The pains and pleasures of using Orthopaedic Patient Reported Outcome Measures (PROMS) in clinical assessment and evaluation

Abstract

Aim This paper aims to explore the usefulness of PROMS in the clinical assessment and evaluation of patients undergoing orthopaedic interventions such as total hip and knee arthroplasty. Also to discuss some of the challenges in the use of PROMS with patients with multiple comorbidities or learning/ communication difficulties. Abstract Health care globally requires the measurement of outcome before and following procedures such as total hip and knee replacement to demonstrate the intervention has resulted in an improvement in the patient’s condition and/or functional status (Jester, Santy & Rogers 2011). Outcome can be assessed from the clinician perspective in a number of ways including: measures of function, clinical investigations such as x-ray or MRI scan and direct observation such as gait analysis. However this does not capture the patient’s perspective of the impact of the disease and subsequent effectiveness of an intervention/s. Patient Reported Outcome Measures (PROMS) have become increasingly used in Orthopaedics to capture the patient’s perspective. One of the most frequently used PROMS used with patients undergoing THR and TKR are the Oxford Hip and Knee Scores. These scores are frequently included in initial clinical assessment to ascertain how patients perceive the severity of their symptoms and the impact on various activities. Subsequently the tools are administered at regular intervals following THR/TKR and compared to the baseline scores to assess improvement in symptoms and function. Oxford hip and knee scores have been used extensively over the last 20 years in the UK and internationally and form part of the data collected for a number of national joint registers. They have been tested extensively to demonstrate their reliability, validity and sensitivity and are minimally influenced by patient co-morbidity (Murray et al, 2007). However there is very little research on the patient’s experience and satisfaction with these scores (Wylde et al, 2005). This presentation will discuss the difficulties patients with co-morbidities, multiple joint involvement and learning or communication difficulties have in completing these scores and the impact this may have during clinical assessment and evaluation of outcome.