Perceived occurrence of an adverse event affects patient-reported outcomes after total hip replacement.

BACKGROUND: Dislocation, periprosthetic fracture and infection are serious complications of total hip replacement (THR) and which negatively impact on patients' outcomes including satisfaction, quality of life, mental health and function. The accuracy with which patients report adverse events (AEs) after surgery varies. The impact of patient self-reporting of AEs on patient-reported outcome measures (PROMs) after THR is yet to be investigated. Our aim was to determine the effect of confirmed and perceived AEs on PROMs after primary THR. METHODS: A prospective single-centre cohort study of patients undergoing primary THR, with one-year follow-up, was performed. Participants completed forms pre-operatively and 3, 6, 9 and 12 months post-operatively, including Work Productivity and Activity Impairment (WPAI), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), EuroQol-5D-3 L (EQ5D), Self-Administered Patient Satisfaction (SAPS) and AE reporting questionnaires. Results were reported in three groups: No AE, reported but not confirmed AE and confirmed AE. A generalised linear model was used to compare among groups using robust standard errors (SE). RESULTS: Forty-one AEs were reported in a cohort of 417 patients (234 females), with 30 AEs reported by 3 months. Eleven (27 reported) infections, two (six reported) periprosthetic fractures and two (eight reported) dislocations were confirmed. Those in the no AE group reported significantly better outcomes that the reported AE group as measured by WOMAC Co-Eff 14.27 (p = 0.01), EQ5D - 0.128 (p = 0.02) and SAPS - 9.926 (p = 0.036) and the combined reported and confirmed AE groups as measured by WOMAC Co-Eff 13.72 (p = 0.002), EQ5D - 0.129 (p = 0.036) and SAPS - 11.512 (p = 0.004). No significant differences were seen in WPAI among groups. CONCLUSIONS: Patients who report AEs have worse outcomes than those who do not, regardless of whether the AEs can be confirmed by standard medical record review methods. The observed negative trends suggest that patient perception of AEs may influence patient outcome in a similar way to those with confirmed AEs.

Validated repeatability of patient-reported outcome measures following primary total hip replacement: a mode of delivery comparison study with randomized sequencing.

Background and purpose - Patient-reported outcome measures (PROMs) are used to understand better the outcomes after total hip replacement (THR). These are administered in different settings using a variety of methods. We investigated whether the mode of delivery of commonly used PROMs affects the reported scores, 1 year after THR. Patients and methods - A prospective test-retest mode comparison study with randomized sequence was done in 66 patients who had undergone primary THR. PROMs were administered by 4 modes: self-administration, face-to-face interview, telephone interview, and postal questionnaire. PROMs included: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Oxford Hip Score (OHS), EQ5D-3L (EQ5D), and Self-Administered Patient Satisfaction Scale (SAPS). Linear regression was used to estimate relationships between the mean scores for PROMs by mode. Individual paired differences by mode were calculated, relationships between modes were identified, and results adjusted by time delay and participant age. Results - There was no statistically significant difference between the mean PROM scores recorded for each mode of delivery for each score. Statistically significant differences in the individual paired differences were detected between modes for the WOMAC stiffness subscale, OHS, EQ5D, and SAPS. OHS difference in individual paired means between face-to-face and telephone interview exceeded the minimal clinically important difference. Interpretation - PROMs mode of administration can affect the recorded results. Modes should not be mixed and may not be comparable between studies. It should not be assumed that different modes will obtain the same results and where not already established this should be checked by researchers before use.