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Relationship between patients' and clinicians' assessments of health status before and after knee arthroplasty
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  1. Elizabeth Bream1,
  2. Susan C Charman1,
  3. Ben Clift2,
  4. David Murray3,
  5. Nick Black1
  1. 1Health Services Research Unit, London School of Hygiene & Tropical Medicine, London, UK
  2. 2Orthopaedic & Trauma Surgery, Ninewells Hospital, Dundee, UK
  3. 3Professor of Orthopaedic Surgery, Nuffield Orthopaedic Centre, Oxford, UK
  1. Correspondence to Dr Elizabeth Bream, Department of Public Health and Health Policy, NHS Lothian, Deaconess House, 148 The Pleasance, Edinburgh EH8 9RS, UK; elizabeth.bream{at}nhs.net

Abstract

Introduction The use of patient reported outcome measures (PROMs) for four elective operations is mandatory in the English NHS from April 2009. In view of some scepticism by some clinicians as to the validity of PROMs, our aim was to explore the relationship between patients' and clinicians' reports of health status before and after knee arthroplasty.

Methods A secondary analysis of linked data from the Knee Arthroplasty Trial (patients' reports using the Oxford Knee Score) and the Tayside Arthroplasty Audit (clinicians' reports using the American Knee Society Score—Knee Score and Functional Score) was carried out. Correlations of scores were obtained for 284 patients before and 226 patients after surgery.

Results There was a moderately strong correlation between patients' and clinicians' views 1 year after surgery: Oxford Knee Score (OKS) versus American Knee Society Scores (AKSS) Knee Score r=−0.64; OKS versus AKSS Functional Score r=−0.44. Before surgery, the correlation between the OKS and the AKSS Functional Score was also moderate (r=−0.55) but was weak with the Knee Score (r=−0.23). There was no systematic direction to the differences between patients' and clinicians' assessments; patients were just as likely to report better health than their clinician as to report worse health.

Discussion Patients' postoperative assessments following knee arthroplasty, as regards their symptoms and disability, are practical to collect and can make a meaningful and useful contribution in routine use. In view of the advantages of collecting data on symptoms and disability directly from patients—lower cost, higher response rates, avoidance of systematic biases—confirmation of a moderately strong association with clinicians' views offers further reassurance for the routine use of PROMs, at least with knee arthroplasty.

  • Outcome assessment (healthcare)
  • arthroplasty
  • replacement
  • knee
  • questionnaires

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Footnotes

  • Funding EB was funded by NHS Scotland. The Knee Arthroplasty Trial was funded by the NIHR Health Technology Assessment Programme, and the Tayside Arthroplasty Audit is funded by NHS Tayside and the University of Dundee.

  • Competing interests NB has advised the Department of Health on the use of PROMs in surgery, and the OKS in particular, in the NHS. DM was one of the original developers of the OKS.

  • Provenance and peer review Not commissioned; externally peer reviewed.