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Article ; Online: Dissatisfaction With Total Knee Arthroplasty at 1 Year Post Surgery Can be Predicted Using a Short Questionnaire Early in the Recovery Process.

Munn, Joseph S / Culliton, Sharon E / Bryant, Dianne M / MacDonald, Steven J / Chesworth, Bert M

2023 Volume 38, Issue 8, Page(s) 1504–1509

Abstract: Background: Approximately 20% of patients are dissatisfied with their total knee arthroplasty (TKA). Identifying patients likely to be dissatisfied early in the recovery process could help reduce the number of dissatisfied patients. The purpose of this ... ...

Abstract	Background: Approximately 20% of patients are dissatisfied with their total knee arthroplasty (TKA). Identifying patients likely to be dissatisfied early in the recovery process could help reduce the number of dissatisfied patients. The purpose of this study was to create an easily administered short questionnaire to identify patients likely to be dissatisfied at 1 year post surgery early in the recovery process. Methods: The study included 275 patients who underwent primary TKA for osteoarthritis. Individual 3-month postsurgery questionnaire items from the Knee Injury and Osteoarthritis Outcome Score and Knee Society Knee Scoring System were pooled together and used as candidate items to create 3 different short questionnaires. Items included in each questionnaire were selected using least absolute shrinkage and selection operator logistic regressions, a backward elimination method, and theory-based approaches. The area under the curve for each short questionnaire was calculated to evaluate predictive performances. Results: All 3 questionnaires contained a small number of items and appeared to successfully predict 1-year postsurgery dissatisfaction early in the recovery process. The least absolute shrinkage and selection operator logistic regression, backward elimination, and theory-based questionnaires were comprised of 4, 7, and 5 items and had the area under the curve scores of 0.893, 0.902, and 0.890, respectively. A question evaluating rising from sitting and activities of daily living appeared in all of the created questionnaires. Conclusion: A short questionnaire that is easy to administer and interpret can effectively predict TKA patient dissatisfaction at 1 year post surgery early in the recovery process.
MeSH term(s)	Humans ; Arthroplasty, Replacement, Knee/methods ; Treatment Outcome ; Osteoarthritis, Knee/surgery ; Patient Satisfaction ; Activities of Daily Living ; Surveys and Questionnaires
Language	English
Publishing date	2023-02-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	632770-9
ISSN	1532-8406 ; 0883-5403
ISSN (online)	1532-8406
ISSN	0883-5403
DOI	10.1016/j.arth.2023.01.070
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Article ; Online: Can Met Expectations Moderate the Relationship Between Pain/Function and Satisfaction in Total Knee Arthroplasty?

Munn, Joseph S / Culliton, Sharon E / Bryant, Dianne M / MacDonald, Steven J / Chesworth, Bert M

The Journal of arthroplasty

2021 Volume 36, Issue 6, Page(s) 1942–1946

Abstract: Background: Approximately 20% of patients are dissatisfied with their total knee arthroplasty (TKA) at 1-year post-surgery. Met expectations have been found by some to significantly predict satisfaction. The role of met expectations in determining ... ...

