The assessment of outcome after total knee arthroplasty

Abstract

The routine use of patient reported outcome measures (PROMs) in evaluating the outcome after arthroplasty by healthcare organisations reflects a growing recognition of the importance of patients' perspectives in improving treatment. Although widely embraced in the NHS, there are concerns that PROMs are being used beyond their means due to a poor understanding of their limitations. This paper reviews some of the current challenges in using PROMs to evaluate total knee arthroplasty. It highlights alternative methods that have been used to improve the assessment of outcome.

Evaluating instrument responsiveness in joint function: The HOOS JR, the KOOS JR, and the PROMIS PF CAT

“…Interpreting Cohen's d for small, medium and large effect sizes were set at d = 0.20, d = 0.50, and d = 0.80, respectively. A 0.80 effect size represents a difference that is as least as great as 4/5 of a standard deviation in scores and represents a large effect …”

“…A 0.80 effect size represents a difference that is as least as great as 4/5 of a standard deviation in scores and represents a large effect. 9 As a second assessment of effect size the standardized response mean (SRM) was calculated. The SRM removes the dependence on sample size from the equation and it is normalized by the standard deviation of change scores.…”

“…The useful measurement and administration qualities of the PROMIS Physical Function (PF) CAT have shown significant measurement efficiency particularly for lower extremity assessment of an orthopaedic population . The use of IRT developed measures, like the PROMIS PF CAT, have been recommended for evaluating arthroplasty outcomes …”

“…8 The use of IRT developed measures, like the PROMIS PF CAT, have been recommended for evaluating arthroplasty outcomes. 9 In the domain of joint function, several PROs have been developed. Though more than 75 PRO measures assess physical function, 10 the knee injury and osteoarthritis outcome score (KOOS) and hip and disability osteoarthritis score (HOOS) provide joint specific information and are now widely used assessments in joint replacement care.…”

Improved Health-Related Quality of Life after Knee Arthroplasty Following an Outpatient Surgery Pathway: an Observational Comparative Case Study

“…The used PROMs in this study did not capturing changes over time due to a lack of sensitivity to change of these scores [23]. Nonetheless, PROMs remain inherently subjective, prone to an individual's interpretation and perception of function [22,24].…”