Use of patient-reported outcome measures (PROMs) by orthopedic surgeons in Saudi Arabia

Alshehri, Fayez; Alarabi, Abdulaziz; Al‐Harthi, Mohammed A.; Alanazi, Thamer; Alohali, Ahmed; Alsaleem, Mohammad K.

doi:10.1186/s13018-020-02135-1

Cited by 16 publications

(20 citation statements)

References 23 publications

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“…Surgeons still perceive limited utility for PROMs in patient care, noting that they preferred talking with patients about outcomes the patient had identified as important, seeing these personalized outcomes as more meaningful rather than a numbered score that can be difficult to explain. Other studies examining perceptions of PROMs have also identified these issues [1,7,11,14,21,23,26,32,40]. To fully incorporate PROM scores into clinical care, well-designed PROM systems will need to be developed with measures that not only have good psychometric properties and strong evidence to support their use for comparisons, but also PROMs that reflect the unique outcomes desired by individual patients.…”

Section: Limitationsmentioning

confidence: 99%

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What Do Orthopaedists Believe is Needed for Incorporating Patient-reported Outcome Measures into Clinical Care? A Qualitative Study

Whitebird

Solberg

Ziegenfuss

et al. 2021

Clin Orthop Relat Res

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BackgroundPatient-reported outcome measures (PROMs) are increasingly promoted for use in routine orthopaedic care with the expectation that if they are made available during encounters, they will be incorporated into clinical practice. We investigated an initiative in which PROMs were systematically collected and provided via the electronic health record but were infrequently used.Questions/purposesIn a qualitative study, we asked: (1) Why are PROM results not being used in clinical care when they are available to surgeons? (2) What aspects of PROMs are seen as useful for clinical care? (3) How are PROMs generally perceived by surgeons and orthopaedic leaders?MethodsA cross-sectional qualitative study was conducted in a single health system in an urban setting using semistructured interviews with a purposive sample of orthopaedic surgeons and leaders who would have substantial knowledge of and experience with the organization’s PROM system, which was embedded in the electronic health record and developed for use in clinical care but was not being used. We included surgeons whose practices consisted of at least 90% patients with osteoarthritis, including surgical and nonsurgical management, and thus their patients would be completing PROMs surveys, or surgeons who were leaders in one of the three orthopaedic divisions in the health plan. The senior research manager for orthopaedics identified 14 potential participants meeting these criteria, 11 of whom agreed to study participation. Participants included nine surgeons and two orthopaedic leaders; the majority were men, with a median of 13 years of clinical practice. Study interviews were conducted by an experienced interviewer not known to participants, in private conference rooms in the healthcare setting, and a median (range) of 27 minutes (16 to 40) in length. A content analysis approach was employed for data analysis, with thematic inductive saturation reached in the analysis and attention to trustworthiness and rigor during the analytic process.ResultsInterviewees reported that PROM scores are not being used in patient clinical care because of logistical barriers, such as access and display issues and the time required, and perceptual barriers, such as concerns about patient understanding and the validity and reliability of measures. Surgeons preferred talking with patients about the personal outcomes patients had identified as important; most patients preferred to assess progress toward their own goals than PROMs scores for other people. Surgeons also identified changes that could facilitate PROM use and reduce barriers in clinical care, including pushing PROM scores to physicians’ inboxes, developing inserts for physician notes, using easy-to-understand graphical displays, and engaging patients about PROMs earlier in the care process. Participants all agreed that PROMs in aggregate use are valuable for the organization, department, and individual surgeons, but individual patient scores are not.ConclusionDespite the availability of PROMs, there are im...

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Section: Limitationsmentioning

confidence: 99%

“…We investigated an initiative in which PROMs were systematically collected and provided via the electronic health record but were infrequently used. Questions/purposes In a qualitative study, we asked: (1) Why are PROM results not being used in clinical care when they are available to surgeons? (2) What aspects of PROMs are seen as useful for clinical care?…”

mentioning

confidence: 99%

What Do Orthopaedists Believe is Needed for Incorporating Patient-reported Outcome Measures into Clinical Care? A Qualitative Study

Whitebird

Solberg

Ziegenfuss

et al. 2021

Clin Orthop Relat Res

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“…However, studies examining this assumption have found limited use of PROs. Main reasons according to surgeons are a lack of knowledge on how to use PROs in daily health care, the perception that PROs do not provide actionable information, and because gathering and handling of PROs add work to an already busy schedule [31,32]. In addition, orthopaedic surgeons state that using PROs on an individual patient level is difficult based on logistical barriers (access and display issues, time required) and perceptual barriers (concerns about patients understanding, and validity and reliability of measures).…”

Section: Discussionmentioning

confidence: 99%

Quality of total hip arthroplasty health care based on four years of patient-reported outcomes in the Netherlands

