{"id":10291,"date":"2022-11-30T15:00:11","date_gmt":"2022-11-30T14:00:11","guid":{"rendered":"https:\/\/blogs.bmj.com\/bjsm\/?p=10291"},"modified":"2022-11-30T15:48:30","modified_gmt":"2022-11-30T14:48:30","slug":"interpreting-patient-reported-outcomes-following-anterior-cruciate-ligament-tears-or-traumatic-meniscal-injuries","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bjsm\/2022\/11\/30\/interpreting-patient-reported-outcomes-following-anterior-cruciate-ligament-tears-or-traumatic-meniscal-injuries\/","title":{"rendered":"Interpreting patient-reported outcomes following anterior cruciate ligament tears or traumatic meniscal injuries"},"content":{"rendered":"<p><b><span style=\"font-weight: 400\">How do we know if our patients are getting better? From an OPTIKNEE <a href=\"https:\/\/bjsm.bmj.com\/content\/early\/2022\/08\/16\/bjsports-2022-105497\">systematic review<\/a>.<\/span><\/b><\/p>\n<p><b>This blog is part of a series on work by <a href=\"https:\/\/msklab.med.ubc.ca\/optiknee\/\">OPTIKNEE Consensus<\/a>. This is an international consensus group focused on improving knee health and preventing osteoarthritis after a traumatic knee injury.<\/b><\/p>\n<p><b>Keywords:<\/b><span style=\"font-weight: 400\"> patient-reported outcome measures (PROMs), anterior cruciate ligament (ACL), meniscus<\/span><\/p>\n<p><span style=\"font-weight: 400\">Patients\u2019 perspectives are critical for understanding if a treatment they have received has been effective e.g. is the questionnaire score, or change in score, meaningful to them? In this blog, we review how patient-reported outcome measures (PROMs) can be used to evaluate whether patients being treated for anterior cruciate ligament (ACL) tears or traumatic meniscal injuries feel that they are satisfied (or not) with their current status, or if they have experienced meaningful change. These suggestions are from one of <\/span><a href=\"http:\/\/dx.doi.org\/10.1136\/bjsports-2022-105497\"><span style=\"font-weight: 400\">several systematic reviews<\/span><\/a><span style=\"font-weight: 400\"> that we published as part of <\/span><a href=\"https:\/\/msklab.med.ubc.ca\/optiknee\/\"><span style=\"font-weight: 400\">OPTIKNEE<\/span><\/a><span style=\"font-weight: 400\">\u2019s international consensus project that aims to optimize knee health and prevent post-traumatic osteoarthritis following traumatic knee injuries.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Generally, the \u2018thresholds\u2019 used to help interpret the score on a PROM are meant to evaluate the \u2018average patient\u2019s experience\u2019 This may have limited use when clinicians are trying to interpret the score from a PROM filled-out by a single patient. Clinicians will likely better understand their patient\u2019s experience if they directly ask them \u201cAre you satisfied with how you are currently doing? What do you think about your improvement?\u201d Combining patient\u2019s subjective answers together with the answers to individual items in the PROM questionnaire will help engage in a meaningful discussion about their treatment.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><b>Why is this study important?<\/b><\/p>\n<p><span style=\"font-weight: 400\">PROMs are used extensively in clinical settings and in research to evaluate a patient\u2019s perception of their pain, function, quality of life, etc. after ACL tears or meniscal injuries. However, it can be difficult to interpret whether a score (or change in score) is clinically meaningful. For example, minimal important change (MIC) indicates the smallest amount of improvement (or worsening) in a PROM score that an average patient would perceive as important. Patient acceptable symptom state (PASS) indicates how high (or for \u2018Treatment Failure\u2019, how low) the score on the PROM would need to be for the average patient to feel their current status is satisfactory, or disappointing. Unfortunately, the terminology and methods used in the field of PROMs are complicated and currently there is no consensus on how to determine meaningful \u2018thresholds\u2019. We brave readers to plunge into our full <\/span><a href=\"https:\/\/bjsm.bmj.com\/content\/early\/2022\/08\/16\/bjsports-2022-105497\"><span style=\"font-weight: 400\">paper<\/span><\/a><span style=\"font-weight: 400\">. The bottom line is that knowing the evidence-based MIC and PASS thresholds for ACL tears and meniscal injuries. This alongside when and how to use these thresholds, can help clinicians interpret PROM scores from an individual patient.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><b>How did the study go about this?<\/b><\/p>\n<p><span style=\"font-weight: 400\">We systematically searched 5 databases for studies that calculated MIC, PASS, Treatment Failure or similar thresholds for any PROM in individuals with ACL tear or traumatic meniscal injury with a mean injury age of \u226435 years. Then we critically appraised and synthesized all the threshold estimates.