Patient-Reported Outcomes Information System Research Articles

Everyday Discrimination and Sleep Among Migrant and Non-migrant Filipinos: Longitudinal Analyses from the Health of Philippine Emigrants Study (HoPES).

This study aimed to (1) identify differences in sleep patterns between Filipino migrants and non-migrants across 2 years and (2) explore the impact of discrimination trajectories on sleep trajectories. The Health of Philippine Emigrants Study (HoPES) consisted of a migrant (n = 832) and non-migrant cohort (n = 805), with baseline data collected in the Philippines. Both cohorts were followed longitudinally, with the non-migrants followed in the Philippines and the migrant cohort followed to the United States. Sleep duration, quality, and difficulty were assessed with the National Institutes of Health Patient-Reported Outcomes Information System (PROMIS) inventory, and discrimination was measured with an adapted version of the Everyday Discrimination scale. Migrants reported a faster decline in sleep duration (-12min a year) but higher sleep quality than non-migrants over 2 years. Migrants who reported high initial levels of everyday discrimination also reported faster declines in sleep duration and a slower decline in sleep difficulty. Further, migrants who reported stable (versus declining) levels of discrimination over 2 years reported a faster decline in sleep quality. These results speak to the complexity of immigrant health patterns and long-term associations between discrimination and sleep processes.

Defining Trajectories of Linguistic, Cognitive-Communicative, and Quality of Life Outcomes in Aphasia: Longitudinal Observational Study Protocol

ObjectiveTo describe the trajectories of linguistic, cognitive-communicative, and health-related quality of life (HRQOL) outcomes after stroke in persons with aphasia. DesignLongitudinal observational study from inpatient rehabilitation to 18 months after stroke. SettingFour US mid-west inpatient rehabilitation facilities (IRFs). ParticipantsWe plan to recruit 400 adult (older than 21 years) English speakers who meet the following inclusion criteria: (1) Diagnosis of aphasia after a left-hemisphere infarct confirmed by CT scan or magnetic resonance imaging (MRI); (2) first admission for inpatient rehabilitation due to a neurologic event; and (3) sufficient cognitive capacity to provide informed consent and participate in testing. Exclusion criteria include any neurologic condition other than stroke that could affect language, cognition or speech, such as Parkinson's disease, Alzheimer's disease, traumatic brain injury, or the presence of right-hemisphere lesions. InterventionsNot applicable. Main Outcome MeasuresSubjects are administered a test battery of linguistic, cognitive-communicative, and HRQOL measures. Linguistic measures include the Western Aphasia Battery-Revised and the Apraxia of Speech Rating Scale. Cognitive-communicative measures include the Communication Participation Item Bank, Connor's Continuous Performance Test-3, the Communication Confidence Rating Scale for Aphasia, the Communication Effectiveness Index, the Neurological Quality of Life measurement system (Neuro-QoL) Communication short form, and the Neuro-QoL Cognitive Function short form. HRQOL measures include the 39-item Stroke & Aphasia Quality of Life Scale, Neuro-QoL Fatigue, Sleep Disturbance, Depression, Ability to Participate in Social Roles & Activities, and Satisfaction with Social Roles & Activities tests, and the Patient-Reported Outcome Measurement and Information System 10-item Global Health short form. The test battery is administered initially during inpatient rehabilitation, and at 3-, 6-, 12-, and 18-months post-IRF discharge. Biomarker samples are collected via saliva samples at admission and a subgroup of participants also undergo resting state fMRI scans. ResultsNot applicable. ConclusionsThis longitudinal observational study will develop trajectory models for recovery of clinically relevant linguistic, cognitive-communicative, and quality of life outcomes over 18 months after inpatient rehabilitation. Models will identify individual differences in the patterns of recovery based on variations in personal, genetic, imaging, and therapy characteristics. The resulting models will provide an unparalleled representation of recovery from aphasia resulting from stroke. This improved understanding of recovery will enable clinicians to better tailor and plan rehabilitation therapies to individual patient's needs.

Factors associated with satisfaction with social roles and activities among people with systemic sclerosis: a Scleroderma Patient-centered Intervention Network (SPIN) cohort cross-sectional study

ObjectiveThe objectives were to (1) compare satisfaction with social roles and activities in a large multinational systemic sclerosis (SSc) cohort to general population normative data and (2) identify sociodemographic, lifestyle...

Longitudinal Associations Between Multimorbidities and Patient-Reported Quality of Life.

