Abstract
The purpose of health outcomes monitoring is to assess the benefits and risks of health care processes, to enable benchmarking and to allow comparative studies of new technologies and variations in clinical practice. This paper critically reviews the discipline of health outcomes monitoring in joint replacement surgery. We reviewed over 250 papers published over the last 20 years in the major English speaking journals were reviewed. We conclude that there are considerable shortcomings of clinical studies which make it difficult to determine the results of different joint replacement designs. The shortcomings include inadequate study design and the lack of comparative data. Despite repeated calls for standardisation of outcome measures, this has yet to be achieved. Considerable resources are often invested in outcomes monitoring programs.It is therefore important that instruments are selected based on them meeting strict psychometric criteria, that adequate follow-up is achieved and that appropriate data analysis techniques are utilised, otherwise interpretation of results is difficult. We have found that patients’ reporting of symptoms and outcomes after hip arthroplasty were found to be consistent with those reported by their reviewing doctor. We therefore suggest that for uncomplicated joint arthroplasty cases, the marginal costs of their regular review in outpatients probably outweighs the marginal benefits and important resources and doctors time would be made available for other patient care activity if these patients were reviewed by patient self-administered questionnaires. Our studies have shown that SF-36 health survey and the WOMAC instruments are useful when administered by mailed survey, however, the cost-benefits of using these outcomes instruments is an important consideration. The lack of comparable outcomes data should encourage greater orthopaedic participation in multi-centre outcomes studies including randomised trials.
The abstracts were prepared by Professor Jegan Krishnan. Correspondence should be addressed to him at the Flinders Medical Centre, Bedford Park 5047, Australia.
