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      Patient-reported outcome measures in arthroplasty registries : Report of the Patient-Reported Outcome Measures Working Group of the International Society of Arthroplasty Registries
      Part II. Recommendations for selection, administration, and analysis


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          Abstract — The International Society of Arthroplasty Registries (ISAR) Patient-Reported Outcome Measures (PROMs) Working Group have evaluated and recommended best practices in the selection, administration, and interpretation of PROMs for hip and knee arthroplasty registries. The 2 generic PROMs in common use are the Short Form health surveys (SF-36 or SF-12) and EuroQol 5-dimension (EQ-5D). The Working Group recommends that registries should choose specific PROMs that have been appropriately developed with good measurement properties for arthroplasty patients. The Working Group recommend the use of a 1-item pain question (“During the past 4 weeks, how would you describe the pain you usually have in your [right/left] [hip/knee]?”; response: none, very mild, mild, moderate, or severe) and a single-item satisfaction outcome (“How satisfied are you with your [right/left] [hip/knee] replacement?”; response: very unsatisfied, dissatisfied, neutral, satisfied, or very satisfied). Survey logistics include patient instructions, paper- and electronic-based data collection, reminders for follow-up, centralized as opposed to hospital-based follow-up, sample size, patient- or joint-specific evaluation, collection intervals, frequency of response, missing values, and factors in establishing a PROMs registry program. The Working Group recommends including age, sex, diagnosis at joint, general health status preoperatively, and joint pain and function score in case-mix adjustment models. Interpretation and statistical analysis should consider the absolute level of pain, function, and general health status as well as improvement, missing data, approaches to analysis and case-mix adjustment, minimal clinically important difference, and minimal detectable change. The Working Group recommends data collection immediately before and 1 year after surgery, a threshold of 60% for acceptable frequency of response, documentation of non-responders, and documentation of incomplete or missing data.

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          An integrative model of shared decision making in medical encounters.

          Given the fluidity with which the term shared decision making (SDM) is used in teaching, assessment and research, we conducted a focused and systematic review of articles that specifically address SDM to determine the range of conceptual definitions. In April 2005, we ran a Pubmed (Medline) search to identify articles published through 31 December 2003 with the words shared decision making in the title or abstract. The search yielded 681 citations, 342 of which were about SDM in the context of physician-patient encounters and published in English. We read and reviewed the full text of all 342 articles, and got any non-redundant references to SDM, which yielded an additional 76 articles. Of the 418 articles examined, 161 (38.5%) had a conceptual definition of SDM. We identified 31 separate concepts used to explicate SDM, but only "patient values/preferences" (67.1%) and "options" (50.9%) appeared in more than half the 161 definitions. Relatively few articles explicitly recognized and integrated previous work. Our review reveals that there is no shared definition of SDM. We propose a definition that integrates the extant literature base and outlines essential elements that must be present for patients and providers to engage in the process of SDM. The integrative definition of SDM is intended to provide a useful foundation for describing and operationalizing SDM in further research.
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            The Oxford hip and knee scores have been extensively used since they were first described in 1996 and 1998. During this time, they have been modified and used for many different purposes. This paper describes how they should be used and seeks to clarify areas of confusion.
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              Pathogenesis and management of pain in osteoarthritis.

              The term osteoarthritis describes a common, age-related, heterogeneous group of disorders characterised pathologically by focal areas of loss of articular cartilage in synovial joints, associated with varying degrees of osteophyte formation, subchondral bone change, and synovitis. Joint damage is caused by a mixture of systemic factors that predispose to the disease, and local mechanical factors that dictate its distribution and severity. Various genetic abnormalities have been described, but most sporadic osteoarthritis probably depends on minor contributions from several genetic loci. Osteoarthritic joint damage may be associated with clinical problems, but the severity of joint disease is only weakly related to that of the clinical problem. For this reason the associations and pathogenesis of pain are in as much need of investigation as joint damage. Subchondral bone and synovium may be responsible for nociceptive stimuli, and peripheral neuronal sensitisation is an important feature, and can result in normal activities (such as walking) causing pain. Central pain sensitisation can also occur, and psychosocial factors are important determinants of pain severity. We present a stepwise approach to the management of osteoarthritis.

                Author and article information

                Acta Orthop
                Acta Orthop
                Acta Orthopaedica
                Taylor & Francis
                July 2016
                05 May 2016
                : 87
                : Suppl 1 , Acta Orthopaedica Supplementum no 362: ISAR meeting Gothenburg 2015
                : 9-23
                [1 ]Swedish Hip Arthroplasty Register and Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
                [2 ]Canadian Joint Replacement Registry and University of Manitoba, Winnipeg, Manitoba, Canada
                [3 ]FORCE-TJR and University of Massachusetts Medical School, Worcester, MA, USA
                [4 ]Hospital for Special Surgery and Weill Cornell Medical College, New York, NY, USA
                [5 ]Dutch Arthroplasty Register, Hertogenbosch, the Netherlands
                [6 ]Nuffield Department of Population Health and University of Oxford. Oxford, UK
                [7 ]New Zealand Joint Registry and University of Otago, Christchurch, New Zealand
                [8 ]California Joint Replacement Registry, San Francisco, CA, USA
                [9 ]Canadian Joint Replacement Registry and Dalhousie University, Halifax, Nova Scotia, Canada
                [10 ]Danish Hip Arthroplasty Register and University of Southern Denmark, Odense, Denmark
                [11 ]Geneva Arthroplasty Registry, Division of Orthopaedic Surgery, Geneva University Hospitals, Geneva, Switzerland.
                Author notes
                © 2016 The Author(s). Published by Taylor & Francis on behalf of the Nordic Orthopedic Federation.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-Non-Commercial License ( https://creativecommons.org/licenses/by-nc/3.0)

                : 15 August 2015
                : 17 September 2015



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