VR-12 Mental Component Score Research Articles

The influence of preoperative 12-item veterans rand physical component scores on outcomes following cervical disc replacement.

To evaluate the influence of preoperative VR-12 physical component scores (PCS) on outcomes following cervical disc replacement (CDR). Patients undergoing elective CDR were retrospectively identified. Patient-reported outcomes (PROs) of interest included VR-12 PCS/VR-12 Mental Component Score (MCS)/9-Item Patient Health Questionnaire (PHQ-9)/Short Form-12 (SF-12) PCS and MCS/Patient-Reported Outcome Measurement Information System-Physical Function (PROMIS-PF)/Visual Analog Scale-Neck Pain (VAS-NP)/VAS-Arm Pain (VAS-AP)/Neck Disability Index (NDI). Baseline up to two-year postoperative scores were obtained (average follow-up: 9.2 ± 6.8months). Two cohorts were created: VR-12 PCS < 35 or VR-12 PCS ≥ 35. Improvements in scores from baseline to six weeks postoperatively and to final follow-up were calculated. Changes in scores were compared to previously reported thresholds to determine rates of minimum clinically important difference (MCID). Of 127 patients, 64 were in the worse VR-12 PCS group. Patients with better VR-12 PCS were more likely to have private insurance (p = 0.034). When accounting for insurance differences, the worse VR-12 PCS group reported inferior NDI/VAS-NP/PHQ-9/PROMIS-PF/VR-12 PCS/SF-12 PCS at six weeks and final follow-up (p ≤ 0.015, all). The worse VR-12 PCS group reported greater improvements in VAS-AP and VR-12 PCS by six weeks and in NDI/VR-12 MCS/VR-12 PCS/SF-12 PCS by final follow-up (p ≤ 0.026, all). Patients with worse VR-12 PCS reported greater MCID achievement for VR-12 MCS and SF-12 PCS (p ≤ 0.034, both). Following surgery, patients with worse VR-12 PCS report greater improvements in PROs, highlighting the increased relative impact of surgery for patients with worse baseline physical function. These findings can be used to optimize patient experience perioperatively and inform postoperative expectations.

Patient-Reported Outcomes of Total Hip Arthroplasty at an Ambulatory Surgery Center Versus a Hospital-Based Center.

The utilization of ambulatory surgery centers (ASCs) and same-day discharge (SDD) from hospital-based centers (HBCs) after total hip arthroplasty (THA) continues to increase. There remains a paucity of literature directly comparing patient-reported outcomes by surgery site. We sought to compare outcomes between patients undergoing THA at an ASC versus HBC while controlling for medical comorbidities. Patients undergoing primary THA with SDD (postoperative day 0) from a single HBC (1,015 patients) or stand-alone ASC (170 patients) from December 2020 to 2021 were identified. Patient demographics, comorbidities, and 90-day complications were collected. Hip Osteoarthritis Outcome Score (HOOS JR), VR-12, and procedural satisfaction scores were collected preoperatively and at 3, 6, and 12 months. Patients were matched by age and American Society of Anesthesiologists (ASA). Chi-squared analysis was conducted to compare categorical variables, and a Wilcoxon rank-sum test was used for continuous variables. Linear regression models were conducted considering age, sex, and presence of comorbidities. Patients undergoing THA at an ASC had markedly higher VR-12 Physical Component Scores at all time points and improved VR-12 Mental Component Scores at preoperative visit and 6 months. These patients had increased procedural satisfaction at 3 months, although there was no difference at 1 year. No notable difference was observed in 90-day complication rates between groups. After matching by age and ASA, each group had 170 patients. In the matched analysis, preoperative HOOS JR scores were markedly lower in the HBC group. However, there was no notable difference in HOOS JR scores, change in HOOS JR scores, and procedural satisfaction, at any postoperative time point. No notable difference was observed in patient-reported outcomes at any time point for SDD after THA performed at an ASC or an HBC when controlling for age and comorbidities. This study suggests noninferiority of stand-alone ASCs for outpatient THA, regarding patient satisfaction and patient-reported outcomes.

Unicompartmental knee arthroplasty improves mental health in patients with single compartment knee osteoarthritis.

The purpose of this study was to determine if preoperative mental health status improves following unicompartmental knee arthroplasty (UKA) in patients with single compartment knee osteoarthritis (OA). A total of 163 patients underwent UKA [115 (71%) medial, 48 (29%) lateral] (mean age = 65 ± 11) completed preoperative and minimum 2-year postoperative veterans RAND 12 item health survey (VR-12) mental component score (MCS). VR-12 MCS was the primary outcome measure. Secondary measures included VR-12 physical component summary score (PCS), knee osteoarthritis outcome score (KOOS) and KOOS patient acceptable symptom state at the final follow-up. The median VR-12 MCS improved from 50.5 [interquartile range (IQR): 43.7-56.8] to 55.0 [IQR: 52.3-57.0] (p < 0.001) at a mean follow-up of 9.5 ± 4 years (range 2-19 years) following UKA. Preoperative VR-12 MCS was significantly correlated with patients postoperative VR-12 PCS (ρ = 0.294, p < 0.01), KOOS pain (ρ = 0.201, p = 0.012), KOOS ADL (ρ = 0.243, p = 0.002) and KOOS quality of life (ρ = 0.233, p < 0.01). Sixty-three (39%) patients improved from low VR-12 MCS (<50) to normal VR-12 MCS (≥50). One hundred forty-two (87%) achieved a normal VR-12 MCS score (≥50) postoperatively. At a mean of 10-year follow-up, patients who underwent UKA for single compartment osteoarthritic knee pain demonstrated significant improvement in mental health scores. UKA resulted in normal mental health in a majority of patients (87%). The resultant improved mental health scores were associated with improved patient pain and activities of daily living. Level III retrospective cohort study.

