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AHRQ Research Studies Date
Topics
- Adverse Events (2)
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- Children/Adolescents (1)
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- (-) Orthopedics (14)
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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 14 of 14 Research Studies DisplayedGraber J, Juarez-Colunga E, Thigpen C
Development of reference charts for monitoring quadriceps strength with handheld dynamometry after total knee arthroplasty.
This retrospective analysis’ purpose was to develop reference charts that describe normative quadriceps strength recovery after total knee arthroplasty (TKA) as measured by handheld dynamometry (HHD). The authors analyzed post-TKA quadriceps strength recovery using a longitudinal dataset consisting of both clinical and research HHD data. They created sex-specific models for recovery using Generalized Additive Models for Location, Scale, and Shape and reference charts from the models to display the recovery of population centiles over the first six postoperative months. They analyzed a total of 588 patient records with 1176 observations. There was a rapid increase in quadriceps strength for both sexes over the first 60 postoperative days followed by a more gradual increase over the next 120 days. They found that males appeared to demonstrate faster recovery and greater strength on average compared to females. The reference charts may aid clinicians’ ability to monitor and intervene upon quadriceps weakness-a pronounced and debilitating post-TKA impairment-throughout rehabilitation.
AHRQ-funded; HS025692.
Citation: Graber J, Juarez-Colunga E, Thigpen C .
Development of reference charts for monitoring quadriceps strength with handheld dynamometry after total knee arthroplasty.
Disabil Rehabil 2022 Dec;44(24):7535-42. doi: 10.1080/09638288.2021.1995054..
Keywords: Surgery, Orthopedics, Rehabilitation
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
Mattioli DD, Thomas GW, Long SA
Minimally trained analysts can perform fast, objective assessment of orthopedic technical skill from fluoroscopic images.
The purpose of this study was to test a new system designed to facilitate rapid, inexpensive, repeatable, and precise analysis of intraoperative fluoroscopic images by minimally trained analysts as a means of objectively assessing orthopedic surgical skills. The study included 4 expert and 4 novice analysts who independently measured one objective metric for skill using both the custom analysis software and a commercial alternative. The study found that in comparison to the expert analysts utilizing the commercial software, the novice analysts were able to measure the objective metric three times faster when utilizing the custom software, and without a practical difference in accuracy.
AHRQ-funded; HS025353.
Citation: Mattioli DD, Thomas GW, Long SA .
Minimally trained analysts can perform fast, objective assessment of orthopedic technical skill from fluoroscopic images.
IISE Trans Healthc Syst Eng 2022;12(3):212-20. doi: 10.1080/24725579.2022.2035022..
Keywords: Orthopedics, Imaging
Khouja T, Polk DE, Suda KJ
Opioid prescribing by oral and maxillofacial surgeons in the United States, 2016-2019.
The objective of this study was to describe opioid prescribing trends among oral and maxillofacial surgeons (OMFS). The IQVIA Longitudinal Prescription Dataset, 2016-2019, was used to identify prescriptions written by OMFS. The results indicated that while OMFS-prescribed hydrocodone and oxycodone decreased in most states, 12 percent of states showed increases. Tramadol and codeine prescriptions also increased. From these findings, the authors concluded that targeted interventions are warranted in some areas.
AHRQ-funded; HS025177.
Citation: Khouja T, Polk DE, Suda KJ .
Opioid prescribing by oral and maxillofacial surgeons in the United States, 2016-2019.
J Public Health Dent 2022 Sep;82(4):491-94. doi: 10.1111/jphd.12544..
Keywords: Opioids, Medication, Practice Patterns, Orthopedics, Surgery, Dental and Oral Health, Provider: Physician
Laskow T, Zhu J, Buta B
Risk factors for nonresilient outcomes in older adults after total knee replacement.
The purpose of this study was to develop a simple measure of physical resilience and identify risk factors for nonresilient patient outcomes in total knee replacement procedures (TKR). The researchers conducted a secondary analysis of the Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement (FORCE-TJR) cohort study, including 7,239 adults aged 60 or older who underwent TKR between 2011 and 2015. The study found that the variables of age, body mass index, and Charlson Comorbidity Index (CCI) were associated with increased risk of physically nonresilient outcomes across the 3 patient-reported outcomes of the physical component summary (PCS), bodily pain (BP), and vitality (VT). A household income of greater than $45 000 associated with lower risk for PCS (RR = 0.81 [0.70-0.93]), BP (RR = 0.80 [0.69-0.91]), and VT (RR = 0.86 [0.78-0.93]). CONCLUSIONS: We operationalized physical resilience and identified factors predicting resilience after TKR. This approach may aid clinical risk stratification, guide further investigation of causes, and ultimately aid patients through the design of interventions to enhance physical resilience.
AHRQ-funded; HS018910.
Citation: Laskow T, Zhu J, Buta B .
Risk factors for nonresilient outcomes in older adults after total knee replacement.
J Gerontol A Biol Sci Med Sci 2022 Sep;77(9):1915-22. doi: 10.1093/gerona/glab257..
