Elsevier

The Journal of Arthroplasty

Volume 34, Issue 12, December 2019, Pages 2937-2943
The Journal of Arthroplasty

Primary Arthroplasty
A One-Question Patient-Reported Outcome Measure Is Comparable to Multiple-Question Measures in Total Knee Arthroplasty Patients

https://doi.org/10.1016/j.arth.2019.07.023Get rights and content

Abstract

Background

Patient-reported outcome measures (PROMs) are important for tracking outcomes following total knee arthroplasty (TKA) but can be limited by time constraints and patient compliance. We sought to evaluate the utility of the one-question, modified single assessment numerical evaluation (M-SANE) score in TKA patients compared to legacy PROMs.

Methods

Patients undergoing TKA completed the Patient-Reported Outcomes Measurement Information System-10 (PROMIS-10), the Knee Disability and Osteoarthritis Outcomes Score Junior (KOOS Jr), and M-SANE (modified-SANE) assessments both preoperatively and postoperatively. The M-SANE score asked patients to rate their native or prosthetic knee on a scale from 0 to 10, with 10 being the best function. M-SANE validity was determined by the Spearman’s correlation between the collected PROMs and the Bland-Altman plots. PROM responsiveness was assessed using the standardized response mean.

Results

In total, 217 patients completed PROMs preoperatively and at 1 year postoperatively. Floor and ceiling effects of the M-SANE were higher than other PROMs but still relatively low (4%-11%). There was a moderate to strong correlation at nearly all time points between the M-SANE and KOOS Jr (ρ = 0.44-0.78, P < .001). There was a weak correlation between the M-SANE and PROMIS physical component summary at the preoperative evaluation (ρ = 0.28) but a strong correlation at 1-year follow up (0.65, P < .001). The long-term responsiveness of the M-SANE to TKA (standardized response mean [SRM] = 0.98, 95% confidence interval [CI] 0.80-1.17) was comparable to both the KOOS Jr (SRM = 1.19, 95% CI 1.00-1.38) and PROMIS physical component summary (SRM = 0.82, 95% CI 0.74-0.91). Bland-Altman plots demonstrated that the M-SANE and KOOS Jr capture combined knee pain and functionality differently.

Conclusion

The M-SANE score was comparable to validated multiple-question PROMs in TKA patients. The demonstrated validity of the M-SANE, as well as its comparable responsiveness to more lengthy PROMs, highlights its use as a one-question PROM for assessment of patient undergoing TKA.

Section snippets

Methods

To evaluate the effectiveness of a single-question PROM, we retrospectively evaluated prospectively collected data from an institutional arthroplasty outcomes database at an academic medical center in the Northeastern United States. Between 2017 and 2019, patients in the TKA clinic completed an M-SANE score assessment where they were asked to rate their knee on a scale from 0 to 10. The M-SANE was modified from the original 0-100 SANE score [15], [17], [18] to a 0-10 scale to make it easier for

Results

In total, M-SANE and KOOS Jr scores were available at both the preoperative and extended follow-up visits from 217 patients (Table 2). Floor and ceiling effects, when the patient scored either a maximum or minimum value, were higher with the M-SANE in comparison to the other PROMs, but still relatively low across all time periods (4%-11%; Table 3). The average M-SANE score preoperatively was 3.5 (SD 2.2) and this increased to 6.6 (SD 2.6) at extended follow-up (Table 1). The minimal clinically

Discussion

PROMs are an increasingly relevant way to assess the effectiveness of orthopedic surgery [2], [4] as they provide insight from the point of view of the patient [1], but can be problematic due to the time and resources associated with their administration [1], [2]. A one-question PROM, such as the SANE, is a shorter alternative that has been evaluated in a number of orthopedic settings with promising results [6], [16], [17], [18], [20]; however, its effectiveness as a longitudinal assessment

Conclusion

PROMs are becoming an increasingly important component for assessing the outcomes following joint arthroplasty but are limited by time constraints and low participation rates, highlighting the need for more simplified measures. The M-SANE score, in which patients respond to a single question asking them to rate their knee on a scale from 0 to 10, performed comparably to multiple-question PROMs including the KOOS Jr and PROMIS-PCS in a population of TKA patients. Although additional studies are

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    Investigation was performed at the Dartmouth-Hitchcock Medical Center, Lebanon, NH

    Sources of Funding: There was no external funding utilized for this project.

    One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2019.07.023.

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