Abstract
SummaryObjectiveThe aim of this study was to compare the responsiveness of various patient-reported outcome measures (PROMs) and clinician-reported outcomes following total knee arthroplasty (TKA) over a 2-year period.MethodsData were collected in a prospective cohort study of primary TKA. Patients who had completed Forgotten Joint Score-12 (FJS-12), Western Ontario and McMaster Universities (WOMAC) osteoarthritis (OA) index, EQ-5D, Knee Society Score and range of movement (ROM) assessment were included. Five time points were assessed: pre-operative, 2 months, 6 months, 1 year and 2 years post-operative.ResultsData from 98 TKAs were available for analysis. Largest effect sizes (ES) for change from pre-operative to 2-month follow-up were observed for the Knee Society Score (KSS) Knee score (1.70) and WOMAC Total (−1.50). For the period from 6 months to 1 year the largest ES for change were shown by the FJS-12 (0.99) and the KSS Function Score (0.88). The EQ-5D showed the strongest ceiling effect at 1-year follow-up with 84.4% of patients scoring the maximum score. ES for the time from 1- to 2-year follow-up were largest for the FJS-12 (0.50). All other outcome measures showed ES equal or below 0.30.ConclusionOutcome measures differ considerably in responsiveness, especially beyond one year post-operatively. Joint-specific outcome measures are more responsive than clinician-reported or generic health outcome tools. The FJS-12 was the most responsive of the tools assessed; suggesting that joint awareness may be a more discerning measure of patient outcome than traditional PROMs.
Highlights
The outcomes of total knee arthroplasty (TKA) can be assessed with various methods; implant survivorship, image-based assessment, clinical assessment and patient-reported outcome measures (PROMs)
PROMs can be broadly dichotomised into generic health status questionnaires such as the EQ-5D or SF-36 and disease/joint-specific tools such as the Western Ontario and McMaster Universities (WOMAC) score which focus on specific constructs such as pain, stiffness and joint function in activities of daily living[2]
As measures of responsiveness we provide effect sizes (ES, mean difference divided by standard deviations (SDs) at earlier assessment), standardised response means (SRMs, mean change divided by the standard deviation of the change score) and relative validity (RV)
Summary
The outcomes of total knee arthroplasty (TKA) can be assessed with various methods; implant survivorship, image-based assessment, clinical assessment and patient-reported outcome measures (PROMs). PROMs can be broadly dichotomised into generic health status questionnaires such as the EQ-5D or SF-36 (that assess the individuals overall quality of life) and disease/joint-specific tools such as the Western Ontario and McMaster Universities (WOMAC) score which focus on specific constructs such as pain, stiffness and joint function in activities of daily living[2] These latter examples allow a more focused evaluation of an intervention such as TKA. If a questionnaire is not sufficiently responsive to the construct being assessed, it will not capture changes at follow-up, which is especially important in mid-to-long-term studies where changes in the patients’ pain and function are typically not as pronounced as in the early post-operative phase This is of direct relevance to measuring PRO following TKA where patient function
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