Session Information
Title: Health Services Research, Quality Measures and Quality of Care - Innovations in Health Care Delivery
Session Type: Abstract Submissions (ACR)
Background/Purpose: Hospital for Special Surgery (HSS) Knee questionnaire has previously been shown to have construct validity. Our objective was to further assess the validity and responsiveness of HSS Knee Questionnaire.
Methods: We used data from the Mayo Clinic Total Joint Registry to assess the validity of HSS Knee questionnaire, by including patients who underwent primary total knee arthroplasty (TKA) between 1993-2005 and responded to the baseline and 2-year post-primary TKA HSS Knee questionnaire. HSS Knee questionnaire combines pain, function, range of motion and muscle strength to derive a total score. Convergent/divergent validity was examined with the association of select demographics (age, gender, number of joints involved) at baseline with HSS Knee scores using linear regression and correlation analyses. Minimally Clinically Important Difference (MCID) and Really Important Difference (RID) were calculated corresponding to “somewhat better now” and “much better now” patient responses, respectively to the question at 2-years- Compared to your condition before the surgery, how would you rate your knee now? For discriminant ability, we calculated effect size by taking the change in respective score from baseline to 2-years and dividing the result by the standard deviation at baseline.
Results: For primary TKA, there were 5,280 knees with both a baseline and a 2-year data. The sample consisted of 2,375 males (45%) and 2,905 females (55%). The mean age at surgery (SD) is 68 (10), median age was 69 (range, 17-93). Male sex, body mass index, Deyo-Charlson index and the number of lower extremity joints involved were significantly associated with HSS scores (p<0.001). HSS correlated highly with knee society score (KSS; correlation coefficient 0.52, p<0.001) and KSS function (0.65, p<0.001). Age was not significantly associated (p<0.34). MCID and RID thresholds were 8.29 and 25.97 respectively. Effect size was 2.95 at 2-years and the standardized response mean was 1.85. HSS score at 2-years in the lowest category had odds ratio of 5.15 (95% confidence interval: 2.73,9.71; p<0.001) for revision of index TKA 2-years or later after primary TKA. Preoperatively only 0.03% and 0.1% were at the floor and ceiling, respectively. At 2-years, 0% and 17% scores were the floor and ceiling, respectively.
Conclusion: The HSS Knee questionnaire is a valid and sensitive outcome measure for patients undergoing primary TKA. Further validation in independent patient samples will improve its usability in more patient populations.
Disclosure:
J. A. Singh,
Takeda, Savient,
2,
Savient, Takeda, Ardea, Regeneron, Allergan,
5,
URL pharmaceuicals Novartis,
5;
C. Schleck,
None;
W. S. Harmsen,
None;
D. Lewallen,
DePuy, Stryker, Biomet and Zimmer.,
2,
Zimmer, Orthosonic and Osteotech,
7,
Pipeline,
5,
Pipeline,
1.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/validation-of-the-hospital-for-special-surgery-knee-questionnaire-convergent-validity-responsiveness-and-sensitivity-to-change/