The global prevalence of multimorbidity is increasing as the population ages. As individuals get older, they are likely to develop multiple chronic conditions, and nearly two-thirds of older adults in the United States are estimated to experience 2 or more chronic conditions. The present preregistered study examined whether multimorbidity was associated with longitudinal changes in health-related quality of life (i.e., anxiety, depression, and physical function) and whether these associations were moderated by sociodemographic factors (i.e., sex, race, marital status, income, insurance, and education). Data come from the Health Literacy and Cognitive Function Among Older Adults Longitudinal Study (LitCog), a prospective cohort study of English-speaking older adults (N = 900). At each measurement occasion, participants reported anxiety, depression, and physical function using the Patient Reported Outcomes Information System, chronic conditions, and sociodemographic characteristics. We employed multilevel growth models to estimate changes in health-related quality of life, with multimorbidities as a predictor and sociodemographics as covariates. Results indicated that individuals with multiple chronic conditions reported persistently high levels of anxiety and depression, and worse physical function. We found evidence for racial health disparities, such that individuals who identified as non-White experienced worse health-related quality of life as multimorbidities increased, relative to White participants. These results contribute to the current conversation about the long-term impacts of structural and systemic barriers experienced by minoritized groups. We further discuss the public health implications of multimorbidity in older adulthood.

Mapping of the PROMIS global health measure to the PROPr in the United States

BackgroundThe Patient-Reported Outcomes Measurement and Information System (PROMIS®) global health items (global-10) yield physical and mental health scale scores and the PROMIS-Preference (PROPr) scoring system estimated from PROMIS domain scores (e.g., PROMIS-29 + 2) produces a single score anchored by 0 (dead or as bad as being dead) to 1 (full health). A link between the PROMIS global-10 and the PROPr is needed.MethodsThe PROMIS-29 + 2 and the PROMIS global-10 were administered to 4102 adults in the Ipsos KnowledgePanel in 2022. The median age was 52 (range 18–94), 50% were female, 70% were non-Hispanic White, and 64% were married or living with a partner. The highest level of education completed for 26% of the sample was a high school degree or general education diploma and 44% worked full-time. We estimated correlations of the PROPr with the PROMIS global health items and the global physical and mental health scales. We examined the adjusted R2 and estimated correlations between predicted and observed PROPr scores.ResultsProduct-moment correlations between the PROMIS global health items and the PROPr ranged from 0.50 to 0.63. The PROMIS global physical health and mental health scale scores correlated 0.74 and 0.60, respectively, with the PROPr. The adjusted R2 in the regression of the PROPr on the PROMIS global health items was 64%. The equated PROPr preference scores correlated (product-moment) 0.80 (n = 4043; p < 0.0001) with the observed PROPr preference scores, and the intra-class correlation (two-way random effects model) was 0.80. The normalized mean absolute error (NMAE) was 0.45 (SD = 0.43). The adjusted R2 in the OLS regression of the PROPr on the PROMIS global health scales was 59%. The equated PROPr preference scores correlated (product-moment) was 0.77 (n = 4046; p < 0.0001) with the observed PROPr preference scores, and the intra-class correlation was 0.77. The NMAE was 0.49 (SD = 0.45).ConclusionsRegression equations provide a reasonably accurate estimate of the PROPr preference-based score from the PROMIS global health items or scales for group-level comparisons. These estimates facilitate cost-effectiveness research and meta-analyses. The estimated PROPr scores are not accurate enough for individual-level applications. Future evaluations of the prediction equations are needed.

Comparison of patient-reported outcomes measurement information system (PROMIS®)-29 and PROMIS global physical and mental health scores

PurposeThe Patient-Reported Outcomes Measurement and Information System (PROMIS®): includes the PROMIS-29 physical and mental health summary and the PROMIS global physical and mental health scores. It is unknown how these scores coincide with one another. This study examines whether the scores yield similar or different information.MethodsThe PROMIS-29 and the PROMIS global health items were administered to 5804 adults from Amazon’s Mechanical Turk (MTurk) in 2021–2022 and to 4060 adults in the Ipsos KnowledgePanel (KP) in 2022.ResultsThe median age of those in MTurk (KP) was 36 (54) and 53% (50%) were male. Mean T-scores on the PROMIS-29 and PROMIS global physical health scales were similar, but PROMIS global mental health was 3–4 points lower than the PROMIS-29 mental health summary score. Product-moment correlations ranged from 0.69 to 0.81 between the PROMIS-29 physical health and PROMIS global physical health scales and 0.56–0.69 between the mental health scales. Multi-trait multimethod analyses indicated that only a small proportion of the correlations between the two methods of measuring mental health were significantly more highly correlated with one another than correlations between physical and mental health.ConclusionsPROMIS-29 and PROMIS global mental health scales provide different information and, therefore, study conclusions may vary depending on which measure is used. Interpretation of results needs to consider that the PROMIS-29 mental health scale is a weighted combination of specific domains while the PROMIS global mental health scale is based on general mental health perceptions. Further comparisons of methods of assessing mental health are needed.

