Patient-reported outcome measures in arthroplasty registries

Figures & data

Table 1. Generic and specific patient-reported outcome measures commonly used in hip and knee arthroplasty^a

Type Name of survey	Abbreviation for survey	Year developed	Registries using the survey	Validated for arthroplasty	License requirements	No. of translations available^b	No. of items	Minutes to complete survey
Generic
EuroQol 5 dimension health outcome survey,
3-level version	EQ-5D-3L	1990	7	Hip and knee	Yes	> 170	6	1–2
5-level version	EQ-5D-5L	2011	0	Unknown	Yes		6	2–3
Short Form 36 health survey	SF-36	1992	1	Hip and knee	Yes	> 50	36	5–10
Short Form 12 health survey	SF-12	1996	4	Unknown	Yes	> 40	12	2
Short Form 6-domain health survey	SF-6D	1998	0	Unknown	Yes	?	6	1–2
Specific
Western Ontario and McMaster Universities Arthritis Index	WOMAC	1982	4	Hip and knee	Yes	92	24	5–10
Knee injury and Osteoarthritis Outcome Score	KOOS	1998	7	Knee	No	44	42	5–10
Hip disability and Osteoarthritis Outcome Score	HOOS	2003	4	Hip	No	17		5–10
KOOS Physical Function Short Form	KOOS-PS	2007	0	Unknown	No	15	7	1–2
HOOS Physical Function Short Form	HOOS-PS	2008	0	Unknown	No	9	5	1–2
Oxford Knee Score	OKS	1998	3	Knee	Yes	19	12	3–4
Oxford Hip Score	OHS	1996	3	Hip	Yes	11	12	3–4
University of California at Los Angeles Activity Score	UCLA	1984	4	Hip and knee No		?	1 (10 levels)	2–3

a Domains covered in surveys:

EQ-5D-3L, EQ-5D-5L: mobility, self-care, usual activities, pain/discomfort, anxiety/depression.

SF-36, SF-12, (and the similar Veterans Rand 12 (VR-12) and Veterans Rand 36 (VR-36)): vitality, physical functioning, bodily pain, general health perceptions, physical role functioning, emotional role functioning, social role functioning, mental health.

SF-6D: physical functioning, role-participation (combined role-physical and role-emotional), social functioning, bodily pain, mental health, vitality.

WOMAC: pain, disability, and joint stiffness in knee and hip osteoarthritis.

KOOS/HOOS: pain, other symptoms, function in activities of daily living (ADL), function in sport and recreation (Sport/Rec), knee-/hip-related quality of life (QOL).

KOOS-PS/HOOS-PS: function, daily living, sport, recreation.

OKS, OHS: joint pain and function.

UCLA: level of activity.

b Translation of a validated PROM into different languages requires a formal methodological approach and specific expertise. Not all translated versions of these surveys have been validated.

