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Abstract Number: 1029

What to Measure after Arthroplasty? Confirmation of a Core Domain Set

Anh Hoang1, Susan M. Goodman2, Mark P. Figgie3, Mathias Bostrom4, Douglas Padgett4, Lisa A. Mandl5,6,7, Peter Sculco8, Alexander McLawhorn9 and Jasvinder A. Singh10, 1Rheumatology, Hospital for Special Surgery, New York, NY, 2Medicine, Hospital for Special Surgery/Weill Cornell Medicine, New York, NY, 3Orthopaedic Surgery, Hospital for Special Surgery/Weill Cornell Medicine, New York, NY, 4Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, 5Department of Medicine, Hospital for Special Surgery, New York, NY, 6Rheumatology, Hospital for Special Surgery/Weill Cornell Medicine, New York, NY, 7Department of Rheumatology, Hospital for Special Surgery, New York, NY, 8Orthopaedic Surgery, Hospital for Special Surgey, New York, NY, 9Hospital for Special Surgey, New York, NY, 10Rheumatology, University of Alabama at Birmingham, Birmingham, AL

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: Arthroplasty, clinical trials and outcome measures, Hip, Knee

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Session Information

Date: Monday, November 6, 2017

Session Title: Health Services Research Poster II: Osteoarthritis and Rheumatoid Arthritis

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: The Outcomes Measures in Rheumatology Trials (OMERACT) TJR Working Group has proposed six core domains that would constitute a standardized measurement set that can be used as a tool to compare outcomes among TJR clinical trials. The specific aim was to query two different groups of stakeholders, patients and surgeons, to establish a consensus regarding the domains.

Methods: We e-mailed a survey to 3810 hip/knee TJR patients and 49 hip/knee arthroplasty surgeons at a high-volume orthopedic center of excellence to rate the importance of the six core domains and two additional domains for consideration. Ratings were on a 1 to 9 scale: 1-3 indicating limited or no importance for patients, 4-6 being important, but not critical, and 7-9 being critical. Scores were summarized with median [interquartile range]. Comparisons between the sexes, age groups (< 55 years vs. ≥ 55 years), and participant types (surgeons vs. patients) were made using the Wilcoxon rank-sum test.

Results: 1295 patients (34%) and 21 (43%) surgeons completed the questionnaire. Patient non-responders were similar in age (≥ 55 years, 86%) and gender (57.5% female) to responders. All core domains were confirmed as “critical” by both patients and surgeons. This consensus rating persisted even when compared between the sexes as well as the age groups. The only exception was cost, while “critical” overall, when compared to patients and females respectively, which both surgeons and males scored cost as only “important”, not “critical”. Cost was also rated differently between those < 55 years vs. participants ≥ 55 years: 6 [5, 8] vs. 7 [5, 8], p=0.015.

Conclusion: Our study confirmed that both orthopedic surgeons and TJR patients agree that the OMERACT TJR core domains were critical for patients. These results support a broad endorsement and encourage the identification of candidate outcome instruments to further develop a TJR standardized measurement set.

Table 1. Demographic Characteristics (n=1316)

N (%)

Sex

Female

743 (56.5%)

Age Groups

< 55 years

157 (12%)

≥ 55 years

1159 (88%)

Participant Type

Hip/Knee TJR Patient

1295 (98.5%)

Orthopedic Surgeon

21 (1.5%)

Arthritis Conditions (TJR Patients only)

Osteoarthritis only

1071 (82.7%)

Rheumatoid Arthritis

34 (2.6%)

Another type of arthritis

44 (3.4%)

Joints aches and pains

66 (5.1%)

No arthritis or joint aches or pains

80 (6.2%)

Table 2. Ratings of Domains for TJR Clinical Trials Between Patients & Surgeons

Core Domains

Overall (N=1316)

Patients

(n=1295)

Surgeons

(n=21)

p-value

Joint Pain

9 [8, 9]

9 [8, 9]

9 [7, 9]

0.75

Function or functional ability

9 [8, 9]

9 [8, 9]

8 [7, 9]

0.01

Patient Satisfaction

9 [8, 9]

9 [8, 9]

8 [8, 9]

0.02

Revision surgery

8 [5, 9]

8 [5, 9]

8 [7, 8]

0.41

Adverse events

8 [7, 9]

8 [7, 9]

7 [6, 9]

0.23

Death

9 [6, 9]

9 [6, 9]

9 [7, 9]

0.47

Additional Domains for Consideration

Overall (N=1316)

Patients

(n=1295)

Surgeons

(n=21)

p-value

Cost

7 [5, 8]

7 [5, 8]

6 [5, 6]

0.01

Patient participation in work and social activities

8 [6, 9]

8 [6, 9]

8 [6, 8]

0.26

Table 3. Ratings of Domains for TJR Clinical Trials Between Males & Females

Core Domains

Overall (N=1316)

Female

(n=743)

Male

(n=573)

p-value

Joint Pain

9 [8, 9]

9 [8, 9]

8 [7, 9]

<0.001

Function or functional ability

9 [8, 9]

9 [8, 9]

9 [8, 9]

<0.001

Patient Satisfaction

9 [8, 9]

9 [8, 9]

8 [8, 9]

<0.001

Revision surgery

8 [5, 9]

8 [5, 9]

7 [5, 9]

<0.001

Adverse events

8 [7, 9]

9 [7, 9]

8 [6, 9]

<0.001

Death

9 [6, 9]

9 [7, 9]

9 [5, 9]

0.002

Additional Domains for Consideration

Overall (N=1316)

Female

(n=743)

Male

(n=573)

p-value

Cost

7 [5, 8]

7 [5, 9]

6 [5, 8]

<0.001

Patient participation in work and social activities

8 [6, 9]

8 [7, 9]

7 [6, 8]

<0.001


Disclosure: A. Hoang, None; S. M. Goodman, None; M. P. Figgie, Lima, 7,Mekanika, 1; M. Bostrom, None; D. Padgett, Pixar Bio, 1,DJO Global, 5,Hip Society, American Joint Registry, 9; L. A. Mandl, Boehringer Ingelheim, 2,American College of Physicians, 3,Up To Date, 7; P. Sculco, None; A. McLawhorn, None; J. A. Singh, Takeda and Savient, 2,Savient, Takeda, Regeneron, Merz, Iroko, Bioiberica, Crealta/Horizon and Allergan pharmaceuticals, WebMD, UBM LLC and the American College of Rheumatology., 5,JAS serves as the principal investigator for an investigator-initiated study funded by Horizon pharmaceuticals through a grant to DINORA, Inc., a 501 (c)(3) entity., 9,JAS is a member of the executive of OMERACT, an organization that develops outcome measures in rheumatology and receives arms-length funding from 36 companies., 9,JAS is the editor and the Director of the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis., 9,Jas is a member of the American College of Rheumatology's (ACR) Annual Meeting Planning Committee (AMPC); Chair of the ACR Meet-the-Professor, Workshop and Study Group Subcommittee., 9,a member of the Veterans Affairs Rheumatology Field Advisory Committee, 9.

To cite this abstract in AMA style:

Hoang A, Goodman SM, Figgie MP, Bostrom M, Padgett D, Mandl LA, Sculco P, McLawhorn A, Singh JA. What to Measure after Arthroplasty? Confirmation of a Core Domain Set [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/what-to-measure-after-arthroplasty-confirmation-of-a-core-domain-set/. Accessed February 4, 2023.
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