PMID- 35436528
OWN - NLM
STAT- MEDLINE
DCOM- 20220817
LR  - 20221006
IS  - 1532-8406 (Electronic)
IS  - 0883-5403 (Linking)
VI  - 37
IP  - 9
DP  - 2022 Sep
TI  - The Paradox of Patient-Reported Outcome Measures: Should We Prioritize "Feeling 
      Better" or "Feeling Good" After Total Knee Arthroplasty?
PG  - 1751-1758
LID - S0883-5403(22)00445-4 [pii]
LID - 10.1016/j.arth.2022.04.017 [doi]
AB  - BACKGROUND: The use of preoperative patient-reported outcome measure (PROM) 
      thresholds for patient selection in arthroplasty care has been questioned 
      recently. This study aimed to identify factors affecting achievement of the 
      minimal clinically important difference (MCID) and patient acceptable symptom 
      state (PASS) after total knee arthroplasty (TKA) and determine the overlap 
      between the two outcomes. METHODS: We identified 1,239 primary, unilateral TKAs 
      performed at a single institution in 2015-2019. PROMs including the Knee injury 
      and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR) and 12-item 
      Short Form Health Survey (SF-12) were collected preoperatively and 1-year 
      postoperatively. The likelihood of attaining PASS as per attainment of MCID was 
      assessed. A multivariable regression was used to identify predictors of MCID and 
      PASS. RESULTS: In total, 71.3% achieved MCID and 75.5% achieved PASS for KOOS-JR. 
      Only 7.7% achieved MCID but not PASS, whereas almost twice this number did not 
      achieve MCID but did achieve PASS (11.9%). Poorer preoperative KOOS-JR (OR 
      0.925), better SF-12 physical (OR 1.025), and mental (OR 1.027) were associated 
      with MCID attainment. In contrast, better preoperative KOOS-JR (OR 1.030) and 
      SF-12 mental (OR 1.025) were associated with PASS attainment. Age, gender, race, 
      ethnicity, body mass index, Charlson index, American Society of Anesthesiologists 
      classification, and smoking status were not significant predictors. CONCLUSION: 
      Preoperative PROMs were associated with achieving MCID and PASS after TKA, albeit 
      some positively and some negatively. In the era of value-based care, clinicians 
      should not only strive to help patients "feel better" but also ensure that 
      patients "feel good" after surgery. This study does not support the use of PROMs 
      in prioritizing access to care.
CI  - Copyright (c) 2022 Elsevier Inc. All rights reserved.
FAU - Goh, Graham S
AU  - Goh GS
AD  - Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA.
FAU - Baker, Colin M
AU  - Baker CM
AD  - Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA.
FAU - Tarabichi, Saad
AU  - Tarabichi S
AD  - Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA.
FAU - Clark, Sean C
AU  - Clark SC
AD  - Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA.
FAU - Austin, Matthew S
AU  - Austin MS
AD  - Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA.
FAU - Lonner, Jess H
AU  - Lonner JH
AD  - Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA.
LA  - eng
PT  - Journal Article
DEP - 20220415
PL  - United States
TA  - J Arthroplasty
JT  - The Journal of arthroplasty
JID - 8703515
SB  - IM
CIN - J Arthroplasty. 2022 Oct;37(10):e10-e11. PMID: 36162930
CIN - J Arthroplasty. 2022 Oct;37(10):e9. PMID: 36162933
MH  - *Arthroplasty, Replacement, Knee
MH  - Humans
MH  - Minimal Clinically Important Difference
MH  - *Osteoarthritis, Knee/surgery
MH  - Patient Reported Outcome Measures
MH  - Registries
MH  - Treatment Outcome
OTO - NOTNLM
OT  - acceptable symptom state
OT  - clinically important difference
OT  - knee arthroplasty
OT  - patient-reported outcomes
OT  - prior authorization
OT  - value-based care
EDAT- 2022/04/19 06:00
MHDA- 2022/08/18 06:00
CRDT- 2022/04/18 20:07
PHST- 2022/02/14 00:00 [received]
PHST- 2022/04/06 00:00 [revised]
PHST- 2022/04/11 00:00 [accepted]
PHST- 2022/04/19 06:00 [pubmed]
PHST- 2022/08/18 06:00 [medline]
PHST- 2022/04/18 20:07 [entrez]
AID - S0883-5403(22)00445-4 [pii]
AID - 10.1016/j.arth.2022.04.017 [doi]
PST - ppublish
SO  - J Arthroplasty. 2022 Sep;37(9):1751-1758. doi: 10.1016/j.arth.2022.04.017. Epub 
      2022 Apr 15.