FORCE-TJR Surpasses Original Goal

A mammoth four-year, $12 million national research effort—known as Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement (FORCE-TJR)—has surpassed its original goal and has become the most comprehensive U.S. database on total hip and knee joint replacement patients and their surgical outcomes. The project is funded by the Agency for Healthcare Research and Quality (AHRQ).

According to the March 23, 2015 news release, new research findings include information on the “timing of hip and knee replacement surgery—patient pain and disability scores now can be compared to national benchmarks. National benchmarks identified by FORCE-TJR data show that while there is remarkable consistency in the level of pain and disability among today’s TJR patients, those who wait too long, or have surgery too early, may not gain the highest level of improvement after TJR.”

Also noted are “Comparisons of patient risk factors and outcomes. FORCE-TJR data documents that post-surgery patient pain and function, and readmission rates, are influenced by a number of pre-operative patient risk factors. FORCE-TJR’s risk-adjustment methods account for varied patient factors so surgeons can, for the first time, compare their patients’ risk factors to national data and adjust, if needed, their patient selection criteria for optimal outcomes and patient care.”

“With this data, for the first time, we can compare patients’ physical outcomes with varied implants, surgical approaches and follow-up programs. We have benchmarks to use to see where our patients fall on a national spectrum both pre- and post-surgery, ” says David Ayers, M.D., co-lead of FORCE-TJR and chair of the Department of Orthopedics and Physical Rehabilitation at UMass Medical School. “The data is invaluable for developing best practices.”

“The research on the original AHRQ-funded cohort will continue indefinitely as we implement annual follow-ups with those patients, ” says Patricia Franklin, M.D., principal investigator of the AHRQ grant and professor of Orthopedics and Quantitative Health Sciences at the UMass Medical School. “The data we’ve collected, and continue to add to, has the potential to directly influence clinical best practices, health care policy and the overall health and quality of life for more than 60 million people in the U.S. living with arthritis.”

Elise Berliner, director, Technology Assessment Program, Center for Evidence and Practice Improvement, AHRQ, told OTW, “Force-TJR is a model for a patient centered approach where patients are considered partners in research. Because every aspect of the study was designed with this philosophy, including incorporating data collection directly from patients, the FORCE data collection method has been extremely successful. With a follow-up PRO (patient reported outcomes) return rate exceeding 85%, it far surpasses the rate of 20-30% seen in other similar registries. This has resulted in gathering previously unavailable data, especially on the under 65 population.”