Orthopaedic surgeons use new patient-focused measures to assess outcomes

Orthopaedists traditionally rely on X-rays, MRI, CT scans, physical measurements, and functional tests for patient outcomes assessments, but this is changing thanks to new technology that communicates ongoing, real-time outcomes feedback from patients, according to research published in the Journal of the American Academy of Orthopaedic Surgeons (JAAOS).

Two studies described the benefits of the National Institutes of Health (NIH) Patient-Reported Outcomes Measurement Information System (PROMIS) to objectively and quantifiably assess and track patient symptoms over time. PROMIS also evaluates the impact of surgical and nonsurgical interventions using the same system to compare and contrast treatment options.

"Orthopaedic surgeons are interested in accurately measuring the outcomes of our treatments," said Alpesh A. Patel, MD, professor of orthopaedic surgery at Northwestern University School of Medicine, in a companion editorial. "Of all the advances in our profession in the last 20 years, one of the most important has been the renewed focus on our patients and their own interpretations of their care."

New PROMIS approaches apply principles of item-response theory, which allows for reliable and efficient estimation of underlying health traits to assess physical function in the upper and lower extremities. The system fosters shared physician-patient decision making and is proving superior to legacy measures. It has been validated in patient populations with orthopaedic disorders of the foot and ankle, upper extremity, and spine.

Until now, patient outcomes scores were evaluated almost exclusively for research purposes, but the data are becoming more valuable in helping doctors and patients assess clinical progress and recovery from surgery. Typically, patients answer surveys in the doctor's office on iPads and their responses go to a data warehouse for scoring and near-immediate transmission to the physician.

"The data we receive from patients reporting on their pain, level of disability, daily function, and overall quality of life can be compared with hundreds of other patients with the same disease or injury," said Darrell S. Brodke, MD, coauthor of one of the studies and professor and vice chair of the Department of Orthopaedics at University of Utah School of Medicine. "So the conversation with patients would be: 'This is where you're at now and here is where we expect you to be.'"

Dr. Brodke added that use of patient-reported outcomes data is expanding rapidly in orthopaedic practices for tracking and assessing patient progress following surgery and also for determining whether surgery is the most appropriate option.

"PROMIS is our best path forward for capturing high-quality, meaningful information for our patients," noted Dr. Patel. "PROMIS will be the new standard of patient-reported outcome measures and should be incorporated into orthopaedic research moving forward. How we define success and value will continue to evolve, but patients' perspectives on their care should remain at the center of our discussions."