Measurement Information System Pain Research Articles

Longitudinal Assessment of Pain in Rheumatoid Arthritis: Increases in Pain and Their Relationship to Functional Declines and Medication Changes.

Electronic health applications (apps) allow patients with rheumatoid arthritis (RA) to report patient-reported outcomes (PROs) between visits. However, almost no data exist on patients' report of pain between visits and how that correlates with change in function and/or modifications to medication. Patients with RA from one rheumatology practice provided data as part of a study of an app. Patients answered PRO short forms using the app, including the Patient-Reported Outcomes Measurement Information System pain interference and physical function questionnaires. Each PRO was answered every eight days. We assessed the frequency of significant worsening in pain using the minimally clinically important difference (MCID) of ≥5 points. Logistic regression assessed whether worsening in pain was associated with functional declines and/or RA medication changes. Among 150 patients with RA using the app, 83 patients qualified for analysis; the mean age was 62 years, and 82% were female. The median number of pain interference PROs answered per patient was 37 over 52 weeks. Using the first five pain interference PRO responses as the baseline, 60 (72%) patients experienced worsening of at least the MCID, with a median duration of 16 days. The odds ratio (OR) relating significantly worsening pain to declines in function over the next 42 days was 2.71 (95% confidence interval [CI] 1.12-6.89). Worsening pain was not significantly associated with changes to RA medication (OR 1.59, 95% CI 0.62-4.17). Clinically significant increases in pain among patients with RA are commonly associated with reductions in function but not with RA medication changes.

Self-Reported Improvement After Carpal Tunnel Release in Patients with Motor Axonal Loss.

Electrodiagnostic studies can identify evidence of sensory and motor axonal loss (AL) in carpal tunnel syndrome (CTS) patients. However, the impact of sensory and motor AL on outcomes following carpal tunnel release (CTR) remains unclear. We hypothesize that patients with no evidence of sensory and motor AL will experience greater improvement following CTR compared to those with evidence of AL. Patients undergoing open and endoscopic CTR by four fellowship-trained orthopedic hand surgeons were identified. Sensory and motor AL were identified using preoperative electromyography and nerve conduction studies. Patients completed the following before surgery and 3-month postoperative patient-reported outcomes: Patient-Reported Outcomes Measurement Information System Upper Extremity (UE) and Pain Interference (PI) as well as Disabilities of the Arm, Shoulder, and Hand (QuickDASH [QD]). Preoperative and postoperative scores, changes in scores, and rates of achieving the minimally clinically important difference (MCID) were compared between patients with and without sensory and motor AL. One hundred and seventy-five patients were included. Of these, 91 exhibited sensory AL and 98 exhibited motor AL. Demographic matched analysis of patients with and without sensory AL showed no differences in before surgery, after surgery, difference, or proportion meeting MCID for UE, PI, or QD. Matched analysis revealed no difference in preoperative PROMs between patients with and without motor AL. Patients with motor AL had increased postoperative UE (better function), decreased postoperative PI (less PI) and QD (less disability), increased changes in PI and QD, as well as a greater proportion meeting MCID for QD compared to those without motor AL. There was no difference in post-CTR improvement between patients with and without sensory AL. However, contrary to our hypothesis, motor AL patients experienced greater postoperative improvement according to QD. These findings suggest surgery should be recommended for severe CTS patients with evidence of AL. These results can better inform physicians and patients as they discuss expectations of CTR outcomes. Prognosis II.

Females report worse outcomes than males one year after ventral hernia repair.

To assess sex differences in patient-reported quality of life, pain, and hernia recurrence after adjusting for confounding features of hernia disease in a large national registry one year after ventral hernia repair. Data were analyzed retrospectively from the Abdominal Core Health Quality Collaborative national registry from pre-operatively until one year post-operatively. 3,172 patients undergoing elective ventral hernia repair with 1-year follow-up data were included for analysis after propensity score matching (1:1 match; females: mean [interquartile range] age, 60 [49, 68]; body mass index, 32 [27, 36]; males: age, 60 [52, 68]; 31 [28, 35]. The primary outcome of interest between sexes was the Hernia Related Quality of Life survey (HerQLes), and secondary outcome measures included the Patient-Reported Outcomes Measurement Information System Pain Intensity (PROMIS) short form (3a) score and hernia recurrence. Female sex was associated with worse HerQLes and PROMIS pain 3a scores at 1 year follow up (adjusted mean difference, -2.42, 95% confidence interval (CI) -4.11 to -0.72; p = 0.004; adjusted mean difference, 1.27, 95% CI 0.67 to 1.87; p < 0.001) compared to male sex. Hernia recurrence rates at 1 year were not different between sexes. Females reported worse quality of life and higher levels of pain at 1-year post ventral hernia repair after accounting for age, BMI, hernia width, and baseline quality of life compared to males. There were no differences between females and males with respect to hernia recurrence at 1-year follow-up, and 1 in 5 patients experienced a recurrence at this time point.

