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• W3142673013 abstract "To the editor,The study by Ayers and colleagues [1] addresses TKA utilization in the United States, a complex and important issue in healthcare. We also published work on this issue [3, 4] as have others [2]. Our comments are directed toward the basic premise of the study by Ayers and colleagues – that site variation in SF-36 and Knee Injury and Osteoarthritis Outcome Score indicate the amount of variation in selection criteria for TKA. To be methodologically sound, this basic premise requires two key considerations: (1) A determination of whether the variation in outcome scores for individual patients is acceptable or unacceptable, and (2) a determination of whether the TKA selection criteria (that is, the outcome score thresholds for determining if TKA is indicated for an individual) are defined.To judge variation in outcome scores, Ayers and colleagues determined site-based mean, median, and 25th and 75th percentile scores for 4900 patients treated by a smaller number of surgeons in 22 participating sites. The authors determined whether variation among sites differed from the grand median from all 22 sites or from the minimal clinically important change – an estimate typically used to make inferences regarding intraindividual important change [5]. Because the upper and lower quartiles of median outcome scores for the sites as compared to the grand median were generally smaller than minimal clinically important change estimates [5], the authors concluded that outcome score variation was acceptable when scheduling patients for TKA.The structure of the data in the study by Ayers and colleagues was multilevel; patients were grouped by surgeons, and surgeons were grouped by sites. The authors only presented the site level data. If one is interested in examining the extent of variation in outcome measures, the inferences should be based on patient-level data after taking into account the multilevel data structure. Data reported at the surgeon level or at the site level represents data only at the group level. Group-level data will mask individual patient variation, which is accentuated when only the middle 50% of the distributions are examined – as performed in this study.Regarding the definitions of individual patient-level TKA selection criteria for the outcome measures, the authors indicated that median scores obtained at participating sites were substantially below general population levels. However, selection criteria for applying to individual patients were not defined. Without a clear definition of outcome score thresholds for TKA selection at the individual patient level, the extent of variation in outcome scores carries little meaning, particularly when variation is described using a group-level approach and central tendency measures.In summary, while we find the overarching topic of TKA selection criteria important, the design and analytic approaches used by Ayers and colleagues do not appear to support the conclusions made in the paper." @default.
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• W3142673013 date "2015-01-01" @default.
• W3142673013 modified "2023-09-27" @default.
• W3142673013 title "Letter to the Editor: Preoperative Pain and Function Profiles Reflect Consistent TKA Patient Selection Among US Surgeons" @default.
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• W3142673013 doi "https://doi.org/10.1007/s11999-014-4035-6" @default.
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