Prospective Evaluation of the Patient Acceptable Symptom State to Identify Clinically Successful Anterior Cruciate Ligament Reconstruction

Abstract

Background: The length of most patient-reported outcome measures creates significant response burden, which hampers follow-up rates. The Patient Acceptable Symptom State (PASS) is a single-item, patient-reported outcome measure that asks patients to consider all aspects of life to determine whether the state of their joint is satisfactory; this measure may be viable for tracking outcomes on a large scale. Hypothesis: The PASS question would identify clinically successful anterior cruciate ligament reconstruction (ACLR) at 1-year follow-up with high sensitivity and moderate specificity. We defined “clinically successful” ACLR as changes in preoperative to postoperative scores on the Knee injury and Osteoarthritis Outcome Score (KOOS) pain subscale and the KOOS knee-related quality of life subscale in excess of minimal clinically important difference or final KOOS pain or knee-related quality of life subscale scores in excess of previously defined PASS thresholds. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Patients enrolled in a prospective longitudinal cohort completed patient-reported outcome measures immediately before primary ACLR. At 1-year follow-up, patients completed the same patient-reported outcome measures and answered the PASS question: “Taking into account all the activity you have during your daily life, your level of pain, and also your activity limitations and participation restrictions, do you consider the current state of your knee satisfactory?” Results: A total of 555 patients enrolled in our cohort; 464 were eligible for this study. Of these, 300 patients (64.7%) completed 1-year follow-up, of whom 83.3% reported satisfaction with their knee after surgery. The PASS question demonstrated high sensitivity to identify clinically successful ACLR (92.6%; 95% CI, 88.4%-95.6%). The specificity of the question was 47.1% (95% CI, 35.1%-59.5%). The overall agreement between the PASS and our KOOS-based criteria for clinically successful intervention was 81.9%, and the kappa value indicated moderate agreement between the two methods (κ = 0.44). Conclusion: The PASS question identifies individuals who have experienced clinically successful ACLR with high sensitivity. The limitation of the PASS is its low specificity, which we calculated to be 47.1%. Answering “no” to the PASS question meant that a patient neither improved after surgery nor achieved an acceptable final state of knee health. The brevity, interpretability, and correlation of the PASS question with significant improvements on various KOOS subscales make it a viable option in tracking ACLR outcomes on a national or global scale.

Preoperative psychometric properties of visual analog scale asessments for function, pain, and strength compared with legacy upper extremity outcome measures in glenohumeral osteoarthritis

“… 5 Question burden is an important consideration given previous work demonstrating significant impact on follow-up rates, as well as the speed and accuracy with which patients complete instruments. 5 , 20 , 53 The time-to-completion data from the current study demonstrates that SANE, the PROMIS UE CAT, and triad of VAS measures are the quickest to complete, with Constant-Murley, qDASH, and ASES each requiring an average time to completion exceeding 2 minutes 30 seconds. Thus, the VAS measures used in this study represent an important example in which the SANE score can be administered and reported in a domain-specific manner without significantly increasing the time (ie, <45 seconds) or questions (ie, 2 additional).…”

Clinical Outcomes After Anterior Cruciate Ligament Injury: Panther Symposium ACL Injury Clinical Outcomes Consensus Group

“… 75 Several studies have since then applied the PASS values for the KOOS and IKDC-SKF when reporting on outcome after ACL treatment. 26 , 42 , 44 , 111 …”

“…75 Several studies have since then applied the PASS values for the KOOS and IKDC-SKF when reporting on outcome after ACL treatment. 26,42,44,111 A single-item outcome like the PASS summarizes the patient's perception and allows the patient to make an overall statement through a binary answer: "yes" or "no." A numeric scale might have its advantages; however, it is associated with difficulties of interpretation for both patients and researchers.…”

Clinical outcomes after anterior cruciate ligament injury: panther symposium ACL injury clinical outcomes consensus group

“…Thresholds for the PASS have been established for the KOOS and the IKDC-SKF by asking the question: “Taking account of all the activity you have during your daily life, your level of pain and also your activity limitations and participations restrictions, do you consider the current state of your knee satisfactory?” alongside the administered PRO [ 76 ]. Several studies have since then applied the PASS values for the KOOS and IKDC-SKF when reporting on outcome after ACL treatment [ 27 , 43 , 45 , 117 ].…”