Does the Use of a Tourniquet Influence Five-Year Outcomes Following Total Knee Arthroplasty?

BackgroundA tourniquet is commonly used during total knee arthroplasty (TKA) to improve surgical field visibility and minimize blood loss. While the short-term effects of tourniquet use on postoperative outcomes have been studied extensively and found to be minimal, its influence on longer-term outcomes remains underexplored. This study examined tourniquet use in TKA with up to five-year follow-up. MethodsIn this post hoc analysis of a randomized controlled trial, 227 patients who underwent primary TKA in the tourniquet (T) group (n = 112) or no tourniquet (NT) group (n = 115) were evaluated. Clinical outcomes and patient-reported outcome measures (PROMs) were compared between the two groups. ResultsThe T group had non-significant trends toward reduced blood loss (131.8 versus 116.7 ml, P = 0.098) and shorter operative time (97.8 versus 95.7 minutes, P = 0.264), with slightly higher postoperative day-one Visual Analog Scale (VAS) pain scores (3.1 versus 3.6, P = 0.197). Length of stay (2.0 versus 2.1 days, P = 0.837) and home discharge rate (88.7 versus 92.0%, P = 0.340) were comparable. The NT group had three 90-day readmissions, while none occurred in the T group (2.7 versus 0%, P = 0.081). The active range of motion at the final follow-up was similar between groups (108.3 versus 106.5 degrees, P = 0.457). All-cause revision rates at five years were comparable between the NT and T groups (5.2 versus 3.6%, P = 0.546). Kaplan-Meier survivorship analysis revealed comparable aseptic implant survival at five years (P = 0.769). There were no significant differences in Knee injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS, JR), Patient-Reported Outcomes Measurement Information System (PROMIS) pain intensity, PROMIS pain interference, or PROMIS physical health scores at three months, one year, and five years postoperatively. ConclusionUsing a tourniquet during primary TKA was not associated with differences in clinical or patient-reported outcomes at up to five-year follow-up. These findings suggest that tourniquet use in TKA can be left to the surgeon’s discretion.

Cast-OFF 2: one week versus three to five weeks of plaster cast immobilization for non-or minimally displaced distal radius fractures, a stepped wedge cluster randomized controlled trial.

Implementation of one week of cast immobilization followed by gradually increasing wrist mobilization for non- or minimally displaced DRF and comparison of the functional outcomes and pain scores with the usual care (three to five weeks of cast immobilization). Design: A randomized stepped wedge cluster design, prospective cohort. Academic and peripheral hospitals in level 1, 2, and 3 trauma centers. All patients between 18 and 85 years old with an isolated non- or minimally and nonreduced DRF were eligible for inclusion. Participating hospitals were randomized to transition from usual care (three to five weeks of cast immobilization) to one week of cast immobilization, following the stepped wedge design. Patient characteristics, secondary dislocation, surgical treatment, visual analog scale (VAS), Patient Rated Wrist Evaluation (PRWE), Patient Reported Outcomes Measurement Information System Pain Interference (PROMIS-PI), Pain Catastrophizing Scale 4 (PCS-4), and patient satisfaction were compared between control, and intervention group at week 1, 3-5, 6, month 3, 6, and 12. A difference around 11 points on the PRWE scale was considered clinically significant. 402 patients were included (control n=197 vs intervention n=205, 267/135, female/male). There were no differences in age (53.7 ± 18.6 vs 53.3 ± 19.5, P = 0.27), sex (66% vs 67% female, P 0.44), dominant hand fractured (44% vs 53%, P 0.39), and type of fracture (39% vs 41% extra-articular, P = 0.44) After six weeks, the PRWE score showed no clinically significant differences (-4.5 [CI -12.9, 4.02], P = 0.30). No significant differences were observed for function, pain scores, and patient satisfaction between groups (all P > 0.05). Furthermore, there was no significant difference in secondary dislocation rate (control 1.5% vs intervention 1.0%, p=0.32, P = 0.32) and operation rate (control 1.5% versus 1.5% intervention P = 0.92). This study compared one week of cast immobilization followed by gradually increasing wrist mobilizationto the usual care of three to five weeks for nonreduced DRF. No clinically significant differences in function, pain scores, patient satisfaction, secondary dislocation, and operations were observed. Therefore, one week of plaster immobilization can be safely recommended for the non- or minimally displaced and nonreduced DRF treatment. Level II. See Instructions for Authors for a complete description of levels of evidence.

Baseline Neck Disability Index and Patient-Reported Outcomes Measurement Information System Physical Function Predict Postoperative Return to Normal in Cervical Spine Surgery.

