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      Defining an International Standard Set of Outcome Measures for Patients With Hip or Knee Osteoarthritis: Consensus of the International Consortium for Health Outcomes Measurement Hip and Knee Osteoarthritis Working Group

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          Abstract

          Objective

          To define a minimum Standard Set of outcome measures and case‐mix factors for monitoring, comparing, and improving health care for patients with clinically diagnosed hip or knee osteoarthritis (OA), with a focus on defining the outcomes that matter most to patients.

          Methods

          An international working group of patients, arthroplasty register experts, orthopedic surgeons, primary care physicians, rheumatologists, and physiotherapists representing 10 countries was assembled to review existing literature and practices for assessing outcomes of pharmacologic and nonpharmacologic OA therapies, including surgery. A series of 8 teleconferences, incorporating a modified Delphi process, were held to reach consensus.

          Results

          The working group reached consensus on a concise set of outcome measures to evaluate patients’ joint pain, physical functioning, health‐related quality of life, work status, mortality, reoperations, readmissions, and overall satisfaction with treatment result. To support analysis of these outcome measures, pertinent baseline characteristics and risk factor metrics were defined. Annual outcome measurement is recommended for all patients.

          Conclusion

          We have defined a Standard Set of outcome measures for monitoring the care of people with clinically diagnosed hip or knee OA that is appropriate for use across all treatment and care settings. We believe this Standard Set provides meaningful, comparable, and easy to interpret measures ready to implement in clinics and/or registries globally. We view this set as an initial step that, when combined with cost data, will facilitate value‐based health care improvements in the treatment of hip and knee OA.

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          Most cited references22

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          The Self-Administered Comorbidity Questionnaire: a new method to assess comorbidity for clinical and health services research.

          To develop the Self-Administered Comorbidity Questionnaire (SCQ) and assess its psychometric properties, including the predictive validity of the instrument, as reflected by its association with health status and health care utilization after 1 year. A cross-sectional comparison of the SCQ with a standard, chart abstraction-based measure (Charlson Index) was conducted on 170 inpatients from medical and surgical care units. The association of the SCQ with the chart-based comorbidity instrument and health status (short form 36) was evaluated cross sectionally. The association between these measures and health status and resource utilization was assessed after 1 year. The Spearman correlation coefficient for the association between the SCQ and the Charlson Index was 0.32. After restricting each measure to include only comparable items, the correlation between measures was stronger (Spearman r = 0.55). The SCQ had modest associations with measures of resource utilization during the index admission, and with health status and resource utilization after 1 year. The SCQ has modest correlations with a widely used medical record-based comorbidity instrument, and with subsequent health status and utilization. This new measure represents an efficient method to assess comorbid conditions in clinical and health services research. It will be particularly useful in settings where medical records are unavailable.
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            Pathogenesis and management of pain in osteoarthritis.

            The term osteoarthritis describes a common, age-related, heterogeneous group of disorders characterised pathologically by focal areas of loss of articular cartilage in synovial joints, associated with varying degrees of osteophyte formation, subchondral bone change, and synovitis. Joint damage is caused by a mixture of systemic factors that predispose to the disease, and local mechanical factors that dictate its distribution and severity. Various genetic abnormalities have been described, but most sporadic osteoarthritis probably depends on minor contributions from several genetic loci. Osteoarthritic joint damage may be associated with clinical problems, but the severity of joint disease is only weakly related to that of the clinical problem. For this reason the associations and pathogenesis of pain are in as much need of investigation as joint damage. Subchondral bone and synovium may be responsible for nociceptive stimuli, and peripheral neuronal sensitisation is an important feature, and can result in normal activities (such as walking) causing pain. Central pain sensitisation can also occur, and psychosocial factors are important determinants of pain severity. We present a stepwise approach to the management of osteoarthritis.
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              The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC): a review of its utility and measurement properties.

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                Author and article information

                Contributors
                ola.rolfson@vgregion.se
                Journal
                Arthritis Care Res (Hoboken)
                Arthritis Care Res (Hoboken)
                10.1002/(ISSN)2151-4658
                ACR
                Arthritis Care & Research
                John Wiley and Sons Inc. (Hoboken )
                2151-464X
                2151-4658
                26 October 2016
                November 2016
                : 68
                : 11 ( doiID: 10.1002/acr.v68.11 )
                : 1631-1639
                Affiliations
                [ 1 ]International Consortium for Health Outcomes Measurement, Cambridge, Massachusetts, Harris Orthopaedic Laboratory, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts, and Sahlgrenska Academy, University of Gothenburg GothenburgSweden
                [ 2 ]International Consortium for Health Outcomes Measurement Cambridge Massachusetts
                [ 3 ]University of Melbourne Melbourne VictoriaAustralia
                [ 4 ]University of Massachusetts Medical School Worchester
                [ 5 ]Kaiser Permanente Oakland California
                [ 6 ]Zerktouni Orthopedic Clinic CasablancaMorocco
                [ 7 ]Dell Medical School, University of Texas at Austin
                [ 8 ]Nicolaas Institute of Constructive Orthopaedic Research and Education Foundation for Arthroplasty and Sports Medicine, Medistra Hospital JakartaIndonesia
                [ 9 ]Hoag Orthopedic Institute Newport Beach California
                [ 10 ]University of Leeds and National Institute for Health Research Leeds Musculoskeletal Biomedical Research Unit LeedsUK
                [ 11 ]Lund University LundSweden
                [ 12 ]University of Otago DunedinNew Zealand
                [ 13 ]Connecticut Joint Replacement Institute Hartford
                [ 14 ]University of Pennsylvania Perelman School of Medicine Philadelphia
                [ 15 ]Aneurin Bevan Health Board Newport WalesUK
                [ 16 ]Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, and Harris Orthopaedic Laboratory, Massachusetts General Hospital, and Harvard Medical School Boston
                [ 17 ]The Johns Hopkins Aramco Health Care Center DhahranSaudi Arabia
                [ 18 ]North Sydney Orthopaedic and Sports Medicine Centre and University of Sydney Institute of Bone and Joint, Royal North Shore Hospital North Sydney New South WalesAustralia
                [ 19 ]University of Leiden LeidenThe Netherlands
                [ 20 ]Arthritis Victoria Elsternwick VictoriaAustralia
                Author notes
                [*] [* ]Address correspondence to Ola Rolfson, MD, PhD, Department of Orthopaedics, Sahlgrenska University Hospital, 431 80 Molndal, Sweden. E‐mail: ola.rolfson@ 123456vgregion.se .
                Article
                ACR22868
                10.1002/acr.22868
                5129496
                26881821
                ba23f32f-9f27-4f1b-9772-5e172779b570
                © 2016, The Authors. Arthritis Care & Research published by Wiley Periodicals, Inc. on behalf of the American College of Rheumatology.

                This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 22 September 2015
                : 20 January 2016
                : 09 February 2016
                Page count
                Figures: 1, Tables: 2, Pages: 9, Words: 5549
                Funding
                Funded by: Hoag Orthopedic Institute
                Funded by: Connecticut Joint Replacement Institute
                Funded by: Harvard Pilgrim Health Care
                Categories
                Osteoarthritis
                Osteoarthritis
                Custom metadata
                2.0
                acr22868
                November 2016
                Converter:WILEY_ML3GV2_TO_NLMPMC version:4.9.8 mode:remove_FC converted:25.11.2016

                Rheumatology
                Rheumatology

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