Methods to evaluate and interpret patient-

reported outcomes

D.Mlinaric AORecon course

 outcome measures are used to assess
change over time and the response to any
intervention, such as a joint replacement

Best way ?

2
 Objective:
understand disease specific, joint specific and generic qualitiy
of life outcome scores in measuring outcomes with THA and
TKA

patient reported (PROMs)

clinician reported

3
 Joint specific
HIP KNEE

Oxford hip score Oxford knee score

HOOS (hip disability and KOOS (knee injury and
osteoarthritis outcome osteoarthritis outcome)
WOMAC score WOMAC score
IKDC (international knee
documentation
committee)

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 Disease specific

WOMAC (Western Ontario McMaster Arthritis index)

HHS ( Harris hip score)
Ab IAP ( Aberdeen impairment , activity limitation and
participation restriction measure)

5
 Generic quality of life tests

SF 36
SF 12
EQ 5D

6
 Problems / limitations

7
 Surgeon evaulation

Surgeons rated their procedure as very

successful
Up to 20 % of patients unsatisfied

Bourne et all, CORR 2010

8
 Surgeons evaluation

Suregon immediate postop satisfaction does

not corelate with outcome measurements
after 1 y
Satisfaction after TKA primarily determined
by patient expectation

9
 Objective measures!

Can Surgeons Predict What Makes a Good TKA?: Intraopeative

Surgeon Impression of TKA Quality Does Not Correlate With Knee
Society Scores

Lee at al., CORR 2012

Surgeons subjective view of technical quality of

surgery did not predict KSS

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 Conventional outcome scores

HHS
KSS

Combination of functional measures with general

questions of limitations and pain

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 Problem

Poor corelation between subjective

(VisualAnalogueScale) and objective outcome systems
(KSS) PH Bullens, J Arthopl 2001
Ceiling effect for HHS up to 20 % K.E.Wamper, Acta Orthop 2010
Assess basic outcomes and not able to discriminate
differences in functional high demanding activities

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 Patient related outcome measures (PROMs)

Pain
Function
HR QoL
social participation
mental health
satisfaction with the outcome of health-care interventions.

display the individual patient outcome, situation, demand and

need

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 PROMs Limitations

Only moderate correlation with comorbidity

Only moderate correlation with functional
measurements ( gait , stand)
Anxyety / depression

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 Conclusions

A single, validated , reliable , and responsiove PROM addressing

TKA patients priorities has not yet been identified

P. N. Ramkumar, BJR

People with anxietiy or depression may assess themselves as

being worse than objective measures suggests
There is no gold standard measure of patient reported outcome

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 Question at the end:

Which view is more important: surgeons or

patients ?

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 To obtain satisfactory picture of
improvement after THA and TKA it
wise to use one of each type of
measure ( PROM/ clinician
reported / functional measures)

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