Does clinically important change in function after knee replacement guarantee good absolute function? the multicenter osteoarthritis study

Jessica L. Maxwell, David T. Felson, Jingbo Niu, Barton L Wise, Michael C. Nevitt, Jasvinder A. Singh, Laura Frey-Law, Tuhina Neogi

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Objective. Poor functional outcomes post-knee replacement are common, but estimates of its prevalence vary, likely in part because of differences in methods used to assess function. The agreement between improvement in function and absolute good levels of function after knee replacement has not been evaluated. We evaluated the attainment of improvement in function and absolute good function after total knee replacement (TKR) and the agreement between these measures. Methods. Using data from The Multicenter Osteoarthritis (MOST) Study, we determined the prevalence of achieving a minimal clinically important improvement (MCII, ≥ 14.2/68 point improvement) and Patient Acceptable Symptom State (PASS, ≤ 22/68 post-TKR score) on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Physical Function subscale at least 6 months after knee replacement. We also assessed the frequency of co-occurrence of the 2 outcomes, and the prevalence according to pre-knee replacement functional status. Results. We included 228 subjects who had a knee replacement during followup (mean age 65 yrs, mean body mass index 33.4, 73% female). Seventy-one percent attained the PASS for function after knee replacement, while only 44% attained the MCII. Of the subjects who met the MCII, 93% also attained the PASS; however, of subjects who did not meet the MCII, 54% still achieved a PASS. Baseline functional status was associated with attainment of each MCII and PASS. Conclusion. There was only partial overlap between attainment of a good level of function and actually improving by an acceptable amount. Subjects were more likely to attain an acceptable level of function than to achieve a clinically important amount of improvement post-knee replacement. The Journal of Rheumatology

Original languageEnglish (US)
Pages (from-to)60-64
Number of pages5
JournalJournal of Rheumatology
Volume41
Issue number1
DOIs
StatePublished - Jan 2014

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Osteoarthritis
Multicenter Studies
Knee
Knee Replacement Arthroplasties
Rheumatology
Ontario
Body Mass Index

Keywords

  • Knee replacement
  • Outcomes
  • Physical function

ASJC Scopus subject areas

  • Rheumatology
  • Immunology
  • Immunology and Allergy

Cite this

Does clinically important change in function after knee replacement guarantee good absolute function? the multicenter osteoarthritis study. / Maxwell, Jessica L.; Felson, David T.; Niu, Jingbo; Wise, Barton L; Nevitt, Michael C.; Singh, Jasvinder A.; Frey-Law, Laura; Neogi, Tuhina.

In: Journal of Rheumatology, Vol. 41, No. 1, 01.2014, p. 60-64.

Research output: Contribution to journalArticle

Maxwell, Jessica L. ; Felson, David T. ; Niu, Jingbo ; Wise, Barton L ; Nevitt, Michael C. ; Singh, Jasvinder A. ; Frey-Law, Laura ; Neogi, Tuhina. / Does clinically important change in function after knee replacement guarantee good absolute function? the multicenter osteoarthritis study. In: Journal of Rheumatology. 2014 ; Vol. 41, No. 1. pp. 60-64.
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abstract = "Objective. Poor functional outcomes post-knee replacement are common, but estimates of its prevalence vary, likely in part because of differences in methods used to assess function. The agreement between improvement in function and absolute good levels of function after knee replacement has not been evaluated. We evaluated the attainment of improvement in function and absolute good function after total knee replacement (TKR) and the agreement between these measures. Methods. Using data from The Multicenter Osteoarthritis (MOST) Study, we determined the prevalence of achieving a minimal clinically important improvement (MCII, ≥ 14.2/68 point improvement) and Patient Acceptable Symptom State (PASS, ≤ 22/68 post-TKR score) on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Physical Function subscale at least 6 months after knee replacement. We also assessed the frequency of co-occurrence of the 2 outcomes, and the prevalence according to pre-knee replacement functional status. Results. We included 228 subjects who had a knee replacement during followup (mean age 65 yrs, mean body mass index 33.4, 73{\%} female). Seventy-one percent attained the PASS for function after knee replacement, while only 44{\%} attained the MCII. Of the subjects who met the MCII, 93{\%} also attained the PASS; however, of subjects who did not meet the MCII, 54{\%} still achieved a PASS. Baseline functional status was associated with attainment of each MCII and PASS. Conclusion. There was only partial overlap between attainment of a good level of function and actually improving by an acceptable amount. Subjects were more likely to attain an acceptable level of function than to achieve a clinically important amount of improvement post-knee replacement. The Journal of Rheumatology",
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N2 - Objective. Poor functional outcomes post-knee replacement are common, but estimates of its prevalence vary, likely in part because of differences in methods used to assess function. The agreement between improvement in function and absolute good levels of function after knee replacement has not been evaluated. We evaluated the attainment of improvement in function and absolute good function after total knee replacement (TKR) and the agreement between these measures. Methods. Using data from The Multicenter Osteoarthritis (MOST) Study, we determined the prevalence of achieving a minimal clinically important improvement (MCII, ≥ 14.2/68 point improvement) and Patient Acceptable Symptom State (PASS, ≤ 22/68 post-TKR score) on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Physical Function subscale at least 6 months after knee replacement. We also assessed the frequency of co-occurrence of the 2 outcomes, and the prevalence according to pre-knee replacement functional status. Results. We included 228 subjects who had a knee replacement during followup (mean age 65 yrs, mean body mass index 33.4, 73% female). Seventy-one percent attained the PASS for function after knee replacement, while only 44% attained the MCII. Of the subjects who met the MCII, 93% also attained the PASS; however, of subjects who did not meet the MCII, 54% still achieved a PASS. Baseline functional status was associated with attainment of each MCII and PASS. Conclusion. There was only partial overlap between attainment of a good level of function and actually improving by an acceptable amount. Subjects were more likely to attain an acceptable level of function than to achieve a clinically important amount of improvement post-knee replacement. The Journal of Rheumatology

AB - Objective. Poor functional outcomes post-knee replacement are common, but estimates of its prevalence vary, likely in part because of differences in methods used to assess function. The agreement between improvement in function and absolute good levels of function after knee replacement has not been evaluated. We evaluated the attainment of improvement in function and absolute good function after total knee replacement (TKR) and the agreement between these measures. Methods. Using data from The Multicenter Osteoarthritis (MOST) Study, we determined the prevalence of achieving a minimal clinically important improvement (MCII, ≥ 14.2/68 point improvement) and Patient Acceptable Symptom State (PASS, ≤ 22/68 post-TKR score) on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Physical Function subscale at least 6 months after knee replacement. We also assessed the frequency of co-occurrence of the 2 outcomes, and the prevalence according to pre-knee replacement functional status. Results. We included 228 subjects who had a knee replacement during followup (mean age 65 yrs, mean body mass index 33.4, 73% female). Seventy-one percent attained the PASS for function after knee replacement, while only 44% attained the MCII. Of the subjects who met the MCII, 93% also attained the PASS; however, of subjects who did not meet the MCII, 54% still achieved a PASS. Baseline functional status was associated with attainment of each MCII and PASS. Conclusion. There was only partial overlap between attainment of a good level of function and actually improving by an acceptable amount. Subjects were more likely to attain an acceptable level of function than to achieve a clinically important amount of improvement post-knee replacement. The Journal of Rheumatology

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