Recent studies assessing the importance of various preoperative factors on postoperative outcomes following spine surgery have uncovered several important variables that influence subjective and objective outcomes following cervical spine surgery, but it is still unclear which patients are most likely to benefit from operative management. The objective of this study was to assess whether preoperative patient-reported outcome measures (PROMs) can be used to predict which patients achieve "normal" levels of pain and function after surgery. This was a prospective cohort study. This study included all adult patients undergoing cervical spine surgery by 1 of 7 senior spine surgeons at our institution between 2016 and 2018. Of the 164 patients who were eligible for 6-month follow-up at the time that study data were collected, 139 had available follow-up data and were included in our analysis. Patients completed the Neck Disability Index (NDI) as well as the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) and Pain Interference computer adaptive tests preoperatively and at 6 months postoperatively. Patients who achieved postoperative patient-acceptable symptom state (PASS) for NDI (≤17) and the normative mean (50) for PROMIS were identified. The relationship between preoperative PROMs and the probability of achieving PASS and the normative mean was assessed. One hundred thirty-nine patients met inclusion criteria with diagnoses of myelopathy (n = 36), radiculopathy (n = 48), and myeloradiculopathy (n = 49). For NDI, a 1-point worsening in the preoperative score resulted in an OR of achieving PASS of 0.96 (P < 0.001) in the overall population. This association held true for patients with radiculopathy (OR 0.96; P = 0.022) but not myelopathy (OR 0.98; P = 0.35). For PROMIS PF, a 1-point improvement in the preoperative score resulted in an OR of achieving the normative mean of 1.10 (P < 0.001). This association held true for patients with radiculopathy (OR 1.14; P = 0.033) but did not reach statistical significance for patients with myelopathy (OR 1.03; P = 0.515). Preoperative PROMs can predict postoperative benefit for patients undergoing cervical spine surgery, with worse baseline function associated with a lower likelihood of attaining PASS for NDI and the normative mean for PROMIS PF, especially for patients with radiculopathy. Baseline symptoms and function, including myelopathy or radiculopathy-dominant symptoms and preoperative PROMs, may predict postoperative outcomes.

Rates of Early Recovery Following Thumb Carpometacarpal Arthroplasty: Comparing Ligament Reconstruction and Tendon Interposition, Abductor Pollicis Longus Suspensionplasty, and Suture Button Suspensionplasty

Abstract Background Several techniques have been previously described for the treatment of thumb carpometacarpal (CMC) arthritis, including trapeziectomy with ligament reconstruction and tendon interposition (LRTI), abductor pollicis longus suspensionplasty (APLS), or suture button suspensionplasty (SBS). It remains unclear whether a specific method produces faster recovery and more rapid return to function. The purpose of this study was to evaluate early clinical outcomes in patients undergoing thumb CMC arthroplasty stratified by method of treatment. Methods This study was conducted using a registry of patients undergoing thumb CMC arthroplasty using LRTI, APLS, or SBS. Patients were grouped by technique for comparison. Patient-reported outcomes were measured using Patient-Reported Outcome Measurement Information System (PROMIS) Upper Extremity, Pain Interference, and Pain Intensity scores and compared across cohorts using analysis of variance. Regression analysis was used to determine factors associated with early clinical outcomes. Results Note that 150 out of 201 patients met inclusion criteria for this study. Univariate regression demonstrated no difference between technique and achievement of minimal clinically important difference (MCID) by 1 year or ∆PROMIS scores at 1 and 3 months postoperatively. Stepwise multivariate regression analysis also found that technique did not contribute significantly to postoperative outcomes. Increased baseline PROMIS Upper Extremity scores were associated with lower odds of achieving MCID (odds ratio 0.80, p &lt; 0.001). Baseline PROMIS scores were also associated with ∆PROMIS scores at 1 and 3 months postoperatively. Conclusion Patients undergoing thumb CMC arthroplasty via LRTI, APLS, or SBS can expect to experience similar improvements from baseline in the early postoperative period regardless of technique choice.

Patient Experience With Efanesoctocog Alfa for Severe Hemophilia A: Results From the XTEND-1 Phase 3 Clinical Study Exit Interviews

