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‘The Forgotten Joint Score’Construct Validity and Test-Retest Reliability
Justin Roe, Justin Webb, Lucy SalmonNorth Sydney Orthopaedic & Sports Medicine CentreMater Hospital, Sydney, Australia
Disclosures
• Educational support from• Smith and Nephew• Stryker
• Funding for this study was received from Stryker Inc.
Associate Professor Justin Roe
Introduction
• 51,212 Total Knee Replacements in Australia 2013*
• Results generally good– 10-15% patients dissatisfied **
• Review of outcomes is important• Patient reported outcome measures (PROMS)
• * ANJRR 2014• ** Becker Knee Surg Sports Traumatol Arthrosc 2011, Kim J Arthroplasty 2009
What makes a good outcome score?
• Measure the outcome in question• Reliable• Reproducible• Responsive• Validated
• Easy to administer
Associate Professor Justin Roe
Why a new score?
• Many validated scores currently available– KOOS, WOMAC, IKS, Oxford
• Pain, function and symptoms variables– Excellent improvement in scores
• The Ceiling Effect – Large percentage responses near perfect– Inability to detect further improvement– Up to 20% in WOMAC
Associate Professor Justin Roe
The Forgotten Joint Score
• Newly developed and Validated in German Language
• Patient awareness of TKR
• The ‘Forgotten Joint’ is a successful TKR
Associate Professor Justin Roe
The Forgotten Joint Score (FJS-12)
Methods
• 240 Consecutive TKR patients enrolled• Patients completed KOOS and FJS-12• FJS-12 repeated at 4 weeks
• Test-retest reliability was analysed calculating a Intraclass Correlation Coefficient
• Convergent construct validity was assessed with a Spearman’s coefficient between the FJS-12 score and a normalised WOMAC and KOOS score
Associate Professor Justin Roe
Results
• 147 patients returned all questionnaires• 68 females and 79 males• Mean age 67 years (range 32-89)• Mean time from surgery to completion of first
questionnaire 39 months (range 18-72)• Mean time between questionnaires 6 weeks
(3-15)
Associate Professor Justin Roe
Results
Mean SD Range
FJS-12 Initial 62 29 0-100
Follow-up 60 29 0-100
Normalised WOMAC Pain 90 13 50-100
Stiffness 84 17 38-100
Function 90 11 52-100
Total 90 11 52-100
KOOS Quality of Life 76 18 12-100
Symptom 65 14 4-100
Pain 90 12 56-100
ADL 89 13 35-100
Test Re-test Reliability
Intra Class Correlation 95% Confidence Interval Landis & Koch Classification
Overall Score 0.97 0.95-0.98 Almost Perfect
Individual Questions
Night Symptoms 0.88 0.84-0.92 Almost Perfect
Sitting 0.84 0.77-0.88 Almost Perfect
Walking 0.92 0.89-0.94 Almost Perfect
Bathing 0.88 0.84-0.92 Almost Perfect
Travelling 0.86 0.81-0.90 Almost Perfect
Stairs 0.94 0.92-0.96 Almost Perfect
Walking uneven ground 0.91 0.88-0.94 Almost Perfect
Rising 0.90 0.86-0.93 Almost Perfect
Associate Professor Justin Roe
Correlation of FJS-12 with Normalised WOMAC
• The FJS and the WOMAC demonstrate a positive correlation
• The FJS scores have a larger range than the WOMAC scores
Associate Professor Justin Roe
Correlation of FJS-12 with Normalised WOMAC and KOOS
Forgotten Joint Score
Spearman’s Significance
Normalised WOMAC Pain 0.67 0.001
Stiffness 0.52 0.001
Function 0.66 0.001
Total 0.70 0.001
KOOS Quality of Life 0.63 0.001
Symptom 0.33 0.007
Pain 0.68 0.001
ADL 0.66 0.001
Associate Professor Justin Roe
Distribution of Scores
0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 54 57 60 63 66 69 72 75 78 81 84 87 90 93 96 990
5
10 FORGOTTEN JOINT SCORE
Forgotten Score Score/100
% o
f pati
ents
0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 54 57 60 63 66 69 72 75 78 81 84 87 90 93 96 990
10
20 NORMALISED WOMAC %
score/100
% o
f pati
ents
0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 54 57 60 63 66 69 72 75 78 81 84 87 90 93 96 9905
101520
KOOS SYMPTOM %
score/100
% o
f pati
ents
0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 54 57 60 63 66 69 72 75 78 81 84 87 90 93 96 990
10
20
30KOOS QOL %
score/100
% o
f pati
ents
0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 54 57 60 63 66 69 72 75 78 81 84 87 90 93 96 990
10
20
30KOOS PAIN %
score/100
% o
f pati
ents
broad distribution
similar distribution, clustered lower
FJS 15% > 95
WOMAC26% > 95
30% perfect scores
Ceiling effect
• WOMAC and KOOS Pain scores demonstrate ceiling effect– Reflects excellent pain relief with TKR
• FJS-12 has much wider score distribution
Associate Professor Justin Roe
Discussion
• FJS-12 similar score distribution to KOOS Symptom score
• FJS-12 - 60• KOOS Symptom -65
• May reflect ongoing symptoms in well functioning pain free TKR
Associate Professor Justin Roe
Summary
• Forgotten Joint Score has near perfect test-retest reliability
• Valid when compared to WOMAC and KOOS
• No Ceiling effect
• 12 question format is quick and easy
• Useful adjunctAssociate Professor Justin Roe
Thank-you for your attention.
See you in Sydney
Associate Professor Justin Roe