Summary

This study presents a novel index designed to address PROM limitations by incorporating missing variables and assess if these new formulas enable to better differentiate between candidates for surgery.

Abstract

Introduction

Patient-Reported Outcome Measures (PROMs) collection is continuing to become mandatory in more countries. They not measure the quality of care from patients’ point of view, but can also be used to manage expectations, benchmark quality, and assess recovery speed. Even so, PROMs lack crucial variables such as physical activity, post-surgery expectations, prior treatments, comorbidities, and BMI. This study presents a novel index designed to address these limitations by incorporating the missing variables and assess if these new formulas enable to better differentiate between candidates for surgery.

Method

We developed a new index overcoming the limitations of traditional PROMs such as KOOS JR and FJS in accounting for key variables (Comprehensive score). This new score is given through a proprietary formula on a scale from 0 to 100. A cohort of 1580 patients, suffering from degenerative knee pain completed the index pre-consultation with an orthopedic surgeon, either remotely via personal devices or in the clinic’s waiting rooms using tablets. The surgery decision was recorded for all patients, with 125 cases selecting surgical treatment (TKA) as the best option. Descriptive statistics were utilized to analyze the distribution of the comprehensive score and the traditional PROM score, with a focus on the impact of overlooked factors on the distribution of surgery decision.

Results

The PROM score which did not include the overlooked factor was 42 (+-10) for surgical patients, vs 52 (+-12) for non-surgical patients. The score which included the overlooked factors was 49 (+-18) for surgical patients and 70 (+-21) for non-surgical patients. Hence, including the overlooked factors, the distribution shifted operated patients by 7 points and non-operated patients by 18 points. The shift was significantly higher for non-operated patients, showing a better segmentation of patients with the comprehensive score.

Conclusion

Patients who underwent TKA displayed lower average scores compared to non-operated counterparts, indicating the utility of the comprehensive score in distinguishing between surgical candidates. Importantly, the inclusion of overlooked factors significantly shifted the score distributions towards higher values, showing that surgery decision should include more comprehensive variables. In conclusion, the novel index offers an improved tool for orthopedic surgeons, facilitating informed decision-making and patient education. Leveraging a web-based platform, the index enables seamless integration into clinical workflows, thereby streamlining triage processes and optimizing patient care in knee arthroplasty.