PurposeHemophilia A is a rare bleeding disorder that leads to recurrent hemarthrosis, which can ultimately result in reduced mobility and poor quality of life. Qualitative exit interviews provide insights into patient perspectives and support the interpretation of quantitative trial data, such as patient-reported outcome measures. In the Phase 3 XTEND-1 study (NCT04161495) of efanesoctocog alfa in participants with severe hemophilia A, exit interviews were conducted to understand pre- and post-study experiences with pain and physical functioning and to evaluate participants’ treatment experiences. MethodsIn XTEND-1, participants (≥12 years old) received once-weekly efanesoctocog alfa prophylaxis 50 IU/kg for 52 weeks (Arm A) or on-demand efanesoctocog alfa 50 IU/kg for 26 weeks followed by 26 weeks once-weekly prophylaxis (50 IU/kg; Arm B). Optional qualitative exit interviews were conducted using a semi-structured guide in a subset of participants following study completion. Interviews included open-ended questions about participants’ pre- and post-study experiences with hemophilia A and targeted questions relating to improvements in patient-reported outcomes assessed during XTEND-1, including the Haemophilia Quality of Life Questionnaire for Adults Physical Health subscale (Haem-A-QoL PH). Content validity of the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity 3a measure was also assessed, particularly the worst pain item. FindingsExit interviews were conducted with 29 of 159 patients enrolled in XTEND-1 (mean [range] age 40 [16−73] years). Of 17 participants enrolled in Arm A, 13 (76.5%) reported a “wearing off” feeling with pre-study treatment, including more aches/pain, breakthrough bleeds, and limited physical activities. Joint pain was the most reported pre-study symptom (96.6%; n = 28/29), followed by a reduced ability to move without pain (89.7%, n = 26/29). Improvements following efanesoctocog alfa prophylaxis in ≥1 Haem-A-QoL PH domain were reported by 89.7% (n = 26/29) of participants, with improvements in joint pain, the ability to move without pain, and painful swellings reported by at least 21 (84%) participants. Participants reported that the PROMIS Pain Intensity 3a items were relevant, clear, and easy to answer. Most participants (96.6%) were “quite satisfied” or “very satisfied” with efanesoctocog alfa prophylaxis. All participants preferred efanesoctocog alfa over pre-study treatment. ImplicationsThe exit interviews demonstrated that once-weekly efanesoctocog alfa prophylaxis resulted in patient-relevant and meaningful improvements in pain and physical functioning, consistent with the quantitative findings from XTEND-1. These results support the validity of the Haem-A-QoL PH and PROMIS Pain Intensity 3a assessed during XTEND-1, demonstrating the potential for change with efficacious treatment. Trial RegistryClinicalTrials.gov Trial Registration NumberNCT04161495 Registry URLhttps://clinicaltrials.gov/study/NCT04161495

Prevalence and Factors Associated With High-Impact Chronic Pain in Knee Osteoarthritis: The Johnston County Health Study

Pain is a hallmark symptom of knee osteoarthritis (KOA), yet intensity and severity vary widely among individuals. There is a knowledge gap in understanding key characteristics of high-impact chronic pain (HICP) within the context of KOA. Therefore, our first purpose was to examine the prevalence of HICP in a cohort of individuals with radiographic evidence of KOA, and our second purpose was to assess patient-level factors associated with HICP. Data from the Johnston County Health Study were used to compare those with and without HICP. Variables included sociodemographic factors, clinical factors, health care use, and psychosocial distress. HICP status was classified with Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference and Physical Function measures. The results indicated that 15.5% (48/310) of participants were classified as having HICP when the PROMIS-Pain Interference cutoff score was used, while 21.2% (66/310) were classified as having HICP with a PROMIS-Physical Function cutoff score. Multivariable analyses indicated that HICP was consistently characterized by increased kinesiophobia and somatization, regardless of PROMIS measure used for HICP status. A secondary insight was that HICP was not consistently characterized by sociodemographic and clinical variables, as these findings were dependent on PROMIS measure used. These findings could be used to develop intervention approaches specific to individuals with KOA and to inform future investigations of sociodemographic and clinical factors associated with HICP. PerspectiveThese findings provide additional information on the characterization of HICP for individuals with KOA. There was consistency in psychosocial factors associated with HICP, while sociodemographic and clinical factors varied based on how HICP status was defined.

Feasibility of Obtaining Patient-Reported Outcome Measures in a High-Volume Multidisciplinary Surgical Limb Salvage Center.

Completion of patient-reported outcome measures (PROMs) is labor-intensive but paramount in improving patient-centered care, allowing for advancement of techniques and scrutinization of outcomes. We report the feasibility of PROM collection and reporting for patients seen in a high-volume, multidisciplinary, tertiary limb salvage center to determine pain and functionality outcomes. The center received grant funding resources for large-scale PROM collection. Patients completed either tablet or paper surveys. Functionality and pain PROMs included 1) Neuro-QoL Lower Extremity Function-Mobility, 2) Numerical Rating Scale, 3) Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity, and 4) PROMIS Pain Interference. Research assistants attended clinic daily to administer surveys. Patients were categorized into the following groups: amputation, flap reconstruction, other surgical management, and nonsurgical management. Five hundred sets of each survey were administered to 420 patients across 2 months, with 16% of patients (n = 80) completing multiple sets at separate visits. The completion rate among eligible patients was 90% or greater for each PROM. Of the respondents, 133 (31.7%) were seen for previous amputation, 32 (7.6%) for local or free flap reconstruction, 68 (16.2%) for other surgical management (eg, debridement, arthroplasty), and 295 (70.2%) for nonsurgical management (eg, lymphedema, hidradenitis). We report that integration of PROM collection in a high-volume limb salvage center is feasible. These metrics allow measurement of the impact and effectiveness of salvage or amputation surgeries from patients' perspectives, providing quantification of satisfaction and aspects of health-related quality of life, improved patient advocacy, and an evidence-based approach to surgical management.

