This study aimed to evaluate the content of outcome measures to assess function after hip or knee arthroplasty to identify how well they cover the functional activities important to patients.
To identify patient-reported outcome measures (PROMs) and performance-based tests (PBTs) used after hip or knee arthroplasty due to osteoarthritis (OA), we systematically searched four databases: CINAHL, MEDLINE, Embase, and Cochrane CENTRAL. We then assessed functional key activity coverage of the included PROMs and PBTs at four time points (within two weeks, and at six, 13, and 26 weeks) after arthroplasty. This analysis was based on key activities identified by a survey of patients who underwent hip or knee arthroplasty. We also documented the recall period for each PROM.
A total of 632 patients identified 14, 15, 7, and 4 key functional activities within two weeks, and at six, 13, and 26 weeks after hip or knee arthroplasty, respectively. A total of 50 PROMs and 28 PBTs were included, whose content analysis indicated varying degrees of coverage of key activities at different time points after hip or knee arthroplasty. PROMs failed to capture more than half of the key functional activities or covered them inadequately across various stages of recovery. All PROMs included between three to 33 non-key activities across four postoperative time points. PROMs had varying recall periods, with the previous week and four weeks being the most common. For PBTs, 17 out of 28 tests covered less than half of the key activities at two and six weeks, and only one test covered a key activity at 13 and 26 weeks after arthroplasty. Five key activities, including washing lower body parts, putting on clothes, taking off clothes, carrying objects, and placing objects on the floor, were not covered by any outcome measures at any time points.
Outcome measures used to assess function after hip or knee arthroplasty do not fully capture functional key activities that are important to patients. Given that outcome measures play a primary role in evaluating treatment efficacy, the limited comprehensiveness and relevance of the measures may result in inaccurate assessments of interventions, which can lead to suboptimal postoperative outcomes. Thus, there is a need to more comprehensively address key activities in outcome measures used after arthroplasty. Researchers should take into account the evolving nature of function following arthroplasty when developing or refining these measures in future research.
By understanding patients’ perspectives on what best reflects their experiences and needs, researchers and clinicians can better select appropriate outcome measures that are patient-centered for clinical and research purposes. In addition, the findings of our study may assist in developing new outcome measures or refining existing ones to provide a more comprehensive view of the patient’s perspective.
outcome measures
patient centeredness
