David Kuklinski1, Carlos J Marques2, Karina Bohlen3, Karl C Westphal4, Frank Lampe3,5, Alexander Geissler6. 1. Technical University Berlin, Department of Health Care Management, Strasse des 17. Juni 135, 10623 Berlin, Germany. 2. Science Office of the Orthopaedic and Joint Replacement Department, Schoen Clinic Hamburg Eilbek, Dehnhaide 120, 22081, Hamburg, Germany. 3. Orthopedic and Joint Replacement Department, Schoen Clinic Hamburg Eilbek, Dehnhaide 120, 22081, Hamburg, Germany. 4. Orthopedic and Joint Replacement Department, Schoen Clinic Neustadt, Am Kiebitzberg 10, 23730, Neustadt in Holstein, Germany. 5. Faculty of Life Sciences at the Hamburg University of Applied Sciences, Lohbrügger Kirchstraße 65, 21033, Hamburg, Germany. 6. School of Medicine, University of St. Gallen, St. Jakob-Strasse 21, 9000, St. Gallen, Switzerland.
Abstract
PURPOSE: To calculate unstratified and patient-specific meaningful improvement (MI) and patient acceptable symptom states (PASS) for the WOMAC total score in patients after total hip (THR) or total knee replacement (TKR). METHODS: A retrospective observational cohort study. Anchor-based receiver operator characteristics curves were used to estimate MI and PASS thresholds. RESULTS: Recovery paths were specific to individual characteristics of patients. An unstratified 12-months MI threshold of 28.1 (PASS: 13.3) and 17.8 (PASS: 15.8) for patients after THR and TKR, respectively, would unfairly detect critical recovery paths. CONCLUSIONS: Thresholds for treatment success need to be as patient-specific as possible.
PURPOSE: To calculate unstratified and patient-specific meaningful improvement (MI) and patient acceptable symptom states (PASS) for the WOMAC total score in patients after total hip (THR) or total knee replacement (TKR). METHODS: A retrospective observational cohort study. Anchor-based receiver operator characteristics curves were used to estimate MI and PASS thresholds. RESULTS: Recovery paths were specific to individual characteristics of patients. An unstratified 12-months MI threshold of 28.1 (PASS: 13.3) and 17.8 (PASS: 15.8) for patients after THR and TKR, respectively, would unfairly detect critical recovery paths. CONCLUSIONS: Thresholds for treatment success need to be as patient-specific as possible.
Keywords:
Level of evidence: level III; MI, Meaningful Improvement; Meaningful improvement; PASS, Patient Acceptable Symptom State; PROMs, Patient-Reported Outcome Measures; Patient-reported outcomes; Prognostic study; THR, Total Hip Replacement; TKR, Total Knee Replacement; Total hip replacement; Total knee replacement; VBHC, Value-Based Health Care; Value-based health care; WOMAC; WOMAC, Western Ontario and McMaster Universities Osteoarthritis Index
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