Agreement between child self-report and parent-proxy report for functioning in pediatric chronic pain

PurposeAccurate assessment of chronic pain and functional disability in children and adolescents is imperative for guiding pain management interventions. Parents have multifaceted roles in their child’s pain experience and frequently provide parent-proxy reports of pain-related functioning. However, cross-informant variance is often observed with limited understanding of contributing factors. This study aims to examine the degree of alignment between child and parent-proxy reports for Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference domain among children with chronic pain and to identify factors associated with improved child-parent agreement.MethodsThis study includes a sample of 127 youth (66.1% female) with mixed etiology chronic pain, ranging in age from 8 to 17 (M = 12.24; SD = 1.598), and their parent. Data was collected at an interdisciplinary pediatric pain clinic and online peer support groups. Measures of demographic, pain intensity, and functioning were collected.ResultsMeans of parent-proxy reports were significantly lower than child self-reports on the PROMIS (p < 0.05). A statistically significant association between child’s pain intensity (β = 0.953, P < 0.05) and the difference between child self-reported and parent-proxy reported PROMIS functional interference scores was found.ConclusionParents underestimated pain-related functional disability relative to children’s self-reports. The difference between the paired child self-report and parent-proxy report of functional disability was significantly associated with greater child self-reported pain intensity. Although parent-proxy reports in pediatric chronic pain is often used in research and practice, findings underscore the importance of incorporating child and adolescent self-report, when possible, to comprehensively capture the child’s pain experience and best inform clinical interventions.

Opioid-Induced Constipation and Associated Symptoms After Orthopedic Trauma

PurposeOpioid-induced constipation is an adverse effect often experienced among patients taking prescription opioid medication. Despite frequent opioid prescribing after orthopedic injury, there is a dearth of research examining opioid-induced constipation presentations in this population. This analysis examines the frequency of opioid-induced constipation manifestations and association with patient-reported outcomes among participants prescribed opioid medication following orthopedic injury. DesignSecondary analysis of 86 clinical trial participants following orthopedic trauma. MethodsParticipants were assessed 2-weeks postoperatively with the following measures: Patient-Reported Outcome Measurement Information System (PROMIS) Pain Interference, PROMIS Physical Function, past 24-hour average pain intensity captured on the numeric pain rating scale, and the Patient Assessment of Constipation Symptoms (PAC-SYM) questionnaire. Linear regressions examined the association between PAC-SYM scores and both pain intensity and PROMIS T-scores while accounting for injury severity and opioid medication dosage. ResultsMost participants (69%) reported experiencing opioid-induced constipation symptoms and 7% reported moderate to severe symptoms. Compared to those without symptoms, participants reporting opioid-induced constipation symptoms were found to have a 3-point increase in PROMIS Pain Interference (95% Confidence Interval [CI]: 0.28-5.90; p = .032), a 3-point decline in PROMIS Physical Function (95% CI: -6.57 to -0.02; p = .049), and a 1.7-point increase in average pain scores (95% CI: 0.50-3.01; p = .007) at 2-weeks following surgery. ConclusionsOpioid-induced constipation symptoms are common after orthopedic trauma and linked to increased pain interference and pain intensity as well as reduced physical function. Clinical ImplicationsNurse-led assessments of opioid-induced constipation can support the timely delivery of interventions to alleviate symptoms and potentially improve patient-reported outcomes after injury.

Exploring Health Inequalities and Presurgical Attitudes on Postsurgical Outcomes in Spine Surgery

The influence of social determinants of health on health disparities is substantial. However, their impact on postsurgical outcomes in spine can be challenging to ascertain at the community level. This study aims to explore the interplay between presurgical attitudes, area deprivation index (ADI), income, employment status, and body mass index (BMI) on postsurgical outcomes at 3, 6, 9, and 12 months after elective spine surgery. The study involved 127 patients who underwent elective spine surgery between August 2021 and August 2022 at a large academic institution. The main objective involved a prospective analysis of presurgical attitudes, coupled with a retrospective assessment of ADI, income, employment status, and BMI over 3, 6, 9, and 12 months following elective spine surgery using a univariate analysis. Utilizing the univariate analyses, ADI displayed a significant correlation with increased Patient-Reported Outcomes Measurement Information System and Visual Analog Scale scores both before surgery and at the 3-, 6-, and 9-month postsurgical intervals (P < 0.05). One year after surgery, patients in the lowest income group (annual income under $25,000) consistently demonstrated the highest Patient-Reported Outcomes Measurement Information System pain (8.00, P= 0.022). Patients who were not employed had significantly lower levels of social support (P= 0.042) and confidence in the health care system (P= 0.009). Individuals who were unemployed were most likely to be readmitted six weeks after surgery (P < 0.001). Presurgical attitudes, ADI, income, employment status, and BMI were important factors associated with improved surgical outcome measurements, indicating potential focal points for combating health disparities in spinal surgery patients.

A history of abuse is associated with more severe migraine- and pain-related disability: Results from the American Registry for Migraine Research.

