Sleep quality and nocturnal pain in patients with femoroacetabular impingement and acetabular dysplasia.

BACKGROUND: Femoroacetabular impingement (FAI) syndrome and acetabular dysplasia (AD) are common pathologies that lead to pain in the young adult hip. Nocturnal pain in these patients is often reported, yet little is known regarding the effect of these hip pathologies on overall sleep quality. The purpose of this study was to evaluate sleep quality in patients with AD and FAI syndrome. METHODS: This cross-sectional study consisted of 115 patients who complained of hip pain secondary to either FAI syndrome or AD. One hundred fifteen patients with hip pain secondary to FAI syndrome and AD were assessed using the Hip Outcome Score (HOS), Modified Harris Hip Score (mHHS), and then Hip disability and Osteoarthritis Outcome Score (HOOS). Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Multiple linear regression, with adaptive LASSO variable selection, was used to assess factors associated with sleep quality. RESULTS: Of the 115 patients, 62 had a diagnosis of FAI syndrome and 53 with AD. The mean age was 34.55 ± 11.66 (age range: 14 to 58 years), 76.52% had an ASA classification of 1 (ASA range: 1 to 3), and all Tonnis grades were either 0 or 1. The mean PSQI global score for all patients was 8.46 ± 4.35 (PSQI range: 0 to 21), indicating poor sleep quality. The adaptive LASSO-penalized least squares multiple linear regression revealed that HOOS Pain, SF-12 Role Emotional, and SF-12 Mental Health significantly predicted Sleep Quality (Adjusted R2 = 0.4041). Sleep quality improved as pain, emotional problems, and mental health improved. CONCLUSION: Patients with symptomatic FAI syndrome and AD have poor sleep quality. Worsening pain from a patient's hip pathology is associated with poor sleep, even prior to the onset of osteoarthrosis of the hip. Patients presenting with hip pain from FAI syndrome and AD should be screened for sleep disturbance and may benefit from a multidisciplinary treatment approach.

Depression and Non-modifiable Patient Factors Associated with Patient Satisfaction in an Academic Orthopaedic Outpatient Clinic: Is it More Than a Provider Issue?

BACKGROUND: Patient satisfaction surveys play an increasingly important role in United States healthcare policy and serve as a marker of provided physician services. In attempts to improve the patient's clinical experience, focus is often placed on components of the healthcare system such as provider interaction and other experiential factors. Patient factors are often written off as "non-modifiable"; however, by identifying and understanding these risk factors for dissatisfaction, another area for improvement and intervention becomes available. QUESTIONS/PURPOSES: (1) Do patients in the orthopaedic clinic with a preexisting diagnosis of depression report lower satisfaction scores than those without a preexisting diagnosis of depression? (2) What other non-modifiable patient factors influence patient-reported satisfaction? METHODS: We reviewed Press Ganey Survey scores, which assess patient experiential satisfaction with a single clinical encounter, from 3044 clinic visits (2527 patients) in adult reconstructive, sports, and general orthopaedic clinics at a single academic medical center between November 2010 and May 2017, during which time approximately 19,000 encounters occurred. Multiple patient factors including patient age, gender, race, health insurance status, number of previous clinic visits with their physician, BMI, and a diagnosis of depression were recorded. Patient satisfaction was operationalized as a binary outcome as satisfied or less satisfied, and a multiple logistic regression analysis was used to estimate the odds of being satisfied. RESULTS: After adjusting for all other covariates in the model, we found that patients with a diagnosis of depression were less likely to be satisfied than patients without this diagnosis (odds ratio 0.749 [95% confidence interval, 0.600-0.940]; p = 0.01). Medicare-insured patients were more likely to be satisfied than non-Medicare patients (OR 1.257 [95% CI, 1.020-1.549]; p = 0.03), patients in the sports medicine clinic were more likely to be satisfied than those seen in the general orthopaedic clinic (OR 1.397 [95% CI, 1.096-1.775]; p = 0.007), and established patients were more likely to be satisfied than new patients (OR 0.763 [95% CI, 0.646-0.902]; p = 0.002). CONCLUSIONS: Given the association of depression with lower satisfaction with a single visit at the orthopaedic clinic, providers should screen for depression and address the issue during the outpatient encounter. The impact of such comprehensive care or subsequent treatment of depression on improving patient-reported satisfaction offers areas of future study. LEVEL OF EVIDENCE: Level III, therapeutic study.

The Dimension of the Press Ganey Survey Most Important in Evaluating Patient Satisfaction in the Academic Outpatient Orthopedic Surgery Setting.

Many studies have examined modifiable and nonmodifiable patient factors influencing patient satisfaction scores. The objective of this study was to evaluate which of the 6 domains making up the Press Ganey Survey had a greater magnitude of relative importance in the expected relationship with patient satisfaction in outpatient orthopedic surgery encounters. Press Ganey Survey satisfaction scores from 4737 clinical encounters from adult reconstructive surgery, sports medicine, hand, foot and ankle, trauma, and general orthopedic clinics at a single academic center from November 2010 to May 2017 were reviewed. Multiple patient factors, modifiable and nonmodifiable, were recorded. The Press Ganey Survey was divided into 6 domains to evaluate the relative importance of each to total patient satisfaction. The standardized parameter estimates from the multiple linear regression revealed that of the 6 domains making up the Press Ganey Survey, care provider had the greatest magnitude of relative importance in the expected relationship with total patient satisfaction (ß=0.53972). Approximately 80% of the variance in total patient satisfaction was accounted for by the care provider. The relative importance of the remaining 5 domains was as follows: access (ß=0.23483), personal issues (ß=0.16796), moving through the visit (ß=0.16795), nurse/assistant (ß=0.10010), and special services/valet (ß=0.06302). A principal components analysis suggested a 6-factor solution for the Press Ganey total satisfaction scale; care provider was the most dominant factor, and valet parking services was the least. The care provider had the most influence on the patient's overall satisfaction. Altogether, access, personal issues, moving through the visit, nurse/assistant, and special services/valet accounted for only approximately 20% of the total variance in patient satisfaction. This knowledge can be used by providers in the current health care climate, where patient consumerism is developing into the driver of care. This could allow resources to be focused on areas of influence, yielding a greater impact on patient satisfaction scores. [Orthopedics. 2019; 42(4):198-204.].