Preoperative Patient-Reported Outcomes Measurement Information System Computerized Adaptive Testing (PROMIS CAT) Scores Predict Achievement of Minimum Clinically Important Difference Following Anterior Cruciate Ligament Reconstruction Using an Anchor-Based Methodology

Yedulla, Nikhil R; Tramer, Joseph S.; Koolmees, Dylan; Franovic, Sreten; Elhage, Kareem; Moutzouros, Vasilios; Makhni, Eric C.

doi:10.1016/j.asmr.2021.09.004

Cited by 10 publications

(8 citation statements)

References 40 publications

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“…With the increasing utility of PROMs in evaluating orthopaedic patients, a number of different thresholds have been assigned to confer “clinical relevance.” Of these, the MCID is among the most common, but the heterogeneity of its determination and its dependence on preoperative scores represent significant limitations. 11 , 20 , 36 The present study found that the MCID-PF was affected only by preoperative PROMIS scores when using a previously reported 0.5 standard deviation–based MCID of 4.6, which was consistent with a recently published anchor-based MCID of 4.5 11 , 38 Thus, patients who have exceedingly low preoperative scores may achieve clinical success according to the MCID, but they may have inferior outcomes relative to their specific population and may not consider their result a success. Conversely, patients who have higher preoperative outcome scores may not achieve the MCID despite having a satisfactory outcome.…”

Section: Discussionsupporting

confidence: 91%

Impact of Sports Participation on Achievement of Clinically Relevant Outcomes 2 Years After ACL Reconstruction

Kuhns,

Sholtis,

Reuter

et al. 2023

Orthopaedic Journal of Sports Medicine

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Background: Clinically relevant threshold values associated with patient-reported outcome measures after orthopaedic procedures such as anterior cruciate ligament reconstruction (ACLR) are important for relating these scores to meaningful postoperative improvement. Purpose/Hypothesis: The purpose of this study was to determine the Patient Acceptable Symptom State (PASS) for the Patient-Reported Outcomes Measurement Information System Computer Adaptive Test (PROMIS-CAT) after ACLR. It was hypothesized that preoperative sport participation would have an impact on PASS achievement. Study Design: Case series; Level of evidence, 4. Methods: Included were consecutive patients who underwent primary assisted ACLR between January 4 and August 1, 2016. Patients were administered the PROMIS-CAT Physical Function (PF) and Pain Interference domains preoperatively and at a minimum 2 years postoperatively, with external anchor questions used to determine the PASS. Receiver operating characteristic (ROC) curves were constructed for the entire study population as well as separately for athletes and nonathletes to determine PROMIS PASS thresholds for each population. A previously published PROMIS-PF minimal clinically important difference was used to evaluate postoperative improvement. A post hoc multivariate nominal logistic multivariate analysis was constructed to assess the effects of preoperative patient characteristics on the likelihood of attaining both the minimal clinically important difference and PASS. Results: In total, 112 patients were included in the study, with 79 (71%) having recreational or higher levels of athletic participation. The PASS for the study population was 56.0 (area under the ROC curve, 0.86) and was unaffected by baseline PROMIS-PF scores but was affected by preoperative athletic participation (56.0 for athletes, 49.0 for nonathletes). A post hoc analysis found 57 patients (51%) achieved the PASS for the PROMIS-PF (cutoff, 56.0), but when the athlete and nonathlete thresholds were applied to their respective patient groups, 66% of athletes and 64% of nonathletes achieved the PASS postoperatively. The multivariate analysis found that sport participation (odds ratio, 6.2; P = .001) but not age, sex, body mass index, or preoperative PROMIS affected the likelihood of achieving the PASS on the PROMIS-PF. Conclusion: Preoperative athletic participation significantly affected the ability to achieve PASS.

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Section: Discussionsupporting

confidence: 91%

Impact of Sports Participation on Achievement of Clinically Relevant Outcomes 2 Years After ACL Reconstruction

Kuhns,

Sholtis,

Reuter

et al. 2023

Orthopaedic Journal of Sports Medicine

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“…A systematic search of the PubMed/MEDLINE databases was used to identify studies examining PROMIS assessments in orthopaedic surgery patients. Studies were included in the anchor-based analyses if they calculated anchor-based thresholds for PROMIS Physical Function for THA, TKA, PLF, ACLR, and APM or the PROMIS Upper Extremity for TSA and RCR [3, 10-12, 16, 18, 23, 24, 29, 34, 37].…”

Section: Methodsmentioning

confidence: 99%

What Is the Clinical Benefit of Common Orthopaedic Procedures as Assessed by the PROMIS Versus Other Validated Outcomes Tools?