Prior studies have established an association between a history of abuse and more severe migraine presentation. This cross-sectional, observational study of a clinic-based migraine population used validated measures to elucidate migraine-specific and migraine-related burdens among patients with a history of abuse. Patients with migraine (n = 866) from the American Registry for Migraine Research self-reported if they had a history of emotional, physical, and/or sexual abuse and completed questionnaires assessing migraine-related burden: Migraine Disability Assessment, Subjective Cognitive Impairment Scale for Migraine Attacks, Work Productivity and Activity Impairment, Patient-Reported Outcomes Measurement Information System Pain Interference, Patient Health Questionnaire-2, and Generalized Anxiety Disorder-7. Migraine-related burden in patients with versus without a history of abuse was compared. Subsequently, a mediation analysis evaluated the impact of depression and anxiety symptoms in the relationship between abuse history and migraine burden. A history of abuse was reported by 36.5% (n = 316/866) of participants. After controlling for patient age, sex, years lived with headache, and headache frequency, a history of abuse was significantly associated with more severe migraine-related disability. The combined burden of depression and anxiety symptoms mediated the relationship. A history of abuse is associated with greater migraine-related disability. Future studies should determine if identification and management of the psychological and physical sequelae of abuse reduce migraine burden.

Worse postoperative outcomes and higher reoperation in smokers compared to nonsmokers for arthroscopic rotator cuff repair.

This study aimed to determine if smokers at the time of arthroscopic rotator cuff repair met the minimally clinical important difference and substantial clinical benefit for Patient-Reported Outcomes Measurement Information System Upper Extremity, Depression, and Pain Interference scores in comparison to nonsmoking patients in a retrospective review. Clinical outcomes and Patient-Reported Outcomes Measurement Information System scores were compared between a cohort of nonsmokers and current or former smokers (smokers). Further sub-analysis compared a cohort of nonsmokers propensity-matched 1:1 to a cohort of current/former smokers via age, body mass index, and tear size. A total of 182 patients, 80 smokers and 102 nonsmokers, were included. Smokers had statistically different-sized tears with more rated massive (P = 0.02) and more reoperations (P = 0.02). Smokers met substantial clinical benefit thresholds at a lower rate than nonsmokers for Patient-Reported Outcomes Measurement Information System Upper Extremity (P = 0.03). In the sub-analysis, 74 smokers were matched to 74 nonsmokers. Smokers had a lower change in Patient-Reported Outcomes Measurement Information System Upper Extremity (P = 0.007) and Patient-Reported Outcomes Measurement Information System Pain Interference (P = 0.03) postoperatively. Fewer smokers met minimally clinical important difference for Patient-Reported Outcomes Measurement Information System Upper Extremity postoperatively (P = 0.003) and more had reoperations (P = 0.02). Overall, smokers demonstrated smaller improvements in function, and pain, and were less likely to meet minimally clinical important differences and substantial clinical benefits for Patient-Reported Outcomes Measurement Information System Upper Extremity at 6 months follow-up when compared to nonsmokers after rotator cuff repair.

Poster 297: Clinical Outcomes and Return to Sports After Revision ACL Reconstruction With Lateral Extraarticular Tenodesis: Comparison to A Control Group of ACL Reconstruction Only at a Minimum 2-Year Follow-Up

Objectives: Lateral extraarticular tenodesis (LET) has been shown to decrease failure rate in settings of revision anterior cruciate ligament (ACL) reconstruction in young, high-demand patients. However, there is a paucity of literature comparing clinical outcomes and return to sports after patients who undergo revision ACL reconstruction LET compared to those without LET (control group). Methods: All patients who underwent revision ACL reconstruction with and without LET between January 2018 and February 2020 were queried at our institutional registry. The LET group was compared to the control group (revision ACL reconstruction without LET) were followed for a minimum of 24 months postsurgery to evaluate patients reported outcome measures, satisfaction, return to sports, rate of reoperation, and psychological readiness for return to sports (using the ACL-Return to Sport After Injury Scale, ACL-RSI). Results: A total of 81 patients with a mean follow-up of 2.75 years were included. The LET group contained 37 patients (76% female) with a mean age of 26.6 years and body mass index (BMI) of 23.5 kg/m^2 compared to 44 patients (80% female) with mean age of 28.2 years and BMI of 26.9 kg/m^2. There were no significant differences between the LET and control groups with respect to mean postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference (47.7 vs 48.3, p = 0.46) and PROMIS Mobility scales (53.3 vs 52.9, p = 0.97). In addition, there were no differences in postoperative International Knee Documentation Committee (78.9 vs 78.3, p=0.45), Marx (7.9 vs 7.2, p = 0.64), or Single Assessment Numeric Evaluation (73.1 vs 74.2, p = 0.38) scores. The same held true with regards to postoperative ACL-RSI scores between the groups (43.3 vs 50.1, p = 0.38). Return to play rates after revision ACL were similar in the LET group compared to the control group (55% vs 45%, p = 0.40) with similar confidence to play their pre-injury sport (scale out of 100, 58.2 vs 56.2, p = 0.82). Lastly, overall reoperation rates were similar between the groups with the LET group having a rate of 21.2% compared to 19.4% for the control group. When isolated for revision due to graft tear, the LET group had a re-revision rate of 13.5% compared to 6.8% in the control group (p = 0.31). Conclusions: Satisfaction and patient reported outcome scores after revision ACL reconstruction are good with or without LET. While both groups have similar rates of return to play and reoperation at greater than 2- year follow-up, these results suggest the addition of LET may provide similar outcomes in high-risk patients when compared to isolated revision ACL reconstruction.

