Correlation between Patient Reported Outcome Measures (PROMs) completed in the ambulatory setting and the remote setting: an analysis of PROMIS PCS, HOOS Jr, KOOS Jr, SANE Hip, and SANE Knee

Authors: David Christensen¹ , Paul Werth¹  , Adriana Lucas¹  , Rebecca Teng²  , David Jevsevar¹

¹Dartmouth-Hitchcock Medical Center

²Force Therapeutics

Abstract

Introduction

THA and TKA are widely successful at improving   patient pain and dysfunction. Patient reported outcomes (PROMs) emphasize patient perspective and increasingly used in clinical  practice and research (now reported to CMS under AJRR). There are multiple PROMs in use : General: SF -36, SF 12, EQ5D; Joint Specific: Harris Hip Score, Oxford Knee Score,  HSS, WOMAC, VAS, HOOS, KOOS, HOOS –JR, KOOS – JR; Hybrid: PROMIS. Most orthopaedic PROMs were developed and validated   using hard copy surveys remotely via mail and in clinic  settings.  PROMs are increasingly collected remotely via internet and  mobile apps. Review of 381 studies: Bias found in presence or absence of an interviewer and  change in sensory stimuli.

Methods

PROMs recorded as a part of routine   assessment of primary TKA and THA patients. PROMIS PCS, HOOS JR, KOOS JR, SANE Hip   and SANE Knee. Recorded by patients in clinic appointments  on tablets and remotely via smart phone application. Clinic based responses were matched with  next closest remote response in 3 time periods. Pre-op, post-op 3 months, post op 6 months.

Discussion

Moderate to strong correlation present in PROMIS,   HOOS JR, KOOS JR and SANE hip scores: very weak to moderate correlation demonstrated in SANE knee  scores, weak HOOS JR at 6 months. Griffiths-Jones JOA 2014: 47 patients s/p open FAI surgery > 2 years prior; Remote Paper vs. Electronic 1 week apart; Oxford Hip, McCarthy Hip, UCLA and howRU: ICC 0.95 - 0.99. Shervin JBJS 2011: 61 THA patients clinic collected HHS, WOMAC, SF-36, EQ5D   and UCLA scores; paper, tablet or computer scores; no difference in ANOVA Pearson or Spearman correlation. Carpenter Acta Ortho 2018: 66 patients, 4 survey modes, 3 time points:  1 - Clinic - face-to-face, self- administered  2 and 3 - Remote - postal and telephone. No differences WOMAC. OHS, EQ5D, SAPS higher on telephone  and face-to-face. Limitations: smaller sample size at 6 month  follow-up but largest study to date. Nonstandardized comparison timing : • <8 weeks  • Majority <4 weeks.