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- Ambulatory Care and Surgery (1)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 19 of 19 Research Studies DisplayedDanielson EC, Li W, Suleiman L
Social risk and patient-reported outcomes after total knee replacement: implications for Medicare policy.
The objective of this study was to determine if county- or patient-level social risk factors are associated with patient-reported outcomes after total knee replacement when added to the comprehensive joint replacement risk-adjustment model. Patient and outcomes data from the Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement cohort were merged with the CDC Social Vulnerability Index. The findings indicated that patient-reported race, education, and income were associated with patient-reported pain or functional scores; pain improvement was negatively associated with Black race and positively associated with higher annual incomes. The authors concluded that these findings suggested that patient-level social factors warrant further investigation to promote health equity in patient-reported outcomes after total knee replacement.
Citation: Danielson EC, Li W, Suleiman L .
Social risk and patient-reported outcomes after total knee replacement: implications for Medicare policy.
Health Serv Res 2024 Feb; 59(1):e14215. doi: 10.1111/1475-6773.14215.
Keywords: Surgery, Orthopedics, Medicare, Outcomes, Patient-Centered Outcomes Research, Social Determinants of Health
Ayers DC, Yousef M, Yang W
Age-related differences in pain, function, and quality of life following primary total knee arthroplasty: results from a FORCE-TJR (Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement) cohort.
The purpose of this prospective, multicenter cohort study was to evaluate the differences in pain, function, and quality of life (QoL) reported 1 year after total knee arthroplasty (TKA) across varying age groups. The researchers preoperatively assessed 11,602 unilateral primary TKA patients, and collected demographic data, comorbid conditions, and patient-reported outcome measures including the knee injury and osteoarthritis outcome score (KOOS), KOOS-12, KOOS Joint Replacement, and Short-Form health survey (12-item) and then collected again at 1-year postoperatively. The study found that prior to surgery, patients less than 55 years reported worse KOOS pain (39), function (50), and QoL (18) scores with poor mental health score (47) than other older patient groups. At 1 year after TKA, patients less than 55 years reported lower KOOS pain, function, and QoL scores when compared to patients 75 years or older. The differences in score changes among the age groups were statistically significant but clinically irrelevant. Further statistical analyses revealed that age was a significant predictor for pain, but not for function at 1 year where KOOS pain score was predicted to be higher in patients 75 years or older when compared to patients less than 55 years of age.
AHRQ-funded; HS018910.
Citation: Ayers DC, Yousef M, Yang W .
Age-related differences in pain, function, and quality of life following primary total knee arthroplasty: results from a FORCE-TJR (Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement) cohort.
J Arthroplasty 2023 Jul; 38(7 Suppl 2):S169-S76. doi: 10.1016/j.arth.2023.04.005..
Keywords: Orthopedics, Surgery, Quality of Life, Outcomes, Comparative Effectiveness, Evidence-Based Practice, Patient-Centered Outcomes Research, Pain
Ko H, Pelt CE, Martin BI
Patient-reported outcomes following cemented versus cementless primary total knee arthroplasty: a comparative analysis based on propensity score matching.
The purpose of this study was to compare baseline and early post-operative global and condition-specific patient reported outcomes (PROs) between patients undergoing cemented versus cementless total knee arthroplasty (TKA). The researchers prospectively collected PROs through the Comparative Effectiveness Pulmonary Embolism Prevention After Hip and Knee Replacement (PEPPER) trial using the short-form of the Knee Injury and Osteoarthritis Outcome Score (KOOS-Jr.), the Patient-Reported Outcomes Measurement Information System Physical Health (PROMIS-PH), and the Numeric Pain Rating Scale (NPRS). Pre- and post-operative outcomes in 5,961 patients undergoing primary TKA between December 2016 and August 2021 were examined. The study found that significant pre to- post-operative were observed in both groups. The researchers concluded that patients with cemented TKA reported early benefit in KOOS-Jr. over those with cementless TKA.
AHRQ-funded; HS024714.
Citation: Ko H, Pelt CE, Martin BI .
Patient-reported outcomes following cemented versus cementless primary total knee arthroplasty: a comparative analysis based on propensity score matching.
BMC Musculoskelet Disord 2022 Oct 27;23(1):934. doi: 10.1186/s12891-022-05899-1..
