Outcomes following Surgical Treatment of Distal Radial Fracture: A Comparison of Older and Younger Patients using PROMIS
Alex M Hollenberg, BS, University of Rochester, Rochester, NY, Jennifer Z Mao, MBA, Philadelphia College of Osteopathic Medicine, Philadelphia, PA and Warren C Hammert, MD, Department of Orthopaedics, University of Rochester, Rochester, NY
Introduction: With the growing emphasis on incorporating patient-reported outcomes in the evaluation of treatment success, the purpose of this study was to use the Patient Reported Outcomes Information System (PROMIS) Physical Function (PF) and Pain Interference (PI) instruments to assess the recovery patterns following surgical treatment of distal radial fracture (DRF) in patients over and under the age of 65 years.
Materials & Methods: Prospectively collected PROMIS data was analyzed from adult patients who underwent open reduction and internal fixation for displaced or unstable DRF from February 2015 to November 2020. Patients met inclusion criteria if PROMIS PF and PI scores were available from a preoperative and at least one postoperative visit. Patients were dichotomized based on elderly status (older cohort - age ≥ 65 years; younger cohort - age < 65 years) and outcomes were compared. Outcomes included PROMIS t-scores and the proportion of patients in each cohort who achieved a minimal clinically important difference (MCID) improvement of 4 points.
Results: In total, 372 patients were included in this study (Table 1). The PROMIS PF and PI recovery patterns are illustrated in Figure 1. Both cohorts experienced significant postoperative improvement in PF and PI. The younger cohort had significantly higher PF scores than the older cohort from 1 month through 6 months postoperatively (p<0.05), however PI scores were not significantly different between the cohorts during any postoperative period. A significantly greater proportion of younger patients than older patients achieved the MCID on the PROMIS PF (80.2% vs 65.7%, p=0.004) and PI (87.5% vs 74.7%, p=0.003) scale. Among patients who achieved the MCID, there was no difference in the time to achievement for either PROMIS PF (older cohort: 42 days vs younger cohort: 47 days, p=0.265) or PI (older cohort: 39 days vs younger cohort: 41 days, p=0.184).
Conclusions: PROMIS is an effective instrument to capture the temporal pattern of change in function and pain postoperatively. Overall, both cohorts demonstrated significant improvement in self-reported outcomes following surgery for DRF, however older patients did not achieve the same degree of functional recovery as younger patients.
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