Resilience and Patient-Reported Outcomes in Patients Undergoing Orthopedic Hand Surgery.

Previous studies have examined the impact of resiliency on postoperative outcomes in other orthopedic domains, but none to date have done so for hand surgery. We performed a retrospective analysis of prospectively collected data of patients undergoing hand surgery at a single institution. We included patients with complete preoperative outcomes scores and 6-month follow-up. All patients completed the Brief Resilience Scale (BRS), Disabilities of the Arm, Shoulder, and Hand (DASH) Score, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), Veterans RAND 12-Item Health Survey (VR-12), and Numeric Rating Scale (NRS) for pain. Patients were stratified into high-resiliency (HR) and low-resiliency (LR) groups based on the preoperative BRS score, and outcomes between groups were compared. We identified 91 patients who underwent hand procedures and completed full preoperative and postoperative outcomes measures. There were no observed preoperative differences between the groups in all outcomes scores except the VR-12 Mental Component Score. Postoperatively, the HR group had superior DASH, QuickDASH, and VR-12 (mental and physical component) scores than the LR group. Postoperative pain, as measured by the NRS, was significantly lower in the HR group despite there being no preoperative difference. A larger percentage of patients in the HR group met the minimal clinically important difference in all outcomes except for the VR-12 Mental Component Scores. Patients with high preoperative resilience appear to have significantly better clinical outcomes following hand surgery with superior DASH, QuickDASH, and VR-12 scores at 6-month follow-up. Prognostic study/Level IV evidence.

Predictors of pain development for contralateral asymptomatic degenerative rotator cuff tears based on features of an ipsilateral painful cuff tear: a prospective longitudinal cohort study

Prior rotator cuff disease natural history studies have focused on tear-related factors that predict disease progression within a given shoulder. The purpose of this study is to examine both patient and tear-related characteristics of a painful rotator cuff tear that predict future pain development and functional impairment in a shoulder with a contralateral asymptomatic cuff tear. This is prospective longitudinal cohort study of subjects ≤65 years who underwent surgery for a painful degenerative rotator cuff tear and possessed an asymptomatic contralateral tear. Subjects were followed prospectively with shoulder ultrasound, physical examination and functional score assessment. Primary outcome was change in ASES score at 2 years. Secondary outcomes included WORC, PROMIS, HADS depression/anxiety, and VR-12 mental component scores. Sixty-five subjects were included with mean follow-up 37 (range 24-42) months. Seventeen (26%) developed contralateral shoulder pain at median 15.2(10.5) months. No difference in age, sex, CCI, occupational demand noted between subjects who did and did not develop pain. In the presenting painful shoulder there was no difference in baseline tear size, muscle degeneration, or biceps pathology between groups. The mean baseline tear length (8.6 vs. 3.8 mm, p=0.0008) and width (8.4 vs. 3.2 mm, p=0.0004) were larger in asymptomatic shoulders that subsequently developed pain compared to those that did not. However, there was no difference mean tear enlargement (length p=0.51, width p=0.90). There were no differences in baseline ASES, WORC, PROMIS scores or HADS depression/anxiety scores between shoulders that did and did not develop pain; however, subjects who developed pain reported lower baseline VR-12 MCS scores (53.3 vs 57.6, p=0.04). Shoulders that developed pain had higher VAS pain scores (2.9 [2.5] vs. 0.6 [1.0], p=0.016, lower ASES scores (7 [33] vs. 100[11.6], p=0.001) and significant changes in all WORC scales with pain onset compared to those that remained asymptomatic. There was no significant difference in changes of HADS anxiety/depression scores but a significant increase in VR-12 MCS scores in subjects who developed pain (7.1[12.6] vs. -1.9[8.7], p=0.036). A quarter of patients with painful cuff tear developed pain in a contralateral asymptomatic cuff tear that resulted in a measurable decline in function within 3 years. Analysis showed only baseline tear size of the asymptomatic shoulder was predictive of pain development. There were no tear-related features of the presenting painful rotator cuff tear or indices of mental health and physical function/occupational demand that were predictive of future pain development at short-term follow-up.

The Role of Severe Lateral Facet Patellar Osteoarthritis in Patient Selection for Success of a Medial Unicompartmental Knee Arthroplasty: Mean Follow-Up of 10 Years

