A SANE Approach to Outcome Collection? Comparing the Performance of Single- Versus Multiple-Question Patient-Reported Outcome Measures After Total Hip Arthroplasty

doi:10.1016/j.arth.2020.01.015

The Journal of Arthroplasty

Volume 35, Issue 6, Supplement, June 2020, Pages S207-S213

https://doi.org/10.1016/j.arth.2020.01.015 Get rights and content

Abstract

Background

Several patient-reported outcome measures (PROMs) exist to measure outcomes after total hip arthroplasty (THA) but can be limited by patient-perceived burden and completion rates. We analyzed whether the modified single assessment numerical evaluation (M-SANE), a one-question PROM, would perform similarly to multiple-question PROMs among patients undergoing primary THA.

Methods

Patients undergoing THA completed the Patient-Reported Outcomes Measurement Information System-10 (PROMIS-10), the Hip Disability and Osteoarthritis Outcomes Score Junior (HOOS-Jr), and M-SANE questionnaires both preoperatively and postoperatively. The M-SANE assessment asked patients to assess their hip on a scale from 0 to 10, with 10 being the best possible score. Validity of M-SANE compared with other PROMs was determined by Spearman’s correlation and floor and ceiling effects. Responsiveness was analyzed using standardized response mean (SRM).

Results

One hundred and thirty six patients with at least 1-year follow-up were reviewed. The average M-SANE score improved from 3.3 preoperatively to 7.1 at one year postoperatively. There was moderate to strong correlation at one-year follow-up between the M-SANE and HOOS-Jr (ρ = 0.75, P < .001) and PROMIS-10 physical component summary (ρ = 0.63, P < .001). Floor and ceiling effects of the M-SANE (floor 2.0%, ceiling 21.3%) were comparable to the HOOS-Jr (floor 0.0%, ceiling 20.8%). The responsiveness of the M-SANE after THA (SRM = 1.06, 95% CI: 0.79-1.33) was comparable to HOOS-Jr (SRM = 1.33, 95% CI: 1.08-1.59) and superior to PROMIS-10 physical component summary (SRM = 0.65, 95% CI: 0.55-0.74).

Conclusion

The M-SANE has performed similarly across multiple psychometric properties compared with more burdensome PROMs in assessing longitudinal patient-reported outcomes after THA.

Section snippets

Materials and Methods

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 2018, patients in the total joint arthroplasty clinic completed an M-SANE score assessment on either an electronic tablet or through an online portal where they were asked to rate their hip on a scale from 0 to 10. Specifically, patients were asked “How do you rate your hip?” and asked to record their

Results

There were a total of 409 patients undergoing THA in 2017 at our institution. Patients in our study were more likely to be female (53.3%), white (97.0%), between the ages of 61-70 (36.9%), and have a BMI between 25.0 and 29.9 (34.2%) (Table 1). The attrition rates according to the three survey collection windows used in the study are shown in Table 2.

The average preoperative M-SANE score was 3.3, which rose to 7.3 in the immediate follow-up period and 7.1 at the extended follow-up period (

Discussion

This study demonstrates that the M-SANE, a single-question PROM, performs similarly across multiple psychometric properties to more burdensome generic and condition-specific PROMs in patients after THA. The aggregate of our results suggests that a single-question, patient-reported assessment of joint function can be used to track patient outcomes within the first year after THA without compromising the integrity of the collected data.

Our results showed strong correlation between the M-SANE and

Conclusions

The M-SANE, a single-question, joint-specific PROM, was performed similarly across multiple psychometric properties to more burdensome PROMs in assessing patient-reported outcomes after THA. The M-SANE is a more efficient PROM to measure the longitudinal outcome of patients undergoing THA without compromising the quality of the data collected. In a health care environment that is increasingly incentivized to measure value after common orthopedic surgical procedures, the single-question M-SANE

Acknowledgment

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

References (33)

