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Validity of self-assessment outcome questionnaires: patient-physician discrepancy in outcome interpretation
1Department of Orthopedics, University of Mississippi Medical Center, Jackson, MS 39216, USA.
Insights
Patient self-assessments after total hip arthroplasty (THA) showed low correlation with clinical evaluations, indicating limitations in self-administered outcome questionnaires for hip replacement patients.
Area of Science:
- Orthopedics
- Rehabilitation Medicine
- Health Outcomes Research
Background:
- Assessing patient outcomes after total hip arthroplasty (THA) is crucial for evaluating surgical success.
- Standardized outcome measures, like the Harris Hip Score (HHS), are used but can be subject to bias.
- Understanding the concordance between patient-reported outcomes and clinical assessments is vital for accurate outcome evaluation.
Purpose of the Study:
- To compare patient-reported outcomes using a self-administered questionnaire with clinically obtained Harris Hip Scores (HHS) in patients who underwent cementless THA.
- To investigate discrepancies between self-reported and clinically assessed hip pain and function.
- To identify factors contributing to the differences in outcome scores.
Main Methods:
- A cohort of 263 patients undergoing cementless THA received a self-administered outcome questionnaire.
- 103 patients completed the questionnaire and underwent updated clinical evaluation.
- A modified Harris Hip Score (HHS) was calculated from patient self-assessments and compared with the clinical HHS from their last office visit.
- Statistical analysis, including correlation, was performed. Patients with low pain scores were interviewed for further clarification.
Main Results:
- A low correlation (r = 0.467) was found between self-administered and clinically obtained HHS.
- Discrepancies were particularly noted in patients reporting low pain scores, with many attributing pain to non-hip-related causes (e.g., trochanteric bursitis, lumbar spondylosis).
- Physician assessment of limping and patient expectations also contributed to score variations.
Conclusions:
- Self-administered patient outcome questionnaires for THA have limitations, including potential misinterpretation of questions and varied attribution of pain.
- While clinician-administered measures have biases, patient-reported outcomes also require careful consideration of patient understanding and context.
- Further research is needed to refine patient-reported outcome measures for greater accuracy in THA evaluations.
Abstract:
Patient outcome following total hip arthroplasty (THA) was evaluated using a previously described patient assessment outcome index questionnaires. The questionnaire was distributed to 263 patients who underwent cementless THA. One hundred and three patients responded to the self-administered questionnaire and had updated clinical evaluation. We obtained a modified Harris Hip Score (HHS) based on patient assessments of their own pain and function and compared it with the clinical HHS obtained at the patients' last office visit. The mean follow up period was 4 years. Statistical analysis was performed between the two scores. The correlation between the scores from the self-administered questionnaire and the patients' last office visit revealed a fairly low correlation coefficient (r = 0.467, p < 0.001). Relative lack of correlation between the HHS's obtained from these two sources was especially noted for patients with a pain score of 30 points or less. These 26 patients were subsequently interviewed in detail about their pain to further explain these differences. The etiology of the perceived "hip pain" was found to be secondary to trochanteric bursitis in 13 patients, lumbar spondylosis in 7 patients, arthrosis of the contralateral hip in 5 patients, and from other causes in 8 patients. Pain that was hip related (anterior thigh or groin) was present in only 5 out of the 26 patients with a pain score of 30 or less. Another source of discrepancy between the total scores of the HHS was found to be on behalf of the physician in evaluating the presence of a limp. We also found that patients' expectations had changed from their preoperative expectations. Although outcome measures developed and administered by clinicians are subject to bias from several sources, results of this study suggest that self administered patient outcome measures also have their limitations. The validity of self-administered patient outcome questionnaires can be severely impacted by the patients' understanding of the questions asked, as even the most seemingly simple questions are subject to misinterpretation.