How Solid Is the Link Between VAS and Functional Improvement?

Hunting the ever elusive objective measure of patient satisfaction could be an exercise in futility or it could be the most valuable initiative in years. A team of researchers from Rush University Medical Center in Chicago took up the challenge and have just published their results.

Their study, “Defining Meaningful Functional Improvement on the Visual Analog Scale [VAS] for Satisfaction at 2 Years After Hip Arthroscopy for Femoroacetabular Impingement Syndrome [FAIS],” appears in the November 14, 2019 edition of Arthroscopy.

Edward Beck, M.D., M.P.H., a co-author on the study, told OTW, “Over the past several years, there has been a trend in using patient satisfaction as a metric for surgeon performance, as well as a tool used for provider incentives and reimbursements.”

“However, we noticed that there is no clear objective level of patient satisfaction that defines postoperative clinical success. Recently, [there] has been a shift in the literature on how to define postoperative clinical success, from statistical differences between pre- and postoperative patient functional scores, to clinical differences in what patients consider as meaningful.”

“In order to identify patients we are helping the most, we set out to identify a satisfaction score.”

The authors prospectively collected data from consecutive patients who underwent primary hip arthroscopy between November 2014 and January 2017 and retrospectively analyzed the data. They included patients in the study who’d received a clinical and radiographic diagnosis of femoroacetabular impingement syndrome (FAIS), who’s also failed nonoperative treatment, who’d received primary hip arthroscopy to address their femoroacetabular impingement syndrome. Finally, the authors only used data that represented a minimum of minimum 2-year.

Ultimately, the team included 355 patients in their analysis.

Co-author Benedict U. Nwachukwu, M.D., M.B.A., summarized the results of their study to OTW, “We determined that over 85% of our patients reached the satisfaction score threshold for achieving the meaningful clinically important difference, which is what is considered the lower threshold of clinical success. The study also showed that higher BMI [body mass index] and a larger cam lesion are predictors of not achieving superior clinical success.”

In conclusion, said Beck, “There is a need for a more-nuanced approach to classifying the range of postsurgical successful clinical outcomes as value-based payments become more prevalent. In our study, we have provided threshold scores for the VAS [Visual Analog Scale] of satisfaction that are anchored to meaningful outcomes as defined by patients and recommend clinicians to adopt similar tiered systems for evaluating patient success.”

“Easy to use patient reported tools such as VAS satisfaction can be used to evaluate whether or not patients achieve clinical success after surgery,” additionally said Dr. Nwachukwu. “Furthermore, meaningful clinically important difference, the patients acceptable symptomatic state, and substantial clinical benefit are thresholds that can be by physicians used to identify outcomes that are meaningful to patients.”