Browsing by Person "Howie, Colin"
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Item Assessing the Viability of the EQ-5D as Part of a Battery of Outcomes in Elderly Total Knee Arthroplasty Patients: A Comparison of Generic, Condition-Specific, and Preference-Based Patient-Reported Outcome Measures(2011-10-07) Davis, Jessica; Lane, Judith; MacDonald, Deborah; Howie, ColinBackground In the current economic climate it has become increasingly important to evaluate the effectiveness of expensive procedures such as total knee arthroplasties (TKAs). Patient-reported outcome measures, such as generic and condition-specific profile measures, are popular ways of determining outcomes. However, these cannot be used reliably for the purpose of economic evaluations. The EQ-5D, designed for cost-utility analysis, could offer potential advantages to outcome measurement; however, little is known about the viability and performance of this measure in more elderly (_ 75 years) patient cohorts. Aims The aim of this study was to assess the viability of the EQ-5D for use in the evaluation of TKA and to provide justification for its continued inclusion in the clinical audit of patients undergoing arthroplasty in a large general hospital. Methods Seven-hundred and seventy-nine consecutive patients undergoing TKA participated in this study. Self-report audit questionnaire booklets were administered at baseline (during a pre-admission clinic appointment) and six months post-operatively (postally). Booklets comprised of the Oxford Knee Scale (OKS;), 12-dimension Short Form (SF-12;), and the EQ-5D (). Results Two-hundred and forty-six subjects completed both the baseline and follow-up audit surveys. Correlations were strongest between the EQ-5D and OKS instruments (baseline: Tb=-0.58; p0.01; follow-up: Tb=-0.41; p0.01),.. The EQ-5D displayed large effect sizes (d=0.94) and was able to detect clinically important HRQoL improvements (ROC P-value=0.65; CI0.08; p0.001), discriminate those patients who were experiencing poorer pre-operative health (p0.001), and detect those who deteriorated post-operatively (p0.001). Adequate reliability (Cronbach's =0.79) of the EQ-5D instrument was seen post-operatively as well. Conclusions Results from this study reveal that the EQ-5D instrument shows good responsiveness to health changes in elderly TKA patients post-operatively. Its correlations with the OKS, detection of poorer pre-operative health, and detection of deterioration post-operatively also suggest good validity for the EQ-5D in this cohort. Finally, the relatively large reliability statistic post-operatively supports the use of the EQ-5D in audits. Together, these findings support the continued use of the EQ-5D instrument in future arthroplasty audits and provide evidence that it is viable for the use in cost-utility analysis.Item Assessing treatment outcomes using a single question: the Net Promoter Score(British Editorial Society of Bone & Joint Surgery, 2014-05) Hamilton, D. F.; Lane, Judith; Gaston, P.; Patton, J. T.; MacDonald, Deborah; Simpson, Hamish; Howie, ColinSatisfaction with care is important to both patients and to those who pay for it. The Net Promoter Score (NPS), widely used in the service industries, has been introduced into the NHS as the 'friends and family test'; an overarching measure of patient satisfaction. It assesses the likelihood of the patient recommending the healthcare received to another, and is seen as a discriminator of healthcare performance. We prospectively assessed 6186 individuals undergoing primary lower limb joint replacement at a single university hospital to determine the Net Promoter Score for joint replacements and to evaluate which factors contributed to the response. Achieving pain relief (odds ratio (OR) 2.13, confidence interval (CI) 1.83 to 2.49), the meeting of pre-operative expectation (OR 2.57, CI 2.24 to 2.97), and the hospital experience (OR 2.33, CI 2.03 to 2.68) are the domains that explain whether a patient would recommend joint replacement services. These three factors, combined with the type of surgery undertaken (OR 2.31, CI 1.68 to 3.17), drove a predictive model that was able to explain 95% of the variation in the patient's recommendation response. Though intuitively similar, this 'recommendation' metric was found to be materially different to satisfaction responses. The difference between THR (NPS 71) and TKR (NPS 49) suggests that no overarching score for a department should be used without an adjustment for case mix. However, the Net Promoter Score does measure a further important dimension to our existing metrics: the patient experience of healthcare delivery.Item Patient interpretations of the term 'stiffness' prior to and following total knee arthroplasty(2011) Lane, Judith; Simpson, Hamish; Howie, Colin; Macmillan, FionaPurpose: to gain further understanding of what patients mean when they say that their joint feels 'stiff' both prior to and following total knee arthroplasty. Relevance: Pain, function and joint stiffness are recommended as core outcome measures following joint replacement surgery although few studies have included stiffness . One study in patients