PMID- 37773026 OWN - NLM STAT- MEDLINE DCOM- 20240325 LR - 20240325 IS - 1528-1132 (Electronic) IS - 0009-921X (Print) IS - 0009-921X (Linking) VI - 482 IP - 4 DP - 2024 Apr 1 TI - Defining Patient-relevant Thresholds and Change Scores for the HOOS JR and KOOS JR Anchored on the Patient-acceptable Symptom State Question. PG - 688-698 LID - 10.1097/CORR.0000000000002857 [doi] AB - BACKGROUND: When evaluating the results of clinical research studies, readers need to know that patients perceive effect sizes, not p values. Knowing the minimum clinically important difference (MCID) and the patient-acceptable symptom state (PASS) threshold for patient-reported outcome measures helps us to ascertain whether our interventions result in improvements that are large enough for patients to care about, and whether our treatments alleviate patient symptoms sufficiently. Prior studies have developed the MCID and PASS threshold for the Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS JR) and Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) anchored on satisfaction with surgery, but to our knowledge, neither the MCID nor the PASS thresholds for these instruments anchored on a single-item PASS question have been described. QUESTIONS/PURPOSES: (1) What are the MCID (defined here as the HOOS/KOOS JR change score associated with achieving PASS) and PASS threshold for the HOOS JR and KOOS JR anchored on patient responses to the single-item PASS instrument? (2) How do patient demographic factors such as age, gender, and BMI correlate with MCID and PASS thresholds using the single-item PASS instrument? METHODS: Between July 2020 and September 2021, a total of 10,970 patients underwent one primary unilateral THA or TKA and completed at least one of the three surveys (preoperative HOOS or KOOS JR, 1-year postoperative HOOS or KOOS JR, and 1-year postoperative single-item anchor) at one large, academic medical center. Of those, only patients with data for all three surveys were eligible, leaving 13% (1465 total; 783 THAs and 682 TKAs) for analysis. Despite this low percentage, the overall sample size was large, and there was little difference between completers and noncompleters in terms of demographics or baseline patient-reported outcome measure scores. Patients undergoing bilateral total joint arthroplasty or revision total joint arthroplasty and those without all three surveys at 1 year of follow-up were excluded. A receiver operating characteristic curve analysis, leveraging a 1-year, single-item PASS (that is, "Do you consider that your current state is satisfactory?" with possible answers of "yes" or "no") as the anchor was then used to establish the MCID and PASS thresholds among the 783 included patients who underwent primary unilateral THA and 682 patients who underwent primary unilateral TKA. We also explored the associations of age at the time of surgery (younger than 65 years or 65 years and older), gender (men or women), BMI (< 30 or >/= 30 kg/m 2 ), and baseline Patient-Reported Outcome Measure Information System-10 physical and mental component scores (< 50 or >/= 50) for each of the MCID and PASS thresholds through stratified analyses. RESULTS: For the HOOS JR, the MCID associated with the PASS was 23 (95% CI 18 to 31), with an area under the receiver operating characteristic curve of 0.75, and the PASS threshold was 81 (95% CI 77 to 85), with an area under the receiver operating characteristic curve of 0.81. For the KOOS JR, the MCID was 16 (95% CI 14 to 18), with an area under the receiver operating characteristic curve of 0.75, and the PASS threshold was 71 (95% CI 66 to 73) with an area under the receiver operating characteristic curve of 0.84. Stratified analyses indicated higher change scores and PASS threshold for younger men undergoing THA and higher PASS thresholds for older women undergoing TKA. CONCLUSION: Here, we demonstrated the utility of a single patient-centered anchor question, raising the question as to whether simply collecting a postoperative PASS is an easier way to measure success than collecting preoperative and postoperative patient-reported outcome measures and then calculating MCIDs and the substantial clinical benefit. LEVEL OF EVIDENCE: Level III, therapeutic study. CI - Copyright (c) 2023 by the Association of Bone and Joint Surgeons. FAU - Dekhne, Mihir S AU - Dekhne MS AUID- ORCID: 0000-0002-0546-5566 AD - Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA. FAU - Fontana, Mark A AU - Fontana MA AD - Center for the Advancement of Value in Musculoskeletal Care, Hospital for Special Surgery, New York, NY, USA. AD - Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA. FAU - Pandey, Sohum AU - Pandey S AD - Center for the Advancement of Value in Musculoskeletal Care, Hospital for Special Surgery, New York, NY, USA. FAU - Driscoll, Daniel A AU - Driscoll DA AUID- ORCID: 0000-0003-4449-8990 AD - Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA. FAU - Lyman, Stephen AU - Lyman S AD - Healthcare Research Institute, Hospital for Special Surgery, New York, NY, USA. FAU - McLawhorn, Alexander S AU - McLawhorn AS AD - Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA. FAU - MacLean, Catherine H AU - MacLean CH AD - Center for the Advancement of Value in Musculoskeletal Care, Hospital for Special Surgery, New York, NY, USA. AD - Department of Medicine, Weill Cornell Medical College, New York, NY, USA. LA - eng PT - Journal Article DEP - 20230929 PL - United States TA - Clin Orthop Relat Res JT - Clinical orthopaedics and related research JID - 0075674 SB - IM CIN - doi: 10.1097/CORR.0000000000002907 MH - Male MH - Humans MH - Female MH - Aged MH - Treatment Outcome MH - *Arthroplasty, Replacement, Hip/adverse effects MH - *Knee Injuries MH - *Osteoarthritis MH - Patient Reported Outcome Measures MH - Minimal Clinically Important Difference PMC - PMC10936968 COIS- Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research (R) editors and board members are on file with the publication and can be viewed on request. EDAT- 2023/09/29 12:42 MHDA- 2024/03/25 06:42 PMCR- 2025/04/01 CRDT- 2023/09/29 10:43 PHST- 2023/05/02 00:00 [received] PHST- 2023/08/15 00:00 [accepted] PHST- 2025/04/01 00:00 [pmc-release] PHST- 2024/03/25 06:42 [medline] PHST- 2023/09/29 12:42 [pubmed] PHST- 2023/09/29 10:43 [entrez] AID - 00003086-990000000-01376 [pii] AID - CORR-D-23-00505 [pii] AID - 10.1097/CORR.0000000000002857 [doi] PST - ppublish SO - Clin Orthop Relat Res. 2024 Apr 1;482(4):688-698. doi: 10.1097/CORR.0000000000002857. Epub 2023 Sep 29.