BackgroundLateral facet patellar osteoarthritis (LFPOA) has been reported as a contraindication for medial unicompartmental (UKA). The purpose of this paper was to determine if severe LFPOA was related to lower survivorship and patient-reported outcomes following medial UKA. MethodsA total of 170 medial UKAs were performed. Severe LFPOA was defined as Outerbridge grade 3 to 4 damage on the lateral facet cartilage surfaces of the patella as noted intraoperatively. There were 122 of 170 patients (72%) who had noLFPOA and 48 of 170 patients (28%) who had had severe LFPOA. A routine patelloplasty was performed in all patients. Patients completed the Veterans RAND 12-Item Health Survey (VR-12) Mental Component Score (MCS) and Physical Component Score (PCS), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Knee Society Score. ResultsThere were 4 patients in the noLFPOA group who required total knee arthroplasty and 2 in the LFPOA group. There was no significant difference in mean survival time: noLFPOA = 17.2 years [95% confidence interval (CI): 17 to 18] and LFPOA = 18.0 years [95% CI: 17 to 19] (P = .94). At mean follow-up of 10 years, there were no significant differences in knee flexion or extension. Patello-femoral crepitus without pain was noted in 7 patients who had LFPOA and 21 patients who had noLFPOA. There were no significant differences in VR-12 MCS, PCS, KOOS subscales, or Knee Society Score between groups. Patient acceptable symptom state (PASS) was achieved in 80% (90 of 112) for KOOS ADL in the noLFPOA group and 82% (36 of 44) in the LFPOA group (P = .68). PASS was achieved in 82% (92 of 112) for KOOS Sport in the noLFPOA group and 82% (36/44) in the LFPOA group (P = .87). ConclusionAt a mean of 10 years, patients who had LFPOA had equivalent survivorship and functional outcomes to patients who did not have LFPOA. These long-term results suggest that asymptomatic grade 3 or 4 LFPOA is not a contraindication to medial UKA.

T3 Sexual Satisfaction and Association with Psychosocial Outcomes Among Burn Survivors

Abstract Introduction Sexual satisfaction is often unaddressed in clinical care despite it being an important aspect of healing and quality of life for burn survivors. Previous literature has focused predominantly on physical function rather than perceived satisfaction. This study aimed to determine the associations of sexual satisfaction with psychosocial outcomes and assess sexual satisfaction recovery over time after burn injury. Methods Patients consenting to provide data to the Burn Model System (BMS) National Database injured after 2015, aged greater than 18 years at the time of burn injury, and alive at discharge were included in the analysis. Sexual satisfaction was collected at six months and then every year for five years post-injury using two PROMIS sexual satisfaction items, a composite T-score was derived, where a higher score indicated higher sexual satisfaction. Analyses included sexual satisfaction scores as outcomes with mixed models that included repeated measures controlling for correlated error of the outcomes and covariates that included demographics. Psychosocial measures analyzed included: PROMIS-29 Anxiety, Depression, Fatigue and Sleep scores; VR-12 mental component score (MCS) and physical component score (PCS); and the Post-Traumatic Growth Inventory (PTGI) total score. Results The analysis identified 561 individuals with sexual satisfaction data for at least one time point. The population demographics included a median age of 46 years (IQR 34, 59), reported sex (female = 171 (30.5%)), and median TBSA burned 10% (IQR 3, 26). Increasing age (p &amp;lt; 0.0001) and marital status with those ‘Divorced’ (p=0.004) or ‘Single’ (p=0.0003) were associated with lower sexual satisfaction. There was no association with TBSA burn size. Within psychosocial metrics, we found that the CIQ Social Integration score (p &amp;lt; 0.0001), VR-12 MCS (p=0.008), PTGI Total Score (p=0.01), and PROMIS 29 Sleep Disturbance score (p=0.0004) were also significantly associated. Change in scores were associated with the VR-12 MSC (p=0.03), where an increased MCS score predicted improved sexual satisfaction by final follow-up. Conclusions A significant association was found between sexual satisfaction and social integration, mental health, and post-traumatic growth. Applicability of Research to Practice These findings suggest that interventions to improve the sexual satisfaction of burn survivors should focus on the importance of social integration, mental health, and sleep quality.

Abstract A051: Inequities in financial burden, quality of life, and physical functioning among cancer survivors: A nationally-representative Medical Expenditures Panel Survey (MEPS) study

Abstract Introduction: We examined the relationship between financial burden, quality of life (QOL), and physical functioning for young adult (YA) cancer survivors under 40 years of age in comparison to their healthy peers and older cancer survivors ages 40-64 while adjusting for demographic factors, utilization, and access to care. Methods: Data from the Medical Expenditures Panel Survey (MEPS) from 2011 to 2018 household component survey were used. We examined differences in 1) out-of-pocket expenditures (first modeled as a binary outcome of any expenditures; then modeled as the sum of office/outpatient visits, emergency department use, inpatient stays, and prescriptions expenditures with log base 10 adjusted to 2018 dollars), 2) quality of life (measured with the VR-12 mental component score or MCS), and 3) physical functioning (measured with the VR-12 physical component score or PCS). Outcomes were compared among 1) YA cancer survivors to YAs without a cancer history (&amp;lt;40) and 2) YA survivors (&amp;lt;40) to older adult cancer survivors (40-64). Multivariable generalized linear models with a log link function were adjusted for demographics (sex, annual household income), utilization (any prescriptions and any outpatient, inpatient, and emergency department visits), and access to care (delayed medical care because of cost and insurance). MEPS sampling weights, stratum, and clusters were used. Results: YA cancer survivors were not more likely to have any expenditures in comparison to their non-cancer peers. However, if YA survivors did have expenditures, their total out-of-pocket expenditures in the multivariable model were 1.3 times more than their non-cancer peers annually. YA survivors were 2.7 times less likely to have expenditures in comparison to older adult cancer survivors. If YA survivors did have expenditures, they were 1.6 times less than older survivors annually. YA survivors experienced an annual decrease in MCS when compared to their healthy peers by 2.3 points and by 1.2 points when compared to older adult survivors. YA survivors experienced an annual decrease in PCS in comparison to their healthy peers by 3.2 points. YA survivors experienced an annual increase in PCS in comparison to older adult survivors by 4.8 points. Conclusion: If YA cancer survivors did have expenditures, they were significantly more than their non-cancer peers. In comparison to older adult survivors, YA survivors were less likely to have any expenditures and if they did have expenditures, they were less. MCS scores were lower among YA cancer survivors, indicating lower QOL in comparison to both healthy peers and older adult survivors. PCS scores were lower among YA survivors in comparison to their healthy peers, indicating decreased physical functioning, and higher than older adult survivors. The findings underscore the need for appropriate access to high-quality care for cancer survivors and interventions associated with improving MCS and PCS, particularly among those most vulnerable. Citation Format: Erin M. Mobley, Gerard Garvan, Daniel Norez, Halle Mitchell, Ramzi Salloum, Michael S. Gutter, Ziad T. Awad, Dejana Braithwaite, Stephen Anton, Matthew Gurka, Alexander S. Parker. Inequities in financial burden, quality of life, and physical functioning among cancer survivors: A nationally-representative Medical Expenditures Panel Survey (MEPS) study [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A051.