Table 2. Case-mix variables in arthroplasty registries^a

Category Case-mix variable	Level of data^b	Registries that directly record the variable^c	Registries that obtain variable the via linkage^d	References
Demographic
Age	1	All		Jones et al. 2001, Franklin et al. 2008, Rolfson et al. 2011a, Judge et al. 2012b, Williams et al. 2013, Gordon et al. 2014a, SooHoo et al. 2015.
Sex	1	All		Rolfson et al. 2011a, Judge et al. 2012b.
Dependency/marital status	2	FORCE-TJR, NJR	SHAR, SKAR	Judge et al. 2012, NHS England Analytical Team 2013, Greene et al. 2014a.
Work status	2	FORCE-TJR		Judge et al. 2010.
Socioeconomic status
Education	2	ACORN, FORCE-TJR, GAR, HSS, MARCQI	DHR, DKR, NAR, SHAR, SKAR	OECD 1999, UNESCO 2006, Judge et al. 2010, Greene et al. 2014a.
Deprivation index	2	RACat	NJR	Judge et al. 2012, Neuberger et al. 2012, 2013, NHS England Analytical Team 2013.
Joint-specific history
Diagnosis	1	All		Judge et al. 2012.
Previous surgery	2	ACORN, BAR, CJRR-Calif, DKR, FAR, FORCE-TJR, GAR, LROI, NAR, NJR, RIAP, RIPO, SKAR		NHS England Analytical Team 2013.
Body habitus
Height and weight (BMI)	2	ACORN, AJRR, AOANJRR, CJRR-Calif, CJRR-Canada, DKR, FORCE-TJR, GAR, HJR, HJRR, HSS, KP-TJRR, LROI, MARCQI, NJR, RACat, RIPO, SIRIS, SHAR, SKAR		Lübbeke et al. 2007, Franklin et al. 2008, Jameson et al. 2014b, Judge et al. 2014.
Lifestyle factors
Smoking	3	AJRR, FORCE-TJR, GAR, LROI, MARCQI, SHAR
Level of activity	3	CJRR-Calif, GAR, HJR, HSS
Alcohol abuse	3	GAR, HJR, MARCQI		Jenkins et al. 2011.
Comorbidities
Charlson Comorbidity Index	2	DHR, FORCE-TJR, HJRR, HSS	NAR, NJR, SHAR, SKAR	Bjorgul et al. 2010, NHS England Analytical Team 2013, Greene et al. 2015.
Elixhauser Comorbidity Index	2	KP-TJRR, RACat	NAR, MARCQI, SHAR, SKAR	Greene et al. 2015.
ASA class	2	ACORN, AJRR, AOANJRR, CJRR-Calif, GAR, HJRR, HSS, KP-TJRR, LROI, MARCQI, NAR, NJR, NZJRR, SHAR, SIRIS, SKAR		Bjorgul et al. 2010, Hooper et al. 2012, Judge et al. 2012, SooHoo et al. 2015.
Charnley class	2	DHR, FORCE-TJR, GAR, HJR, LROI, NAR, RIPO, SIRIS, SHAR, SKAR		Dunbar et al. 2004, Bjorgul et al. 2010, Rolfson et al. 2011a.
Back pain	2	FORCE-TJR		Ayers et al. 2013.
Mental health/depression	2	GAR, FORCE-TJR, HJR		Franklin et al. 2008, Rolfson et al. 2009, Judge et al. 2012.
Preoperative PROMs
Pain, function, and/or HRQoL	3	ACORN, AJRR, CJRR-Calif, FORCE-TJR, GAR, HJR, HSS, INOR, LAR, LROI, MARCQI, RIAP, SHAR, SKAR	NJR (through NHS)	Franklin et al. 2008, Rolfson et al. 2009, Judge et al. 2011, 2012, Greene et al. 2015, Maratt et al. 2015, SooHoo et al. 2015.

a Case-mix variable is a variable that is predictive of improvement in an outcome measure. Abbreviations: ASA, American Society of Anesthesiologists Physical Status Classification; BMI, body mass index; NHS, National Health Service England; HRQoL, health-related quality of life; PROMs, patient-reported outcome measures.

b Register level of data (Rolfson et al. 2011b). [Authors: not very clear/language editor]

c Registries: ACORN, Arthroplasty Clinical Outcomes Registry National Australia; AJRR, American Joint Replacement Registry; AOANJRR, Australian Orthopaedic Association National Joint Replacement Registry; BAR, Belgian Arthroplasty Register ORTHOpride; CJRR-Calif, California Joint Replacement Registry; CJRR-Canada, Canadian Joint Replacement Registry; DHR, Danish Hip Arthroplasty Register; DKR, Danish Knee Arthroplasty Register; FAR, Finnish Arthroplasty Register; FORCE-TJR, Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement; GAR, Geneva Arthroplasty Registry; HJR, Harris Joint Registry; HJRR, HealthEast Joint Replacement Registry; HSS, Hospital for Special Surgery Hip and Knee Joint Replacement Registry; INOR, Irish National Orthopaedic Register; KP-TJRR, Kaiser Permanente National Total Joint Replacement Registry; LAR, Lithuanian Arthroplasty Register; LROI, Dutch Arthroplasty Register; MARCQI, Michigan Arthroplasty Registry Collaborative Quality Initiative; NAR, Norwegian Arthroplasty Register; NJR, National Joint Registry for England, Wales, Northern Ireland and the Isle of Man; NZJR, New Zealand Joint Registry; RACat, Catalan Arthroplasty Register; RIAP, Italian Arthroplasty Registry Project; RIPO, Registro dell’implantologia Protesica Ortopedica (Register of the Orthopaedic Prosthetic Implants); SHAR, Swedish Hip Arthroplasty Register; SIRIS, Swiss Implant Register; SKAR, Swedish Knee Arthroplasty Register.

d Obtained by linkage to other health data registries.

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