J.S. Kalantar et al.
The effects of lottery incentive and length of questionnaire on health survey response rates: a randomized study
J Clin Epidemiol
(1999)
T. Sueyoshi et al.
Correlation between single assessment numerical evaluation score and Lysholm score in primary total knee arthroplasty patients
Arthroplasty Today
(2018)
J.A. Husted et al.
Methods for assessing responsiveness: a critical review and recommendations
J Clin Epidemiol
(2000)
G. Cunningham et al.
Correlation between American shoulder and Elbow surgeons and single assessment numerical evaluation score after rotator cuff or SLAP repair
Arthroscopy
(2015)
S.A. Hunt et al.
Arthroscopic treatment of osteochondral lesions of the talus with correlation of outcome scoring systems
Arthroscopy
(2003)
E. Codman
The registry of bone sarcoma as an example of the end-result idea in hospital organization
Bull Am Coll Surg
(1924)
M.E. Porter
A strategy for health care reform—toward a value-based system
N Engl J Med
(2009)
K.J. Bozic et al.
Value-based healthcare and orthopaedic surgery: editorial comment
Clin Orthop Relat Res
(2012)
B.U. Nwachukwu et al.
Measuring value in orthopaedic surgery
JBJS Rev
(2013)
D. Cella et al.
The Patient-Reported Outcomes Measurement Information System (PROMIS): progress of an NIH Roadmap cooperative group during its first two years
Med Care
(2007)

J.E. Ware et al.

The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection

Med Care

(1992)

A.K. Nilsdotter et al.

Hip disability and osteoarthritis outcome score (HOOS)--validity and responsiveness in total hip replacement

BMC Musculoskelet Disord

(2003)

E.M. Roos et al.

Knee injury and osteoarthritis outcome score (KOOS)--development of a self-administered outcome measure

J Orthop Sports Phys Ther

(1998)

N. Bellamy et al.

Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee

J Rheumatol

(1988)

J.C. Fairbank et al.

The Oswestry low back pain disability questionnaire

Physiotherapy

(1980)

P.L. Hudak et al.

Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder, and head)

Am J Ind Med

(1996)

Cited by (12)