Cannabis Use Disorder Not Associated With Opioid Analgesic Use or Patient-Reported Outcomes After ACL Reconstruction: A Retrospective Matched-Cohort Analysis.

The purpose of this study was to compare opioid analgesic use and patient-reported outcomes (PROs) after anterior cruciate ligament reconstruction (ACLR) between patients with and without cannabis use disorder (CUD). We hypothesized that patients with CUD would have greater postoperative opioid usage with comparable improvement in PROs. Retrospective matched-cohort study. Level 3. We identified patients with CUD who underwent primary ACLR at a single center and had minimum 3-month follow-up. Patients with CUD were propensity score matched 1:1 to non-CUD controls with respect to age, sex, and follow-up time. Total refills, days supply, and morphine milligram equivalents (MMEs) of opioid analgesics prescribed were calculated for up to 1 year postoperatively. Patient-Reported Outcome Information System (PROMIS) instruments were used to assess PROs. Opioid use and outcomes were compared between CUD and control groups using Mann-Whitney U test and Fisher's exact test. P values <0.05 were considered significant. A total of 104 patients with CUD were matched to 104 controls. Both groups were majority male (65.4% male, 34.6% female). The CUD group had a mean age of 29.9 years and mean follow-up time of 16.1 months. There was no significant intergroup difference in opioid prescription rates (CUD 82.7% vs control 83.7%, P ≥ 0.99). Among patients prescribed opioids, there were no significant intergroup differences in total days supply (P = 0.67), total MMEs (P = 0.71), or MMEs per day (P = 0.65). There were no significant differences in pre- to postoperative improvement in PROMIS Pain Intensity (P = 0.51), Pain Interference (P = 0.81), Mobility (P = 0.90), Mental Health (P = 0.74), or Physical Health (P = 0.94). There were no significant differences detected in opioid usage or PRO improvement after ACLR between patients with CUD and those without. However, because a sample size was not determined a priori, a larger sample may show a difference. CUD does not appear to correlate with inferior outcomes after ACLR.

Poster 174: Arthroscopic rotator cuff repair with bioinductive patch achieves equivalent patient- reported outcomes at 1 year

Objectives: To compare patient reported outcomes, range of motion (ROM), and complications of patients undergoing arthroscopic rotator cuff repair (RCR) augmented with a bioinductive patch compared to standard repair. Methods: A retrospective review of patients undergoing primary arthroscopic rotator cuff repair with and without bioinductive bovine collagen patch augmentation for supraspinatus/infraspinatus tears from 2016 to 2021 at a single institution was performed. Patients were excluded based on the following criteria: age &lt;18 years, open or mini-open rotator cuff repair, prior surgery of the affected shoulder (except diagnostic arthroscopy), rheumatological disease, active infection, or cancer. Patients who underwent RCR augmented with a collagen patch were matched 1:1 to those undergoing standard rotator cuff repair based on tear thickness and size. The electronic medical record was used to obtain patient demographics, range of motion (ROM), and assess for complications. MRI or ultrasound was used to confirm tear and classify size using the DeOrio and Cofield classification of small (&lt;1cm), medium (1-3cm), large (3-5cm), and massive (&gt;5cm). In addition, Patient Reported Outcome Information System (PROMIS) scores were recorded at preoperative, 6 weeks, 3 months, 6 months, and 1 year postoperative time points. Results: Fifty-four patients underwent RCR with patch augmentation and were matched to 54 controls. No significant differences were found between groups in terms of age (56.7 ± 9.0 patch vs. 59.3 ± 8.5 years control, p=0.12), sex, smoking, diabetes, degenerative vs. traumatic tears (50% vs. 50.9%, p=1.0), partial vs. full thickness (38.9% vs. 25.5%, p=0.2), as well as tear size (p=0.8). ROM in forward flexion (FF) and abduction (ABD) were significantly increased at 1 year compared to controls (FF 162 +/- 22 vs. 148 +/- 26 degrees, p&lt;0.01; ABD 137 +/- 37 vs. 117 +/- 40, p=0.047). No differences were seen for PROMIS- UE, but PROMIS-PI scores were significantly lower in the patch group at 6 months (55.2 +/- 8.0 vs. 61.9 +/- 2.0, p&lt;0.01) and 1 year (56.0 +/- 7.5 vs. 62.1 +/- 3.6, p&lt;.01). The patch group had 7 retears compared to 0 controls (13.0% vs 0%, 2/7 for subscapularis tears not augmented) and 1 biceps tenodesis rupture, with 5 requiring revision surgery. Conclusions: Bioinductive patch augmentation for RCR demonstrated increased ROM, but equivalent physical function after 1 year. [Table: see text][Table: see text]

Radiographic and Patient-Reported Outcomes of a Low-Cost Modified Lapidus Bunion Correction Technique.