Preoperative Veteran RAND-12 Mental Composite Score of >60 Associated With Increased Likelihood of Patient Satisfaction After Total Hip Arthroplasty

BackgroundThe present study aimed to determine the distribution of Veterans RAND 12-Item health survey (VR-12) mental component scores (MCS) of patients undergoing primary total hip arthroplasty (THA) and the thresholds of VR-12 MCS scores that predict higher health care utilizations and 1-year patient-reported outcome measures (PROMs). MethodsA prospective cohort of 4,194 primary THA patients (January 2016 to December 2019) were included. Multivariable and cubic spline regression models were used to test for associations between preoperative VR-12 MCS and postoperative outcomes, including: 90-day hospital resource utilization (nonhome discharge, prolonged length of stay [LOS](ie, ≥3 days), all-cause readmission), attainment of patient acceptable symptom state (PASS) at 1-year postoperative and substantial clinical benefit (SCB) in the hip disability osteoarthritis outcome score (HOOS)-pain and HOOS-physical short form. ResultsLower VR-12 MCS was associated with older age, obesity, Black race, women, and smokers (all P < .001). Preoperative VR-12 MCS<20 was associated with more than twice the odds of nonhome discharge (odds ratio [OR]:2.31) and prolonged LOS (OR: 3.46). VR-12 MCS >60 was associated with higher odds of achieving PASS (OR: 2.00) and SCB in HOOS-joint related (JR) (OR: 1.16). Starting VR-12 MCS ≤40, there were exponentially higher odds of worse outcomes. ConclusionLow preoperative VR-12 MCS, specifically less than 40, may predict increased health care utilization. Furthermore, preoperative VR-12 MCS>60 predicts greater satisfaction at 1 year and higher odds of achieving SCB in HOOS-JR. Quantifiable thresholds for VR-12 MCS may aid in shared decision-making and patient counseling in setting expectations or may guide specific care pathway interventions to address mental health during THA. Level of EvidenceII.

Mental health status, not resilience, influences functional recovery after arthroscopic rotator cuff repairs

Recent literature has shown the importance of patient psychosocial status in overcoming stressful events, such as surgery. Resilience, the ability to "bounce back" from adversity, has been recently correlated to outcomes following arthroscopic rotator cuff repair (RCR). Overall mental well-being has also been shown to be important because patients with clinical depression and anxiety may have worse outcomes. Substantial clinical benefit (SCB) is the threshold of outcome improvement that a patient perceives as considerable. The purpose of this study was to assess the influence of preoperative resilience, mental health status, and rotator cuff tear size on patient outcome recovery measured by the American Shoulder and Elbow Surgeons (ASES) score. Patients undergoing arthroscopic RCR performed from 2016 through 2019 at a single tertiary institution by fellowship-trained sports surgeons with a high-volume shoulder practice were included. The Brief Resilience Scale (BRS) score and Veterans RAND 12-Item Health Survey (VR-12) Mental Component Score (MCS) were collected preoperatively. ASES scores were obtained preoperatively, as well as 6 and 12 months postoperatively. Patients were divided into 2 groups based on the SCB threshold of 87 for the ASES score based on validated, established literature. Rotator cuff tear size was classified as small (≤3 cm) or large (>3 cm). VR-12 MCS, BRS, and ASES scores were compared at baseline, 6 months, and 1 year using separate mixed-model analyses of variance between the tear size and SCB groups. For ASES score comparison, the VR-12 MCS was used as a covariate to account for differences in baseline mental status. RCR was performed in 119 patients, with an average age of 61 years (standard deviation, 10 years). There were 71 male and 48 female patients. At 6 months, 43% of patients met the SCB threshold. The VR-12 MCS was significantly different between RCR patients who met the SCB threshold for the ASES score and those who did not at 6 and 12 months for large rotator cuff tears (P=.001) but not small tears (P=.07). The BRS score was not different between the tear size and SCB groups at any time point (P=.12). Our results show that patients who met the SCB threshold at 6 months postoperatively after arthroscopic RCR demonstrated higher preoperative VR-12 MCS values; however, higher preoperative BRS scores were not seen in those meeting the SCB threshold. In fact, when baseline VR-12 MCS values were accounted for in patients with large rotator cuff tears, the differences in ASES scores normalized. This finding suggests that baseline mental health status, as measured by the VR-12 MCS, significantly influenced patients' functional recovery following RCR. Future research should focus on preoperative psychosocial well-being to optimize postoperative outcomes.

