PROMIS physical function two weeks following orthopaedic surgery

Gregory Perraut; Ali Aneizi; Vidushan Nadarajah; Patrick Mj Sajak; Michael P Smuda; Julio J Jauregui; Min Zhan; Jonathan D Packer; R Frank Henn 3rd

doi:10.1016/j.jcot.2020.06.014

PROMIS physical function two weeks following orthopaedic surgery

J Clin Orthop Trauma. 2020 Oct;11(Suppl 5):S837-S843. doi: 10.1016/j.jcot.2020.06.014. Epub 2020 Jun 11.

Authors

Gregory Perraut¹, Ali Aneizi¹, Vidushan Nadarajah¹, Patrick Mj Sajak¹, Michael P Smuda¹, Julio J Jauregui¹, Min Zhan², Jonathan D Packer¹, R Frank Henn 3rd¹

Affiliations

¹ Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.
² Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.

Abstract

Many patients opt for elective orthopaedic procedures to regain physical function. However, little data exist about patient-reported early postoperative function.

Purpose: To characterize physical function two weeks postoperative from upper and lower extremity orthopaedic surgery and to determine pre-operative factors that are associated with physical function two weeks following surgery.

Methods: Patients 17 years and older undergoing elective orthopaedic surgery at one institution were enrolled prospectively and completed questionnaires prior to surgery and again two weeks postoperatively. The questionnaires included: six of the PROMIS computer adaptive questionnaires: Physical Function (PF), Pain Interference, Fatigue, Social Satisfaction, Anxiety, and Depression; a joint-specific function questionnaire, a joint numeric pain scale, and a body numeric pain scale. Physical activity levels were measured using Tegner, IPAQ, and Marx. Responses were analyzed using Spearman's correlation coefficient, ANOVA, and multivariate linear stepwise regression with two-week PF as the dependent variable.

Results: 435 patients (47% female) with mean age 41.1 ± 15.7 were included in our final analysis. Mean baseline PF score was 42.1 and mean two-week PF score was 35.5 (p < .0001). Patients undergoing upper extremity surgery had higher PF at two weeks than those undergoing lower extremity surgery (39.1 vs 32.2, p < .0001). Younger age, Hispanic ethnicity, preoperative narcotic use, injury prior to surgery, and procedure all had a significant relationship with lower 2-week postoperative PF score (p < 0.05). Numerous baseline and 2-week measures were correlated with postoperative PF score, with 2-week Social Satisfaction demonstrating the strongest correlation (r_s = 0.604, p < .0001). Multivariable regression confirmed that the better preoperative PF score and upper extremity surgery were independent preoperative predictors of better 2-week PF scores.

Conclusions: Patients have a significant decline in physical function following orthopaedic surgery, with those undergoing lower extremity surgery having a significantly greater decline. Many factors are associated with activity levels, including mental health, pain, and satisfaction. This information can be used to help manage patients' short-term expectations.

Keywords: Orthopaedic surgery; PROMIS; Patient reported outcomes; Physical function.