Keywords: Orthopedics, Surgery, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice
Graber J, Kittelson A, Juarez-Colunga E
Comparing "people-like-me" and linear mixed model predictions of functional recovery following knee arthroplasty.
This study compared the relative strengths and weaknesses of 2 prediction model approaches for predicting functional recovery after knee arthroplasty: a neighbors-based "people-like-me" (PLM) approach and a linear mixed model (LMM) approach. The authors used 2 distinct datasets to train and then test PLM and LMM prediction approaches. They used the Timed Up and Go (TUG)-a common test of mobility-to operationalize physical function. Both approaches use patient characteristics and baseline postoperative TUG values to predict TUG recovery from days 1-425 following surgery. They then compared the accuracy and precision of the two approaches. A total of 317 patient records with 1379 TUG observations were used to train approaches, and 456 patient records with 1244 TUG observations were used to test the predictions. Both approaches performed similarly in terms of mean squared error and bias, but the PLM approach provided more accurate and precise estimates of prediction uncertainty.
AHRQ-funded; HS025692.
Citation: Graber J, Kittelson A, Juarez-Colunga E .
Comparing "people-like-me" and linear mixed model predictions of functional recovery following knee arthroplasty.
J Am Med Inform Assoc 2022 Oct 7;29(11):1899-907. doi: 10.1093/jamia/ocac123..
Keywords: Orthopedics, Surgery, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Outcomes
Franklin PD, Bond CP, Rothrock NE
Strategies for effective implementation of patient-reported outcome measures in arthroplasty practice.
This study’s goal was to synthesize patient-reported outcome measure (PROM) implementation strategies that are successfully used by hundreds of arthroplasty surgeons and early PROM-adopter clinical systems. The authors developed guidelines to inform clinical care, drive quality-improvement activities, and support reporting for payer-sponsored incentives. They also outlined future research that is needed to define methods for optimal patient engagement, technology infrastructure, and operational systems to seamlessly integrate PROM collection in clinical care.
AHRQ-funded; HS018910.
Citation: Franklin PD, Bond CP, Rothrock NE .
Strategies for effective implementation of patient-reported outcome measures in arthroplasty practice.
J Bone Joint Surg Am 2021 Dec 15;103(24):e97. doi: 10.2106/jbjs.20.02072..
Keywords: Patient-Centered Outcomes Research, Orthopedics, Quality Improvement, Quality of Care, Evidence-Based Practice, Implementation, Outcomes
Kittelson AJ, Loyd BJ, Graber J
Examination of exclusion criteria in total knee arthroplasty rehabilitation trials: influence on the application of evidence in day-to-day practice.
This study investigated whether total knee arthroplasty (TKA) patients seen in routine practice who meet common exclusion criteria in clinical trials recover differently compared to research-eligible patients. Postoperative functional outcomes were compared using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Timed Up and Go (TUG). A total of 2,528 participants from 27 trials were compared to 474 patients from the clinical dataset. Research participants were older, with lower BMI than patients in the clinical dataset. There were no differences observed in functional recovery rate between groups, except for patients with diabetes whose TUG recovered more slowly than “eligible” patients.
AHRQ-funded; HS024316.
Citation: Kittelson AJ, Loyd BJ, Graber J .
Examination of exclusion criteria in total knee arthroplasty rehabilitation trials: influence on the application of evidence in day-to-day practice.
J Eval Clin Pract 2021 Dec;27(6):1335-42. doi: 10.1111/jep.13564..
Keywords: Orthopedics, Surgery, Rehabilitation, Patient-Centered Outcomes Research, Evidence-Based Practice, Outcomes
Snell DL, Dunn JA, Jerram KAS
AHRQ Author: Hsieh CJ
Associations between comorbidity and quality of life outcomes after total joint replacement.
In this study, a cross-sectional, questionnaire-based national survey, the authors examined associations between self-reported and clinician-assessed comorbidity and quality of life (QOL) outcomes after hip and knee replacement. The investigators concluded that the results showed that general QOL outcomes following hip and knee joint replacement, while typically high, were associated with comorbidity burden and BMI.
AHRQ-authored.
Citation: Snell DL, Dunn JA, Jerram KAS .