Mental Health as a Predictor of Preoperative Expectations for Pain and Disability Following Lumbar Fusion

To evaluate impact of preoperative mental health on expectations in patients undergoing transforaminal, anterior, or lateral lumbar interbody fusion. Demographics, perioperative characteristics, duration of preoperative symptoms, and preoperative mental health scores were collected. Pain and disability were recorded using preoperative visual analog scale (VAS) for back and leg pain and Oswestry Disability Index scores. Patients' expectations were recorded. Preoperative mental health was recorded using Patient Health Questionnaire-9 (PHQ-9), 12-Item Short Form Health Survey (SF-12) mental component score (MCS), and Veterans RAND 12-Item Health Survey (VR-12) MCS. PHQ-9 scores were categorized by severity of depressive symptoms. Simple linear regression evaluated impact of preoperative mental health on patient expectations for pain and disability; multiple linear regression evaluated the same while accounting for preoperative scores. In 181 patients, PHQ-9 and increasing severity of depressive symptoms significantly predicted VAS back pain expectations (P ≤ 0.006); significance was lost after accounting for preoperative VAS back pain. All mental health outcomes significantly predicted VAS leg pain expectations (P ≤ 0.040); only PHQ-9 retained significance after accounting for preoperative VAS leg pain. All mental health scores significantly predicted ODI expectations (P < 0.001); none retained significance after accounting for preoperative ODI. PHQ-9, SF-12, and VR-12 significantly predicted all ODI domains except personal care and pain intensity (P ≤ 0.045). PHQ-9 significantly predicted patient expectations for lifting, walking, standing, sleeping, sex life, and social life. SF-12 MCS significantly predicted expectations for lifting, walking, standing, sleeping, and social life after accounting for preoperative domain scores. VR-12 MCS significantly predicted expectations for lifting, walking, standing, sleeping, sex life, and social life (P ≤0.050, all), even after accounting for preoperative scores. Mental health scores impact expectations regarding improvement in more active areas of a patient's life. Poor mental health scores may be associated with lower expectations for preoperative symptom improvement.

Health Conditions, Substance Use, Physical Activity, and Quality of Life in Current and Former Baseball Players.

Background:A comprehensive understanding of lifestyle (health conditions and substance use), health-related quality of life (HRQoL), flourishing (holistic representation of health), and physical activity can inform stakeholders (players, coaches, and clinicians) and help improve long-term health across the life span.Purpose:To describe health conditions (comorbidities or diagnoses), substance use, physical activity, HRQoL, and flourishing in current and former collegiate and professional baseball players and to assess the relationship between playing position and HRQoL/flourishing in former baseball players.Study Design:Descriptive epidemiology study.Methods:Eligible participants were those ≥18 years old with ≥1 season of collegiate or professional baseball experience. Participants completed a survey on health conditions (asthma, diabetes, hypertension, hypercholesterolemia, and depression), substance use (tobacco, alcohol, and energy drinks), physical activity (International Physical Activity Questionnaire–Short Form), HRQoL (Veterans Rand 12-Item Health Survey [VR-12] physical and mental component scores), and flourishing (Flourishing Scale). Adjusted multivariable regressions were performed for HRQoL and flourishing.Results:Overall, 260 baseball players opened the survey, and 214 (current players, 97; former players, 117) participated for an 82% response rate. Of the former players, 32% had hypertension or hypercholesterolemia. In addition, 26% of current players had used smokeless tobacco (median, 3 years; interquartile range [IQR], 1-5 years) as compared with 34% of former players (median, 15 years; IQR, 5-25 years). In addition, 14% of current players had used electronic cigarettes (median, 2 years; IQR, 0-4 years) as opposed to 3% of former (median, 3 years; IQR, 2-4 years). Energy drinks were consumed by 31% and 14%, respectively, of current and former players on at least a weekly basis. Current baseball players performed 8667 metabolic equivalents per week of physical activity as opposed to 3931 in former players. Pitching was associated with worse VR-12 Mental Component Scores (–5.0; 95% confidence interval, –9.0 to –1.0). Playing position was not related to VR-12 Physical Component Scores or flourishing in former baseball players.Conclusion:The similar smokeless tobacco prevalence between current and former baseball players suggests that they may start using tobacco products during baseball participation and continue after retirement. Similar reported HRQoL as compared with the general US population and high flourishing and physical activity levels suggest that baseball players may present with good musculoskeletal and psychological health.

Do patient-reported outcome measures improve after aseptic revision total hip arthroplasty?