The modified Lapidus (ML) is a powerful procedure for correction of hallux valgus (HV) with emerging techniques. Studies considering patient-reported outcomes, radiographic measures, complications, and implant costs are currently limited. Retrospective cohort with prospectively collected Patient Reported Outcome Information System Physical Function (PROMIS-PF) Computerized Adaptive Test (CAT) scores, radiographic parameters (intermetatarsal angle, IMA; hallux valgus angle, HVA; and tibial sesamoid position, TSP), complications, and total operative time and implant costs were reviewed from 2014 to 2019. Seventy-three feet (68 patients) underwent bunion correction by ML with lag-screw fixation. Median age was 55.8 years (IQR 45.6, 53.9), 4 of 73 (5.5%) were male, 11 of 73 (15.1%) were smokers, and 15 of 73 (20.6%) were diabetic (median HbA1c 6.4% [IQR 6.0, 7.4], none insulin dependent, 5 of 15 with neuropathy). Complications included 6 of 73 (8.2%) wound issues resolved with topical or oral treatment, 9 of 73 (12.3%) painful or broken hardware requiring hardware removal. Two of 73 (2.7%) had persistent pain despite union. One of 73 (1.4%) was overcorrected and required first MTP arthrodesis. Of 3 nonunions (2.7%), 1 resolved with corrected hypothyroidism, 1 was asymptomatic and required no treatment, 1 had a hallux valgus recurrence and sought revision surgery elsewhere. Preoperative radiographic angles were HVA 35 degrees, IMA 14 degrees which improved at final postoperative follow up to HVA 10 degrees, IMA 6 degrees. Tibial sesamoid position improved from 6.05 ± 1.00 to 2.22 ± 1.38. Thirty-two patients had preoperative and 42 had 1-year postoperative outcomes. PROMIS-PF (51% collection rate) was 43 (IQR 37,52) preoperatively, 37 (31, 39) at 6 weeks, 46 (42, 51) at 3 months, and 49 (41, 53) at >360 days postoperatively. The drop in PROMIS-PF between preoperative and 6 weeks and the rise from 6 weeks to 3 months were statistically significant. Pre- and postoperative PROMIS-PF scores were not significantly different. Implant cost averaged US$146. We report low complication rates and costs with high patient postoperative functional and radiographic outcomes. PROMIS-PF decreased acutely postoperatively but recovered and maintained high levels by 3 months postoperatively. Level IV, case series.

Poster 125: Cannabis Use Disorder is Not Associated with Opioid Analgesic Use or Patient-Reported Outcomes after Anterior Cruciate Ligament Reconstruction: A Retrospective Matched-Cohort Analysis

Objectives: Cannabis use disorder (CUD), also known as marijuana use disorder, is prevalent yet underdiagnosed psychiatric condition among the U.S. population. Epidemiologic studies have identified a high rate of comorbidity between CUD and chronic pain and other psychiatric disorders. There is a concern among orthopedic surgeons that patients with CUD who undergo elective procedures, such as anterior cruciate ligament reconstruction (ACLR), may be at higher risk for long-term opioid use and poorer outcomes following surgery. The aim of this study was to compare opioid use and patient- reported outcomes (PROs) following ACLR between patients with CUD versus controls. Methods: We conducted a retrospective review of patients with an active diagnosis of CUD who underwent primary ACLR surgery at a single center from 2011-2021 with minimum 3-month follow-up. Patients with CUD were identified using ICD-10 code F12 and its associated sub-codes. CUD patients were matched to controls on age, sex, and follow-up time using greedy nearest-neighbor propensity score matching. Analgesic prescriptions up to one year postoperative were abstracted from medical records and all opioid analgesic doses were converted to morphine milligram equivalents (MMEs). Pre- and post-operative Patient-Reported Outcome Information System (PROMIS) scores, 90-day readmissions, and 90-day revisions were also abstracted from medical records. Outcomes were compared between CUD and control groups using Mann-Whitney U test and Fisher’s exact test. P-values &lt;0.05 were considered significant. Results: 104 CUD patients were matched to 104 controls. Sex demographics were the same in both groups (65.4% male, 34.6% female) and there were no significant differences in mean age (CUD 29.9 vs control 29.2 years; p=0.57), BMI (CUD 25.5 vs control 25.5 years; p=0.95), or follow-up time (CUD 16.1 vs control 15.1 months; p=0.65). Both groups were prescribed postoperative opioids at similar rates (CUD 82.7% vs control 83.7%; p=1.00). Among those prescribed opioids, there were no significant differences in total days supplied (CUD 12.5 vs control 10.8; p=0.67), total MMEs (CUD 558 vs control 445; p=0.71), or MMEs per day (CUD 47.5 vs control 46.3; p=0.65). Likewise, there were no significant differences in pre-to-postoperative improvement in PROMIS Pain Intensity (CUD -5.8 vs control -5.1; p=0.51), Pain Interference (CUD -8.3 vs control -7.6; p=0.81), Mobility (CUD 10.9 vs control 11.1; p=0.90), Mental Health (CUD 0.03 vs control 0.54; p=0.74), or Physical Health (CUD 3.9 vs control 4.2; p=0.94). Conclusions: Patients with CUD do not appear to consume opioid analgesics at a higher frequency or duration than their counterparts without CUD following ACLR surgery. Furthermore, both groups experience similar improvements in patient-reported outcomes following ACLR and these improvements are not diminished among CUD patients. While orthopedic surgeons should continue to screen patients for cannabis use as part of a thorough preoperative assessment, cannabis abuse or dependence in itself is not cause for concern for worse post-ACLR outcomes.

