Should We Aim to Help Patients “Feel Better” or “Feel Good” After Total Hip Arthroplasty? Determining Factors Affecting the Achievement of the Minimal Clinically Important Difference and Patient Acceptable Symptom State

• Published in: The Journal of arthroplasty Vol. 38; no. 2; pp. 293 - 299
• Main Authors: Goh, Graham S., Tarabichi, Saad, Baker, Colin M., Qadiri, Qudratullah S., Austin, Matthew S.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-02-2023
• Subjects: acceptable symptom state; Arthroplasty, Replacement, Hip; clinically important difference; hip arthroplasty; Humans; Male; Minimal Clinically Important Difference; Patient Reported Outcome Measures; patient-reported outcomes; prior authorization; Treatment Outcome; value-based care; value-based care; patient-reported outcomes; acceptable symptom state; hip arthroplasty; prior authorization; clinically important difference
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2022.08.014

Recent attempts have been made to use preoperative patient-reported outcome measure (PROM) thresholds as prior authorization criteria based on the assumption that patients who have higher baseline scores are less likely to achieve the minimal clinically important difference (MCID). This study aimed to identify factors affecting the achievement of MCID and patient acceptable symptom state (PASS) after total hip arthroplasty (THA), and to determine the overlap between the two outcomes.
We identified 3,581 primary, unilateral THAs performed at a single practice in 2015-2019. PROMs including Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS-JR) and 12-item Short Form Health Survey were collected preoperatively and 1-year postoperatively. The likelihood of attaining PASS according to attainment of MCID was assessed. Multivariable regression was used to identify independent predictors of MCID and PASS.
In total, 79.8% achieved MCID and 73.6% achieved PASS for HOOS-JR. Approximately 1 in 7 patients who achieved MCID did not eventually achieve PASS. Worse preoperative HOOS-JR (odd ratio 0.933) was associated with MCID attainment. Better preoperative HOOS-JR (odd ratio 1.015) was associated with PASS attainment. Men, lower body mass index, better American Society of Anesthesiologists score, and better preoperative 12-item Short Form Health Survey mental score were predictors of MCID and PASS. Age, race, ethnicity, Charlson Comorbidity Index, and smoking status were not significant predictors.
Preoperative PROMs were associated with achieving MCID and PASS after THA, albeit in opposite directions. Clinicians should strive to help patients “feel better” and “feel good” after surgery. Preoperative PROMs should not solely be used to prioritize access to care.