The purpose of this study was to determine patient-reported outcome measures (PROMs) changes in: (1) pain, function and global health; and (2) predictors of PROMs in patients undergoing aseptic revision total hip arthroplasty (rTHA) using a multilevel model with patients nested within surgeon. A prospective cohort of 216 patients with baseline and 1-year PROMs who underwent aseptic rTHA between January 2016 and December 2017 were analysed. The most common indication for rTHA was aseptic loosening, instability, and implant failure. The PROMs included in this study were HOOS Pain and HOOS Physical Function Short-form (PS), Veterans RAND-12 Physical Component Score (VR-12 PCS), and VR-12 Mental Component Score (MCS). Multivariable linear regression models were constructed for predicting 1-year PROMs. Mean 1-year PROMs improvement for aseptic revisions were 30.4 points for HOOS Pain and 22.1 points for HOOS PS. Predictors of better pain relief were patients with higher baseline pain scores. Predictors of better 1-year function were patients with higher baseline function and patients with a posterolateral hip surgical approach during revision. Although VR-12 PCS scores had an overall improvement, nearly 50% of patients saw no improvement or had worse physical component scores. Only 30.7% of patients reported improvements in VR-12 MCS. Overall, patients undergoing aseptic rTHA improved in pain and function PROMs at 1 year. Although global health assessment improved overall, nearly half of aseptic rTHA patients reported no change in physical/mental health status. The associations highlighted in this study can help guide the shared decision-making process by setting expectations before aseptic revision THA.

Can We Predict Unplanned Intensive Care Unit Admission in Hip and Knee Arthroplasty?

AbstractPreoperative risk stratification remains important for both patient safety and cost-effective allocation of resources in total joint arthroplasty. Limited literature exists investigating risk factors for unplanned intensive care unit (ICU) admission following arthroplasty. Therefore, the purpose of this study was to assess a broader spectrum of factors that may increase the risk of ICU admission across multiple surgical settings. We retrospectively reviewed 18,169 patients who underwent a hip (40.7%) or knee (59.3%) arthroplasty procedure (primary: n = 13,384, 90%; revision: n = 1,485, 10%) between August 1, 2015, and January 31, 2019, across nine sites at a single institution. Patient demographics, laboratory data, surgical parameters, and preoperative scores on the Hip Disability and Osteoarthritis Outcome Score (HOOS) or Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Veterans RAND 12-Item Health Survey (VR-12) were recorded. A univariate analysis was conducted to identify differences between patients who required an ICU admission and those with no ICU involvement. Logistic regression was then used to generate predicted risk of ICU Involvement. A total of 147 patients (0.99%) required an ICU admission. Increasing age, higher Charlson's comorbidity index, American Society of Anesthesiologists (ASA) class 3 or greater, elevated blood urea nitrogen (BUN), elevated creatinine, decreased preoperative hemoglobin level, general anesthesia, surgical setting, revision procedure, and lower baseline scores on the KOOS Quality of Life (QOL) subscale (17 vs. 22.5, p = 0.032), VR-12 physical component score (PCS; 24.4 vs 27.1, p = 0.001), and VR-12 mental component score (MCS; 45.9 vs. 49.6, p = 0.003) were associated with a statistically significant increase in the risk of ICU admission. As performance of arthroplasty shifts in both the setting of care and the complexity of patients, identifying patients most at risk of requiring higher acuity of care is important. Preoperative assessment of comorbidities, kidney function, surgical setting, KOOS QOL subscale score, and VR-12 scores may provide guidance for the improvement of value-based care pathways.

Associations of preoperative patient mental health status and sociodemographic and clinical characteristics with baseline pain, function, and satisfaction in patients undergoing primary shoulder arthroplasty

Shoulder pain and dysfunction are common indications for shoulder arthroplasty, yet the factors that are associated with these symptoms are not fully understood. This study aimed to investigate the associations of patient and disease-specific factors with preoperative patient-reported outcome measures (PROMs) in patients undergoing primary shoulder arthroplasty. We hypothesized that worse mental health status assessed by the Veterans RAND 12-Item Health Survey (VR-12) mental component score (MCS), glenoid bone loss, and increasing rotator cuff tear severity would be associated with lower values for the preoperative total Penn Shoulder Score (PSS) and its pain, function, and satisfaction subscores. We prospectively identified 12 patient factors and 4 disease-specific factors as possible statistical predictors of preoperative PROMs in patients undergoing primary shoulder arthroplasty at a single institution over a 3-year period. Multivariable statistical modeling and Akaikeinformation criterioncomparisons were used to investigate the unique associations with, and relative importance of, these factors in accounting for variation in the preoperative PSS and its subscores. A total of 788 cases performed by 12 surgeons met the inclusion criteria, with a preoperative median total PSS of 31 points (pain, 10 points; function, 18 points; and satisfaction, 1 point). As hypothesized, a lower VR-12 MCS was associated with lower preoperative PSS pain, function, and total scores, but patients with intact status or small to medium rotator cuff tears had modestly lower PSS pain subscores (ie, more pain) than patients with large to massive superior-posterior rotator cuff tears. Glenoid bone loss was not associated with the preoperative PSS. Female sex and fewer years of education (for all 4 outcomes), lower VR-12 MCS and preoperative opioid use (for all outcomes but satisfaction), and rotator cuff tear severity (for pain only) were the factors most prominently associated with preoperative PROMs. In addition to mental health status and rotator cuff tear status, patient sex, years of education, and preoperative opioid use were most prominently associated with preoperative PROMs in patients undergoing shoulder arthroplasty. Further studies are needed to investigate whether these factors will also predict postoperative PROMs.

Preoperative cut-off values for body mass index deny patients clinically significant improvements in patient-reported outcomes after total hip arthroplasty.