Why Do Patients Choose Skilled Nursing Facilities After Total Hip and Knee Arthroplasty?

BackgroundCurrent research indicates that total joint arthroplasty patients who are discharged to skilled nursing facilities (SNFs) have higher complication rates as compared to home. Many factors like age, sex, race, Medicare status, and past medical history have been shown to influence discharge destination. The present study sought to gather patient-indicated reasons for SNF discharge and identify potentially modifiable factors influencing the decision. MethodsPrimary total joint arthroplasty patients were asked to complete surveys at their presurgical and 2-week postsurgical follow-up appointments. The surveys included home access and social support questions as well as patient-reported outcome measures: Patient-Reported Outcomes Measurement and Information System, Risk Assessment and Prediction Tool, Knee injury and Osteoarthritis Outcome Score for Joint Replacement, or Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement. ResultsOf 765 patients who met inclusion criteria, 3.9% were discharged to an SNF and these were more frequently post-THA, women, older, Black, and persons living alone. Regression analyses indicated that lower Risk Assessment and Prediction Tool score, higher age, no caregiver presence, and Black race were significantly associated with SNF discharge. Patients discharged to an SNF most commonly reported social concerns rather than medical or home access concerns as the main factor for SNF discharge. ConclusionsWhile age and sex are nonmodifiable factors, the availability of a caregiver and social support represents an important modifiable factor in regard to discharge destination. Dedicated attention during the preoperative planning period may help augment social support and avoid unnecessary discharges to SNFs.

Urban stress and its association with symptoms of depression, fatigue, and sleep disruption in women in Mexico City

ABSTRACT Women in urban neighborhoods often face disproportionately higher levels of environmental and social stressors; however, the health effects from urban stressors remain poorly understood. We evaluated the association between urban stress and depression, fatigue, and sleep disruption in a cohort of 460 women in Mexico City. To assess urban stress, women were administered the Urban Annoyances scale. Six constructs were summarized to create an overall index. Depressive symptoms were assessed using the Edinburgh Depression Scale; the Patient-Reported Outcomes Information System scales were used to assess sleep disruption and fatigue. Linear regression models were used to estimate the association with continuous symptoms comparing women with high stress to those with lower levels. Models were adjusted for socioeconomic status, education, age, social support, and previous depressive symptoms. High urban stress was associated with greater depressive symptoms (β: 1.77; 95% CI: 0.83, 2.71), fatigue (β: 2.47; 95% CI: 0.87, 4.07), and sleep disruption (β: 2.14; 95% CI: 0.54, 3.73). Urban stress plays an important role in women’s psychological and physical health, highlighting the importance of including these measures in environmental health studies. Urban interventions, such as promoting alternative transport options, should additionally be addressed to improve health of urban populations.

Impact of COVID-related Discrimination on Psychological Distress and Sleep Disturbances across Race-Ethnicity

