Sharpening Reported Outcomes for Knee Meniscal Surgery

New work from Rush University Medical Center, “How Should We Define Clinically Significant Improvement on Patient-Reported Outcomes Measurement Information System Test for Patients Undergoing Knee Meniscal Surgery?” has been published in the January 2020 edition of Arthroscopy.

Brian J. Cole, M.D., M.B.A., associate chairman and professor in the Department of Orthopedics at Rush and co-author on the study explained how difficult it is to assess and define patient improvement after meniscal surgery to OTW, “Meniscal surgery is one of the most commonly performed orthopedic procedures worldwide. We see many patients improve following meniscal procedures and complications are relatively infrequent. However, in many cases, it is difficult to assess and define if the procedure made a meaningful positive impact on the patient’s health. Therefore, we use patient-reported outcomes measures to help us evaluate how patients are doing after specific procedures.”

“The Patient-Reported Outcomes Measurement Information System (PROMIS) was introduced by the National Institutes of Health (NIH), as a new outcome measure, using item response theory and a large database of questions. PROMIS relies on computerized adaptive testing (CAT) to select specific questions that best discriminate outcome scores and decrease question burden.”

“Since the introduction of PROMIS we have performed many studies to evaluate outcomes of different orthopedic procedures, based on PROMIS. Specifically, in this paper we wanted to define what are the clinically significant thresholds for the PROMIS physical function instrument in patients undergoing arthroscopic meniscal surgery.”

“The main issue is that patients and orthopedic surgeons are in need of an optimal tool to assess patient outcomes for specific surgeries. Elucidating what outcomes are expected for a specific procedure in a specific patient, can help both orthopedic surgeons and patients make better decisions regarding their treatment plan.”

“While many patient-reported assessment tools had been introduced in the past, the numerical result they produce does not always accurately portray the patient’s real health status after the surgery. To more accurately define patient outcomes, clinically significant outcomes (CSOs), such as minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) have been introduced.”

“Identifying patient characteristics which are correlated with achieving or failing to achieve CSOs of PROMIS, may help us in patient selection for our procedures, and in this case for arthroscopic meniscal procedures. These values also aid us in guiding our research endeavors and analyzing data of thousands of patients over decades.”

“This study defined the clinically significant outcomes for the PROMIS physical function instrument. These may help patients and orthopedic surgeons understand the outcomes of a patient undergoing a meniscal procedure. These may also help in future research investigations evaluating the efficacy of meniscal procedures and determining patient-care treatment algorithms.”

“This investigation identified several preoperative patient factors that may assist patients and physicians in determining the odds a patient will enjoy a clinically significant outcome following arthroscopic meniscal procedures.”

“We found that a preoperative PROMIS score below 37.6 was predictive of achieving a meaningful clinical change with surgery whereas a preoperative score above 41.9 was predictive of patients who would attain an acceptable postoperative health state. In addition, exercising more days per week and the absence of arthritis increased the likelihood of achieving postoperative CSOs. Therefore, clinical patient-physician decision making should consider these factors and how they may be correlated to outcomes for a specific patient considering undergoing an arthroscopic meniscal procedure.”