Abstract	Background: Approximately 20% of patients are dissatisfied with their total knee arthroplasty (TKA) at 1-year post-surgery. Met expectations have been found by some to significantly predict satisfaction. The role of met expectations in determining patient satisfaction has not been exhaustively explored. The primary aim of this study is to evaluate if met expectations moderate the relationship between pain and function variables and satisfaction. Methods: Patients who underwent primary TKA for osteoarthritis were included in the study (n = 304). Patient-reported outcomes at pre-surgery and 1-year post-surgery were collected. The Knee Society Score (KSS) satisfaction subscale was used as the dependent variable. Candidate independent variables included the following: demographics, KSS, Knee injury and Osteoarthritis Outcome Score (KOOS), 12-Item Short Form Health Survey (SF-12), Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale, Self-Administered Comorbidity Questionnaire, and University of California Los Angeles activity score. Separate linear regression models were created to test interactions for KSS met expectations with pain and KSS met expectations with function. Results: Significant predictors of satisfaction were KSS symptoms (pain), KOOS activities of daily living (function), KSS met expectations, KOOS pre-surgery activities of daily living, body mass index, and SF-12 general health. A significant interaction between met expectations and pain was found (P = .043) and the met expectations and function interaction approached significance (P = .086). For both interactions, as met expectations increased, pain and function predicted satisfaction less strongly. Conclusion: Met expectations were found to moderate the relationship between pain and satisfaction. There may be more value in improving pain for patients with low met expectations. Level of evidence: Level IV.
MeSH term(s)	Activities of Daily Living ; Arthroplasty, Replacement, Knee ; Humans ; Knee Joint/surgery ; Los Angeles ; Motivation ; Osteoarthritis, Knee/surgery ; Patient Satisfaction ; Personal Satisfaction ; Surveys and Questionnaires ; Treatment Outcome
Language	English
Publishing date	2021-01-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	632770-9
ISSN	1532-8406 ; 0883-5403
ISSN (online)	1532-8406
ISSN	0883-5403
DOI	10.1016/j.arth.2021.01.028
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Article ; Online: Corrigendum to "Logistic Regression and Machine Learning Models Cannot Discriminate Between Satisfied and Dissatisfied Total Knee Arthroplasty Patients [The Journal of Arthroplasty 37 (2022) 267-273].

Munn, Joseph S / Lanting, Brent A / MacDonald, Steven J / Somerville, Lyndsay E / Marsh, Jacquelyn D / Bryant, Dianne M / Chesworth, Bert M

The Journal of arthroplasty

2022 Volume 37, Issue 6, Page(s) 1211

Language	English
Publishing date	2022-03-20
Publishing country	United States
Document type	Published Erratum
ZDB-ID	632770-9
ISSN	1532-8406 ; 0883-5403
ISSN (online)	1532-8406
ISSN	0883-5403
DOI	10.1016/j.arth.2022.02.104
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Article ; Online: A Rasch-validated version of the upper extremity functional index for interval-level measurement of upper extremity function.

Hamilton, Clayon B / Chesworth, Bert M

Physical therapy

2013 Volume 93, Issue 11, Page(s) 1507–1519

Abstract: Background: The original 20-item Upper Extremity Functional Index (UEFI) has not undergone Rasch validation.: Objective: The purpose of this study was to determine whether Rasch analysis supports the UEFI as a measure of a single construct (ie, upper ...

Abstract	Background: The original 20-item Upper Extremity Functional Index (UEFI) has not undergone Rasch validation. Objective: The purpose of this study was to determine whether Rasch analysis supports the UEFI as a measure of a single construct (ie, upper extremity function) and whether a Rasch-validated UEFI has adequate reproducibility for individual-level patient evaluation. Design: This was a secondary analysis of data from a repeated-measures study designed to evaluate the measurement properties of the UEFI over a 3-week period. Methods: Patients (n=239) with musculoskeletal upper extremity disorders were recruited from 17 physical therapy clinics across 4 Canadian provinces. Rasch analysis of the UEFI measurement properties was performed. If the UEFI did not fit the Rasch model, misfitting patients were deleted, items with poor response structure were corrected, and misfitting items and redundant items were deleted. The impact of differential item functioning on the ability estimate of patients was investigated. Results: A 15-item modified UEFI was derived to achieve fit to the Rasch model where the total score was supported as a measure of upper extremity function only. The resultant UEFI-15 interval-level scale (0-100, worst to best state) demonstrated excellent internal consistency (person separation index=0.94) and test-retest reliability (intraclass correlation coefficient [2,1]=.95). The minimal detectable change at the 90% confidence interval was 8.1. Limitations: Patients who were ambidextrous or bilaterally affected were excluded to allow for the analysis of differential item functioning due to limb involvement and arm dominance. Conclusion: Rasch analysis did not support the validity of the 20-item UEFI. However, the UEFI-15 was a valid and reliable interval-level measure of a single dimension: upper extremity function. Rasch analysis supports using the UEFI-15 in physical therapist practice to quantify upper extremity function in patients with musculoskeletal disorders of the upper extremity.
MeSH term(s)	Activities of Daily Living ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Canada ; Female ; Humans ; Male ; Middle Aged ; Musculoskeletal Diseases/physiopathology ; Psychometrics/methods ; Reproducibility of Results ; Surveys and Questionnaires ; Upper Extremity/physiopathology ; Young Adult
Language	English
Publishing date	2013-06-27
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Validation Study
ZDB-ID	415886-6
ISSN	1538-6724 ; 0031-9023
ISSN (online)	1538-6724
ISSN	0031-9023
DOI	10.2522/ptj.20130041
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Article ; Online: Logistic Regression and Machine Learning Models Cannot Discriminate Between Satisfied and Dissatisfied Total Knee Arthroplasty Patients.