COVID-related discrimination towards historically marginalized racial-ethnic groups in the United States has been well-documented; however, its impact on psychological distress and sleep (overall and within specific racial-ethnic groups) is largely unknown. We used data from our nationally representative, online survey of 5,500 American Indian/Alaska Native, Asian, Black/African American, Native Hawaiian/Pacific Islander, Latino, White, and multiracial adults, conducted from 12/2020-2/2021. Participants were asked how often they experienced discriminatory behaviors “because they think you might have COVID-19” (modified Everyday Discrimination Scale). Psychological distress was captured as having experienced anxiety-depression symptoms (Patient Health Questionairre-4, PHQ-4), perceived stress (modified Perceived Stress Scale), or loneliness-isolation (“How often have you felt lonely and isolated?”). Sleep disturbances were measured using the Patient-Reported Outcomes Information System Short Form Sleep Disturbance scale (PROMIS-SF 4a). Overall, 22.1% reported COVID-related discriminatory behaviors (sometimes/always: 9.7%; rarely: 12.4%). 48.4% of participants reported anxiety-depression symptoms (moderate/severe: 23.7% mild: 24.8%), 62.4% reported feeling stressed (moderate/severe: 34.3%; mild: 28,1%), 61.0% reported feeling lonely-isolated (fairly often/very often: 21.3%; almost never/sometimes: 39.7%), and 35.4% reported sleep disturbances (moderate/severe:19.8%; mild: 15.6%). Discrimination was only associated with increased psychological distress among racial-ethnic minorities. For example, COVID-related discrimination was strongly associated with anxiety-depression among Black/African American adults (mild: aOR=2.12, 95% CI=1.43-5.17; moderate/severe: aOR=5.19, 95% CI=3.35-8.05), but no association was observed among White or multiracial adults. Mitigating pandemic-related discrimination could help alleviate mental and sleep health disparities occurring among minoritized racial-ethnic groups.

Revision total knee arthroplasty for arthrofibrosis improves range of motion

PurposeArthrofibrosis after primary total knee arthroplasty (TKA) is a significant contributor to patient dissatisfaction. While treatment algorithms involve early physical therapy and manipulation under anaesthesia (MUA), some patients ultimately require revision TKA. It is unclear whether revision TKA can consistently improve these patient's range of motion (ROM). The purpose of this study was to evaluate ROM when revision TKA was performed for arthrofibrosis.MethodsA retrospective study of 42 TKA’s diagnosed with arthrofibrosis from 2013 to 2019 at a single institution with a minimum 2-year follow-up was performed. The primary outcome was ROM (flexion, extension, and total arc of motion) before and after revision TKA, and secondary outcomes included patient reported outcomes information system (PROMIS) scores. Categorical data were compared using chi-squared analysis, and paired samples t tests were performed to compare ROM at three different times: pre-primary TKA, pre-revision TKA, and post-revision TKA. A multivariable linear regression analysis was performed to assess for effect modification on total ROM.ResultsThe patient's pre-revision mean flexion was 85.6 degrees, and mean extension was 10.1 degrees. At the time of the revision, the mean age of the cohort was 64.7 years, the average body mass index (BMI) was 29.8, and 62% were female. At a mean follow-up of 4.5 years, revision TKA significantly improved terminal flexion by 18.4 degrees (p < 0.001), terminal extension by 6.8 degrees (p = 0.007), and total arc of motion by 25.2 degrees (p < 0.001). The final ROM after revision TKA was not significantly different from the patient’s pre-primary TKA ROM (p = 0.759). PROMIS physical function, depression, and pain interference scores were 39 (SD = 7.72), 49 (SD = 8.39), and 62 (SD = 7.25), respectively.ConclusionRevision TKA for arthrofibrosis significantly improved ROM at a mean follow-up of 4.5 years with over 25 degrees of improvement in the total arc of motion, resulting in final ROM similar to pre-primary TKA ROM. PROMIS physical function and pain scores showed moderate dysfunction, while depression scores were within normal limits. While physical therapy and MUA remain the gold standard for the early treatment of stiffness after TKA, revision TKA can improve ROM.Level of evidenceIV.

Pain acceptance and psychological inflexibility predict pain interference outcomes for persons with chronic pain receiving pain psychology.

Awareness (being present), acceptance, and engagement (committed action) are three dimensions of psychological flexibility. Understanding these in the context of chronic pain may identify treatment targets to help refine individual treatment. Our objective was to test the predictive capacity of three dimensions within the psychological flexibility model on the longitudinal trajectory of pain interference. Patients receiving pain psychology treatment at a pain management center participated in this pragmatic clinical longitudinal study (n=86 with at least three assessments; Mean age=51 years; Gender=60 females, 26 males). Measures included the Five Facet Mindfulness Questionnaire (FFMQ-SF); Chronic Pain Acceptance Questionnaire (CPAQ-8); Psychological Inflexibility in Pain Scale (PIPS-12); and Committed Action Questionnaire (CAQ-8). The dependent variable was the Patient Reported Outcomes Information System (PROMIS) Pain Interference (PI). We used latent growth modelling to analyze scores assessed within 180days of patient care. Psychological inflexibility (PIPS-12) and pain acceptance (CPAQ-8) measured at baseline predicted PI outcomes (n=86). PIPS-12 showed a direct relationship with pain interference (PI), where higher PIPS-12 scores predicted significantly higher PI mean scores on average across the study period (ρ=0.422, r2=0.382) but also predicted significantly greater decreases in PI across time (ρ=-0.489, r2=0.123). Higher CPAQ-8 scores predicted significantly lower PI mean scores on average across the study period (ρ=-0.478, r2=0.453) but also significantly smaller decreases in PI across time (ρ=0.495, r2=0.076). Awareness (FFMQ-SF) and engagement (CAQ-8) were not predictive of PI outcomes. Patients who entered pain psychology treatment with lower pain acceptance and higher psychological inflexibility showed the largest reductions in pain interference across time. These results contribute towards a novel prognostic understanding of the predictive roles of an enhancing dimension and limiting dimension of psychological flexibility.