Associations between comorbidity and quality of life outcomes after total joint replacement.
Qual Life Res 2021 Jan;30(1):137-44. doi: 10.1007/s11136-020-02610-6..
Keywords: Quality of Life, Surgery, Orthopedics, Outcomes
Hsieh CJ, DeJong G, Vita M
AHRQ Author: Hsieh CJ
Effect of outpatient rehabilitation on functional mobility after single total knee arthroplasty: a randomized clinical trial.
Researchers compared post-total knee arthroplasty (TKA) functional mobility outcomes among 3 newly-developed physical therapy protocols with a standard-of-care post-TKA rehabilitation protocol. They found no statistically or clinically significant differences in outcomes across the 4 study arms (control, treadmill, neuromuscular stimulation device, and combination intervention). As outcomes were similar among arms, they recommended that clinicians instead consider relative cost in tailoring TKA rehabilitation.
AHRQ-authored.
Citation: Hsieh CJ, DeJong G, Vita M .
Effect of outpatient rehabilitation on functional mobility after single total knee arthroplasty: a randomized clinical trial.
JAMA Netw Open 2020 Sep;3(9):e2016571. doi: 10.1001/jamanetworkopen.2020.16571..
Keywords: Rehabilitation, Orthopedics, Surgery, Outcomes, Evidence-Based Practice
Whitebird RR, Solberg LI, Norton RR, Solberg LI, Norton CK
What outcomes matter to patients after joint or spine surgery?
In this study, semi-structured interviews were conducted with 65 patients undergoing hip or knee replacement, spinal discectomy/laminectomy, or a spinal fusion to examine what patient-reported outcome measures (PROMs) patients identified as most important. The investigators found that patients identified specific preferred outcomes from these surgical procedures that were important and meaningful to them and that framed whether they saw their surgery as a success. They also identified personal factors that they assumed their surgeons knew about, which affected their care and recovery.
AHRQ-funded; HS025618.
Citation: Whitebird RR, Solberg LI, Norton RR, Solberg LI, Norton CK .
What outcomes matter to patients after joint or spine surgery?
J Patient Cent Res Rev 2020 Spr;7(2):157-64. doi: 10.17294/2330-0698.1738..
Keywords: Surgery, Orthopedics, Patient-Centered Outcomes Research, Outcomes
Carey K, Morgan JR, Lin MY
Patient outcomes following total joint replacement surgery: a comparison of hospitals and ambulatory surgery centers.
This study used a large claims database of non-Medicare patients to examine inpatient and outpatient total knee replacement and total hip replacement surgery performed on a near-elderly population during 2014-2016. Findings support the argument that outpatient total joint replacement is appropriate for select patients treated in both hospital outpatient departments and ambulatory surgery centers, although in the commercially insured population, the latter services may come at a cost. Until further study of outpatient total joint replacement in the Medicare population becomes available, how this will extrapolate to the Medicare population is unknown.
AHRQ-funded; HS022242.
Citation: Carey K, Morgan JR, Lin MY .
Patient outcomes following total joint replacement surgery: a comparison of hospitals and ambulatory surgery centers.
J Arthroplasty 2020 Jan;35(1):7-11. doi: 10.1016/j.arth.2019.08.041..
Keywords: Orthopedics, Surgery, Ambulatory Care and Surgery, Hospitals, Outcomes
Lange JK, DiSegna ST, Yang W
Using cluster analysis to identify patient factors linked to differential functional gains after total knee arthroplasty.
This study used cluster analysis to identify patient factors linked to different outcomes following total knee arthroplasty (TKA). The study analyzed Short Form 36 Physical Component Score (PCS) trajectories of 656 patients at 3 time points over a 1-year period. The MultiExperiment View (MeV) built-in bootstrapping method was used to assess statistical significance of the clusters. They found two distinct clusters: Cluster 1 included 550 patients (84%) who demonstrated persistent improvement at 6 and 12 months. The remainder of patients consisted of Cluster 2 who demonstrated decline in PCS at 6 months but improved by 12 months. Cluster 1 was found to have higher baseline mental health scores, lower baseline PCS, and a significantly higher proportion of non-Hispanic Whites compared to Cluster 2.
