This study aims to explore the factors influencing the patient-centeredness of current PROMs and PBTs used after hip or knee arthroplasty.
We drew upon findings from our previous research, which included two systematic reviews identifying 50 PROMs and 28 PBTs, along with a patient-centered content analysis of these outcome measures to assess how effectively they cover the key functional activities prioritized by 632 patients who underwent arthroplasty within two weeks, at six, 13 and 26 weeks postoperatively. Furthermore, we conducted a scoping review to evaluate the level of patient involvement during the development of these outcome measures. Using these results, we performed a Mann-Whitney U test analysis to compare the coverage of key activities between PROMs developed with and without patient involvement, and between PBTs specifically designed for patients who underwent arthroplasty and those developed for other health conditions.
Contrary to the expectation that PROMs developed with patient involvement in the development process may show higher coverage, the analysis did not find a significant association between the extent of coverage and the level of patient involvement in the development of PROMs within two weeks, and at six, 13, and 26 weeks following hip or knee arthroplasty (p > 0.05). Findings for PBTs indicated that tests developed specifically for hip or knee arthroplasty patients had higher coverage of key activities at six weeks (p = 0.003), 13 weeks (p = 0.05), and 26 weeks (p = 0.05) following surgery. The results also showed that, with the exception of three PROMs, none were developed with input from patients within the first 26 weeks postoperatively.
The lack of an association between patient involvement and the coverage of key activities suggests that simply involving patients in the development of PROMs does not ensure improved coverage of relevant activities. This may be attributed to several factors, including insufficient representation of patients’ perspectives in the first 26 weeks after arthroplasty when most functional recovery occurs, inadequate active patient engagement as research partners during the development process, neglect of the evolution of functional recovery following arthroplasty, and the failure to employ appropriate qualitative methods to effectively integrate patient input. Future research is needed to improve the outcome measures development process by more comprehensively incorporating patient involvement, which could be achieved by developing guidelines that enhance patient-centeredness through the proper integration of patient feedback.
The findings enable researchers and clinicians to address deficiencies in existing outcome measures, allowing for a more accurate capture of patient-relevant activities throughout the recovery process after arthroplasty. This can be achieved through the development of new outcome measures or by modifying or combining existing ones.
Outcome measures
patient centeredness
