How to interpret patient-reported outcomes? - Stratified adjusted minimal important changes for the EQ-5D-3L in hip and knee replacement patients

Abstract Background As one of the main goals of hip and knee replacements is to improve patients' health-related quality of life, a meaningful evaluation can be achieved by calculating minimal important changes (MICs) for improvements in patient-reported outcome measures (PROMs). This study aim...

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Main Authors: Irene Salvi (Author), David Ehlig (Author), Justus Vogel (Author), Anja Bischof (Author), Alexander Geissler (Author)
Format: Book
Published: SpringerOpen, 2024-11-01T00:00:00Z.
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042 |a dc 
100 1 0 |a Irene Salvi  |e author 
700 1 0 |a David Ehlig  |e author 
700 1 0 |a Justus Vogel  |e author 
700 1 0 |a Anja Bischof  |e author 
700 1 0 |a Alexander Geissler  |e author 
245 0 0 |a How to interpret patient-reported outcomes? - Stratified adjusted minimal important changes for the EQ-5D-3L in hip and knee replacement patients 
260 |b SpringerOpen,   |c 2024-11-01T00:00:00Z. 
500 |a 10.1186/s41687-024-00812-x 
500 |a 2509-8020 
520 |a Abstract Background As one of the main goals of hip and knee replacements is to improve patients' health-related quality of life, a meaningful evaluation can be achieved by calculating minimal important changes (MICs) for improvements in patient-reported outcome measures (PROMs). This study aims at providing MICs adjusted for patient characteristics for EQ-5D-3L index score improvements after hip and knee replacements. It adds to existing literature by relying on a large national sample and precise clustering algorithms, and by employing a state-of-the-art methodology for the calculation of improved adjusted MICs. Methodology A retrospective observational study was conducted using the publicly available National Health Service (NHS) PROMs dataset for primary hip and knee replacements. We used information on 252,331 hip replacements and 279,668 knee replacements from all NHS-funded providers in England between 2013 and 2020. Clusters of patients were created based on pre-operative EQ-VAS, depression status, and sex. Unstratified and stratified estimates for meaningful EQ-5D-3L improvements were obtained through anchor-based predictive MICs corrected for the proportion of improved patients and the reliability of transition ratings. Results Stratifying patients showed that MICs varied across subgroups based on pre-operative EQ-VAS, depression status, and sex. MICs were larger for patients with worse pre-operative EQ-VAS scores, while patients with better pre-operative scores required smaller MICs to achieve a meaningful change. We show how after stratification the percentage of patients achieving their stratified MIC was better in line with the actual share of improved patients. Larger MICs were found for patients with depression and for female patients. MICs calculated for knee replacements were consistently lower than those for hip replacements. Conclusions Our findings show the importance of adjusting MICs for patients' characteristics and should be considered for quality-related choices and policy initiatives. 
546 |a EN 
690 |a Minimal important changes 
690 |a Adjusted minimal important changes 
690 |a Patient-reported outcomes 
690 |a EQ-5D 
690 |a Patient characteristics 
690 |a Hip replacement 
690 |a Public aspects of medicine 
690 |a RA1-1270 
655 7 |a article  |2 local 
786 0 |n Journal of Patient-Reported Outcomes, Vol 8, Iss 1, Pp 1-12 (2024) 
787 0 |n https://doi.org/10.1186/s41687-024-00812-x 
787 0 |n https://doaj.org/toc/2509-8020 
856 4 1 |u https://doaj.org/article/c06a5b7c0e6f4e18b4ee6ecd21b7149d  |z Connect to this object online.