RESUMO
Background: When used appropriately, the minimal clinically important difference (MCID) provides a powerful tool for identifying meaningful improvements brought about by a given treatment, offering more clinically relevant information than frequentist statistical analysis. However, recent studies have shown inconsistent derivation methods and use of MCIDs. The goal of this study was to report the rate of patient-reported outcome measures (PROMs) and MCIDs use in the literature and assess how this rate has changed over time. Methods: All articles published in 2010 and 2020 reporting on total hip arthroplasty or total knee arthroplasty in The Journal of Clinical Orthopaedics and Related Research, The Journal of Bone and Joint Surgery, and The Journal of Arthroplasty were reviewed. In each reviewed article, every reported PROM and, if present, its corresponding MCID was recorded. These data were used to calculate the rate of reporting of each PROM and MCID. Results: While the total number of articles on total hip arthroplasty and total knee arthroplasty reporting PROMs increased over time, the proportion of articles reporting PROMs decreased from 49.8% (131/263) in 2010 to 35.5% (194/546) in 2020 (P = .011). Of these articles that report PROMs, the proportion of articles reporting any MCID increased from 2.3% (3/131) in 2010 to 16.5% (32/194) in 2020 (P = .002). Conclusions: The rate of reporting of MCIDs among articles relating to total hip arthroplasty and total knee arthroplasty that report PROMs has increased significantly between 2010 and 2020 but remains low. Continued emphasis on appropriate inclusion and value of MCIDs when PROMS are reported in clinical outcomes studies is needed.
RESUMO
PURPOSE: To identify the clinical practice preferences of orthopaedic surgeons regarding anterior cruciate ligament reconstruction (ACLR) rehabilitation through a survey of members of the Arthroscopy Association of North American (AANA) and the American Orthopaedic Society for Sports Medicine (AOSSM). METHODS: An online survey was distributed to members of AANA and AOSSM between November 2020 and September 2021. Participants reported on their clinical preferences for ACLR protocol development and patient selection, use of technology in ACLR recovery and rehabilitation, and preferences for advancing through multiple phases of the rehabilitative process. RESULTS: Responses from 46 orthopaedic surgeons were analyzed. Patient-reported outcome measures were not found to be utilized often at various phases of the perioperative period. Thirty-eight (82.6%) participants reported utilization of postoperative bracing. There was no consensus on when participants allow their patients to advance through rehabilitation, but most report waiting 3 to 4 months for advancement to jogging/lateral movement, 6 to 8 months for return to noncontact sport, and 9 months of more for return to unrestricted sport. Many participants utilize functional and strength testing with associated limb symmetry indices to determine patient readiness to return to sport, with 18, 26, and 25 participants reporting use of functional testing and 28, 26, and 27 participants reporting use of strength testing at the return to jogging/lateral movements, noncontact return to sport, and unrestricted return-to-sport phases, respectively. CONCLUSIONS: This study provides an insight into the rehabilitative protocols and modalities utilized for ACLR by orthopaedic surgeons in practice across the United States. There is notably substantial variation in rehabilitative patterns and preferences, particularly with regards to what constitutes criteria for progressing patients through the phases of returning to unrestricted sport. Additionally, our findings show that while many surgeons believe that quantitative assessment technology could be beneficial in decision-making for returning patients to sport, there are still many barriers that stand in the way of its implementation into clinical practice. CLINICAL RELEVANCE: Postoperative rehabilitative protocols after ACLR vary by surgeon.