Examining the Relationship Between Value and Patient Satisfaction With Treatment in Total Joint Arthroplasty
2024, Arthroplasty Today
A shift toward performance, cost, outcomes, and patient satisfaction has occurred with healthcare reform promoting value-based programs. The purpose of this study was to evaluate the relationship between patient satisfaction and value with treatment in a cohort of patients undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA).
Value was determined by the relationship of treatment outcome with episodic cost. Measurements included both clinical outcomes and patient-reported outcomes. Participating surgeons took part in the modified Delphi method resulting in an algorithm measuring patient value. Treatment outcome, cost, and resultant value (outcome/cost) of both TKA and THA were evaluated using binomial logistic regression by adjusting for age, gender, body mass index, Charlson comorbidity index, tobacco, education, and income with patient-reported satisfaction as the outcome.
This study had a total of 909 patients (TKA n = 438; THA n = 471), with an average age of 67 (TKA) and 65 (THA) years. Patient satisfaction shared a significant positive relationship with treatment outcome for TKA (odds ratio [OR] = 1.53, confidence interval [CI] = 1.35-1.73, P < .001) and THA (OR = 1.93, CI = 1.62-2.29, P < .001). Higher value was associated with a significantly higher odds of patient satisfaction for both TKA (OR = 1.39, CI = 1.25-1.54, P < .001) and THA (OR = 1.70, CI = 1.47-1.97, P < .001).
This study showed a positive relationship between treatment outcome but not cost with subsequent value and patient satisfaction. This method provides a promising approach to comprehensively evaluate outcomes, cost, and value of total joint arthroplasty procedures. This approach can help predict the probability of value-driven patient satisfaction.
The Oxford Elbow Score demonstrated good measurement properties when used with a shortened 7-day recall period
2023, JSES International
The Oxford Elbow Score (OES) is a well-validated, elbow-specific, patient-reported outcome measure (PROM), originally assigned a 4-week recall period. For PROMs, short recall periods could have some advantages, such as optimizing validity by minimizing the negative effects of inaccurate recollection and temporal trends (increase or decrease) in symptoms over the course of the recall period. Temporal trends in elbow function can, for example, be expected to occur over 4 weeks in patients recovering from an injury or surgery. The purpose of this study was to evaluate the measurement properties of the OES using a shortened, 7-day, recall period (OES-7d).
The inclusion criteria were fracture, tendon rupture or dislocation affecting the elbow, and age ≥18 years. Patients with Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores of ≥10 points preinjury (pre-existing upper extremity condition) or concurrent upper extremity injuries were excluded. Patients completed the OES-7d, QuickDASH, and Single Assessment Numeric Evaluation-Function for the last 7 days preinjury (T1), the first 7 days postinjury (T2) and a 7-day period 3-5 months postinjury (T3). Correlations were assessed with Spearman’s rho. Analyses of construct validity (correlation between scores) and internal consistency (Cronbach’s alpha) were based on T3 data. Responsiveness was assessed by correlating changes in scores (change scores) between time points. Intra-rater reliability was assessed by calculating intraclass correlation coefficients based on 2 administrations (1- to 3-week interval) of PROMs in a separate group of patients who had sustained an elbow injury 1-2 years previously.
Seventy-five patients (45 women) were included between May 2020 and July 2021. Their mean age was 51.7 years. At T3, Spearman’s rho was −0.91 for the correlation between OES total and QuickDASH scores and 0.76 for the correlation between OES total scores and Single Assessment Numeric Evaluation-Function values (construct validity). Spearman’s rho for correlation between OES total and QuickDASH change scores from T2 to T3 (T3 minus T2) was −0.85 (responsiveness for improvement) and −0.88 for change scores from T1 to T2 (T2 minus T1, responsiveness for deterioration). For the OES domains, Cronbach’s alpha was 0.83 for elbow function, 0.91 for pain and 0.90 for social-psychological domains. The intraclass correlation coefficient for the OES total score was 0.96.
The OES demonstrated good measurement properties when used with a 7-day recall period (OES-7d). These results further establish the OES as a well-validated, elbow-specific PROM and support using a 7-day recall period.
Substantial Improvement in Self-Reported Mental Health Following Total Hip Arthroplasty Occurs Independent of Anesthetic Technique
2023, Journal of Arthroplasty
The influence of anesthetic type on mental health after total hip arthroplasty (THA) is poorly understood. Adverse effects of general anesthesia (GA) on cognition following major non-cardiac surgery are well known, but mental health following THA is less well-studied. We hypothesized that neuraxial anesthesia (NA) would provide favorable mental health profiles compared with GA after THA.
Prospectively collected Patient-Reported Outcomes Measurement Information System-10 (PROMIS) Global Mental Health (GMH) scores at preoperative baseline, and 1, 3, and 6 months after THA were accessed on 4,353 patients in the Pulmonary Embolism Prevention After HiP and KneE Replacement (PEPPER) Trial (ClinicalTrials.gov: NCT02810704). Anesthesia was categorized as: general (GA), neuraxial (NA), and neuraxial with peripheral block (NAP). The GMH was assessed longitudinally and compared between groups.
Postoperative GMH improved (P < .05) over preoperative in every anesthetic group. Groups receiving NA had higher baseline GMH scores. Improvement in GMH was diminished after GA alone and plateaued after 1 month. Adding NA or peripheral nerve block to GA conferred additional benefit to GMH improvement.
Patient-perceived mental health improves significantly after THA regardless of anesthetic type. Patients who have higher baseline GMH scores more commonly received NA, likely due to nonsurgical care determinants; these differences in mental wellness persisted at follow-up. Adjunctive NA or peripheral nerve block favored GMH improvement, whereas solitary GA diminished GMH improvement, which plateaued after 1 month. Substantial mental health benefits of THA may overshadow subtle differences in GMH attributable to anesthetic type.
Response rate underreports improvement in patients with major depressive disorder and comorbidities treated with repetitive transcranial magnetic stimulation (rTMS)
2022, Psychiatry Research Communications
To study the efficacy of repetitive Transcranial Magnetic Stimulation (rTMS) in Major Depressive Disorder (MDD) including comorbidities of Generalized Anxiety Disorder (GAD), Post-Traumatic Stress Disorder (PTSD), and Borderline Personality Disorder (BPD). We compared response and remission rates to a single question patient-reported outcome (PRO).
A retrospective review of patients completing rTMS from 1/2009-2/2021. Standard response (≥50% reduction in Patient Health Questionnaire-9 [PHQ-9]) and remission (PHQ-9 < 5) definitions were used. The PRO was a single yes/no question “Did you feel rTMS was helpful?” rTMS parameters were 10 Hz, 3000 pulses/session, 120% of motor threshold over the left dorsolateral prefrontal cortex (DLPFC). Student’s t-test was used to compare PHQ-9 baseline, endpoint, and change scores with and without comorbidities. Response, remission, and PRO were analyzed using chi-square or Fisher’s Exact tests. Logistic regression examined gender and age predictors.
84 patients were analyzed, with comorbidities of GAD (52.4%), PTSD (13.1%), and BPD (15.5%). Response and remission rates were 42.9% and 16.7%, respectively. The PRO was 61.9%. There were no significant differences in these rates with versus without comorbidities. In post-hoc analysis, gender was not a predictor for better outcomes, and older patients were more likely to experience remission than younger patients.
Retrospective study, small sample size of PTSD and BPD.
Comorbidities did not influence response and remission rates. The standard response rate underreported the patient’s perceived improvement. The patient’s point of view should be taken into account when discussing the clinical use of rTMS for MDD.
The Single Assessment Numeric Evaluation (SANE) after anterior cervical discectomy and fusion: A pilot study
2021, Journal of Clinical Neuroscience
Citation Excerpt :
Mean scores, as well as floor and ceiling rates, were calculated for all PROMs pre-operatively and at final follow up. A floor or ceiling effect was only considered to be present if greater than 15% of patients recorded the maximum or minimum score possible in the PROM [3,4]. Standardized response mean (SRM), to assess the responsiveness of each survey to detect a change in health state [13], was calculated using a previously described technique [3,4].
Retrospective cohort.
To evaluate the single assessment numerical evaluation (SANE) as a patient reported outcomes measure (PROM) after anterior cervical discectomy and fusion (ACDF), by comparing to legacy measures.
We included all patients undergoing ACDF with at least one year of follow up with complete PROM data. Patients completed the Neck Disability Index (NDI), the RAND-36 and the EuroQual Five Dimension (EQ-5D) scale, as well as the one-question SANE, pre- and post-operatively. Validity of SANE compared with other PROMs was determined utilizing Pearson’s correlation (ρ), proportional bias (B), responsiveness, minimal clinically important difference (MCID) and agreement.
Sixty-nine patients were included. There were moderate-to-strong correlations at a minimum of one-year follow-up between the SANE and NDI (ρ = −0.73, P < 0.0001), RAND (ρ = 0.80, P < 0.0001), and EQ-5D (ρ = −0.66, P < 0.0001). No significant proportional bias was found for the SANE when compared to the RAND (B = 0.03, p = 0.99), NDI (B = −0.003, p = 0.99), or EQ-5D (B = −0.0007, p = 0.99). Responsiveness for SANE was statistically similar to all other PROMs. The MCID for SANE was determined to be 10.5, with 42% of patients achieving the MCID. Bland-Altman plots demonstrated high agreement between all PROMs.
We found the SANE score provides clinically important patient outcomes data after ACDF, despite only requiring answering one question. The SANE performs comparably to more burdensome health questionnaires. The SANE score may offer spine surgeons the option to easily and quickly collect clinically relevant data on their surgical patients.
Reliability, Measurement Error, Responsiveness, and Minimal Important Change of the Patient-Specific Functional Scale 2.0 for Patients With Nonspecific Neck Pain
2024, Physical Therapy

