Minimal important changes and differences were estimated for Oxford hip and knee scores following primary and revision arthroplasty

Sabah, Shiraz A.; Alvand, Abtin; Beard, David; Price, Andrew

doi:10.1016/j.jclinepi.2021.12.016

Cited by 38 publications

(49 citation statements)

References 31 publications

(50 reference statements)

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“…No previous studies have determined MIC or TF values, but a PASS value of 41.5 points for the OKS in people undergoing UKA at 24 months postoperatively has been suggested ( 11 ). Additionally, in people undergoing TKA, a MIC value of 6.9 for the OKS at 6 months’ follow-up and TF values of 27 at 12 and 24 months has been presented ( 12 , 13 ). Although UKA is deemed a viable alternative to TKA it remains to be investigated as to whether PROM scores should be interpreted alike across both patient populations.…”

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confidence: 99%

Interpretation threshold values for the Oxford Knee Score in patients undergoing unicompartmental knee arthroplasty

Harris

Troelsen

Terluin³

et al. 2022

ActaO

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Background and purpose: Developing meaningful thresholds for the Oxford Knee Score (OKS) advances its clinical use. We determined the minimal important change (MIC), patient acceptable symptom state (PASS), and treatment failure (TF) values as meaningful thresholds for the OKS at 3-, 12-, and 24-month follow-up in patients undergoing unicompartmental knee arthroplasty (UKA).Patients and methods: This is a cohort study with data from patients undergoing UKA collected at a hospital in Denmark between February 2016 and September 2021. The OKS was completed preoperatively and at 3, 12, and 24 months postoperatively. Interpretation threshold values were calculated with the anchor-based adjusted predictive modeling method. Non-parametric bootstrapping was used to derive 95% confidence intervals (CI).Results: Complete 3-, 12-, and 24-month postoperative data was obtained for 331 of 423 (78%), 340 of 479 (71%), and 235 of 338 (70%) patients, median age of 68–69 years (58–59% females). Adjusted OKS MIC values were 4.7 (CI 3.3–6.0), 7.1 (CI 5.2–8.6), and 5.4 (CI 3.4– 7.3), adjusted OKS PASS values were 28.9 (CI 27.6–30.3), 32.7 (CI 31.5–33.9), and 31.3 (CI 29.1–33.3), and adjusted OKS TF values were 24.4 (CI 20.7–27.4), 29.3 (CI 27.3–31.1), and 28.5 (CI 26.0–30.5) at 3, 12, and 24 months postoperatively, respectively. All values statistically significantly increased from 3 to 12 months but not from 12 to 24 months.Interpretation: The UKA-specific measurement properties and clinical thresholds for the OKS can improve the interpretation of UKA outcome and assist quality assessment in institutional and national registries.

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confidence: 99%

Interpretation threshold values for the Oxford Knee Score in patients undergoing unicompartmental knee arthroplasty

Harris

Troelsen

Terluin³

et al. 2022

ActaO

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“…the trends we have observed are unlikely to be recognized as a meaningful difference by the patients in general undergoing surgery today, compared to their counterpart who underwent surgery in 2013/14. 23 however, it is important to recognize that most patients already achieved a very good outcome following surgery at the start of the study period, with a postoperative ohs of approximately 39 points and oKs of approximately 35 points. indeed, in 2013/14, approximately 89% of patients undergoing primary tha (n = 36,859/41,530) and approximately 82% of patients undergoing primary tKa (n = 35,667/43,699) experienced a clinically important improvement in joint function.…”

Section: Discussionmentioning

confidence: 99%

“…The observed trends in patient-reported outcomes can be interpreted as ‘marginal gains’ over time. 32 While the average patient may not recognize these improvements as a clinically important difference, 23,33 they do represent an increase in the transfer of health to the population as a whole. This may be important from a health economic perspective (for example, through fewer complications requiring treatment or fewer dissatisfied patients needing to be followed up).…”

Section: Discussionmentioning

confidence: 99%

“…Individual patients were classified as a 'responder' (if their change in score was equal to or greater than the minimalimportantchange(MIC))ora'non-responder'.We used MiC adjusted estimates of eight points for tha and seven points for tKa, based on our recent study. 23 3. Postoperative quality of life (Qol): this was measured using the EuroQol five-dimension three-level questionnaire (eQ-5d-3l).…”

Section: Methodsmentioning

confidence: 99%

“…We used MIC adjusted estimates of eight points for THA and seven points for TKA, based on our recent study. 23…”

Section: Methodsmentioning

confidence: 99%

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Early patient-reported outcomes from primary hip and knee arthroplasty have improved over the past seven years

