Stephen Lyman|Yuo Yu Lee|Alexander S. McLawhorn|Wasif Islam|Catherine H. MacLean
What Are the Minimal and Substantial Improvements in the HOOS and KOOS and JR Versions After Total Joint Replacement?
National Institute of Arthritis and Musculoskeletal and Skin Diseases|National Institutes of Health|OMNI Institute|The Japanese Society of Gastroenterological Surgery|Clinical Orthopaedics and Related Research|National Institute of Arthritis and Musculoskeletal and Skin Diseases|National Institutes of Health|OMNI Institute|The Japanese Society of Gastroenterological Surgery|Clinical Orthopaedics and Related Research|National Institute of Arthritis and Musculoskeletal and Skin Diseases|National Institutes of Health|OMNI Institute|The Japanese Society of Gastroenterological Surgery|Clinical Orthopaedics and Related Research|National Institute of Arthritis and Musculoskeletal and Skin Diseases|National Institutes of Health|OMNI Institute|The Japanese Society of Gastroenterological Surgery|Clinical Orthopaedics and Related Research|National Institute of Arthritis and Musculoskeletal and Skin Diseases|National Institutes of Health|OMNI Institute|The Japanese Society of Gastroenterological Surgery|Clinical Orthopaedics and Related Research
patientreported outcome measures proms gold standard measuring therapeutic outcomes research extending use inform clinical care decisions determine appropriateness therapeutic choices assess healthcare quality attractive require professional community establish valid estimates minimal substantial clinical improvementsthe purposes study 1 assess validity estimates minimal clinically important difference mcid calculated using distribution anchorbased methods determining whether exceed minimal detectable change mdc hip disability osteoarthritis outcome score hoos knee injury osteoarthritis outcome score koos domains hoos joint replacement jr koos jr among patients underwent tha tka 2 determine substantial clinical benefit thresholds hoos koos domains hoos jr koos jr among patients underwent tha tka 3 assess proportions patients underwent tha tka achieved mcid hoos koos domains hoos jr koos jr based distributionbased anchorbased methods well percentages patients achieved substantial clinical benefit using anchorbased methodmedicare patients enrolled institutional joint replacement registry subsequently underwent tha n 2323 tka n 2630 2007 2012 completed hoos koos preoperatively 2 years postoperatively shortform joint replacement jr versions prom derived full proms eligible patients 78 3161 4080 thas 74 tkas 3815 5156 consented join registry completed baseline survey 88 2796 3161 thas 85 3230 3815 tkas eligible followup survey administration 83 thas 2323 2796 81 2630 3230 tkas returned 2year surveys hoos domain koos domain hoos jr koos jr calculated calibration variation instrument mdc confidence intervals cis reflecting 80 mdc80 90 mdc90 95 mdc95 certainty calculated smallest difference joint health patients might detect mcid using distribution anchorbased approaches difference considered large improvement joint health substantial clinical benefit using anchorbased approachpatients undergoing tha 57 female mean sd age 73 6 years whereas patients undergoing tka 63 female mean age 74 6 years depending ci chosen mdc values ranged 7 16 hoos koos domains jrs mcids ranged 6 9 distributionbased approach 7 36 anchorbased approach hoos koos domains jr scores scores 0 worst joint health 100 best joint health mcids calculated using distributionbased approach valid lower mdc hooskoos domains jrs every confidence level anchorbased receiver operating characteristic approach hand resulted mcids exceeding mdc80 seven eight hooskoos domains mdc95 jr scores domains jr versions substantial clinical benefits ranged 15 36 exceeding mdc95 domains jr scores across hoos koos domains well jr proportion patients undergoing tha achieved mcid ranged 77 95 distributionbased method 67 96 using anchorbased method proportion achieving substantial clinical benefit ranged 67 85the mdc mcid differ greatly based assumptions methods used mcid anchorbased approach superior construct face validity compared mcid distributionbased approach never exceeded even small mdcs achieving consensus standard definitions meaningful improvement necessary maximize utility proms inform clinical care performance measurementlevel iii diagnostic study