Abstract TP155: Patient Centered Outcomes In Pediatric Moyamoya Arteriopathy

Introduction: Little is known about quality of life, sleep, and mental health in children with moyamoya arteriopathy (MMA). A better understanding of patient-centered outcomes may lead to improved counseling and treatment of childhood MMA. Methods: MMA patients &lt;26 years old (when developmentally appropriate) and their parents/guardians completed a series of validated, age-appropriate questionnaires. Measures included the Pediatric Quality of Life (PedsQL) Inventory (assessing health-related quality of life), Patient-Reported Outcomes Information System (PROMIS) sleep questionnaires (assessing sleep disturbance, defined as disturbed sleep, and sleep impairment, defined as impairment of daily activities due to poor sleep), and PROMIS depression/anxiety questionnaires. Results: Seventeen participants with MMA were enrolled, with 8 children and 17 parent proxies completing questionnaires. Median age was 7.3 years (IQR 6.6, 10.1 years). The cohort included 8 (47%) females and children with both moyamoya disease (n=9, 53%) and moyamoya syndrome (sickle cell disease n=4, neurofibromatosis n=3, hemophilia A n=1). On the PedsQL (100 = best quality of life), children with MMA scored relatively low in emotional (mean = 73.2), social (mean = 74.5), and school/work (mean = 72.1) quality of life domains compared to the physical (mean = 82.6) domain. On parent proxy PROMIS sleep questionnaires, 53% of children with MMA qualified as having sleep disturbance (41% moderate-severe) and 47% had sleep impairment (35% moderate-severe). Of 25 child and parent proxy PROMIS depression/anxiety forms, 48% indicated moderate-severe anxiety and 24% moderate-severe depressive symptoms. Conclusions: Children with MMA have high rates of poor quality of life, sleep disturbance, sleep impairment, anxiety, and depressive symptoms. Future directions include comparison of patient centered outcomes in MMA to children with other stroke etiologies as well as unaffected siblings. A better understanding of patient centered outcomes will allow for improved counseling and targeted therapies to address MMA-related sleep, emotional, social, and school-based impairment.

Longitudinal Course of Sleep Disturbance and Relationship With Itch in Adult Atopic Dermatitis in Clinical Practice.

Background: Sleep disturbance (SD) is common in atopic dermatitis (AD). We examined the longitudinal course of SD and relationship with itch in AD patients. Methods: A prospective, dermatology practice-based study was performed (N = 1295) where patients were assessed at baseline and follow-up visits. Results: At baseline, 16.9% of the patients had severe SD based on Patient-Reported Outcomes Information System (PROMIS) SD T scores, 19.1% had difficulty falling asleep, 22.9% had difficulty staying asleep, and 34.2% had SD from AD. A total of 31.4% of the patients with difficulty staying asleep at baseline experienced persistent difficulties (for 3 follow-ups or more). Only 17.7% with baseline difficulty falling asleep had persistent disturbance. Despite significant fluctuation in sleep scores, SD generally improved over time. Of the patients facing baseline SD from AD, 31.5% experienced SD at the first visit, and only 12.3% experienced persistent SD at the second follow-up visit. Predictors of increased PROMIS sleep-related impairment T scores over time included baseline PROMIS sleep-related impairment T scores (0.74 [0.68-0.80]), having 3 to 6 nights of itch (2.22 [0.85-3.59]), and severe/very severe AD (4.40 [2.60-6.20]). Conclusions: A significant proportion of adult AD patients, particularly those with moderate-severe AD and frequent itch, had baseline SD. Although sleep scores generally improved over time, many patients experienced a fluctuating or persistent course.

Barth Syndrome: Psychosocial Impact and Quality of Life Assessment.