AHRQ-funded; HS018910.
Citation: Lange JK, DiSegna ST, Yang W .
Using cluster analysis to identify patient factors linked to differential functional gains after total knee arthroplasty.
J Arthroplasty 2020 Jan;35(1):121-26.e6. doi: 10.1016/j.arth.2019.08.039..
Keywords: Orthopedics, Surgery, Arthritis, Outcomes, Chronic Conditions
Singh JA, Lemay CA, Nobel L
Association of early postoperative pain trajectories with longer-term pain outcome after primary total knee arthroplasty.
Studies to date have not comprehensively examined pain experience after total knee arthroplasty (TKA). Discrete patterns of pain in this period might be associated with pain outcomes at 6 to 12 months after TKA. The purpose of this study was to examine patterns of individual post-TKA pain trajectories and to assess their independent associations with longer-term pain outcome after TKA.
AHRQ-funded; HS021110; HS018910.
Citation: Singh JA, Lemay CA, Nobel L .
Association of early postoperative pain trajectories with longer-term pain outcome after primary total knee arthroplasty.
JAMA Netw Open 2019 Nov;2(11):e1915105. doi: 10.1001/jamanetworkopen.2019.15105..
Keywords: Pain, Surgery, Orthopedics, Patient-Centered Outcomes Research, Outcomes
Kim SC, Jin Y, Lee YC
Association of preoperative opioid use with mortality and short-term safety outcomes after total knee replacement.
The purpose of this study was to determine the association of preoperative opioid use among patients 65 years and older with mortality and other complications at 30 days post-total knee replacement (TKR). Findings show that continuous opioid users had a higher risk of revision operations, vertebral fractures, and opioid overdose at 30 days post-TKR but not of in-hospital or 30-day mortality, compared with opioid-naive patients. Highlights include the need for better understanding of patient characteristics associated with chronic opioid use to optimize preoperative assessment of overall risk after TKR.
AHRQ-funded; HS018910.
Citation: Kim SC, Jin Y, Lee YC .
Association of preoperative opioid use with mortality and short-term safety outcomes after total knee replacement.
JAMA Netw Open 2019 Jul 3;2(7):e198061. doi: 10.1001/jamanetworkopen.2019.8061..
Keywords: Opioids, Medication, Surgery, Orthopedics, Elderly, Patient-Centered Outcomes Research, Mortality, Outcomes, Arthritis, Evidence-Based Practice
Nguyen UDT, Perneger T, Franklin PD
Improvement in mental health following total hip arthroplasty: the role of pain and function.
This prospective study examined whether mental health improved in patients who had total hip arthroplasty (THA) due to improvement in pain and function 1 year post-surgery. Patients enrolled in a THA registry from 2010 to 2014 were included and the mental component score (MCS) was examined before and 1 year post-surgery. There was a significant improvement in mental health due to less pain and improved function.
AHRQ-funded; HS018910.
Citation: Nguyen UDT, Perneger T, Franklin PD .
Improvement in mental health following total hip arthroplasty: the role of pain and function.
BMC Musculoskelet Disord 2019 Jun 29;20(1):307. doi: 10.1186/s12891-019-2669-y..
Keywords: Health Status, Behavioral Health, Orthopedics, Outcomes, Pain, Patient-Centered Outcomes Research, Quality of Life, Surgery
Soffin EM, Gibbons MM, Wick EC
Evidence review conducted for the Agency for Healthcare Research and Quality Safety Program for I
This evidence review was conducted as part of AHRQ’s Safety Program for Improving Surgical Care and Recovery. An evidence review of interventions was conducted to create an enhanced recovery after surgery (ERAS) protocol for anesthesiology for hip fracture repair surgery. The researchers identified anesthesiology components of care and evaluated them across the perioperative continuum. They created ERAS protocols for the preoperative, intraoperative, and postoperative phases.
AHRQ-funded; 233201500020I.
Citation: Soffin EM, Gibbons MM, Wick EC .
Evidence review conducted for the Agency for Healthcare Research and Quality Safety Program for I
Anesth Analg 2019 Jun;128(6):1107-17. doi: 10.1213/ane.0000000000003925..
