Abstract
Background: The length of most patient-reported outcome measures creates significant response burden, which hampers follow-up rates. The Patient Acceptable Symptom State (PASS) is a single-item, patient-reported outcome measure that asks patients to consider all aspects of life to determine whether the state of their joint is satisfactory; this measure may be viable for tracking outcomes on a large scale. Hypothesis: The PASS question would identify clinically successful anterior cruciate ligament reconstruction (ACLR) at 1-year follow-up with high sensitivity and moderate specificity. We defined “clinically successful” ACLR as changes in preoperative to postoperative scores on the Knee injury and Osteoarthritis Outcome Score (KOOS) pain subscale and the KOOS knee-related quality of life subscale in excess of minimal clinically important difference or final KOOS pain or knee-related quality of life subscale scores in excess of previously defined PASS thresholds. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Patients enrolled in a prospective longitudinal cohort completed patient-reported outcome measures immediately before primary ACLR. At 1-year follow-up, patients completed the same patient-reported outcome measures and answered the PASS question: “Taking into account all the activity you have during your daily life, your level of pain, and also your activity limitations and participation restrictions, do you consider the current state of your knee satisfactory?” Results: A total of 555 patients enrolled in our cohort; 464 were eligible for this study. Of these, 300 patients (64.7%) completed 1-year follow-up, of whom 83.3% reported satisfaction with their knee after surgery. The PASS question demonstrated high sensitivity to identify clinically successful ACLR (92.6%; 95% CI, 88.4%-95.6%). The specificity of the question was 47.1% (95% CI, 35.1%-59.5%). The overall agreement between the PASS and our KOOS-based criteria for clinically successful intervention was 81.9%, and the kappa value indicated moderate agreement between the two methods (κ = 0.44). Conclusion: The PASS question identifies individuals who have experienced clinically successful ACLR with high sensitivity. The limitation of the PASS is its low specificity, which we calculated to be 47.1%. Answering “no” to the PASS question meant that a patient neither improved after surgery nor achieved an acceptable final state of knee health. The brevity, interpretability, and correlation of the PASS question with significant improvements on various KOOS subscales make it a viable option in tracking ACLR outcomes on a national or global scale.
| Original language | English |
|---|---|
| Pages (from-to) | 1159-1167 |
| Number of pages | 9 |
| Journal | American Journal of Sports Medicine |
| Volume | 47 |
| Issue number | 5 |
| DOIs | |
| State | Published - Apr 1 2019 |
Bibliographical note
Publisher Copyright:© 2019 The Author(s).
Funding
One or more of the authors has declared the following potential conflict of interest or source of funding: Research reported in this publication was partially supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award No. R01AR053684 (K.P.S.) and under Award No. K23AR066133, which supported a portion of M.H.J.’s professional effort. The content is solely the responsibility of the authors and does not necessarily represent official views of the National Institutes of Health. G.J.S. has received royalties or consulting fees from nPhase. L.F. has received hospitality payments from the Musculoskeletal Foundation and consulting fees from Zimmer Biomet. A.M. has received royalties from Arthrosurface and Zimmer Biomet; consulting fees from Amniox Medical, Linvatec, Smith & Nephew, and Stryker; and hospitality payments from Arthrosurface, Arthrex, Rock Medical Orthopedics, and DJO. R.D.P. has received hospitality payments from the Musculoskeletal Transplant Foundation, Smith & Nephew, and Zimmer Biomet and royalties from Zimmer Biomet. J.R. has received speaking fees and hospitality payments from Smith & Nephew. P.S. has received speaking fees from Arthrex; consulting fees from DePuy and DJO; and hospitality payments from Arthrex, the Musculoskeletal Transplant Foundation, and Rock Medical Orthopedics. K.P.S. has received royalties or consulting fees from nPhase, NFL, Cytori, and Mitek; funding for research from Smith & Nephew Endoscopy and DonJoy Orthopaedics; and hospitality payments from DePuy and Biosense Webster. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. The authors thank the Cleveland Clinic orthopaedic patients, staff, and research personnel whose efforts related to regulatory issues, data collection, patient follow-up, data quality control, analyses, and manuscript preparation have made this consortium successful. The authors also thank Thomas E. Anderson, MD, for his contribution, and Brittany Stojsavljevic, editor assistant, Cleveland Clinic Foundation, for editorial management.
| Funders | Funder number |
|---|---|
| National Institutes of Health (NIH) | |
| National Institute of Arthritis and Musculoskeletal and Skin Diseases | R01AR053684 |
| National Institute of Arthritis and Musculoskeletal and Skin Diseases | |
| Cleveland Clinic | |
| Cleveland Clinic Foundation |
Keywords
- PASS
- anterior cruciate ligament
- outcomes
ASJC Scopus subject areas
- Physical Therapy, Sports Therapy and Rehabilitation
- Orthopedics and Sports Medicine