A Proof of Concept Study Regarding the Utilization of Different Patient-related Outcome Measurements in a Certified Centre of Excellence for Joint Replacement (EndoProthetikZentrum)

Abstract

Background The aim of the study is to identify those patients without improved pain sensation and functionality of the joint, thus with a potential necessity of re-intervention by using the evaluation of the PROMs (Oxford Hip Score, European Quality of Life Scale, EndoCert-Risk-Score). The task was to determine the value of the scores which represents the limit above/below, which a re-examination of the patient is necessary. Additionally, further secondary objectives such as influence of complications on scores, the percentage of questionnaire return and the quality of the provided data in the questionnaires were recorded to define minimal requirements on patientʼs response. Material and Methods Members of the EndoCert certification committee developed a questionnaire for pre- (decision on treatment) and post-operative (discharge and 3-months follow-up) use. A total of 112 primary hip replacements and 25 hip revision arthroplasties, which were recruited from a centre of excellence for joint replacement (EndoProthetikZentrum der Maximalversorgung), were included in the study. Results The return of questionnaires amounted to 80%. Quality of data in the questionnaires declined with BMI (≥ 25), ASA classification (≥ 3), age (≥ 65) and depended on the time point questioning. Based on the EndoCert risk score there was a significant improvement in the experience of pain postoperatively compared to pre-operation (p < 0.05). However, the functionality of the joint, as measured as the use of walking frames or crutches as well as the need for help from others, did not improve. The results revealed that there was no correlation between the incidence of complications and a detrimental score. It was furthermore shown that patient specific attributes, e.g. age or BMI, or perioperative performance (duration of operation) did not influence the likelihood of a complication. Conclusion It was shown that Oxford Hip Score and EQ-5D were not negatively influenced by complication during hospital stay. The evaluation of the EndoCert risk score showed not improvement between pre- and post-operative values regarding function but revealed a significant pain relief. A further study is intended to evaluate the intensity of pain after three months as part of an extended systemic follow-up. This could provide further insights whether the EndoCert risk score is a suitable tool to identify unsuccessfully treated patients.

EndoProthetikZentrum

“…Osmanski-Zenk et al 38 konnten 2019 zeigen, dass der Oxford-Hip-Score und der EQ-5D – beides „Patient-related Outcome Measurements“ (PROMs) zur Erfassung der Zufriedenheit der Patienten mit dem Behandlungsprozess und -ergebnis – nicht negativ durch eine Komplikation beeinflusst werden. Es konnte keine Verbesserung hinsichtlich der Funktion, jedoch eine signifikante Linderung des Schmerzes nachgewiesen werden.…”

Identification of Potential High-Risk Patients on the Basis of PROMs in a Certified Centre for Joint Replacement (EndoProthetikZentrum) Using the Example of Hip Arthroplasty

“…der EQ visuellen Analogskala (VAS), für den der deutsche Algorithmus für die Berechnungen verwendet wurde. Der Endo-Cert-Risk-Score wurde auf Basis der Ergebnisse unserer ersten Untersuchung 2015-2016 [9] inhaltlich modifiziert und enthält 3 schmerzbezogene Fragen. Die Frage "Warum haben Sie sich für unsere Klinik entschieden" auf dem präoperativen ERS (▶ Abb.…”

“…Gleiches gilt für die 3 Net-Promoter-Fragen des postoperativen ERS, welche die Zufriedenheit der Patienten mit der Versorgung messen, (Frage d-f, ▶ Abb. 3) [9]. Für den Oxford Hip Score wurde das empfohlene Bewertungsverfahren nach Murray et al [10] zugrunde gelegt.…”

“…This questionnaire comprised, among others, the more advanced EndoCert Risk Score (ERS) of EndoCert GmbH ( Fig. 2 and 3 ) 9 , the joint-specific Oxford Hip Score (OHS), and the quality of life-related EuroQuol-5D-3 L (European Quality of Life Scale – EQ-5D 3 level version), including the EQ visual analogue scale (VAS), for which the German algorithm was used for the calculations. The content of the EndoCert risk score was modified based on the results of our first study in 2015 – 2016 9 and includes three pain-related questions.…”

“…B. Pfanneninklination), Infektionsraten, Luxationsraten und intraoperative periprothetische Frakturen [8]. Diese Parameter stimmen aber nicht immer mit dem subjektiven Ergebnis auf der Patientenseite überein, da die Zahl an unzufriedenen Patienten meist deutlich höher ist als beispielsweise die Revisionsrate [9]. Um aber diese subjektiv unzufriedenen Patienten, sog.…”