile approach served as sensitivity analyses. The external validation cohort comprised 1,472 patients who had undergone THA. PASS thresholds were used to dichotomize the external validation sample. The ability of the threshold to predict satisfaction was evaluated with receiver operating characteristic (ROC) curve analysis. Patient subcohorts were stratified by age (>65 and ≤65 years) and sex. Results: Three THA PASS thresholds of 0.77 (our newly defined threshold), 0.82, and 0.92 were validated in this study. The EQ-5D PASS threshold of 0.77 (area under the curve [AUC] = 0.816) best predicted satisfaction 1 year after THA. Subcohort analyses yielded comparable 1-year PASS thresholds for THA between age cohorts and between sex cohorts. Conclusions: This study identifies PASS thresholds that best predict patient satisfaction 1 year following THA. Although the varied methodology and patient cohorts used to derive PASS values complicate the comparison of these thresholds, this analysis can help surgeons understand the level of health-related quality of life associated with patient satisfaction following THA. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

20-year hip survivorship and patient-reported outcome measures after transpositional osteotomy of the acetabulum for dysplastic hips

“…Keurentjes et al 31 reported a similar threshold for OHS in a study that assessed clinical outcomes three years after THA. Since many factors (such as an anchor used, a deviation cohort, and the observation period) affect the PASS threshold, 29,31 simple comparison is difficult even for the same procedure, and comparison between different procedures can be even more difficult. Nevertheless, as we determined thresholds via the long-term follow-up of cases, our results may be used as a guide for evaluating whether long-term PROMs are favourable after PAO in future studies.…”

“…The patientacceptable symptom state (PASS) is defined as a value within the range in which patients feel that the condition of their hip joint is good. 28,29 In the present study, a good hip joint condition after TOA was defined by the following two criteria: 'high satisfaction with the hip joint', and 'no or little hip pain'. One way to determine the PASS is to analyze the response to an anchor question using a receiver operating characteristic (ROC) curve.…”

“…One way to determine the PASS is to analyze the response to an anchor question using a receiver operating characteristic (ROC) curve. [29][30][31] It is recommended that the anchor question is intuitive and has been previously confirmed as related to the PROM of interest. 29 Prior studies have used anchor questions based on a VAS or numerical rating scale to evaluate patient satisfaction with surgical outcomes.…”

“…[29][30][31] It is recommended that the anchor question is intuitive and has been previously confirmed as related to the PROM of interest. 29 Prior studies have used anchor questions based on a VAS or numerical rating scale to evaluate patient satisfaction with surgical outcomes. 30,31 In the present study, we used the following external criteria to determine the PASS: a cut-off value for VAS Satisfaction ≥ 50, 32 and a cut-off value for VAS Pain < 20.…”

Patient-reported outcome after primary and aseptic revision hip arthroplasty: 1-year follow-up of 3,559 primary and 406 revision THAs in an institutional registry

“…The reported MCII for HOOS are inconsistent (20). A recent study validated PASS for EQ-5D in hip arthroplasty patients (21); however, we were not able to find reports on MCII for EQ-5D after THA surgery. These parameters are therefore not included in our analyses.…”