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Can patients help with long-term total knee arthroplasty surveillance? Comparison of the American Knee Society Score self-report and surgeon assessment.

ABSTRACT: To compare patient self-report of knee flexion, extension, range of motion (ROM) and American Knee Society (AKS) Pain, Knee and Functional scores with a clinician assessment.A total of 239 consecutive total knee arthroplasty (TKA) patients (290 knees) were mailed surveys with an AKS questionnaire and lateral knee photographs that showed knee ROM in 10 degrees increments to compare their operated knee(s) ROM. Patients were subsequently seen in clinic and their ROM, AKS Pain, Knee and Functional scores were measured. Patient- and physician-reported measures were compared using independent sample t-test and correlated using Spearman's correlation coefficient. A priori rules for comparisons were based on previously published reports.A total of 286 knees had both survey and clinic data available and constituted the analytic set. Patient-reported and physician-assessed extension, flexion and ROM were: 3 +/- 4.8 degrees vs 1.4 +/- 4.3 degrees (P < 0.001), 111.4 +/- 14.6 degrees vs 110 +/- 12.8 degrees (P = 0.04) and 108.6 +/- 16.8 vs 108.6 +/- 14.3 degrees (P = 0.98). There was a moderate correlation between patient and physician assessments (extension = 0.31; flexion = 0.44; ROM = 0.42; P < or = 0.001 for all). Patient-reported and physician-assessed AKS Pain, Knee and Functional scores were: 35.8 +/- 15.6 vs 43.9 +/- 11.1 (P < 0.001), 79.8 +/- 20 vs 88.9 +/- 13.3 (P < 0.001) and 57.7 +/- 23.1 vs 65.7 +/- 26.4 (P < 0.001), respectively. Patient- and physician-assessed AKS Pain, Knee and Functional scores had moderate-high correlation (r = 0.49, 0.49 and 0.70; P < or = 0.001 for all).Long-term surveillance of TKA patients may be possible using a self-report AKS, but the average 8- to 10-point difference between patient- and physician-reported AKS scores (patients reporting poorer scores) represents a substantial impact on this outcome instrument. Since patient-reported responses have clear value in global assessment, further evaluation with other validated outcome instruments is warranted.

SUBMITTER: Gioe TJ

PROVIDER: S-EPMC2722797 | biostudies-other | 2009 Feb

REPOSITORIES: biostudies-other

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Can patients help with long-term total knee arthroplasty surveillance? Comparison of the American Knee Society Score self-report and surgeon assessment.

Gioe T J TJ Pomeroy D D Suthers K K Singh J A JA

Rheumatology (Oxford, England) 20081223 2

<h4>Objectives</h4>To compare patient self-report of knee flexion, extension, range of motion (ROM) and American Knee Society (AKS) Pain, Knee and Functional scores with a clinician assessment.<h4>Methods</h4>A total of 239 consecutive total knee arthroplasty (TKA) patients (290 knees) were mailed surveys with an AKS questionnaire and lateral knee photographs that showed knee ROM in 10 degrees increments to compare their operated knee(s) ROM. Patients were subsequently seen in clinic and their R ...[more]

PMID: 19106165

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Project description:BackgroundWhether a particular surgeon's opioid prescribing behavior is associated with prolonged postoperative opioid use is unknown. This study tested the hypothesis that the patients of surgeons with a higher propensity to prescribe opioids are more likely to utilize opioids long-term postoperatively.MethodsThe study identified 612,378 Medicare fee-for-service patients undergoing total knee arthroplasty between January 1, 2011, and December 31, 2016. "High-intensity" surgeons were defined as those whose patients were, on average, in the upper quartile of opioid utilization in the immediate perioperative period (preoperative day 7 to postoperative day 7). The study then estimated whether patients of high-intensity surgeons had higher opioid utilization in the midterm (postoperative days 8 to 90) and long-term (postoperative days 91 to 365), utilizing an instrumental variable approach to minimize confounding from unobservable factors.ResultsIn the final sample of 604,093 patients, the average age was 74 yr (SD 5), and there were 413,121 (68.4%) females. A total of 180,926 patients (30%) were treated by high-intensity surgeons. On average, patients receiving treatment from a high-intensity surgeon received 36.1 (SD 35.0) oral morphine equivalent (morphine milligram equivalents) per day during the immediate perioperative period compared to 17.3 morphine milligram equivalents (SD 23.1) per day for all other patients (+18.9 morphine milligram equivalents per day difference; 95% CI, 18.7 to 19.0; P < 0.001). After adjusting for confounders, receiving treatment from a high-intensity surgeon was associated with higher opioid utilization in the midterm opioid postoperative period (+2.4 morphine milligram equivalents per day difference; 95% CI, 1.7 to 3.2; P < 0.001 [11.4 morphine milligram equivalents per day vs. 9.0]) and lower opioid utilization in the long-term postoperative period (-1.0 morphine milligram equivalents per day difference; 95% CI, -1.4 to -0.6; P < 0.001 [2.8 morphine milligram equivalents per day vs. 3.8]). While statistically significant, these differences are clinically small.ConclusionsAmong Medicare fee-for-service patients undergoing total knee arthroplasty, surgeon-level variation in opioid utilization in the immediate perioperative period was associated with statistically significant but clinically insignificant differences in opioid utilization in the medium- and long-term postoperative periods.Editor’s perspective

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Can patients help with long-term total knee arthroplasty surveillance? Comparison of the American Knee Society Score self-report and surgeon assessment.

Publications

Can patients help with long-term total knee arthroplasty surveillance? Comparison of the American Knee Society Score self-report and surgeon assessment.

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