Feasibility Of Obtaining Patient-reported Outcome Measures In A High-volume Outpatient Tertiary Reconstructive Surgical Limb Salvage Center
Adaah A. Sayyed, BS1, Rebecca Yamamoto, BS, BA2, Jina Lee, MS2, Christopher Choi, BA2, Jayson N. Atves, DPM1, John S. Steinberg, DPM1, Kenneth L. Fan, MD1, David H. Song, MD, MBA1, Christopher E. Attinger, MD1, Karen K. Evans, MD1.
1MedStar Georgetown University Hospital, Washington, DC, USA, 2Georgetown University School of Medicine, Washington, DC, USA.
Purpose: Completion of patient-reported outcome measures (PROMs) is a labor-intensive but crucial cornerstone in advancement of patient-centered care, but there is infrequent and inconsistent reporting of these outcomes in comorbid chronic wound patient populations, with no standardized methods to collect and report PROMs for these patients. We report the feasibility and reproducibility of PROM collection for all patients seen in a high-volume, multidisciplinary tertiary limb salvage center to determine both pain and functionality outcomes. Methods: Plastic Surgery Research Foundation provided a grant to our institution for this study, funding the installation of iPads in each clinic room in the limb salvage center. Surveys were uploaded to the iPad Tonic app, allowing patients to complete surveys either through the app or through paper surveys. Functionality and pain were assessed using the following surveys: 1) Neuro-QoL Lower Extremity Function - Mobility (LEFM), 2) 11-point Numerical Rating Scale (NRS), 3) Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity, and 4) PROMIS Pain Interference. Three dedicated research assistants attended clinic daily from June to July 2021 to administer surveys between clinic visits. Patients were categorized based on a retrospective review of medical and surgical history into one of the following groups: 1) amputation, 2) flap reconstruction, 3) other surgical procedure, and 4) non-surgical condition. Results: Mean age of patients completing the surveys was 63.2 (SD 16.4). 53.0% of patients were male (n=224). 500 sets of all four surveys were administered to 420 patients over two months, with 16% (n=80) of patients completing multiple survey sets at separate clinic visits. Survey completion rate was ≥ 90% for each PROM administered (Table 1). Of the 420 patients, 133 underwent prior amputation (above-the-knee amputation, below-the-knee amputation, or partial foot amputation), 32 underwent local or free flap reconstruction, 68 underwent other surgical procedures (e.g. debridement, arthroplasty, etc.), and 295 were non-surgical patients seen for other conditions (e.g. ulcers, lymphedema, hidradenitis, etc.). Mean survey scores included the following: LEFM 42.2 (SD 9.9), PROMIS pain intensity 53.5 (SD 11.6), PROMIS pain interference 54.9 (SD 10.2), NRS current pain 2.9 (SD 3.0), NRS worst pain 4.1 (SD 3.5), and NRS best pain 2.7 (SD 2.9). Figure 1 outlines the protocol used to implement survey collection in a high-volume clinic setting. Conclusions: We report that integration of PROM collection in a high-volume tertiary limb salvage center is feasible. Dedicated research assistants were required to be present throughout clinics to consent patients, resolve technical issues, and assist patients with conditions limiting their abilities to complete surveys. Through PROM collection and analysis, we hope to improve the analysis of various limb salvage procedures, promote routine evaluation of postoperative PROMs, and expand the generalizability of PROM studies to improve patient outcomes.
| Patient Demographics (n, %) | |
| Age (mean ± SD) | 63.2 ± 16.4 |
| Sex | |
| Male | 224 (53) |
| Female | 196 (47) |
| CCI (median, IQR) | 4 (3-6) |
| Surveys Administered (n, %) | |
| Total Patients Surveyed | 420 |
| Total Survey Sets Administered | 500 |
| 1 Survey Set | 420 (84) |
| 2 Survey Sets | 69 (14) |
| 3 Survey Sets | 11 (2) |
| Completion by Survey Type (n, %) | |
| NRS: Current Pain, 1-item | 459 (92) |
| NRS: Best Pain, 1-item | 458 (92) |
| NRS: Worst Pain, 1-item | 456 (91) |
| PROMIS Pain Intensity 3a, 3-item | 454 (91) |
| PROMIS Pain Interference 8a, 8-item | 448 (90) |
| Neuro-QoL LEFM Short Form, 8-item | 479 (96) |
| Abbreviations: SD, standard deviation; CCI, Charlson Comorbidity Index; IQR, interquartile range; NRS, Numerical Rating Scale; PROMIS, Patient-Reported Outcomes Measurement Information System; Neuro-QoL LEFM, Neurology Quality-of-Life Lower Extremity Function - Mobility. | |
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