Patient-Reported Outcome Measures in Orthopedic Surgery

Background 

The EQ-5D and other PROMs aim to measure the Quality of Life and estimate the disease burden of a patient. In Orthopedic Surgery, PROMs provide key information on the health status of a patient before an intervention, and the success of an intervention. Besides the use of PROMs in trials, registries, and public health accounts of the burden of specific diseases,  other (clinical) applications have developed over the years. Examples are the use of PROMs to detect the impact of a nation-wide event such as the COVID pandemic on Quality of Life, or the use of PROMs to detect socio-economic health inequalities and impact of differential access to care, e.g. rehabilitation or surgery. Exploring these applications within Orthopedic Surgery will advance our knowledge on the potential of PROMs in this context and contribute to quality of care.

Methods

In this PhD, we have several work packages. Firstly, we synthesize the available literature on the use of PROMs to advance healthcare quality. This overview will provide insight into old and novel applications. Subsequently, we illustrate the potential of PROMs in clinical registries in multiple registry data studies (mentioned above). Moreover, we have explored how to analyse health inequalities in more depth in another registry like project at the Mount Sinai Hospital (supervised by dr. J. Poeran), New York, the United States. Finally, we address a measurement challenge in chronic conditions: to establish a PROM that measures health from child- into adulthood. We compare two well-developed versions of the EQ-5D (one aimed at children and one aimed at adults) in an adolescent population. This study will show which one is most appropriate in this age group, and provides some insight into whether we can measure health consistently from adolescence into adulthood.

Significance

The evidence generated in this PhD will inform stakeholders on the use of PROMs within the field of Orthopedic Surgery, whilst also improving our understanding of outcomes in specific patient groups (patients treated during the COVID-19 pandemic and deprived patients).