with rheumatoid arthritis showed that the interpretation of the word 'stiffness' was varied. If groups with osteoarthritis and TKA were to demonstrate a similar variability, doubt could be cast upon the robustness of currently used measures of stiffness. Participants: Patients (n = 40) who were due to undergo TKA for osteoarthritis within 6 weeks were recruited from a pre-admission clinic. TKA patients (n = 76) were recruited from a group who had undergone primary TKA for osteoarthritis in the previous 10-14 months. Methods: Participants rated their level of perceived stiffness from 0 -100 using a visual analogue scale. They were also asked to select words that they felt best described their stiffness from a list of 21. The stiffness descriptors included words that were related to pain, difficulty with movement and sensation. Analysis: VAS stiffness was not normally distributed and therefore Mann-Whitney U tests were used to detect inter-group differences in self reported level of stiffness, number of words used. Chi-square tests were used to explore difference between the groups in the type of words used to describe stiffness. Results: The OA group had a higher median VAS stiffness score of 60.0 compared to 40.0 in the TKA group. These differences were significant (p < 0.001). The median number of words used to describe stiffness was 4.0 in the OA group compared to 1.0 in the TKA. Overall 49% of participants used words from the pain category to describe stiffness. A significantly greater proportion (2 = 19.65, p < 0.001) of participants in the OA group (78%) included words from the pain category to describe their stiffness compared to the TKA group (34%). A similar proportion of participants in the OA group (75%) included words from the difficulty with movement category compared to the TKA group (65%). A significantly higher proportion (2 = 42.88, p < 0.001) of participants in the OA group (60%) than the TKA group (5%) used words from the sensation category. The most common combination of words in the OA group was pain + stiffness+sensation (43%) whereas the largest proportion of TKA patients (41%) used the difficulty with movement category only. Conclusions: All participants were likely to use a range of words to describe stiffness but the OA group were more likely to use pain or sensation related words than the TKA group. Implications: When a patient reports stiffness either prior to and following TKA, care should be taken to explore with the patient what they mean. Many patients confused sensations of pain with sensations of stiffness and this could have implications for provision of adequate pain relief. Further work is necessary to ensure the validity of patient reported measures of stiffness.Item Physical function following TKA compared to age matched healthy controls(2011) Lane, Judith; Simpson, Hamish; Howie, Colin; Macmillan, FionaPurpose: to explore whether physical and functional impairments exist in those who have undergone primary TKA compared to age matched healthy controls. Relevance: Many studies have suggested that although function generally improves following TKA, patients continue to experience significant functional limitations. Most of these studies however have assessed function using self-reported measures despite recommendations that both self-report and performance based measures are required to capture the full spectrum of functional ability. Furthermore, there have been no recent studies that have comprehensively compared outcomes in TKA with those who have no knee related pathology. Therefore, the evidence to suggest that functional limitations persist cannot be considered as robust. Participants: A group of patients (n = 15) were recruited who had undergone primary TKA for osteoarthritis between 10 and 14 months previously (median age = 71 years). A group of age matched health controls (n = 12, median age = 69.5 years) were recruited from local community groups. Methods: Self reported function (0-100 scale where 0 is best), timed-up-and-go, stair ascent/descent, walking speed, leg extensor power and range of motion were compared between groups. Analysis: Mann-Whitney U-tests were used to detect inter-group differences. The alpha level was set at 0.05. Results: Maximum flexion in the TKA group (median = 110o) was significantly less (p = 0.002) than the control group (median = 120o). The TKA group reported significantly worse function (median scores TKA = 10.0, control = 0.00, p = 0.028). No significant differences (p >0.05) however were found between groups in any of the performance based measures of function (timed up and go, timed stair ascent/descent, walking speed) or in knee extensor strength. Conclusions: although individuals with TKA perceived their functional ability to be significantly worse than their healthy counterparts, there was no evidence to suggest that significant functional impairments existed in this small group. Implications: expectations of outcome in TKA have been shown to be an important factor in overall patient satisfaction with their surgery. The results of this study could help to provide improved information regarding functional ability following TKA.