ePoster #1209 - ISHA Annual Scientific Meeting 2016
The Effects Of Setting Of Administration On Patient Reported Outcomes In Patients With Hip-Related Concerns
Stephen Kenji Aoki, MD, Salt Lake City, UT UNITED STATES
Bill Garrett Bodine, BS, Salt Lake City, UT UNITED STATES
Ashley Lynn Kapron, PhD, Salt Lake City, UT UNITED STATES
Madison Marie Hunt, BS, Salt Lake City, UT UNITED STATES
Travis Maak, MD, Salt Lake City, UT UNITED STATES
University of Utah, Salt Lake City, UT, UNITED STATES
FDA Status Not Applicable
Summary: There is no significant difference between home and clinic completions of hip-specific and physical function questionnaires, enabling hospitals to offer patients the option to complete questionnaires during their clinic appointment or electronically at home.
Patient reported outcomes (PROs) are important clinical tools to assess general health and physical function. Depending on the hospital, PROs may be administered during a patient’s clinic appointment or emailed to the patient to complete at home. While previous studies have indicated that the setting of administration can influence mental health and quality-of-life scores, there is currently no data investigating the effects of setting on physical function scores in the field of orthopaedics. Therefore, the assumption of using home and clinic completions interchangeably is not yet supported. To this end, the objective of this study was to determine if the setting of administration results in statistically and clinically significant differences in patient scores from questionnaires assessing hip and general physical function.
With IRB approval, 52 adult (>18 years) patients with hip-related concerns scheduled for clinic appointments with two high-volume, sports fellowship-trained orthopaedic surgeons specializing in hip arthroscopy gave informed consent and participated in this study. Patients completed the sports subscore of Hip Outcome Score (HOS), Modified Harris Hip Score (MHHS), and the Physical Function Computerized Adaptive Test (PFCAT) twice: 1. on electronic tablet at the time of their clinic appointment and 2. at home via website within 3-5 days of clinical appointment. Patients were randomized to complete the home questionnaires either before or after their clinic appointment. Mixed effects multivariable linear regression analysis including order of completion as a covariate (i.e., home or clinic first), was used for each questionnaire to determine differences in scores reported at home or in the clinic. Intraclass correlation coefficient (ICCs) were calculated to evaluate each questionnaire’s reliability. The agreement between clinic and home completions was evaluated with a Bland-Altman analysis.
There was no significant difference between home and clinic completions for the PFCAT (p = 0.625), HOS (p = 0.432) and MHHS (p = 0.270). The covariate representing order of completion was not significant (all p > 0.346). Reliability was almost perfect with ICCs of 0.96 for the PFCAT, 0.94 for the MHHS and 0.93 for the HOS. The Bland-Altman analysis indicated a very small bias of higher home scores than clinic scores for all three questionnaires, with a mean difference of: -0.2 for the PFCAT, -1.2 for MHHS, and -1.3 for the HOS. The PFCAT had the tightest limits of agreement (-5.9 to 5.5), followed by the MHHS (-16.8 to 14.4) and HOS (-24.2 to 21.7).
The MHHS, PFCAT and HOS have high repeatability and are, on average, not affected by settings of administration. Therefore, when reviewing data on the level of the cohort, no distinction is required for PROs completed at home or clinic within 5 days of a clinical appointment. However, it is important to note that some individual patient scores for the HOS and MHHS may vary substantially between completions (reflected in the wide limits of agreement).