Karhade

Bernstein

Desai

et al. 2022

Clin Orthop Relat Res

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Background Patient-reported outcome measures (PROMs), including the Patient-reported Outcomes Measurement Information System (PROMIS), are increasingly used to measure healthcare value. The minimum clinically important difference (MCID) is a metric that helps clinicians determine whether a statistically detectable improvement in a PROM after surgical care is likely to be large enough to be important to a patient or to justify an intervention that carries risk and cost. There are two major categories of MCID calculation methods, anchor-based and distribution-based. This variability, coupled with heterogeneous surgical cohorts used for existing MCID values, limits their application to clinical care. Questions/purposes In our study, we sought (1) to determine MCID thresholds and attainment percentages for PROMIS after common orthopaedic procedures using distribution-based methods, (2) to use anchor-based MCID values from published studies as a comparison, and (3) to compare MCID attainment percentages using PROMIS scores to other validated outcomes tools such as the Hip Disability and Osteoarthritis Outcome Score (HOOS) and Knee Disability and Osteoarthritis Outcome Score (KOOS). Methods This was a retrospective study at two academic medical centers and three community hospitals. The inclusion criteria for this study were patients who were age 18 years or older and who underwent elective THA for osteoarthritis, TKA for osteoarthritis, one-level posterior lumbar fusion for lumbar spinal stenosis or spondylolisthesis, anatomic total shoulder arthroplasty or reverse total shoulder arthroplasty for glenohumeral arthritis or rotator cuff arthropathy, arthroscopic anterior cruciate ligament reconstruction, arthroscopic partial meniscectomy, or arthroscopic rotator cuff repair. This yielded 14,003 patients. Patients undergoing revision operations or surgery for nondegenerative pathologies and patients without preoperative PROMs assessments were excluded, leaving 9925 patients who completed preoperative PROMIS assessments and 9478 who completed other preoperative validated outcomes tools (HOOS, KOOS, numerical rating scale for leg pain, numerical rating scale for back pain, and QuickDASH). Approximately 66% (6529 of 9925) of patients had postoperative PROMIS scores (Physical Function, Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. Ethical approval for this study was obtained from Partners HealthCare, Somerville, MA, USA (number 2019P003521).

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“…Because previous studies have found associations between preoperative PROs and outcomes after ACLR, a subset of patients with complete PRO data were analyzed in the current study. 35,45 Analysis of the subset of patients with PRO data demonstrated similar findings of age and sex being associated with knee extensor LSI, yet PROs were not associated with knee extensor LSI and did not impact previous associations. Finally, there are variables that were not assessed that could influence the results of the study.…”

Section: Limitationsmentioning

confidence: 77%

Factors Associated With Knee Extension Strength Symmetry After Anterior Cruciate Ligament Reconstruction With Quadriceps Tendon Autograft

Greiner,

Drain,

Setliff

et al. 2024

Orthopaedic Journal of Sports Medicine

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Background: Diminished postoperative knee extension strength may occur after anterior cruciate ligament reconstruction (ACLR) with quadriceps tendon (QT) autograft. Factors influencing the restoration of knee extensor strength after ACLR with QT autograft remain undefined. Purpose: To identify factors that influence knee extensor strength after ACLR with QT autograft. Study Design: Case-control study; Level of evidence, 3. Methods: The authors performed a retrospective review of patients who underwent primary ACLR with QT autograft at a single institution between 2010 and 2021. Patients were included if they completed electromechanical dynamometer testing at least 6 months after surgery. Exclusion criteria consisted of revision ACLR, <6 months of follow-up, concomitant procedure (osteotomy, cartilage restoration), and concomitant ligamentous injury requiring surgery. Knee extension limb symmetry index (LSI) was obtained by comparing the peak torque of the operated and nonoperated extremities. Univariable and multivariable analyses were performed to identify factors associated with knee extension LSI in the patient, injury, rehabilitation, and preoperative patient-reported outcomes score domains. Results: A total of 107 patients (58 male; mean age, 22.8 years) were included. Mean knee extension LSI of the overall cohort was 0.82 ± 0.18 at 7.5 ± 2.0 months; 35 patients (33%) had a value of ≥0.90. Multivariable analysis demonstrated significant negative associations between knee extension LSI and female sex (−0.12; P < .001), increased age at the time of surgery (−0.01; P = .018), and larger QT graft width (−0.049; P = .053). Conclusion: Factors influencing knee extensor LSI after ACLR with QT autograft in this study population spanned patient and surgical factors, including female sex, older age at the time of surgery, and wider graft harvest. Surgeons should consider the association between these factors and lower postoperative knee extensor LSI to optimize patient outcomes.

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Preoperative Patient-Reported Outcomes Measurement Information System Computerized Adaptive Testing (PROMIS CAT) Scores Predict Achievement of Minimum Clinically Important Difference Following Anterior Cruciate Ligament Reconstruction Using an Anchor-Based Methodology

Cited by 10 publications

References 40 publications

Impact of Sports Participation on Achievement of Clinically Relevant Outcomes 2 Years After ACL Reconstruction

Impact of Sports Participation on Achievement of Clinically Relevant Outcomes 2 Years After ACL Reconstruction

What Is the Clinical Benefit of Common Orthopaedic Procedures as Assessed by the PROMIS Versus Other Validated Outcomes Tools?

Factors Associated With Knee Extension Strength Symmetry After Anterior Cruciate Ligament Reconstruction With Quadriceps Tendon Autograft

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