Susan M Goodman1, Bella Y Mehta1, Lisa A Mandl1, Jackie D Szymonifka2, Jackie Finik3, Mark P Figgie4, Iris Y Navarro-Millán5, Mathias P Bostrom4, Michael L Parks4, Douglas E Padgett4, Alexander S McLawhorn4, Vinicius C Antao6, Adolph J Yates7, Bryan D Springer8, Stephen L Lyman9, Jasvinder A Singh10. 1. Department of Medicine, Hospital for Special Surgery, New York, NY. 2. Department of Medicine, Hospital for Special Surgery, New York, NY; Division of Biostatistics, Department of Public Health, New York University, New York, NY. 3. City University of New York Graduate School of Public Health, New York, NY. 4. Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY. 5. Department of Medicine, Hospital for Special Surgery, New York, NY; Department of Medicine, Weill Medical College of Cornell University, New York, NY. 6. Center for the Advancement of Value in Musculoskeletal Care, Hospital for Special Surgery, New York, NY. 7. Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA. 8. Department of Orthopaedic Surgery, OrthoCarolina Hip and Knee Center, Charlotte, NC. 9. Healthcare Research Institute, Hospital for Special Surgery, New York, NY. 10. Division of Epidemiology at the School of Public Health, Department of Medicine at the School of Medicine, The University of Alabama at Birmingham Medical Center, Birmingham, AL.
Abstract
BACKGROUND: Total hip replacement (THR)/total knee replacement (TKR) studies do not uniformly measure patient centered domains, pain, and function. We aim to validate existing measures of pain and function within subscales of standard instruments to facilitate measurement. METHODS: We evaluated baseline and 2-year pain and function for THR and TKR using Hip disability and Osteoarthritis Outcome Score (HOOS)/Knee Injury and Osteoarthritis Outcome Score (KOOS), with primary unilateral TKR (4796) and THR (4801). Construct validity was assessed by correlating HOOS/KOOS pain and activities of daily living (ADL), function quality of life (QOL), and satisfaction using Spearman correlation coefficients. Patient relevant thresholds for change in pain and function were anchored to improvement in QOL; minimally clinically important difference (MCID) corresponded to "a little improvement" and a really important difference (RID) to a "moderate improvement." Pain and ADL function scores were compared by quartiles using Kruskal-Wallis. RESULTS: Two-year HOOS/KOOS pain and ADL function correlated with health-related QOL (KOOS pain and Short Form 12 Physical Component Scale ρ = 0.54; function ρ = 0.63). Comparing QOL by pain and function quartiles, the highest levels of pain relief and function were associated with the most improved QOL. MCID for pain was estimated at ≥20, and the RID ≥29; MCID for function ≥14, and the RID ≥23. The measures were responsive to change with large effect sizes (≥1.8). CONCLUSION: We confirm that HOOS/KOOS pain and ADL function subscales are valid measures of critical patient centered domains after THR/TKR, and achievable thresholds anchored to improved QOL. Cost-free availability and brevity makes them feasible, to be used in a core measurement set in total joint replacement trials.
BACKGROUND: Total hip replacement (THR)/total knee replacement (TKR) studies do not uniformly measure patient centered domains, pain, and function. We aim to validate existing measures of pain and function within subscales of standard instruments to facilitate measurement. METHODS: We evaluated baseline and 2-year pain and function for THR and TKR using Hip disability and Osteoarthritis Outcome Score (HOOS)/Knee Injury and Osteoarthritis Outcome Score (KOOS), with primary unilateral TKR (4796) and THR (4801). Construct validity was assessed by correlating HOOS/KOOS pain and activities of daily living (ADL), function quality of life (QOL), and satisfaction using Spearman correlation coefficients. Patient relevant thresholds for change in pain and function were anchored to improvement in QOL; minimally clinically important difference (MCID) corresponded to "a little improvement" and a really important difference (RID) to a "moderate improvement." Pain and ADL function scores were compared by quartiles using Kruskal-Wallis. RESULTS: Two-year HOOS/KOOS pain and ADL function correlated with health-related QOL (KOOS pain and Short Form 12 Physical Component Scale ρ = 0.54; function ρ = 0.63). Comparing QOL by pain and function quartiles, the highest levels of pain relief and function were associated with the most improved QOL. MCID for pain was estimated at ≥20, and the RID ≥29; MCID for function ≥14, and the RID ≥23. The measures were responsive to change with large effect sizes (≥1.8). CONCLUSION: We confirm that HOOS/KOOS pain and ADL function subscales are valid measures of critical patient centered domains after THR/TKR, and achievable thresholds anchored to improved QOL. Cost-free availability and brevity makes them feasible, to be used in a core measurement set in total joint replacement trials.
Authors: Jasvinder A Singh; Michael Dohm; Andrew P Sprowson; Peter D Wall; Bethan L Richards; Laure Gossec; Gillian A Hawker; Daniel L Riddle; Rachelle Buchbinder Journal: J Rheumatol Date: 2015-04-01 Impact factor: 4.666
Authors: C A Mancuso; T P Sculco; T L Wickiewicz; E C Jones; L Robbins; R F Warren; P Williams-Russo Journal: J Bone Joint Surg Am Date: 2001-07 Impact factor: 5.284
Authors: Meridith E Greene; Kevin A Rader; Göran Garellick; Henrik Malchau; Andrew A Freiberg; Ola Rolfson Journal: Clin Orthop Relat Res Date: 2015-11 Impact factor: 4.176
Authors: Anh Hoang; Susan M Goodman; Iris Y Navarro-Millán; Lisa A Mandl; Mark P Figgie; Mathias P Bostrom; Douglas E Padgett; Peter K Sculco; Alexander S McLawhorn; Jasvinder A Singh Journal: Arthritis Res Ther Date: 2017-12-06 Impact factor: 5.156
Authors: Mark Alan Fontana; Cathlyn K Medina; Eleni C Kohilakis; Andrew D Pearle; Catherine H MacLean; Alexander S McLawhorn Journal: J Arthroplasty Date: 2021-12-21 Impact factor: 4.757
Authors: Marilyn Heng; Xiaodan Tang; Benjamin D Schalet; Austin K Collins; Antonia F Chen; Christopher M Melnic; Todd M O'Brien; Rachel C Sisodia; Patricia D Franklin; David Cella Journal: Clin Orthop Relat Res Date: 2021-12-01 Impact factor: 4.176