Barth syndrome (BTHS) is a rare X-linked genetic disease that affects multiple systems and leads to complex clinical manifestations. Although a considerable amount of research has focused on the physical aspects of the disease, less has focused on the psychosocial impact and quality of life (QoL) in BTHS. The current study investigated caregiver- (n = 10) and self-reported (n = 16) psychological well-being and QoL in a cohort of BTHS-affected patients and families. Participants completed the depression and anxiety components of the Patient-Reported Outcomes Information System (PROMIS) Short Form 8A and Health-related quality of life (HRQoL) surveys at enrollment and again during a follow-up period ranging from 6 to 36 months after baseline. Quality of life changed significantly over time and the various domains with some improvement and some decline. Among the available caregiver-patient dyad data, there was a trend toward discordance between caregiver and self-reported outcomes. Most notably, patients reported improvement in HRQoL, while caregivers reported declines. This suggests that there may be differences in perceived quality of life between the patients and parents, though our study is limited by small sample size. Our study provides valuable insights into the impacts of psychosocial and mental health aspects of BTHS. Implications of these findings include incorporating longitudinal assessment of QoL and screening for psychological symptoms in BTHS care to identify interventions that may drastically impact health status and the course of the disease.

Quantifying Surgeon Intuition Using a Judgment Analysis Model: Surgeon Accuracy of Predicting Patient-Reported Outcomes in Patients Undergoing Hip Arthroscopy for Femoroacetabular Impingement Is Moderate at Best

To quantify surgeon intuition, determine whether a surgeon's prediction of outcomes after hip arthroscopy correlates with actual patient-reported outcomes (PRO), and identify differences in clinical judgment between expert and novice examiners. This prospective, longitudinal study was conducted at an academic medical center on adults undergoing primary hip arthroscopy for treatment of femoroacetabular impingement. A Surgeon Intuition and Prediction (SIP) score was completed preoperatively by an attending surgeon (expert) and physician assistant (novice). Baseline and postoperative outcome measures included legacy hip scores (e.g., Modified Harris Hip score) and Patient-Reported Outcomes Information System tools. Mean differences were assessed using t-tests. Generalized estimating equations assessed longitudinal changes. Pearson correlation coefficients (r) evaluated associations between SIP score and PRO scores. Data from 98 patients (mean age 36 years, 67% female) with complete data sets at 12-month follow-up were analyzed. Weak-to-moderate strength correlations were seen between SIP score and PRO scores (r= 0.36 to r= 0.53) for pain, activity and physical function. Significant improvements were seen in all primary outcome measures at 6 and 12 months postoperatively when compared to baseline scores (P < .05), with about 50% to 80% of patients achieving the minimum clinically important difference and patient acceptable symptomatic state thresholds postoperatively. An experienced, high-volume hip arthroscopist had only weak-to-moderate ability to intuitively predict PRO. Surgical intuition and judgment were not superior in an expert examiner compared to a novice. Level III, retrospective comparative prognostic trial.

Cannabis Use Among Lower-Extremity Arthroplasty Patients Does Not Lead to Worse Postoperative Outcomes.

Smoking and general categorizations of substance use are linked with increased postoperative complications following total knee arthroplasty (TKA) and total hip arthroplasty (THA). There is a lack of similar evidence on how cannabis use may affect outcomes after arthroplasty. The present study aims to compare postoperative outcomes in cannabis users versus non-cannabis users who underwent THA/TKA. We hypothesize that cannabis users will have no difference in primarily the complication rate, revision rate, and secondarily post-operative Patient-Reported Outcomes Information System (PROMIS) scores, hospital stay, or pain compared to matched controls. Billing codes were used to generate lists of hip/knee arthroplasty patients from 2013 to 2019 at our institution. In the case group, cannabis use was confirmed via chart review. Cannabis-using patients were matched appropriately with non-users by (1) the same arthroplasty procedure; (2) BMI ± 3.5; (3) age ± 3 years; (4) sex. Data on postoperative outcomes were collected from charts and compared between groups using either a Chi-square test for qualitative variables or a paired t-test for quantitative variables. A total of 24 patients with an average age of 57.1 and a BMI of 30.6 were confirmed to have isolated cannabis use. They were matched to 24 patients with an average age of 57.6 and a BMI of 31.4. There were no significant differences in the complication rate (4.2% vs 4.2%, p=1.00), the revision rate (0% vs 4.2%, p=0.31), days of hospital stay (2.7 vs 3.3, p=0.22), or postoperative pain (4.7 vs 4.9, p=0.86). Similarly, there were no significant differences in all PROMIS score measures. Current research shows that cannabis use may lead to increased revision arthroplasty and decreased mortality, with mixed findings regarding post-surgical complications. The present study suggests that cannabis-using patients have no difference in postoperative complication rate, revision rate, PROMIS scores, hospital stay, or pain compared to matched controls.