Munn, Joseph S / Lanting, Brent A / MacDonald, Steven J / Somerville, Lyndsay E / Marsh, Jacquelyn D / Bryant, Dianne M / Chesworth, Bert M

The Journal of arthroplasty

2021 Volume 37, Issue 2, Page(s) 267–273

Abstract: Background: Approximately 20% of total knee arthroplasty (TKA) patients are found to be dissatisfied or unsure of their satisfaction at 1-year post-surgery. This study attempted to predict 1-year post-surgery dissatisfied/unsure TKA patients with pre- ... ...

Abstract	Background: Approximately 20% of total knee arthroplasty (TKA) patients are found to be dissatisfied or unsure of their satisfaction at 1-year post-surgery. This study attempted to predict 1-year post-surgery dissatisfied/unsure TKA patients with pre-surgery and surgical variables using logistic regression and machine learning methods. Methods: A retrospective analysis of patients who underwent primary TKA for osteoarthritis between 2012 and 2016 at a single institution was completed. Patients were split into satisfied and dissatisfied/unsure groups. Potential predictor variables included the following: demographic information, patella re-surfaced, posterior collateral ligament sacrificed, and subscales from the Knee Society Knee Scoring System, the Knee Society Clinical Rating System, the Western Ontario and McMaster Universities Osteoarthritis Index, and the 12-Item Short Form Health Survey version 2. Logistic regression and 6 different machine learning methods were used to create prediction models. Model performance was evaluated using discrimination (AUC [area under the receiver operating characteristic curve]) and calibration (Brier score, Cox intercept, and Cox slope) metrics. Results: There were 1432 eligible patients included in the analysis, 313 were considered to be dissatisfied/unsure. When evaluating discrimination, the logistic regression (AUC = 0.736) and extreme gradient boosted tree (AUC = 0.713) models performed best. When evaluating calibration, the logistic regression (Brier score = 0.141, Cox intercept = 0.241, and Cox slope = 1.31) and gradient boosted tree (Brier score = 0.149, Cox intercept = 0.054, and Cox slope = 1.158) models performed best. Conclusion: The models developed in this study do not perform well enough as discriminatory tools to be used in a clinical setting. Further work needs to be done to improve the performance of pre-surgery TKA dissatisfaction prediction models.
MeSH term(s)	Arthroplasty, Replacement, Knee ; Humans ; Logistic Models ; Machine Learning ; Osteoarthritis, Knee/surgery ; Patient Satisfaction ; Personal Satisfaction ; Retrospective Studies
Language	English
Publishing date	2021-11-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	632770-9
ISSN	1532-8406 ; 0883-5403
ISSN (online)	1532-8406
ISSN	0883-5403
DOI	10.1016/j.arth.2021.10.017
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Article ; Online ; Conference proceedings: IFOMPT 2012: a rendez-vous of hands and minds.

Werstine, Rob / Chesworth, Bert M

The Journal of orthopaedic and sports physical therapy

2012 Volume 42, Issue 10, Page(s) A1–A83

Abstract: Since its founding in Montreal, Canada in 1974, the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) has been providing orthopaedic and manual therapists from around the world with the highest-quality learning ... ...

