Developing and Implementing an Orthopaedic Outcomes Program

Pulido, Pamela A.; Hardwick, Mary E.; Sandwell, Julie C.; Colwell, Clifford W.

doi:10.1097/01.nor.0000315621.21267.a6

Cited by 3 publications

(1 citation statement)

References 13 publications

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“…In a fashion similar to the development of new PROMs, the administration of PROMs is undergoing rapid evolution as outcomes initiatives are increasingly being implemented at orthopedic care centers. 41 , 43 , 57 Previous literature has suggested that theoretically the optimal PROM is one single domain-specific question, with appropriate outcome discrimination, and without significant floor or ceiling effects. 5 Question burden is an important consideration given previous work demonstrating significant impact on follow-up rates, as well as the speed and accuracy with which patients complete instruments.…”

Section: Discussionmentioning

confidence: 99%

Preoperative psychometric properties of visual analog scale asessments for function, pain, and strength compared with legacy upper extremity outcome measures in glenohumeral osteoarthritis

Beletsky

Nwachukwu

et al. 2020

JSES International

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Background Patient-reported outcome measures (PROMs) are increasingly being used in orthopedic surgery; however, there is significant variability and burden associated with their administration. The visual analog scale (VAS) may represent an efficient, single-question method to establish functional baselines in a domain-specific manner for glenohumeral arthritis. Methods Single-question VAS measures assessing function, strength, and pain as a percentage of normal were administered alongside legacy PROMs in patients with primary glenohumeral arthritis in a preoperative setting between October 2015 and March 2017. PROM performance was assessed using Spearman correlation coefficients. Both absolute and relative floor and ceiling effects were examined. Results A total of 70 patients (age 66.09 ± 9.84 years, body mass index 28.8 ± 9.77, 57.1% male, 54.2% right-sided) were included. The VAS Pain instrument ( r = 0.45-0.64) outperformed the VAS Function ( r = 0.23-0.62) and VAS Strength ( r = 0.21-0.65) in correlation to preoperative PROMs. The performance of VAS Pain was comparable to American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES; r = 0.47-0.84). None of the VAS instruments in our study demonstrated preoperative floor effects (7.1%-8.6%) or ceiling effects (0.0%-4.3%). The most efficient instruments were Single-Assessment Numerical Evaluation (SANE; 0.87 ± 0.41 minutes), Patient-Reported Outcome Measurement Information System Upper Extremity Computer Adaptive Test (PROMIS UE CAT; 1.27 ± 1.30 minutes), and the triad of VAS measures (1.51 ± 1.61 minutes). Conclusion VAS Pain outperformed VAS Strength and Function relative to legacy PROMs, while performing comparable to ASES. None of the VAS measures were susceptible to significant floor or ceiling effects preoperatively. The VAS instruments along with SANE and PROMIS UE were the most time-efficient measures. VAS instruments may have a role in establishing preoperative baselines in those with glenohumeral arthritis in a simple, efficient, and adoptable manner.

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Section: Discussionmentioning

confidence: 99%

Preoperative psychometric properties of visual analog scale asessments for function, pain, and strength compared with legacy upper extremity outcome measures in glenohumeral osteoarthritis

Beletsky

Nwachukwu

et al. 2020

JSES International

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Nurse-led follow up replaces consultant outpatient clinic

Williams

Taylor

Awad

et al. 2018

British Journal of Healthcare Management

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Increasingly, hospitals are adopting a nurse-led follow-up service (NLFU), aimed at improving post operative community care following total hip/knee arthroplasty. This article hypothesises that it is feasible for NLFU services to replace traditional 6-week consultant-led hospital follow-up. The experience of implementing domiciliary 6-week NLFU, an approach previously unreported by any other UK centre is reported upon. This article presents the NLFU pathway protocol and a retrospective analysis of total hip arthroplasty (n=347) and total knee arthroplasty patients (n=356) the year after its introduction in September 2015. The pathway's utilisation, safety, and patient satisfaction from a postal survey are detailed. During the study period, the 6-week NLFU pathway utilisation rates were 30% for total hip arthroplasty (n=103) and 27% for total knee arthroplasty (n=96). NLFU was deemed safe, with a 10% re-referral to consultant clinic rate and no reported adverse outcomes related to process. Patients reported high levels of satisfaction. This article demonstrates that domiciliary NLFU at 6 weeks provides a feasible follow-up mechanism for primary hip and knee total joint arthroplasty, with high patient satisfaction levels. This offers clear benefits to healthcare Trusts in reducing follow-up appointments, in turn releasing capacity for new referrals and freeing staff for other duties.

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