Keywords: Orthopedics, Surgery, Elderly, Risk
Ayers DC, Yousef M, Zheng H
The prevalence and predictors of patient dissatisfaction 5-years following primary total knee arthroplasty.
This retrospective cohort study’s purpose was to determine dissatisfaction among total knee arthroplasty (TKA) patients 5 years after the procedure and to determine patient factors predictive of dissatisfaction. Demographic and clinical data on 4402 patients who underwent primary unilateral TKA between 2012 and 2015 were collected prospectively through the Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement (FORCE-TJR) comparative effectiveness consortium including diverse community and academic practices distributed across 23 states in the United States. Several different satisfaction scales were used to collect data at 1 year preoperatively and 5 years postoperatively including patient satisfaction (using a 5-point Likert satisfaction scale) and patient-reported outcome measures (PROMs) including the Knee injury and Osteoarthritis Outcome Score (KOOS) and Short-Form health survey (36-item). A total of 12.7% (5549) patients expressed dissatisfaction 5 years postoperatively. Higher dissatisfaction rates were present in young patients, patients with less education, and non-White patients. It was also significantly associated with poor preoperative and 5-year postoperative PROMs scores and less score improvement from baseline to 5 years.
AHRQ-funded; HS018910.
Citation: Ayers DC, Yousef M, Zheng H .
The prevalence and predictors of patient dissatisfaction 5-years following primary total knee arthroplasty.
J Arthroplasty 2022 Jun;37(6s):S121-s28. doi: 10.1016/j.arth.2022.02.077..
Keywords: Orthopedics, Surgery, Patient Experience
DeKeyser GJ, Martin BI, Ko H
Increased complications and cost associated with hip arthroplasty for femoral neck fracture: evaluation of 576,119 Medicare patients treated with hip arthroplasty.
The authors compared perioperative complications and costs of total hip arthroplasty (THA) for treatment of osteoarthritis (OA) to hemiarthroplasty (HA) and THA for treatment of femoral neck fractures (FNFs). Data from CMS were used to identify all patients 65 or older undergoing primary hip arthroplasty. The results showed that CMS hip arthroplasty patients with an FNF had significantly higher rates of mortality, thromboembolic events, readmission, and greater direct cost. The authors concluded that reimbursement models for arthroplasty should account for different perioperative complication and resource utilization for FNF patients.
AHRQ-funded; HS024714.
Citation: DeKeyser GJ, Martin BI, Ko H .
Increased complications and cost associated with hip arthroplasty for femoral neck fracture: evaluation of 576,119 Medicare patients treated with hip arthroplasty.
J Arthroplasty 2022 Apr; 37(4):742-47.e2. doi: 10.1016/j.arth.2021.12.027..
Keywords: Orthopedics, Surgery, Healthcare Costs, Medicare
Eisenberg MT, Block AM, Vopat ML
Rates of infection after ACL reconstruction in pediatric and adolescent patients: a MarketScan database study of 44,501 patients.
This study’s objective was to describe and analyze the rates of surgical site infections after anterior cruciate ligament (ACL) surgery in pediatric patients. The Truven Health Analytics MarketScan Commercial Claims and Encounters database was used to access data for privately insured individuals aged 5 to 30 years old. ACL reconstruction operation records were accessed for operations performed from 2006 to 2018. The database identified 44,501 individuals up to 18 years old, and 63,495 individuals aged 18 to 30 years old that underwent arthroscopic ACL reconstruction. No differences in infection rates were found between the two groups. However, among patients younger than 18 years, patients below 15 years old had a significantly lower infection rate at 0.37% compared with adolescents 15 to 17 years old at 0.55%. Among young adults, males had a higher infection rate than females, while no differences were observed in the pediatric and adolescent population.
AHRQ-funded; HS019455.
Citation: Eisenberg MT, Block AM, Vopat ML .
Rates of infection after ACL reconstruction in pediatric and adolescent patients: a MarketScan database study of 44,501 patients.
J Pediatr Orthop 2022 Apr;42(4):e362-e66. doi: 10.1097/bpo.0000000000002080..
Keywords: Children/Adolescents, Surgery, Orthopedics, Healthcare-Associated Infections (HAIs), Adverse Events, Injuries and Wounds
Lin E, Uhler LM, Finley EP
Incorporating patient-reported outcomes into shared decision-making in the management of patients with osteoarthritis of the knee: a hybrid effectiveness-implementation study protocol.
This article describes a US-based 2-year, two-site hybrid type 1 study to assess clinical effectiveness and implementation of a machine learning-based patient decision aid integrating patient-reported outcomes and clinical variables to support shared decision-making for patients with knee osteoarthritis considering total knee replacement. Study results will be disseminated through conference presentations, publications and professional societies.
AHRQ-funded; HS027037.
Citation: Lin E, Uhler LM, Finley EP .
Incorporating patient-reported outcomes into shared decision-making in the management of patients with osteoarthritis of the knee: a hybrid effectiveness-implementation study protocol.