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><b>What did the study find?<\/b><\/p>\n<p><span style=\"font-weight: 400\">We found 18 studies (15 ACL tear, 3 meniscal injury). We focused on \u2018anchor-based MIC thresholds\u2019 (where an anchor e.g., \u2018much worse\u2019 and \u2018much better,\u2019 is used at either end of a scale) because they are more valid than distribution-based thresholds (where the change in scores is compared to some measure of variability e.g., standard deviation). Below we report thresholds (or ranges of thresholds) that were assessed to be of either: (1) high credibility; or (2) low credibility in more than one study where scores fell within a range (&lt; 10 points) (Table). The interested reader can see the remaining thresholds in our <\/span><a href=\"https:\/\/bjsm.bmj.com\/content\/early\/2022\/08\/16\/bjsports-2022-105497\"><span style=\"font-weight: 400\">paper<\/span><\/a><span style=\"font-weight: 400\">.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><b><i>Table 1. MIC and PASS thresholds in which Credibility was rated \u2018High\u2019 or in which scores among multiple low credibility thresholds converged to within a 10-point range<\/i><\/b><\/p>\n<table style=\"height: 465px\" width=\"482\">\n<tbody>\n<tr>\n<td><b>PROM<\/b><\/td>\n<td><b>Threshold<\/b><\/td>\n<td><b>Credibility<\/b><\/td>\n<\/tr>\n<tr>\n<td><b>ACL tears\u00a0<\/b><\/td>\n<td><b>MIC<\/b><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400\">KOOS* Quality of Life<\/span><\/td>\n<td><span style=\"font-weight: 400\">18<\/span><\/td>\n<td><span style=\"font-weight: 400\">High<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400\">KOOS Symptoms<\/span><\/td>\n<td><span style=\"font-weight: 400\">-1.2 to 5.4<\/span><\/td>\n<td><span style=\"font-weight: 400\">Low<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400\">KOOS Function in Daily Living<\/span><\/td>\n<td><span style=\"font-weight: 400\">0.5 to 8.1<\/span><\/td>\n<td><span style=\"font-weight: 400\">Low<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400\">IKDC-SKF<\/span><\/td>\n<td><span style=\"font-weight: 400\">7.1 to 16.2<\/span><\/td>\n<td><span style=\"font-weight: 400\">Low<\/span><\/td>\n<\/tr>\n<tr>\n<td><b>ACL tears<\/b><\/td>\n<td><b>PASS<\/b><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400\">KOOS Function in Daily Living<\/span><\/td>\n<td><span style=\"font-weight: 400\">92 to 100<\/span><\/td>\n<td><span style=\"font-weight: 400\">n\/a^<\/span><\/td>\n<\/tr>\n<tr>\n<td><b>Traumatic meniscal tears<\/b><\/td>\n<td><b>PASS<\/b><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400\">KOOS Symptoms<\/span><\/td>\n<td><span style=\"font-weight: 400\">73 to 78<\/span><\/td>\n<td><span style=\"font-weight: 400\">n\/a^<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400\">KOOS Quality of Life<\/span><\/td>\n<td><span style=\"font-weight: 400\">53 to 57<\/span><\/td>\n<td><span style=\"font-weight: 400\">n\/a^<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><i><span style=\"font-weight: 400\">*KOOS: Knee injury and Osteoarthritis Outcome Score; IKDC-SKF: International Knee Documentation Committee \u2013 Subjective Knee Form; <\/span><\/i><span style=\"font-weight: 400\">^No tool available to measure credibility in PASS or Treatment Failure thresholds<\/span><\/p>\n<p><strong>Key messages:<\/strong><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-10312\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2022\/11\/OPTIKNEE-PROM-infographic-28-Nov-22-120x300.png\" alt=\"\" width=\"274\" height=\"685\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2022\/11\/OPTIKNEE-PROM-infographic-28-Nov-22-120x300.png 120w, https:\/\/blogs.bmj.com\/bjsm\/files\/2022\/11\/OPTIKNEE-PROM-infographic-28-Nov-22-768x1920.png 768w, https:\/\/blogs.bmj.com\/bjsm\/files\/2022\/11\/OPTIKNEE-PROM-infographic-28-Nov-22-614x1536.png 614w, https:\/\/blogs.bmj.com\/bjsm\/files\/2022\/11\/OPTIKNEE-PROM-infographic-28-Nov-22-640x1600.png 640w, https:\/\/blogs.bmj.com\/bjsm\/files\/2022\/11\/OPTIKNEE-PROM-infographic-28-Nov-22.png 800w\" sizes=\"auto, (max-width: 274px) 100vw, 274px\" \/><\/p>\n<p>&nbsp;<\/p>\n<p><b>Authors:<\/b><\/p>\n<p><b><i>Erin Macri, Alison Hoens, James Young, Adam Culvenor, Jackie Whittaker, Ewa Roos<\/i><\/b><\/p>\n<p>&nbsp;<\/p>\n<p><b>Resources and references:<\/b><\/p>\n<p><a href=\"https:\/\/msklab.med.ubc.ca\/optiknee\/\"><span style=\"font-weight: 400\">OPTIKNEE | Musculoskeletal Health, Sport &amp; Exercise Lab (ubc.ca)<\/span><\/a><\/p>\n<p><span style=\"font-weight: 400\">Macri EM, Young JJ, Ingelsrud LH, et al. Meaningful thresholds for patient-reported outcomes following interventions for anterior cruciate ligament tear or traumatic meniscus injury: a systematic review for the OPTIKNEE consensus. British Journal of Sports Medicine Published Online First: 16 August 2022. <\/span><a href=\"http:\/\/dx.doi.org\/10.1136\/bjsports-2022-105497\"><span style=\"font-weight: 400\">http:\/\/dx.doi.org\/10.1136\/bjsports-2022-105497<\/span><\/a><span style=\"font-weight: 400\">\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Devji T, Carrasco-Labra A, Qasim A, et al. Evaluating the credibility of anchor based estimates of minimal important differences for patient reported outcomes: instrument development and reliability study. BMJ 2020;369:m1714.