Current Challenges and Future Directions for Patient-Reported Outcome Measures in Orthopaedic Research

SUMMARY: The use of patient-reported outcome measures (PROMs) in orthopaedic surgery is widespread. The American Board of Orthopaedic Surgeons recently incorporated PROM collection into the board approval process, and the Centers for Medicare & Medicaid Services has instituted mandates for PROM collection in hip and knee arthroplasty patients. However, the use of PROMs as the sole primary outcome in orthopaedic research has challenges including (1) a high administrative and cognitive burden in their collection, leading to low participation rates; (2) using PROMs that were developed without the input of the specific patient population being investigated; (3) challenges comparing the relative recovery of individual patients, limiting the interpretability of their findings; and (4) insensitivity to detecting meaningful differences in adverse events between treatment groups. The purpose of this review was to examine these challenges and to offer future directions for conducting PROMs research that is meaningful to both patients and physicians, specifically by incorporating PROMs into patient-centered hierarchical composite outcomes for analysis using the win ratio method.