BMJ Open 2022 Feb 21;12(2):e055933. doi: 10.1136/bmjopen-2021-055933..
Keywords: Clinical Decision Support (CDS), Decision Making, Arthritis, Patient-Centered Outcomes Research, Orthopedics, Health Information Technology (HIT), Evidence-Based Practice
Graber J, Lockhart S, Matlock DD
"This is not negotiable. You need to do this…": a directed content analysis of decision making in rehabilitation after knee arthroplasty.
In this qualitative study, researchers sought to understand patients' and physical therapists' perspectives related to decision making during outpatient rehabilitation after total knee arthroplasty (TKA) and further to describe potential barriers and opportunities for shared decision making (SDM) in this setting. They found that physical therapists described using decision-making strategies with varying levels of patient involvement, while both patients and physical therapists described barriers to routine use of SDM in the outpatient setting. They also presented actionable strategies for overcoming these barriers for providers and organizations seeking consistently to use SDM in outpatient TKA rehabilitation.
AHRQ-funded; HS025692.
Citation: Graber J, Lockhart S, Matlock DD .
"This is not negotiable. You need to do this…": a directed content analysis of decision making in rehabilitation after knee arthroplasty.
J Eval Clin Pract 2022 Feb;28(1):99-107. doi: 10.1111/jep.13591..
Keywords: Decision Making, Rehabilitation, Orthopedics, Surgery, Patient-Centered Healthcare
Ko H, Martin BI, Nelson RE
Patient selection in the Comprehensive Care for Joint Replacement model.
This study investigated whether the Comprehensive Care for Joint Replacement (CJR) program induced participating hospitals to 1) preferentially select lower risk patients, 2) reduce 90-day episode-of-care costs, 3) improve quality of care, and 4) achieve greater cost reduction during its second year. The authors identified Medicare beneficiaries age 65 years or older undergoing hip or knee joint replacement from fee-for-service inpatient (Part A) claims from January 2013 through August 2017. Cases were linked to subsequent outpatient, Part B, home health agency, and skilled nursing facility claims. The effect of CJR was estimated for 785 participating hospitals in 67 metropolitan statistical area (MSA) and compared to those in 104 non-CJR MSAs (962 hospitals total). They excluded 172 hospitals from their analysis due to their preexisting BPCI participation. Reductions in 90-day episode-of-care costs were greater among CJR hospitals, which was largely driven by a 16.8% decline in 90-day spending in skilled nursing homes. CJR hospitals also significantly reduced the 90-day readmission rate and preferentially avoided patients 85 years or older and Black patients.
AHRQ-funded; HS024714.
Citation: Ko H, Martin BI, Nelson RE .
Patient selection in the Comprehensive Care for Joint Replacement model.
Health Serv Res 2022 Feb;57(1):72-90. doi: 10.1111/1475-6773.13880..
Keywords: Orthopedics, Surgery
Fatemi P, Zhang Y, Han SS
A, et al. External validation of a predictive model of adverse events following spine surgery.
The authors externally validated a previously developed predictive model for common 30-day adverse events after spine surgery, the Risk Assessment Tool for Adverse Events after Spine Surgery (RAT-Spine). Their results are presented as low-, moderate-, and high-risk designations.
AHRQ-funded; HS023800.
Citation: Fatemi P, Zhang Y, Han SS .
A, et al. External validation of a predictive model of adverse events following spine surgery.
Spine J 2022 Jan;22(1):104-12. doi: 10.1016/j.spinee.2021.06.006..
Keywords: Surgery, Adverse Events, Orthopedics, Risk
Chrenka EA, Solberg LI, Asche SE
Is shared decision-making associated with better patient-reported outcomes? A longitudinal study of patients undergoing total joint arthroplasty.
This study examined whether shared decision making (SDM) provides better outcomes using patients undergoing total joint arthroplasty as a test case. This observational longitudinal survey-based study surveyed patients receiving an initial THA or TKA from a large, multispecialty medical group in the Midwestern United States after they were scheduled for surgery and again at 12 months after their procedure. The majority of included patients were white (1255 of 1344) with only 3% using Medicaid benefits at the time of surgery. The three-item collaboRATE measure of SDM was added to existing patient surveys of patient-reported outcome measures (PROMs). Patient responses were analyzed in regression models to estimate the association between preoperative collaborate scores and Oxford knee or hip scores at 12 months postoperatively. There was a moderate, positive association between preoperative collaborate scores and the Oxford scores at 12 months. The association suggests that SDM could be one tool to encourage better outcomes.
AHRQ-funded; HS025618.
Citation: Chrenka EA, Solberg LI, Asche SE .
Is shared decision-making associated with better patient-reported outcomes? A longitudinal study of patients undergoing total joint arthroplasty.
Clin Orthop Relat Res 2022 Jan;480(1):82-91. doi: 10.1097/corr.0000000000001920..
Keywords: Decision Making, Patient-Centered Outcomes Research, Orthopedics, Surgery