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KOOS score maps were externally validated to inform knee arthroplasty shared decision making

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The Knee injury and Osteoarthritis Outcome Survey (KOOS) profile of outcome measures are among the most commonly used outcome measures in knee arthroplasty (KA). The purpose was to develop and externally validate “score maps” (one-page figural depictions of most likely scores) for KOOS Pain and Function subscales to facilitate a variety of clinical decisions related to shared decision making prior to KA.

Methods

Presurgical KA data collected within 1 year of surgery and obtained in two independent studies were used in this cross-sectional study. Score maps were designed to be easily understandable, single-page graphical depictions of predicted KOOS Pain, and KOOS Function, daily activity subscales. To create the score maps, individual item scores from one dataset were used to determine the most probable responses for each item for the entire range of possible scores. Predicted KOOS score maps were derived from Osteoarthritis Initiative (OAI) data and externally validated using an independent single site KA cohort study. Score map predicted scores from OAI were compared to actual presurgical KOOS subscale scores using Weighted Kappa (Κw) agreement coefficients and actual versus predicted differences in scores.

Results

The score maps derived from OAI and applied to actual scores in the validation sample demonstrated moderate to substantial chance-corrected agreement for both KOOS Pain and KOOS Function, daily activity subscale items. For example, KOOS Pain score map scores applied to the external validation dataset showed chance-corrected agreement with Κw ranging from 0.43 to 0.73. Score maps predicted actual item scores within ± 1 point at least 94% of the time. Findings for the KOOS Function, daily activity subscale items were similar.

Conclusions

Score maps derived from OAI data agreed with actual KOOS scores obtained on an independent dataset at an acceptable degree of precision. Easy-to-use KOOS Pain and Function, daily activity score maps have potential to facilitate a variety of important clinical decisions during discussions between patients and surgeons prior to KA.

Level of evidence

Level III prognostic study.

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Data availability

Osteoarthritis Initiative data are publicly available at https://nda.nih.gov/oai/. External validation data are not available.

Abbreviations

KA:

Knee arthroplasty

KOOS:

Knee injury and osteoarthritis outcome survey

Kw :

Weighted kappa

NIH:

National institutes of health

OA:

Osteoarthritis

OAI:

Osteoarthritis initiative

PROMIS:

Patient-reported outcomes measurement information system

PROMs:

Patient-reported outcome measures

SPSS:

Statistical package for the social sciences

References

  1. Alshehri F, Alarabi A, Alharthi M, Alanazi T, Alohali A, Alsaleem M (2020) Use of patient-reported outcome measures (PROMs) by orthopedic surgeons in Saudi Arabia. J Orthop Surg Res 15:598

    Article  PubMed  PubMed Central  Google Scholar 

  2. Bellamy N, Buchanan WW (1986) A preliminary evaluation of the dimensionality and clinical importance of pain and disability in osteoarthritis of the hip and knee. Clin Rheumatol 5:231–241

    Article  CAS  PubMed  Google Scholar 

  3. Bujang MA, Baharum N (2017) Guidelines of the minimum sample size requirements for Cohen’s Kappa. Epidemiol Biostat Public Health 14(2):e12267–e12271

    Google Scholar 

  4. Collins NJ, Misra D, Felson DT, Crossley KM, Roos EM (2011) Measures of knee function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL) Lysholm Knee Scoring Scale, Oxford Knee Score (OKS) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC, Activity Rating Scale (ARS) and Tegner Activity Score (TAS). Arthritis Care Res (Hoboken) 63 Suppl 1:S208–S228

  5. Collins NJ, Prinsen CA, Christensen R, Bartels EM, Terwee CB, Roos EM (2016) Knee Injury and Osteoarthritis Outcome Score (KOOS): systematic review and meta-analysis of measurement properties. Osteoarthritis Cartilage 24:1317–1329

    Article  CAS  PubMed  Google Scholar 

  6. Collins NJ, Roos EM (2012) Patient-reported outcomes for total hip and knee arthroplasty: commonly used instruments and attributes of a “good” measure. Clin Geriatr Med 28:367–394

    Article  PubMed  Google Scholar 

  7. Dumenci L, Perera R, Keefe F, Ang D, Slover J, Jensen M, Riddle D (2019) Model-based pain and function outcome trajectory types for patients undergoing knee arthroplasty: a secondary analysis from a randomized clinical trial. Osteoarthritis Cartilage 27:878–884

