What is the optimal time point to assess patient-reported recovery after hip and knee replacement? a systematic review and analysis of routinely reported outcome data from the English patient-reported outcome measures programme

Abstract

BackgroundIt is unclear if there is a clinically important improvement in the six to 12-month recovery period after hip and knee replacement. This is an obvious gap in the evidence required by patients undergoing these procedures. It is also an issue for the English PROMs (Patient-Reported Outcome Measures) Programme which uses 6-month outcome data to compare the results of hospitals that perform hip and knee replacements.MethodsA systematic review of studies reporting the Oxford Hip Score (OHS) or Oxford Knee Score (OKS) at 12 months after surgery was performed. This was compared with six-month outcome data collected for 60, 160 patients within the English PROMs programme. A minimally important difference of one standard error of the measurement, equivalent to 2.7 for the OHS and 2.1 for the OKS, was adopted.Results and discussionSix studies reported OHS data for 10 different groups containing 8,308 patients in total. In eight groups the change scores reported were at least 2.7 points higher than the six-month change observed in the PROMs programme (20.2 points). Nine studies reported OKS data for 13 different groups containing 4,369 patients in total. In eight groups the change scores reported were at least 2.1 points higher than the six-month change observed in the PROMs programme (15.0 points).ConclusionsThere is some evidence from this systematic review that clinically important improvement in the Oxford hip and knee scores occurs in the six to 12 month recovery period. This trend is more apparent for hip than knee replacement. Therefore we recommend that the English Department of Health study the impact on hospital comparisons of using 12- rather than six-month outcome data.

Functionality and feedback: a realist synthesis of the collation, interpretation and utilisation of patient-reported outcome measures data to improve patient care

“…For knee and hip replacement, postoperative PROMs data are collected 6 months after the operation, and for groin hernia repair and varicose vein surgery, they are collected 3 months after the operation. As Browne et al 151 observe:…”

“…Browne et al 151 note that the cut-off point of 6 months to measure the impact of hip and knee replacement was based on 'clinical consensus' and on the need for the output to be timely to enhance the likelihood that it will stimulate health-care providers to review and improve the quality of their care. By choosing 6 months, it is not assumed that a patient has reached the maximum benefit of the operation; however, some have expressed concern that the use of 6 months as the cut-off point does not capture the longer-term benefit of the interventions.…”

“…Reproduced from Browne et al 151 under the terms of the Creative Commons Attribution License (http://creative commons.org/licenses/by/2.0)…”

Empowering knowledge and Quality of Recovery after hip or knee replacement

“…The recovery process starts directly after surgery and improvements occur during the whole recovery period, even after several years (Browne et al 2013). It takes several weeks for elderly patients with severe osteoarthritis to recover after hip or knee replacement (Hamel et al 2008).…”

“…The process of recovery after hip or knee replacement starts directly after surgery, and it takes several weeks or even years to recover to the level that each individual perceives as normality (Browne et al 2013, Hamel et al 2008. Postoperative recovery frequently refers to recovery from anaesthesia (Grover & Haire 2004, Parida & Badhe 2014.…”