Same Day Discharge Total Knee Arthroplasty: Hospital Demonstrates Similar Outcomes to Ambulatory Surgery Center in a More Complex Patient Population

BackgroundThe purpose of this study was to compare outcomes between patients undergoing same-day discharge (SDD) total knee arthroplasty (TKA) at an ambulatory surgery center (ASC) versus a tertiary care university hospital setting. MethodsA single tertiary academic center’s institutional database was reviewed for patients who underwent primary TKA and were discharged the same day from August 2021 to January 2024. Patients who did not have at least 1 year of follow-up were excluded. Patient demographics, comorbidities, patient-reported outcome measures, emergency department visits, admissions, reoperations, and revisions were collected. Patients were stratified by the location of their surgery: ASC versus hospital. Specific criteria had to be met prior to surgery at the ASC, and the final decision regarding the location of surgery was made via shared decision-making between the patient and their surgeon. Patients who did not meet ASC criteria underwent TKA at the main hospital. Univariable analyses were used to compare groups, and multivariable logistic regression was used to determine if surgical location was a significant factor. Of the 449 TKAs meeting inclusion criteria, 63.3% (284) were performed at the ASC and 36.7% (165) at the university hospital at a mean follow-up of 1.51 years (range, 1.00 to 2.40). Of those 165 whose surgery was done at the hospital, 93.9% met at least one ASC exclusion criteria. ResultsPatients whose TKA was done at the hospital had significantly higher weight (P = 0.003), body mass index (P < 0.001), Elixhauser comorbidity index (P < 0.001), proportion of patients who had an American Society of Anesthesiologists classification of 3 (P = 0.023), and proportion of patients who required general anesthesia (P < 0.001). Additionally, patients whose TKA was done at the hospital had higher preoperative patient-reported outcome measurement information system (PROMIS) pain interference (PI) (62.0 [59.0, 66.0] versus 63.0 [61.8, 67.0]; P = 0.006), and lower physical function (PF) (39.0 [36.0, 43.0] versus 38.0 [34.0, 41.0]; P = 0.001). At 1 year, however, patients in both groups had similar PROMIS PI (53.0 [49.0, 59.0] versus 54.0 [44.0, 59.0]; P = 0.785) and PROMIS PF (47.0 [42.0, 51.0] versus 47.0 [41.0, 50.0]; P = 0.422) scores as well as similar rates of achieving minimum clinically important difference for PROMIS PI (64.4 versus 71.4%; P = 0.336) and PROMIS PF (60.5 versus 71.4%; P = 0.124). They also had a similar number of emergency department visits and admissions at 30 and 90 days, as well as similar reoperation-free (92.0 versus 93.3%; P = 0.79) and revision-free (95.5 versus 99.4%; P = 0.59) survival at 2 years ConclusionsAlthough ASCs have strict patient criteria for SDD TKA, complex patients at a tertiary university hospital can be sent home the same day with equivalent outcomes. Therefore, unhealthier patients can safely achieve SDD without compromising outcomes if done in the appropriate setting.

Poster 203: Staged Hip Arthroscopy and Periacetabular Osteotomy Versus Hip Arthroscopy Alone in Patients with Borderline Hip Dysplasia: A Propensity-Matched Study