Thresholds for operative eligibility based on body mass index (BMI) alone may restrict patient access to the benefits of arthroplasty. The purpose of this study was to evaluate the relationship between BMI and improvements in patient-reported outcome measures (PROMs), and to determine how many patients would have been denied improvements in PROMs if BMI cut-offs were to be implemented. A prospective cohort of 3,449 primary total hip arthroplasties (THAs) performed between 2015 and 2018 were analyzed. The following one-year PROMs were evaluated: hip injury and osteoarthritis outcome score (HOOS) pain, HOOS Physical Function Shortform (PS), University of California, Los Angeles (UCLA) activity, Veterans Rand-12 Physical Component Score (VR-12 PCS), and VR-12 Mental Component Score (VR-12 MCS). Positive predictive values for failure to improve and the number of patients denied surgery in order to avoid a failed improvement were calculated for each PROM at different BMI cut-offs. There was a trend to improved outcomes in terms of pain and function improvements with higher BMI. Patients with BMI ≥ 40 kg/m2 had median (Q1, Q3) HOOS pain improvements of 58 points (interquartile range (IQR) 41 to 70) and those with BMI 35 to 40 kg/m2 had median improvements of 55 (IQR 40 to 68). With a BMI cut-off of 30 kg/m2, 21 patients would have been denied a meaningful improvement in HOOS pain score in order to avoid one failed improvement. At a 35 kg/m2 cut-off, 18 patients would be denied improvement, at a 40 kg/m2 cut-off 21 patients would be denied improvement, and at a 45 kg/m2 cut-off 21 patients would be denied improvement. Similar findings were observed for HOOS-PS, UCLA, and VR-12 scores. Patients with higher BMIs show greater improvements in PROMs. Using BMI alone to determine eligibility criteria did not improve the rate of clinically meaningful improvements. BMI thresholds prevent patients who may benefit the most from surgery from undergoing THA. Surgeons should consider PROMs improvements in determining eligibility for THA while balancing traditional metrics of preoperative risk stratification. Cite this article: Bone Joint J 2020;102-B(6):683-692.

Hip Status and Long-term Functional Outcomes in Spina Bifida.

Nearly 50% of individuals with myelomeningocele will develop a dislocated hip by skeletal maturity. The purpose of this study was to determine the influence of hip status on functional outcomes in a cohort of adult patients with myelomeningocele. Patients with a diagnosis of myelomeningocele >18 years were prospectively enrolled over a 12-month period. Neurological level of involvement was obtained from chart review and interview. Clinical examination included hip range of motion and leg-length discrepancy. Reimer's migration index was calculated from a current anteroposterior pelvic radiograph. All subjects completed the VR-12 and the NIH PROMIS outcomes measures for pain interference and physical function. The χ, the Pearson correlation coefficients, and linear regression models were applied to evaluate the influence of hip status on functional outcomes. In total, 31 patients (average age 31, range 19 to 49) were included. Eight thoracic, 9 lumbar, and 14 sacral level patients participated. Twenty had bilaterally located hips, 5 had a unilateral subluxation or dislocation, and 6 had bilaterally subluxated or dislocated hips. In univariate analysis, patients with bilaterally located hips performed better in lower extremity function than those with unilateral subluxation/dislocation (36.7 vs. 26.0; P=0.03) but worse in pain interference than those with bilateral subluxation/dislocation (52.0 vs. 43.3; P=0.03). After controlling for neurological level, there was no statistically significant difference in the VR-12 mental (P=0.32) or physical component summary (P=0.32) scores, nor in the PROMIS lower extremity function (P=0.26) or pain interference scores (P=0.33) between groups. Decreased extension and abduction were indirectly correlated with VR-12 mental component scores (P=0.0038, 0.0032). Leg-length discrepancy was not associated with any outcome measure. Long-term outcomes are not associated with hip status in adult patients with myelomeningocele. Functional outcomes are more closely correlated with neurological level and hip range of motion. These results suggest efforts to keep myelomeningocele hips reduced are likely without functional benefit and should be avoided in favor of maintaining motion with contracture release as needed. Level III.

Sport and Physical Activity Level Impacts Health-Related Quality of Life Among Collegiate Students.

To examine and compare the role of self-assessed sport and physical activity involvement on the health-related quality of life among undergraduate student-athletes and general undergraduate college students. Cross-sectional survey. Data set was examined for differences in physical and mental health by self-assessed sport and physical activity level. Large Midwestern University in the fall of 2016. A combined data set representing undergraduate Division I student athletes (n = 842) and general undergraduate students (n = 1322). Veterans RAND 12 Item Health Survey (VR-12), as measure of health-related quality of life, comprised of physical component score (PCS) and mental component score (MCS). Self-assessed sport and physical activity level categorized as Division I athlete, club athlete, intramural player, student who works out regularly, or student who is physically inactive. Standard univariable statistics described the study population. Two-sample t tests and χ2 tests were conducted, as appropriate, to compare Division I student-athletes to the general undergraduate group. Multivariable linear regression models were then built to assess associations between physical activity level and year in school with VR-12 outcomes, after adjusting for sex. All pairwise interactions were considered for inclusion in the final models. Adjusted least-square means were calculated for all variables in the model; pairwise comparisons were adjusted for multiple comparisons via Tukey-Kramer adjustment criteria. A linear test for trend was also conducted for the association between VR-12 MCS and increasing physical activity. Significant differences in MCS were noted between levels of sport and physical activity; however, such differences were not detected in PCS. After controlling for sex, a positive relationship between increased sport and physical activity level and greater MCS was found. This study represents the first prospective assessment of health-related quality of life among undergraduate athletes and general college students. Higher levels of sport and physical activity were associated with more positive mental health in these populations.