Keywords: Evidence-Based Practice, Patient-Centered Outcomes Research, Surgery, Orthopedics, Quality Improvement, Quality of Care, Outcomes, Care Management
Perez FA, Quinet S, Jarvik JG
Lumbar spinal stenosis severity by CT or MRI does not predict response to epidural corticosteroid versus lidocaine injections.
This study compared the results of patients with lumbar spinal stenosis injected epidurally with corticosteroids and lidocaine, or lidocaine alone. A prospective, double-blind study was conducted on 350 patients who were then evaluated for qualitative or quantitative MR imaging or CT measures of lumbar spinal stenosis. There were no differences in improvement of disability or leg pain scores at 3 weeks between the two subgroups.
AHRQ-funded; HS019222; HS022972.
Citation: Perez FA, Quinet S, Jarvik JG .
Lumbar spinal stenosis severity by CT or MRI does not predict response to epidural corticosteroid versus lidocaine injections.
AJNR Am J Neuroradiol 2019 May;40(5):908-15. doi: 10.3174/ajnr.A6050..
Keywords: Comparative Effectiveness, Evidence-Based Practice, Imaging, Medication, Orthopedics, Outcomes, Patient-Centered Outcomes Research
Pellegrini CA, Chang RW, Dunlop DD
Comparison of a Patient-Centered Weight Loss Program starting before versus after knee replacement: a pilot study.
This article reports the results of a randomized pilot study that assessed changes in weight during a Patient Centered Weight Loss Program (PACE) initiated either before or after knee replacement. The feasibility of recruiting and retaining participants over 26 weeks was also examined. Recruitment outreach was extended to patients scheduled for knee replacement. Sixteen participants were randomly assigned to a 14-session weight loss program that started either at least 6 weeks before surgery or at 12 weeks following surgery. The authors conclude that behavioral intervention is challenging but feasible in a knee replacement population. Preliminary evidence suggests that initiating a program 12 weeks after surgery produces greater weight losses at 26 weeks when compared to a program that begins before knee replacement.
AHRQ-funded; HS023011.
Citation: Pellegrini CA, Chang RW, Dunlop DD .
Comparison of a Patient-Centered Weight Loss Program starting before versus after knee replacement: a pilot study.
Obes Res Clin Pract 2018 Sep - Oct;12(5):472-78. doi: 10.1016/j.orcp.2018.06.009..
Keywords: Orthopedics, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Obesity: Weight Management, Surgery, Obesity, Outcomes
Goodman SM, Mandi LA, Mehta B
Does education level mitigate the effect of poverty on total knee arthroplasty outcomes?
The authors assessed the interaction between education and poverty on 2-year Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function. They found that having no college was associated with worse pain and function at baseline and 2 years and that living in a poor neighborhood was associated with worse 2-year pain and function. There was a strong interaction between individual education and community poverty with WOMAC scores at 2 years. Patients without college living in poor communities had pain scores that were ~10 points worse than those with some college; in wealthy communities, college was associated with a 1-point difference in pain. Function was similar. The authors recommended further study on how education protects those in impoverished communities.
AHRQ-funded; HS016075.
Citation: Goodman SM, Mandi LA, Mehta B .
Does education level mitigate the effect of poverty on total knee arthroplasty outcomes?
Arthritis Care Res 2018 Jun;70(6):884-91. doi: 10.1002/acr.23442..
Keywords: Arthritis, Education, Low-Income, Orthopedics, Outcomes, Patient-Centered Outcomes Research, Social Determinants of Health
Ehlers AP, Khor S, Cizik AM
Use of patient-reported outcomes and satisfaction for quality assessments.
This study investigated the relationship between PROs and satisfaction among spine surgery patients. The authors hypothesized that there would be significant disparities between patient satisfaction and PROs at the 1-year postoperative time point. The study found that overall, patients undergoing elective lumbar spine surgery reported being satisfied with outcomes, but the reported responses in PROs were much more variable.
AHRQ-funded; HS020025.
Citation: Ehlers AP, Khor S, Cizik AM .
Use of patient-reported outcomes and satisfaction for quality assessments.
Am J Manag Care 2017 Oct;23(10):618-22..
Keywords: Patient-Centered Outcomes Research, Patient Experience, Quality of Care, Surgery, Outcomes, Orthopedics