Abstract	Since its founding in Montreal, Canada in 1974, the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) has been providing orthopaedic and manual therapists from around the world with the highest-quality learning opportunities through a conference held every 4 years. In 2012, IFOMPT is partnering with The International Private Practitioners Association (IPPA) to host this prestigious event in Quebec City, Canada. As more than 51% of the Canadian Physiotherapy Association membership is working in private practice, this adds even greater value to this quadrennial event. This conference emulates best-evidence practice in the marriage of research and clinical excellence by pulling together some of the best and brightest hands and minds in orthopaedic physiotherapy. Through a call for proposals that equally emphasized research, clinical excellence, and the knowledge translation link between the two, the IFOMPT mandate of clinical and academic excellence has been kept at the forefront of this year's conference. Included in this supplement are the IFOMPT 2012 keynote addresses, schedule, and abstracts.
MeSH term(s)	Evidence-Based Practice ; Humans ; Manipulation, Orthopedic/methods ; Quebec ; Research ; Societies
Language	English
Publishing date	2012-10
Publishing country	United States
Document type	Addresses ; Congresses
ZDB-ID	604640-x
ISSN	1938-1344 ; 0190-6011
ISSN (online)	1938-1344
ISSN	0190-6011
DOI	10.2519/jospt.2012.0302
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Article ; Online: [No title information]

Primeau, Codie A / Birmingham, Trevor B / Leitch, Kristyn M / Willits, Kevin R / Litchfield, Robert B / Fowler, Peter J / Marsh, Jacquelyn D / Chesworth, Bert M / Dixon, Stephanie N / Bryant, Dianne M / Giffin, J Robert

CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne

2022 Volume 194, Issue 11, Page(s) E428–E436

Title translation	Arthroplastie totale du genou après ostéotomie tibiale haute: analyse du temps écoulé avant l’événement et des prédicteurs.
Language	French
Publishing date	2022-03-31
Publishing country	Canada
Document type	Journal Article
ZDB-ID	215506-0
ISSN	1488-2329 ; 0008-4409 ; 0820-3946
ISSN (online)	1488-2329
ISSN	0008-4409 ; 0820-3946
DOI	10.1503/cmaj.200934-f
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Article ; Online: Validity and Internal Consistency of the New Knee Society Knee Scoring System.

Culliton, Sharon E / Bryant, Dianne M / MacDonald, Steven J / Hibbert, Kathryn M / Chesworth, Bert M

Clinical orthopaedics and related research

2018 Volume 476, Issue 1, Page(s) 77–84

Abstract: Background: In 2012, a new Knee Society Knee Scoring System (KSS) was developed and validated to address the needs for a scoring system that better encompasses the expectations, satisfaction, and physical involvement of a younger, more active population ...

