Abstract
Summary
Patient-reported experience measures (PREMs) are integral component of care for fracture patients. Using a multicenter cohort, we showed that the presence of chronic kidney disease (CKD) attenuated the probability of PREM improvement in fracture patients.
Introduction
Assessing PREM can assist physicians in improving patients’ experiences. Patients with CKD are at an increased risk of exhibiting poor PREM and developing fractures. We aimed to assess whether CKD influences the probability of PREM improvement during follow-up among patients with fractures.
Methods
We prospectively enrolled patients with hip or vertebral fractures from different institutes into a fracture liaison service program. After registering clinical histories, they received a baseline PREM assessment based on EuroQol group–5 dimension content, including self-care, daily activity, and pain severity using a 5-point Likert scale. A follow-up PREM assessment was arranged 4 months later, and we evaluated whether baseline CKD was predictive of PREM improvement.
Results
Among 593 fracture patients (18% with CKD), 37.3% and 62.7% presented with hip and vertebral fractures, respectively. Self-care, daily activity, and pain severity improved after follow-up in 32%, 27%, and 43% participants; those with CKD exhibited worse self-care ability and daily activity than those without. Multivariate logistic regression analyses showed that baseline CKD was significantly associated with lower possibility of improvement in daily activity (odds ratio [OR] 0.58, p = 0.049) and pain severity (OR 0.52, p = 0.01), and an insignificant change in the possibility of improvement in self-care ability (OR 0.61, p = 0.09).
Conclusions
The presence of CKD predicts a significantly lower probability of PREM improvement among fracture patients. An early emphasis on renal function during fracture care should be considered.
Abbreviations
- BMD:
-
bone mineral density
- BMI:
-
body mass index
- CI:
-
confidence interval
- CKD:
-
chronic kidney disease
- eGFR:
-
estimated glomerular filtration rate
- DM:
-
diabetes mellitus
- EQ-5D:
-
EuroQol Group–5 dimensions
- FLS:
-
fracture liaison service
- KDIGO:
-
Kidney Disease Improving Global Outcomes
- OR:
-
odds ratio
- PREM:
-
patient-reported experience measure
- SERM:
-
selective estrogen receptor modulator
- SF-36:
-
short-form 36
- VCF:
-
vertebral compression fracture
- WHO-QOL:
-
World Health Organization–quality of life
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Funding
The study is financially sponsored by internal research fund from National Taiwan University Hospital.
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Contributions
Study design: CTC, RSY, DCC; data analysis: CTC, DCC; article drafting: CTC, LWH, KST, JKP, CHC, WYC, KPL, CTW, CJW, DCC; article approval: all authors.
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Ethics declarations
The current study has been approved by the local institutional review board (National Taiwan University Hospital, NO. 201311048RINC), which allowed recruitment of suitable candidates from its main facility and branches. All participants provided written informed consent on enrollment. The study protocol adhered to the declaration of Helsinki.
Conflict of interest
None.
Sponsor’s role
The sponsors have no role in the study design, data collection, analysis, and result interpretation of this study.
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Chao, CT., Yang, RS., Hung, LW. et al. Chronic kidney disease predicts a lower probability of improvement in patient-reported experience measures among patients with fractures: a prospective multicenter cohort study. Arch Osteoporos 13, 126 (2018). https://doi.org/10.1007/s11657-018-0539-0
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DOI: https://doi.org/10.1007/s11657-018-0539-0