Responsiveness of patient reported outcome measures in total joint arthroplasty patients.

UNLABELLED: This study reports the responsiveness to change and minimal clinically important difference (MCID) of three patient reported outcome measures following total hip arthroplasty (THA) and total knee arthroplasty (TKA). Patient-reported outcome measures were collected preoperatively and 3 months postoperatively for 391 patients enrolled in the California Joint Replacement Registry. Effect size, standardized response means, and MCID were calculated for each measure. The WOMAC and the SF12v2 physical component summary (PCS) score were the most responsive to perioperative changes. The MCID was 4.97 for the SF12v2 PCS and 10.21 for the WOMAC. THA patients were more likely to exhibit improvements above the MCID than TKA patients. The WOMAC and SF12v2 PCS are useful to measure health status changes in TJA patients. LEVEL OF EVIDENCE: Prognostic Level II.

The emerging case for shared decision making in orthopaedics.

The Institute of Medicine outlined a standard for patient-centered care, which has become the centerpiece of healthcare reform in the United States. Shared decision-making interventions, which include decision and communication aids, are formal embodiment of this philosophy. Although the concept of shared decision making has been shown to be an effective tool, and its relevance to orthopaedic medicine has been well documented, it has not been widely adopted by orthopaedic surgeons. It is helpful to examine the benefits of shared decision making, along with incentives to encourage adoption and implementation of this important philosophy.

Incorporating Patient-Reported Outcomes Into Health Care To Engage Patients And Enhance Care.

The provision of patient-centered care requires a health care environment that fosters engagement between patients and their health care team. One way to encourage patient-centered care is to incorporate patient-reported outcomes into clinical settings. Collecting these outcomes in routine care ensures that important information only the patient can provide is captured. This provides insights into patients' experiences of symptoms, quality of life, and functioning; values and preferences; and goals for health care. Previously embraced in the research realm, patient-reported outcomes have started to play a role in successful shared decision making, which can enhance the safe and effective delivery of health care. We examine the opportunities for using patient-reported outcomes to enhance care delivery and outcomes as health care information needs and technology platforms change. We highlight emerging practices in which patient-reported outcomes provide value to patients and clinicians and improve care delivery. Finally, we examine present and future challenges to maximizing the use of patient-reported outcomes in the clinic.