Abstract	Background: In 2012, a new Knee Society Knee Scoring System (KSS) was developed and validated to address the needs for a scoring system that better encompasses the expectations, satisfaction, and physical involvement of a younger, more active population of patients undergoing TKA. Revalidating this tool in a separate population by individuals other than the developers of the scoring system seems important, because such replication would tend to confirm the generalizability of this tool. Questions/purposes: The purposes of this study were (1) to validate the KSS using a separate sample of patients undergoing primary TKA; and (2) to evaluate the internal consistency of the KSS. Methods: Intervention and control groups from a randomized controlled trial with no between-group differences were pooled. Preoperative and postoperative (6 weeks and 1 year) data were used. Patients with osteoarthritis undergoing primary TKA completed the patient-reported component of the KSS, Knee Injury and Osteoarthritis Outcome Score (KOOS), SF-12, two independent questions about expectations of surgery, and the Patient Acceptable Symptom State (PASS) single-question outcome. This study included 345 patients with 221 (64%) women, an average (SD) age of 64 (8.6) years, a mean (SD) body mass index of 32.9 (7.5) kg/m, and 225 (68%) having their first primary TKA. Loss to followup in the control group was 18% and loss to followup in the intervention group was 13%. We quantified cross-sectional (preoperative scores) and longitudinal validity (pre- to postoperative change scores) by evaluating associations between the KSS and KOOS subscales using Spearman's correlation coefficient. Preoperative known-group validity of the KSS symptoms and functional activity score was evaluated with a one-way analysis of variance across three levels of physical health status using the SF-12 Physical Component Score. Known-group validity of the KSS expectation score was evaluated with an unpaired t-test by comparing means across known expectation groups. Known-group validity of the KSS satisfaction score was evaluated with an unpaired t-test by comparing means across yes/no response groupings of the PASS single-question outcome. Internal consistency for each KSS subscale was evaluated with Cronbach's α. Results: Cross-sectional validity (ie, associations at a single point in time) was supported because correlation coefficients between KSS symptoms, functional activities, and satisfaction scores and scores on the KOOS pain subscale ranged from 0.60 to 0.73 (all correlations p < 0.01). Values were similar for associations with the KOOS function in the activities of daily living (ADL) subscale (0.66-0.69) and less (0.41-0.58) for correlations with the other three KOOS subscales. Longitudinal validity (ie, associations of change scores between two time points) was also supported because correlation coefficients between KSS symptoms, functional activities, and satisfaction change scores and the KOOS pain and ADL change scores varied from 0.63 to 0.73. Correlation coefficients were lower for the other three KOOS subscale change scores, suggesting a weaker relationship with KOOS symptoms (0.48-0.53), sports (0.47-0.51), and quality of life (0.60-0.65) (all correlations p < 0.01). Known-group validity (ie, differences between groups that are known to differ on a given characteristic) was confirmed by between-group differences for the symptoms and functional activities score comparisons as well as the comparisons with the expectations and satisfaction scores of the KSS (all p < 0.01). Cronbach's α (ie, association among subscale items) varied from 0.68 (discretionary activities) to 0.94 (postoperative expectations) across four KSS subscales. Conclusions: Moderate-sized correlation coefficients and consistent differences between known groups support the validity of the KSS. Internal consistency values were also acceptable. The patient-reported subscales of the KSS are a valid and internally consistent outcome assessment for TKA.
MeSH term(s)	Activities of Daily Living ; Age Factors ; Aged ; Arthroplasty, Replacement, Knee/adverse effects ; Biomechanical Phenomena ; Female ; Health Status ; Humans ; Knee Joint/physiopathology ; Knee Joint/surgery ; Male ; Middle Aged ; Pain Measurement ; Pain, Postoperative/etiology ; Patient Reported Outcome Measures ; Patient Satisfaction ; Predictive Value of Tests ; Randomized Controlled Trials as Topic ; Recovery of Function ; Reproducibility of Results ; Time Factors ; Treatment Outcome
Language	English
Publishing date	2018-03-09
Publishing country	United States
Document type	Journal Article ; Validation Studies
ZDB-ID	80301-7
ISSN	1528-1132 ; 0009-921X
ISSN (online)	1528-1132
ISSN	0009-921X
DOI	10.1007/s11999.0000000000000014
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Article ; Online: Effect of an e-Learning Tool on Expectations and Satisfaction Following Total Knee Arthroplasty: A Randomized Controlled Trial.

Culliton, Sharon E / Bryant, Dianne M / MacDonald, Steven J / Hibbert, Kathy M / Chesworth, Bert M

The Journal of arthroplasty

2018 Volume 33, Issue 7, Page(s) 2153–2158

Abstract: Background: Orthopedic surgeons recognize patient expectations of total knee arthroplasty (TKA) can be managed through education. E-learning is the application of educational technology. The objective of this study was to evaluate whether an e-learning ... ...