Wednesday, September 26, 2018 3:35 PM – 5:05 PM Preserving Spinal Motion: 83. Outcomes of 3- and 4-level cervical disc arthroplasty

BACKGROUND CONTEXT Cervical disc arthroplasty (CDA) is FDA-approved for the treatment of 1- and 2-level cervical disc disease. The long-term safety and efficacy of CDA at one or two levels is supported by extensive Level I evidence. However, little research evidence exists for CDA performed at more than two levels. To our knowledge, this is the largest reported cohort of 3- and 4-level CDA patients to date. PURPOSE This study investigates the safety and effectiveness of 3- and 4-level CDA. STUDY DESIGN/SETTING This is a statistical analysis of prospectively-collected data from a patient cohort at a single ambulatory surgery center. PATIENT SAMPLE Patients treated by one fellowship-trained surgeon for cervical disc disease underwent 3- or 4-level CDA between April 2008 and July 2017. Demographic, diagnostic, and surgical characteristics were recorded and measured. OUTCOME MEASURES Pre- to postoperative changes in patient-reported outcomes (PROs), including in Neck Disability Index (NDI), numerical rating scales for neck and arm pain, and the Veterans Rand 12-item health survey (VR-12) physical component score (PCS) and mental component score (MCS) were analyzed out to 3+ years after surgery. All secondary surgeries from April 2008 to July 2017 were recorded. METHODS Chi-square test and t test were used to assess preoperative and postoperative differences for categorical and continuous variables, respectively. RESULTS A total of 87 patients underwent 3-level (N=71) or 4-level (N=16) CDA. The sample was 56.3% male with an average age of 50.30 ± 8.68 years and average BMI of 30.42±5.08 at surgery. No significant differences in demographic characteristics were detected between the 3- and 4- level groups, except for age (49.31±8.89 vs. 54.69±6.11, p=.024). The preoperative to postoperative improvement in scores was statistically significant for all PROs, and the postoperative scores were not statistically different between the two groups. The large improvements in NDI (58.82±15.67 to 28.80±20.86), neck pain intensity (7.15±1.90 to 2.98±2.33), and arm pain intensity (6.38±2.67 to 2.54±2.76) scores indicate a reduction in disability and pain ranging from 45% to 61%. VR-12 PCS improved from 31.94±8.34 to 41.71±10.69 and VR-12 MCS from 39.20±10.26 to 46.81±11.26. The majority of patients (89.23%) reported being definitely or mostly satisfied with the surgery, and 80.0% reported being completely recovered or much improved. Four 3-level patients underwent a secondary surgery after 17.00±8.45 months. Three of these additional surgeries were for further decompression due to ongoing foraminal stenosis. One surgery was an implant removal and fusion due to subsidence. CONCLUSIONS Patients reported significant pain and disability improvement and high satisfaction following 3- and 4-level cervical disc arthroplasty. No statistical differences in improvement were seen between the two groups. These findings indicate that 3- and 4 level CDA may be performed safely and effectively in appropriately-selected patients. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Establishing Minimal Important Differences for the VR-12 and SANE Scores in Patients Following Treatment of Rotator Cuff Tears.

Background:Minimal important differences (MIDs) for the Veterans RAND 12-Item Health Survey (VR-12) and the Single Assessment Numeric Evaluation (SANE) have not been reported in patients following treatment for rotator cuff tears (RCTs).Purpose:To determine the MIDs for the VR-12 and SANE among patients with RCT after treatment.Study Design:Cohort study (diagnosis); Level of evidence, 2.Method:A total of 222 patients diagnosed with RCT completed the VR-12 and SANE at baseline and then received surgical or nonsurgical treatment. After 64 weeks, 160 patients completed the VR-12, the SANE, and a global change questionnaire. We applied a distribution-based approach to estimate the MIDs for the SANE and for the physical component score (PCS) and mental component score (MCS) of the VR-12. We then used the global rating score as an anchor for 20 patients who perceived a minimal improvement, and we applied an anchor-based approach. One-half standard deviation of the baseline score was used in the distribution-based approach. Linear regression analyses and backward model selection were conducted to evaluate the associations between patients’ characteristics and the anchor-based MIDs.Results:The MIDs derived from distribution-based method estimates for the VR-12 PCS, MCS, and SANE scores were 4.94, 5.99, and 11.80, respectively. The MIDs estimated using the anchor-based method for the PCS, MCS, and SANE scores were 2.57 (90% CI, –1.62 to 6.76), 1.87 (90% CI, –2.07 to 5.80), and 27.25 (90% CI, 16.17 to 38.33), respectively. The final regression model for significant predictors of the MID on the PCS included baseline PCS (P < .001), body mass index (P = .014), symptom duration (P = .011), diabetes (P = .009), and surgery (P = .089). The final model for the MID on the MCS included baseline MCS (P < .001), patient sex (P = .027), and diabetes (P = .083). The final model for the MID on SANE included baseline SANE score (P = .059) and diabetes (P = .050).Conclusion:This is the first study to assess the MIDs for the VR-12 and SANE scores in patients with rotator cuff disease. The estimates of MID will facilitate the interpretation and application of these outcome measures in clinical practice and research.