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Frankel L, Sanmartin C, Hawker G, De CC, Dunbar M, Bohm E, Noseworthy T (2016) Perspectives of orthopaedic surgeons on patients’ appropriateness for total joint arthroplasty: a qualitative study. J Eval Clin Pract 22:164–170

    Article  PubMed  Google Scholar 

  9. Hafkamp FJ, Gosens T, de Vries J, den Oudsten BL (2020) Do dissatisfied patients have unrealistic expectations? a systematic review and best-evidence synthesis in knee and hip arthroplasty patients. EFORT Open Rev 5:226–240

    Article  PubMed  PubMed Central  Google Scholar 

  10. Jette AM, Tao W, Norweg A, Haley S (2007) Interpreting rehabilitation outcome measurements. J Rehabil Med 39:585–590

    Article  PubMed  Google Scholar 

  11. Juhl C, Lund H, Roos EM, Zhang W, Christensen R (2012) A hierarchy of patient-reported outcomes for meta-analysis of knee osteoarthritis Trials: empirical evidence from a survey of high impact journals. Arthritis 2012(1):17

    Google Scholar 

  12. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  CAS  PubMed  Google Scholar 

  13. Lester G (2012) The Osteoarthritis initiative: A NIH public-private partnership. HSS J 8:62–63

    Article  PubMed  Google Scholar 

  14. Lingard EA, Katz JN, Wright EA, Sledge CB (2004) Predicting the outcome of total knee arthroplasty. J Bone Joint Surg Am 86(10):2179–2186

    Article  PubMed  Google Scholar 

  15. Mou D, Sisodia RC, Castillo-Angeles M, Ladin K, Bergmark RW, Pusic AL, del Carmen MG, Heng M (2022) The surgeon’s perceived value of patient-reported outcome measures (PROMs). Ann Surg 275:500–505

    Article  PubMed  Google Scholar 

  16. Nilsdotter AK, Toksvig-Larsen S, Roos EM (2009) A 5 year prospective study of patient-relevant outcomes after total knee replacement. Osteoarthritis Cartilage 17:601–606

    Article  PubMed  Google Scholar 

  17. Patten RK, Tacey A, Bourke M, Lane R, Woessner MN, Levinger I (2022) The impact of waiting time for orthopaedic consultation on pain levels in individuals with osteoarthritis: a systematic review and meta-analysis. Osteoarthritis Cartilage In Press

  18. Rastogi R, Davis AM, Chesworth BM (2007) A cross-sectional look at patient concerns in the first six weeks following primary total knee arthroplasty. Health Qual Life Outcomes 5:48

    Article  PubMed  PubMed Central  Google Scholar 

  19. Reeve BB, Hays RD, Bjorner JB, Cook KF, Crane PK, Teresi JA, Thissen D, Revicki DA, Weiss DJ, Hambleton RK, Liu H, Gershon R, Reise SP, Lai JS, Cella D (2007) Psychometric evaluation and calibration of health-related quality of life item banks: plans for the patient-reported outcomes measurement information system (PROMIS). Med Care 45:522–531

    Article  Google Scholar 

  20. Riddle DL (2018) Prevalence and predictors of symptom resolution and functional restoration in the index knee after knee arthroplasty: a longitudinal study. Arch Phys Med Rehabil 99(5):887–892

    Article  PubMed  Google Scholar 

  21. Riddle DL, Macfarlane GJ, Hamilton DF, Beasley M, Dumenci L (2022) Cross-validation of good versus poor self-reported outcome trajectory types following knee arthroplasty. Osteoarthritis Cartilage 30:61–68

    Article  CAS  PubMed  Google Scholar 

  22. Riddle DL, Perera RA, Jiranek WA, Dumenci L (2015) Using surgical appropriateness criteria to examine outcomes of total knee arthroplasty in a United States sample. Arthritis Care Res (Hoboken) 67:349–357

    Article  PubMed  Google Scholar 

  23. Riddle DL, Sando T, Tarver T, Slover J, Sierra RJ, Brito JP, Montori VM (2021) Shared decision-making applied to knee arthroplasty: a systematic review of randomized trials. Arthritis Care Res (Hoboken) 73:1125–1133