Objectives: The management of borderline hip dysplasia (BHD) remains an area of interest in the field of hip preservation. The purpose of this study was to (1) evaluate mean 2-year outcomes for patients with BHD treated with staged hip arthroscopy and periacetabular osteotomy (PAO) to those who underwent hip arthroscopy alone, and (2) evaluate rates of complications, hardware removal, reoperations, conversions to total hip arthroplasty (THA), along with conversions to PAO. Methods: Hips with a lateral center-edge angle (LCEA) values 18° ≤ LCEA &lt; 25° that underwent a hip arthroscopy for femoroacetabular impingement syndrome (FAIS) between January 2018 and June 2022 were reviewed. Patients who underwent staged periacetabular osteotomy and hip arthroscopy were identified. Staged hips were propensity-matched 1:4 to other borderline dysplastic hips that underwent hip arthroscopy alone. Matching was performed based on age, sex, and body-mass index (BMI). Patient-reported outcomes (PROs) were collected, including Hip Outcome Score – Activities of Daily Living (HOS-ADL), HOS-Sports Specific (HOS-SS) subscale, 12-item International Hip Outcome Tool (iHOT-12) questionnaire, Patient-Reported Outcomes Measurement Information System-Pain Interference (PROMIS-PI) subscale, and PROMIS-Physical Function (PROMIS-PF) subscale. Cohort-specific minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) thresholds were calculated. Postoperative PROs, rates of MCID/PASS achievement, and rates of reoperation and conversion to THA were compared. Results: Twenty-four patients who underwent staged hip arthroscopy and PAO were successfully matched to 96 patients who underwent hip arthroscopy alone. Both groups were similar in terms of age, sex, and BMI. The patients who underwent a PAO had smaller LCEAs and larger Tönnis angles (21.0° vs. 23° and 11.6° vs. 9.1°, respectively). Both groups demonstrated significant improvement in PROs at minimum 1-year postoperatively (p &lt; 0.001, for all). There were no significant differences in postoperative PRO scores between the groups (p ≥ 0.223, for all). There were no significant differences in MCID/PASS achievement (p ≥ 0.224. for all). There were no reoperations or conversion to THA in the staged hip arthroscopy and PAO group. In the hip arthroscopy alone cohort, reoperation rates were 5.2% and conversion to THA occurred in 1% of the patients. There were no significant differences in secondary surgery rates between the groups (p = 1.000). Three patients in the hip arthroscopy alone group ultimately underwent PAO, 1 underwent a proximal femoral osteotomy (PFO), and one underwent a revision hip arthroscopy. These female patients were young and athletic with an LCEA &lt; 20°. Conclusions: Patients undergoing staged PAO and hip arthroplasty and isolated hip arthroplasty for treatment of BHD demonstrate similar clinical improvement. Rates of revision surgery and conversion to THA were similarly low. A small subset of patients who were initially treated arthroscopically ultimately received a PAO. This group was entirely made up of young, athletic female patients. This is encouraging early data and more long-term data is needed to evaluate the differences in survivorship. [Figure: see text]

Fractional CO2 Laser for Burn Scars: A Comparison of Patient-Reported Outcomes Between Those With and Without Laser Treatment.

Burn reconstruction outcomes are an area of growing investigation. Although there is evidence of measured physical improvements in scar characteristics after laser treatment, there is little information on patient-reported outcomes. The purpose of this study is to compare patient-reported outcomes between burn survivors with and without laser treatment. The study included participants in the Burn Model System National Database at a single center; participants that received outpatient laser treatment for burn scars were compared to a matched group of burn survivors that did not receive laser. The following outcomes were examined: Satisfaction With Life Scale, Mental and Physical Component Summary of the Veterans Rand Survey, and the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity Scale. Regression analyses examined the associations between laser treatment and each outcome at 12 and 24 months. The study population included 287 adult burn survivors (65 laser group and 222 control group). The significant differences found between the 2 groups included: burn size (laser: 14.9, 13.5 SD, control: 8.9, 11.1 SD; P < .001), insurance type (P = .036), inhalation injury (laser: 17.2%, control: 2.7%; P < .001), and ventilator requirement (laser: 27.7%, control: 13.5%; P = .013). Laser treatment was not associated with any of the outcomes at both follow-up time points. Further research is needed to develop patient-reported outcome measures that are more sensitive to the clinical changes experienced by burn survivors receiving laser treatment.

Relationship of Fatigue, Pain Interference, and Physical Disability in Children Newly Diagnosed With Juvenile Idiopathic Arthritis.

Our objectives were to quantify the relationships among fatigue, pain interference, and physical disability in children with juvenile idiopathic arthritis (JIA) and to test whether fatigue mediates the relationship between pain interference and physical disability in JIA. Patients enrolled within three months of JIA diagnosis in the Canadian Alliance of Pediatric Rheumatology Investigators (CAPRI) Registry between February 2017 and May 2023 were included. Their parents completed the Patient-Reported Outcomes Measurement Information System fatigue and pain interference short proxy questionnaires and the Childhood Health Assessment Questionnaire disability index at registry enrollment. Associations were assessed using Pearson correlations and multiple linear regression. Structural equation modeling (SEM) was used to test if fatigue mediates the relationship between pain interference and physical disability. Among 855 patients (61.4% female, 44.1% with oligoarthritis), most reported fatigue and pain interference scores similar to those in the reference population, but 15.6% reported severe fatigue and 7.3% reported severe pain interference, with wide variation across JIA categories. Fatigue was strongly correlated with pain interference (r = 0.72, P < 0.001) and with physical disability (r = 0.60, P < 0.001). Pain interference (β = 0.027, P < 0.001) and fatigue (β = 0.013, P < 0.001) were both associated with physical disability after controlling for each other and potential confounders. SEM supported our hypothesis that fatigue partially mediates the relationship between pain interference and physical disability. Our findings suggest both fatigue and pain interference are independently associated with physical disability in children newly diagnosed with JIA, and the effect of pain interference may be partly mediated by fatigue.