View all citing articles on Scopus

: This study was completed at Dartmouth-Hitchcock Medical Center; Lebanon, NH, USA.

: 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.2020.01.015.

View full text

Primary HipA SANE Approach to Outcome Collection? Comparing the Performance of Single- Versus Multiple-Question Patient-Reported Outcome Measures After Total Hip Arthroplasty

Abstract

Background

Methods

Results

Conclusion

Section snippets

Materials and Methods

Results

Discussion

Conclusions

Acknowledgment

J Clin Epidemiol

Arthroplasty Today

J Clin Epidemiol

Arthroscopy

Arthroscopy

The registry of bone sarcoma as an example of the end-result idea in hospital organization

Bull Am Coll Surg

A strategy for health care reform—toward a value-based system

N Engl J Med

Value-based healthcare and orthopaedic surgery: editorial comment

Clin Orthop Relat Res

Measuring value in orthopaedic surgery

JBJS Rev

The Patient-Reported Outcomes Measurement Information System (PROMIS): progress of an NIH Roadmap cooperative group during its first two years

Med Care

The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection

Med Care

Hip disability and osteoarthritis outcome score (HOOS)--validity and responsiveness in total hip replacement

BMC Musculoskelet Disord

Knee injury and osteoarthritis outcome score (KOOS)--development of a self-administered outcome measure

J Orthop Sports Phys Ther

Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee

J Rheumatol

The Oswestry low back pain disability questionnaire

Physiotherapy

Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder, and head)

Am J Ind Med

Primary Hip
A SANE Approach to Outcome Collection? Comparing the Performance of Single- Versus Multiple-Question Patient-Reported Outcome Measures After Total Hip Arthroplasty