    Article  PubMed  Google Scholar 

  24. Roos EM, Lohmander LS (2003) The knee injury and osteoarthritis outcome score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes 1:64

    Article  PubMed  PubMed Central  Google Scholar 

  25. Roos EM, Toksvig-Larsen S (2003) Knee injury and osteoarthritis outcome score (KOOS) - validation and comparison to the WOMAC in total knee replacement. Health Qual Life Outcomes 1:17

    Article  PubMed  PubMed Central  Google Scholar 

  26. Rothrock NE, Amtmann D, Cook KF (2020) Development and validation of an interpretive guide for PROMIS scores. J Patient Rep Outcomes 4:16

    Article  PubMed  PubMed Central  Google Scholar 

  27. Sayah SM, Karunaratne S, Beckenkamp PR, Horsley M, Hancock MJ, Hunter DJ, Herbert RD, de Campos TF, Steffens D (2021) Clinical course of pain and function following total knee arthroplasty: a systematic review and meta-regression. J Arthroplasty 36:3993–4002

    Article  PubMed  Google Scholar 

  28. Sim J, Wright CC (2005) The kappa statistic in reliability studies: use, interpretation, and sample size requirements. PhysTher 85:257–268

    Google Scholar 

  29. Wang YC, Hart DL, Stratford PW, Mioduski JE (2009) Clinical interpretation of computerized adaptive test-generated outcome measures in patients with knee impairments. Arch Phys Med Rehabil 90:1340–1348

    Article  PubMed  Google Scholar 

  30. Wang YC, Hart DL, Werneke M, Stratford PW, Mioduski JE (2010) Clinical interpretation of outcome measures generated from a lumbar computerized adaptive test. Phys Ther 90:1323–1335

    Article  PubMed  Google Scholar 

  31. Whitebird RR, Solberg LI, Ziegenfuss JY, Norton CK, Chrenka EA, Swiontkowski M, Reams M, Grossman ES (2022) What do orthopaedists believe is needed for incorporating patient-reported outcome measures into clinical care? a qualitative study. Clin Orthop Relat Res 480:680–687

    Article  PubMed  Google Scholar 

  32. Ziegenfuss JY, Grossman ES, Solberg LI, Chrenka EA, Werner A, Asche SE, Norton CK, Nelson A, Reams M, Whitebird RR (2022) Is the promise of proms being realized? implementation experience in a large orthopedic practice. Am J Med Qual 37:489–494

    Article  PubMed  Google Scholar 

  33. Zywiel MG, Mahomed A, Gandhi R, Perruccio A, v, Mahomed NN, (2013) Measuring expectations in orthopaedic surgery: a systematic review. Clin Orthop Relat Res 471:3446–3456

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The author wishes to thank Nancy Henderson for providing the validation dataset.

Funding

The Osteoarthritis Initiative (OAI) is a public–private partnership comprising 5 contracts (N01-AR-2–2258, N01-AR-2–2259, N01-AR-2–2260, N01-AR-2–2261, N01-AR-2–2262) funded by the National Institutes of Health (NIH), a branch of the Department of Health and Human Services, and conducted by the OAI study investigators. Private funding partners include Merck Research Laboratories, Novartis Pharmaceuticals Corporation, GlaxoSmithKline, and Pfizer Inc. Private sector funding for the OAI is managed by the Foundation for the National Institutes of Health. This manuscript was prepared using an OAI public use dataset and does not necessarily reflect the opinions or views of the OAI investigators, the NIH, or the private funding partners.

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Authors and Affiliations

  1. Departments of Physical Therapy, Orthopaedic Surgery and Rheumatology, Virginia Commonwealth University, 900 East Leigh Street, Fourth Floor, Room 100, Richmond, VA, USA

    Daniel L. Riddle

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Contributions

DLR contributed to conception and design, analysis and collection and interpretation of the data, drafting the article, and revising it critically for important intellectual content, final approval of the article, provision of study materials, administrative, technical, and logistic support.

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Correspondence to Daniel L. Riddle.

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The author reports no financial conflicts of interest.

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University IRB approval was obtained from all sites in both studies and all participants provided informed consent.

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Riddle, D.L. KOOS score maps were externally validated to inform knee arthroplasty shared decision making. Knee Surg Sports Traumatol Arthrosc 31, 1491–1499 (2023). https://doi.org/10.1007/s00167-023-07315-0

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