Validation of a second-generation appropriateness classification system for total knee arthroplasty: a prospective cohort study.

Autor: Escobar A; Osakidetza Basque Health Service, Basurto University Hospital, Research Unit, Bilbao, Spain.; Health Service Research Network on Chronic Diseases (REDISSEC), Bilbao, Spain.; Kronikgune Institute for Health Services Research, Barakaldo, Spain., Bilbao A; Osakidetza Basque Health Service, Basurto University Hospital, Research Unit, Bilbao, Spain. amaia.bilbaogonzalez@osakidetza.eus.; Health Service Research Network on Chronic Diseases (REDISSEC), Bilbao, Spain. amaia.bilbaogonzalez@osakidetza.eus.; Kronikgune Institute for Health Services Research, Barakaldo, Spain. amaia.bilbaogonzalez@osakidetza.eus., Bertrand ML; Health Service Research Network on Chronic Diseases (REDISSEC), Bilbao, Spain.; University of Malaga, Malaga, Spain.; Department of Orthopaedic Surgery and Traumatology, Hospital Costa del Sol, Marbella, Spain., Moreta J; Biocruces-Bizkaia Health Research Institute, Group of Lower Limb Reconstructive Surgery, Barakaldo, Spain.; Osakidetza Basque Health Service, Department of Orthopaedic Surgery and Traumatology, Galdakao-Usansolo University Hospital, Galdakao, Spain., Froufe MA; Department of Orthopaedic Surgery and Traumatology, Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain., Colomina J; Department of Orthopaedic Surgery and Traumatology, Santa Maria University Hospital, Lleida, Spain., Martınez-Cruz O; Àmbit d'Avaluació, Agència de Qualitat i Avaluacio´ Sanitaries de Catalunya (AQuAS), Departament de Salut - Generalitat de Catalunya, Barcelona, Spain., Perera RA; Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA., Riddle DL; Departments of Physical Therapy, Orthopaedic Surgery and Rheumatology, Virginia Commonwealth University, Richmond, VA, USA.
Jazyk: angličtina
Zdroj: Journal of orthopaedic surgery and research [J Orthop Surg Res] 2021 Mar 29; Vol. 16 (1), pp. 227. Date of Electronic Publication: 2021 Mar 29.
DOI: 10.1186/s13018-021-02371-z
Abstrakt: Background: To test the validity of a second-generation appropriateness system in a cohort of patients undergoing total knee arthroplasty (TKA).
Methods: We applied the RAND/UCLA Appropriateness Method to derive our second-generation system and conducted a prospective study of patients diagnosed with knee osteoarthritis in eight public hospitals in Spain. Main outcome questionnaires were the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short-Form-12 (SF-12), and the Knee Society Score satisfaction scale (KSS), completed before and 6 months after TKA. Baseline, changes from baseline to 6 months (journey outcome), and 6-month scores (destination outcome) were compared according to appropriateness category. Percentage of patients attaining the minimal clinically important difference (MCID) and responders according to Outcome Measures in Rheumatology-Osteoarthritis Research Society (OMERACT-OARSI) criteria were also reported.
Results: A total of 282 patients completed baseline and 6-month questionnaires. Of these, 142 (50.4%) were classified as Appropriate, 90 (31.9%) as Uncertain, and 50 (17.7%) as Inappropriate. Patients classified as Appropriate had worse preoperative pain, function, and satisfaction (p < 0.001) and had greater improvements (i.e., journey scores) than those classified as Inappropriate (p < 0.001). At 6 months, destination scores for pain, function, or satisfaction were not significantly different across appropriateness categories. The percentage of patients meeting responder criteria (p < 0.001) and attaining MCID was statistically higher in Appropriate versus Inappropriate groups in pain (p = 0.04) and function (p = 0.004).
Conclusions: The validity of our second-generation appropriateness system was generally supported. The findings highlight a critical issue in TKA healthcare: whether TKA appropriateness should be driven by the extent of improvement, by patient final state, or by both.
Databáze: MEDLINE
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