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Review
. 2023 Apr;38(4):616-621.
doi: 10.1016/j.arth.2022.11.011. Epub 2022 Dec 5.

Nuts and Bolts of Patient-Reported Outcomes in Orthopaedics

Minji K Lee  1 , Isabella Zaniletti  2 , Dirk R Larson  1 , David G Lewallen  3 , Daniel J Berry  3 , Hilal Maradit Kremers  4
Affiliations
Review

Nuts and Bolts of Patient-Reported Outcomes in Orthopaedics

Minji K Lee et al. J Arthroplasty. 2023 Apr.

Abstract

Patient-reported outcomes (PROs) are commonly used in orthopaedic clinical practice, comparative effectiveness research (CER), and label claims. In this paper, we provide an overview of PROs, their development, validation, and use in orthopaedic research with examples and conclude with practical guidelines for researchers and reviewers. We discuss considerations for conceptual framework, validity, reliability, factor analysis, and measurement of change with Knee Injury and Osteoarthritis Outcome score (KOOS), as an example. We also describe advantages of instruments developed based on item response theory and statistical analyses for data collected using PRO measures. Please visit the following (https://www.youtube.com/watch?v=4p-DtZgUHOA&t=354s) for a video that explains the highlights of the paper in practical terms.

Keywords: factor analysis; function; pain; patient reported outcomes; quality of life; total joint arthroplasty.

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Conflict of interest statement

Conflict of Interest: One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work.

Figures

Fig. 1.
Fig. 1.
A conceptual framework for 12-item short form of the Knee injury and Osteoarthritis Outcome Score (KOOS-12)
Fig. 2.
Fig. 2.
Exploratory (EFA) and confirmatory (CFA) factor analyses Legend. The double-headed arc arrow between the two constructs (pain and function) indicates correlation or covariation. The terms, e1 through e6, indicate the residual variance in each item that is not explained by the pain or function constructs.
Fig. 3.
Fig. 3.
IRT-based standard errors and SEM (Example from PROMIS pain interference v1.1 short form)
See this image and copyright information in PMC

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