Relationship Between Magnitude of Limitations and Patient Experience During Recovery from Upper-Extremity Fracture

Abstract

Background:The relationship between the magnitude of limitations (measured by patient-reported outcome measures, or PROMs) and satisfaction with care providers and hospital services (measured by patient-reported experience measures, or PREMs) over the course of recovery after injury is unclear. The purpose of this study was to assess the relationship between a range of PROMs and 2 PREMs at 3 time points (initial office visit within a week, 2 to 4 weeks, and 6 to 9 months) after shoulder, elbow, and wrist fractures.Methods:We enrolled 744 adult patients with an isolated shoulder, elbow, or wrist fracture and invited them to complete PROMs (the Patient-Reported Outcomes Measurement Information System Upper Extremity Physical Function computer adaptive test [PROMIS UE], PROMIS Physical Function (PROMIS PF) scale, Quick Disabilities of the Arm, Shoulder and Hand [QuickDASH] questionnaire, EuroQol 5-Dimensions 3-Level Index [EQ-5D-3L], and Oxford Shoulder Score [OSS], Oxford Elbow Score [OES], or Patient-Rated Wrist Evaluation [PRWE]) and PREMs (Numerical Rating Scale [NRS] for satisfaction with care providers [NRS-C] and for satisfaction with hospital services [NRS-S]) at their initial visit at the outpatient surgical practice (maximum, 1 week after the fracture), between 2 and 4 weeks after the injury, and between 6 and 9 months after the injury. Correlational analysis was performed at each time point.Results:There was moderate correlation between the PROMIS UE and the NRS-C (r = 0.56) and NRS-S (r = 0.59) at 6 to 9 months after injury, which was stronger than the correlation at the 2 to 4-week mark (NRS-C, r = 0.34; NRS-S, r = 0.36) and at the evaluation that took place within a week after the injury (NRS-C, r = 0.18; NRS-S, r = 0.16). These correlational trends were observed with all forms of PROMs. Patients reporting greater limitations after injury were also less satisfied with their care and services.Conclusions:The increasing alignment of PROMs and PREMs over the course of recovery after an upper-extremity fracture suggests that restored physical function may improve perceptions of satisfaction with care providers and hospital services over time. Future studies should assess factors that could be addressed to improve patient satisfaction and their limitations during recovery after fracture in order to maximize patient outcomes.Level of Evidence:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Comparison of an Artificial Intelligence–Enabled Patient Decision Aid vs Educational Material on Decision Quality, Shared Decision-Making, Patient Experience, and Functional Outcomes in Adults With Knee Osteoarthritis

“…The primary outcome was the decision process score of the knee decision quality instrument (K-DQI) questions 3.1 through 3.5 (eFigure in Supplement 2 ) ( Figure 2 ). 24 Secondary outcomes included the level of SDM (assessed using the CollaboRATE survey), 25 patient satisfaction with the consultation (numerical rating scale [NRS]), 26 condition-specific symptoms and functional limitations (KOOS JR), 27 duration of consultation in minutes, TKR rates (proportion of patients undergoing surgery), and treatment concordance (K-DQI question 1.6) (eFigure in Supplement 2 ). 24 All outcomes were assessed at the end of the clinical visit except KOOS JR and treatment concordance, which were assessed prior to the consultation and again at a follow-up appointment 4 to 6 months from initial consultation or date of TKR, as applicable.…”

Use of patient reported experience measure and patient reported outcome measures to evaluate differences in surgical or non-surgical management of humeral shaft fractures

“…The different ways of obtaining data by telephone, online or in person, may however have introduced bias in the reported results. The same author 15 studied the relationship between a range of PROMs and the two PREMs mentioned above in patients with upper limb fractures. The study concluded that increasing alignment of PROMs and PREMs over the course of recovery after an upper-extremity fracture suggests that restored physical function may improve perceptions of satisfaction with care providers and hospital services over time.…”

“…The National Institute for Health and Care Excellence (NICE) has published a quality standard that focuses on the patient experience 23 stating that “people using NHS services should be supported in shared decision making”. Patient's experiences have been investigated and utilised to identify disease processes that attenuate patient experience, 8 assess the relationship with validated PROMs 15 and validate predictors of health outcomes. 14…”

Attempts to Limit Censoring in Measures of Patient Satisfaction

“…Asking to rate satisfaction of the process of care or treatment outcome may give different scores ( 29 ). Sixth, we did not perform separate analysis for different diagnoses because none of the diagnoses had sufficient numbers and—based on prior work—we did not feel diagnosis was likely to be important ( 30 , 31 ). Differentiating between preoperative and postoperative patients and between acute and chronic disorders may lead to different results.…”