Pronk

Weegen

Schreurs

et al. 2023

Health Qual Life Outcomes

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Background Joint arthroplasty registries have incorporated patient-reported outcomes (PROs) to evaluate outcomes from a patients’ perspective to improve total hip arthroplasty (THA). To draw valid conclusions on PROs, a minimum response rate (RR) of 60% is advised. This study investigated (1) if the quality of THA health care based on PROs improved over the years in the Netherlands, (2) if RRs improved over the years, and (3) difference in PROs over the years in hospitals with RR ≥ 60% compared to RR < 60%. Methods Longitudinal study with publicly available datasets from 2016 to 2019. Primary outcome was increase/decrease in PRO change scores including 95%CI ranges over the years between preoperatively and 3 months postoperatively (pre-3 m), and 12 months postoperatively (pre-12 m). Improved quality of health care was arbitrary defined as when ≥ 3 of 4 included scores or ranges were statistically significant improved. Secondary outcome was increase/decrease in RRs over the years. Subgroups RR ≥ 60% and RR < 60% were compared. Results Hospitals (%) collecting THA PROs increased from 78 to 92%. EQ VAS change score increased over the years, and 95%CI ranges of EQ VAS, EQ-5D descriptive system and NRS pain during activity decreased over the years at pre-3 m (p < 0.05). All THA pre-12 m PRO change scores and 95%CI ranges remained equal (p > 0.05). Pre-3 m RR remained equal (around 43%, p = 0.107) and pre-12 m RR decreased 9% (49% to 40%, p = 0.008). Pre-3 m subgroup RR ≥ 60% was too small to analyse (5%). No difference was found between pre-12 m subgroups (RR ≥ 60% = 16%), p > 0.05). Conclusions Quality of THA health care based on PROs seems equal in the Netherlands between 2016 and 2019. Although more hospitals participated in PRO collection, low RRs with large IQRs are observed and only 16% of the hospitals achieved the advised RR ≥ 60%. Multiple recommendations are provided to improve PRO collection and use.

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“…PROMs have recently been used in national registries and could be helpful in decision-making in total joint arthroplasty and as an early indicator in implant failure [20,21]. However, it is crucial to limit their use to evaluate aspects for which the scale was constructed for and to interpret their results according to their psychometric qualities [22,23]. Moreover, Gagnier et al [2] reported that no single PROM can evaluate all dimensions and have the required psychometric properties.…”

Section: Discussionmentioning

confidence: 99%

Validation of the Spanish version of the Goodman score in total hip arthroplasty

Brañes

Barahona

Carvajal³

et al. 2021

J Orthop Surg Res

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Purpose Currently, patient-reported outcome measures (PROMs) are the standard instruments used to compare arthroplasty results. Goodman et al. recently published a well-constructed scale with excellent psychometric properties that can be quickly administered. The main objective of our study was to translate, culturally adapt, and validate a Spanish version of the Goodman questionnaire in patients who underwent total hip arthroplasty (THA). Methods The original Goodman scale was translated into Spanish and cross-culturally adapted. Then, the data from this version were tested for psychometric quality. We designed a cross-sectional study for data collection. This study enrolled 2 institutions. Patients who underwent hip replacement due to primary osteoarthritis secondary to dysplasia between 1 January 2018 and 31 December 2019 were included. A total of 153 patients were contacted twice to record the Goodman and Oxford hip scales (OHS) to assess the validity of the questionnaire. Reliability was tested using the Cronbach’s alpha, Concordance using 3 test: intraclass correlation coefficient (ICC), Lin's concordance correlation coefficient (CCC), and the Bradley-Blackwood F test. The spearman correlation was used to asses correlation between the OHS and the Spanish-adapted Goodman scale. Results The overall satisfaction after THA was reported to be “very satisfied” by 137 patients (75%), and only 14 patients reported some degree of dissatisfaction (6%). The improvement in quality of life was reported to be “more than I ever dreamed possible” by 41% patients. Cronbach’s alpha was acceptable, reaching a coefficient of 0.95 (95% confidence interval, 0.82–1). No statistical difference (t test, p = 0.55) was found in the original version, with great internal validity. Test re-test concordance was optimal among the 3 tests used. A moderate correlation was found between the OHS and the Spanish-adapted Goodman scale. Conclusion The Spanish version of the Goodman questionnaire in THA is a reliable, consistent, and feasible scale to evaluate patient satisfaction and improvement in the quality of life in Spanish speakers.

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Use of patient-reported outcome measures (PROMs) by orthopedic surgeons in Saudi Arabia

Cited by 16 publications

References 23 publications

What Do Orthopaedists Believe is Needed for Incorporating Patient-reported Outcome Measures into Clinical Care? A Qualitative Study

What Do Orthopaedists Believe is Needed for Incorporating Patient-reported Outcome Measures into Clinical Care? A Qualitative Study

Quality of total hip arthroplasty health care based on four years of patient-reported outcomes in the Netherlands

Validation of the Spanish version of the Goodman score in total hip arthroplasty

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