Sabah

Knight

Alvand

et al. 2022

The Bone & Joint Journal

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Aims Routinely collected patient-reported outcome measures (PROMs) have been useful to quantify and quality-assess provision of total hip arthroplasty (THA) and total knee arthroplasty (TKA) in the UK for the past decade. This study aimed to explore whether the outcome following primary THA and TKA had improved over the past seven years. Methods Secondary data analysis of 277,430 primary THAs and 308,007 primary TKAs from the NHS PROMs programme was undertaken. Outcome measures were: postoperative Oxford Hip/Knee Score (OHS/OKS); proportion of patients achieving a clinically important improvement in joint function (responders); quality of life; patient satisfaction; perceived success; and complication rates. Outcome measures were compared based on year of surgery using multiple linear and logistic regression models. Results For primary THA, multiple linear regression modelling found that more recent year of surgery was associated with higher postoperative OHS (unstandardized coefficient (B) 0.15 points (95% confidence interval (CI) 0.14 to 0.17); p < 0.001) and higher EuroQol five-dimension index (EQ-5D) utility (B 0.002 (95% CI 0.001 to 0.002); p < 0.001). The odds of being a responder (odds ratio (OR) 1.02 (95% CI 1.02 to 1.03); p < 0.001) and patient satisfaction (OR 1.02 (95% CI 1.01 to 1.03); p < 0.001) increased with year of surgery, while the odds of any complication reduced (OR 0.97 (95% CI 0.97 to 0.98); p < 0.001). No trend was found for perceived success (p = 0.555). For primary TKA, multiple linear regression modelling found that more recent year of surgery was associated with higher postoperative OKS (B 0.21 points (95% CI 0.19 to 0.22); p < 0.001) and higher EQ-5D utility (B 0.002 (95% CI 0.002 to 0.003); p < 0.001). The odds of being a responder (OR 1.04 (95% CI 1.03 to 1.04); p < 0.001), perceived success (OR 1.02 (95% CI 1.01 to 1.02); p < 0.001), and patient satisfaction (OR 1.02 (95% CI 1.01 to 1.02); p < 0.001) all increased with year of surgery, while the odds of any complication reduced (OR 0.97 (95% CI 0.97 to 0.97); p < 0.001). Conclusion Nearly all patient-reported outcomes following primary THA/TKA improved by a small amount over the past seven years. Due to the high proportion of patients achieving good outcomes, PROMs following THA and TKA may need to focus on better discrimination of patients achieving high scores to be able to continue to measure improvement in outcomes. Cite this article: Bone Joint J 2022;104-B(6):687–695.

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Measurement Properties of the Oxford Shoulder Score and Minimal Clinically Important Changes After Primary Total Shoulder Replacement Surgery

Fang,

Ackerman,

Page

et al. 2024

Arthritis Care & Research

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ObjectiveTo evaluate the measurement properties of the Oxford Shoulder Score (OSS) and estimate the minimal clinically important change (MCIC) in patients undergoing primary total shoulder replacement in Australia.MethodsDe‐identified data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) were used for this analysis. Pre‐ and 6‐month post‐operative OSS scores were used, with EQ‐5D‐5L and shoulder pain scores used as comparators. Floor and ceiling effects, internal consistency reliability, construct validity and responsiveness to change were evaluated using standard psychometric methods. Mean change and predictive modelling approaches (with and without adjustment for the proportion of improved patients) were used to calculate MCIC thresholds, with patient‐perceived improvement after surgery as the anchor.ResultsPre‐operative OSS data were available for 1,117 patients (59% female; 90% aged ≥ 60 years) undergoing primary total shoulder replacement. No floor or ceiling effects were observed pre‐ or post‐operatively. The OSS showed high internal consistency reliability (Cronbach alpha >0.89), good construct validity and high responsiveness to change (effect size 1.88). The MCIC derived from the mean change method was 6.50 points (95% confidence interval [CI] 4.41, 8.61). The predictive modelling approach produced an MCIC estimate of 8.42 points (95% CI 5.68, 12.23) after adjustment.ConclusionThe OSS has good measurement properties to capture pain and function outcomes following shoulder replacement procedures, and is highly responsive to change. Based on robust methods, an increase in OSS scores of at least 8 points can be considered as meaningful improvement after surgery from the patient's perspective.

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Minimal important changes and differences were estimated for Oxford hip and knee scores following primary and revision arthroplasty

Cited by 38 publications

References 31 publications

Interpretation threshold values for the Oxford Knee Score in patients undergoing unicompartmental knee arthroplasty

Interpretation threshold values for the Oxford Knee Score in patients undergoing unicompartmental knee arthroplasty

Early patient-reported outcomes from primary hip and knee arthroplasty have improved over the past seven years

Measurement Properties of the Oxford Shoulder Score and Minimal Clinically Important Changes After Primary Total Shoulder Replacement Surgery

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