Abstract	Background: Orthopedic surgeons recognize patient expectations of total knee arthroplasty (TKA) can be managed through education. E-learning is the application of educational technology. The objective of this study was to evaluate whether an e-learning tool could affect whether patients' expectations were met and they were satisfied 1 year following TKA. Methods: Patients with osteoarthritis from the London Health Sciences Centre, Canada, were randomly assigned to either a control group (n = 207) receiving standard patient education or an intervention group (n = 209) using the e-learning tool in addition to the standard. We used a web-based system with permuted block sizes, stratified by surgeon and first or second TKA. Preoperative measures were completed following the patients' preadmission clinic visit. Postoperative patient-reported outcome measures were completed at 6 weeks, 3 months, and 1 year after TKA. One year after TKA, risk difference was used to determine between-group differences for patient satisfaction and expectations being met. Results: One year postoperatively, the risk that expectations of patients were not met was 21.8% in the control group and 21.4% in the intervention group for an adjusted risk difference of 1.3% (95% confidence interval, -7.8% to 10.4%, P = .78). The proportion of patients satisfied with their TKA at 1 year postoperative was 78.6% in the intervention and 78.2% in the control groups. Conclusion: There was no between-group difference at 1 year between intervention and control groups for either the risk that expectations of patients were not met or the proportion of patients who were dissatisfied with their TKA.
MeSH term(s)	Aged ; Arthroplasty, Replacement, Knee/psychology ; Canada ; Computer-Assisted Instruction/methods ; Female ; Humans ; Male ; Middle Aged ; Motivation ; Orthopedics/standards ; Osteoarthritis, Knee/surgery ; Patient Reported Outcome Measures ; Patient Satisfaction ; Personal Satisfaction ; Postoperative Period ; Surveys and Questionnaires ; Treatment Outcome
Language	English
Publishing date	2018-02-17
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	632770-9
ISSN	1532-8406 ; 0883-5403
ISSN (online)	1532-8406
ISSN	0883-5403
DOI	10.1016/j.arth.2018.02.040
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Article ; Online: Development of a Clinician-Rated Drop Vertical Jump Scale for Patients Undergoing Rehabilitation After Anterior Cruciate Ligament Reconstruction: A Delphi Approach.

Gagnon, Sheila S / Birmingham, Trevor B / Chesworth, Bert M / Bryant, Dianne / Werstine, Melanie / Giffin, J Robert

The Journal of orthopaedic and sports physical therapy

2017 Volume 47, Issue 8, Page(s) 557–564

Abstract: Study Design Delphi panel study. Background Biomechanical parameters measured during a drop vertical jump task are risk factors for anterior cruciate ligament (ACL) injury and are targeted during rehabilitation after ACL reconstruction. A clinically ... ...

Abstract	Study Design Delphi panel study. Background Biomechanical parameters measured during a drop vertical jump task are risk factors for anterior cruciate ligament (ACL) injury and are targeted during rehabilitation after ACL reconstruction. A clinically feasible tool that quantifies observed performance on the drop vertical jump would help inform treatment efforts. The content and scoring of such a tool should be deliberated on by a group of experts throughout its development. Objectives To establish consensus on the content and scoring of a clinician-rated drop vertical jump scale (DVJS) for use during rehabilitation after ACL reconstruction. Methods Using a modified Delphi process, a panel of experts (researchers and clinicians) on the risk factors, prevention, treatment, and biomechanics of ACL injury anonymously critiqued versions of a DVJS. The DVJS was developed iteratively, based on the feedback from the panel, using Likert scale responses to questions and providing written comments. Three to 5 rounds were planned a priori, with a requirement of 75% agreement on included items after the final round. Results Twenty of the 31 invited experts (65%) participated. Approximately 93% agreement was achieved after the fourth round. Final items on the scale included the rating of knee valgus collapse (no collapse to extreme collapse) and the presence of other undesirable movements, including lateral trunk lean, insufficient knee flexion, and limb-to-limb asymmetry. Conclusion The Delphi process resulted in a beta version of a DVJS. Expert consensus was achieved on its content and scoring to support further clinical testing of the scale. J Orthop Sports Phys Ther 2017;47(8):557-564. Epub 6 Jul 2017. doi:10.2519/jospt.2017.7183.
Language	English
Publishing date	2017-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	604640-x
ISSN	1938-1344 ; 0190-6011
ISSN (online)	1938-1344
ISSN	0190-6011
DOI	10.2519/jospt.2017.7183
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