When Is the Optimal Time to Assess PROMs?

Are your patients’ Patient Reported Outcome Measures (PROMS) changing between initial clinic visit and day of surgery?

A group of researchers from the Henry Ford Health System in Detroit, concerned about the lack of data on this topic, set out to give clarity on when exactly pre-operative PROM scores should be measured.

Their work, “Changes in Patient Reported Outcome Measure Scores from Initial Presentation to Day-of-Surgery in Patients Undergoing Hip and Knee Arthroplasty,” was published in the June 5, 2022, edition of The Journal of Arthroplasty.

“Patient reported outcome measures, or PROMs, are key determinants of health care value, especially with regards to score changes before and after treatment,” explained co-author Eric Makhni, M.D., M.B.A., medical director of the Center for Patient Reported Outcome Measures at Henry Ford, to OTW. “Even though PROMs have been a key component of orthopedic clinical research, little is known about the optimal timing of administration of these measures.”

“For those of us who collect PROMs as part of routine clinical care, we assess them upon presentation to the clinic and use the scores as part of shared decision-making. Others may track PROM scores before and after surgery and often collect PROMs on the day of surgery.”

“It is therefore unknown if:

1. PROMs vary in surgical patients if collected in the clinic at the time of surgical indication versus collected on the day of surgery and
2. If either of these time points is ‘more appropriate’ for measurement.”

“In our study, we collected PROMs for pain and function in a group of patients undergoing hip and knee replacement at two pre-operative time points: in the clinic on the day of surgical indication and in the pre-operative holding area on the day of surgery.”

The researchers examined the following measures for 497 patients:

• Patient-Reported Outcomes Measurement Information System Physical Function,
• Hip Disability and Osteoarthritis Outcome Score for Joint Replacement, and
• Knee Injury and Osteoarthritis Outcome Score for Joint Replacement scores.

Individual – Versus Population-Level Data

The researchers found no significant statistical difference in mean PROM scores between the first clinic visit and day-of-surgery Patient-Reported Outcomes Measurement Information System Physical Function or Hip Disability and Osteoarthritis Outcome Score for Joint Replacement scores. When they compared the initial and preoperative scores, they determined that only the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement demonstrated a significant statistical difference (2 ± 14). Patients undergoing partial knee arthroplasty had a strong positive correlation between initial Patient-Reported Outcomes Measurement Information System Physical Function and day of surgery scores.

Turning to the patient-level data, however, they found that the mean absolute value changes were 4 ± 4, 11 ± 39, and 11 ± 10 for Patient-Reported Outcomes Measurement Information System Physical Function, Hip Disability and Osteoarthritis Outcome Score for Joint Replacement, and the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement.

Dr. Makhni told OTW, “The results of our study indicate that there are real differences in PROM scores within the same patient across these two time points, highlighting the fact that pre-operative PROM scores—a key metric when considering value of surgical intervention—vary depending on when they are collected. This indicates that further research is needed to not only identify which pre-operative time point is most appropriate but also in establishing standardized guidelines for PROM collection for quality and research purposes.”