\u00a0 <\/span><a href=\"https:\/\/doi.org\/10.1136\/bmj.m1714\"><span style=\"font-weight: 400\">https:\/\/doi.org\/10.1136\/bmj.m1714<\/span><\/a><span style=\"font-weight: 400\">\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Urhausen AP, Berg B, \u00d8iestad BE, et al. Measurement properties for muscle strength tests following anterior cruciate ligament and\/or meniscus injury: What tests to use and where do we need to go? A systematic review with meta-analyses for the OPTIKNEE consensus. British Journal of Sports Medicine Published Online First: 16 September 2022. <\/span><a href=\"http:\/\/dx.doi.org\/10.1136\/bjsports-2022-105498\"><span style=\"font-weight: 400\">http:\/\/dx.doi.org\/10.1136\/bjsports-2022-105498<\/span><\/a><span style=\"font-weight: 400\">\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Berg B, Urhausen AP, \u00d8iestad BE, et al. What tests should be used to assess functional performance in youth and young adults following anterior cruciate ligament or meniscal injury? A systematic review of measurement properties for the OPTIKNEE consensus. British Journal of Sports Medicine Published Online First: 13 June 2022. <\/span><a href=\"http:\/\/dx.doi.org\/10.1136\/bjsports-2022-105510\"><span style=\"font-weight: 400\">http:\/\/dx.doi.org\/10.1136\/bjsports-2022-105510<\/span><\/a><span style=\"font-weight: 400\">\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Culvenor AG, Girdwood MA, Juhl CB, et al. Rehabilitation after anterior cruciate ligament and meniscal injuries: a best-evidence synthesis of systematic reviews for the OPTIKNEE consensus. British Journal of Sports Medicine Published Online First: 29 June 2022. <\/span><a href=\"http:\/\/dx.doi.org\/10.1136\/bjsports-2022-105495\"><span style=\"font-weight: 400\">http:\/\/dx.doi.org\/10.1136\/bjsports-2022-105495<\/span><\/a><span style=\"font-weight: 400\">\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Whittaker JL, Losciale JM, Juhl CB, et al. Risk factors for knee osteoarthritis after traumatic knee injury: a systematic review and meta-analysis of randomised controlled trials and cohort studies for the OPTIKNEE Consensus. British Journal of Sports Medicine Published Online First: 02 September 2022. <\/span><a href=\"http:\/\/dx.doi.org\/10.1136\/bjsports-2022-105496\"><span style=\"font-weight: 400\">http:\/\/dx.doi.org\/10.1136\/bjsports-2022-105496<\/span><\/a><span style=\"font-weight: 400\">\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Filbay SR, Skou ST, Bullock GS, et al. Long-term quality of life, work limitation, physical activity, economic cost and disease burden following ACL and meniscal injury: a systematic review and meta-analysis for the OPTIKNEE consensus. British Journal of Sports Medicine Published Online First: 28 September 2022. <\/span><a href=\"http:\/\/dx.doi.org\/10.1136\/bjsports-2022-105626\"><span style=\"font-weight: 400\">http:\/\/dx.doi.org\/10.1136\/bjsports-2022-105626<\/span><\/a><!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>How do we know if our patients are getting better? From an OPTIKNEE systematic review. This blog is part of a series on work by OPTIKNEE Consensus. This is an international consensus group focused on improving knee health and preventing osteoarthritis after a traumatic knee injury. Keywords: patient-reported outcome measures (PROMs), anterior cruciate ligament (ACL), [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bjsm\/2022\/11\/30\/interpreting-patient-reported-outcomes-following-anterior-cruciate-ligament-tears-or-traumatic-meniscal-injuries\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":463,"featured_media":10312,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[16068],"class_list":["post-10291","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized","tag-featured"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Interpreting patient-reported outcomes following anterior cruciate ligament tears or traumatic meniscal injuries - BJSM blog - social media&#039;s leading SEM voice<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bjsm\/2022\/11\/30\/interpreting-patient-reported-outcomes-following-anterior-cruciate-ligament-tears-or-traumatic-meniscal-injuries\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Interpreting patient-reported outcomes following anterior cruciate ligament tears or traumatic meniscal injuries - BJSM blog - social media&#039;s leading SEM voice\" \/>\n<meta property=\"og:description\" content=\"How do we know if our patients are getting better? 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