Current Use of Patient-Reported Outcome Measures Ignores Functional Demand

Area of Science:

• Orthopaedic Surgery
• Musculoskeletal Health
• Patient-Reported Outcomes

Background:

• Patient-reported outcome measures (PROMs) assess patient-important musculoskeletal function like disability and pain.
• Current PROMs may not fully account for individual functional demands, potentially confounding results.
• Functional demands can influence a patient's perception of their functional ability.

Purpose of the Study:

• To investigate the association between patient-reported function and functional demand in orthopaedic patients.
• To determine if functional demand confounds the interpretation of PROMs in musculoskeletal care.

Main Methods:

• Cross-sectional study of 150 new orthopaedic patients.
• Collected data on demographics, function (Patient-Reported Outcomes Measurement Information System), functional demand (Tegner Activity Level Scale), pain self-efficacy, and depression.
• Utilized multivariable regression analysis.

Main Results:

• Patient-reported function was significantly associated with higher functional demand (β = 0.17, P < 0.001).
• Pain self-efficacy, acuity, and older age (≥80 years) also showed significant associations with function.
• No significant association was found with depression or age 65-79 years.

Conclusions:

• Higher reported physical function correlates with higher functional demand, even after controlling for psychosocial factors and age.
• Functional demand is a significant confounder in PROMs and should be assessed alongside PROMs.
• Incorporating functional demand into models is essential for accurate quality of care assessment in orthopaedic surgery, particularly in payment models.