Patient reported outcomes after femur shaft fracture surgery at Kigali University Teaching Hospital

Abstract

Background: Femur shaft fractures are common injuries in orthopedic trauma. Their treatment is generally by surgical means, but their outcome may differ between the surgeon‟s and the patient‟s perspective. Numerous studies have shown that even properly managed femur shaft fractures result in decreased physical function and quality of life, and only patients are the most accurate in describing their own symptoms, pain, function, and quality of life. Methods: This study used mixed quantitative and qualitative methods to understand perceptions about the outcomes for adult patients (18years and above) operated at CHUK for femur shaft fracture with at least 6 months period of post-surgery. We used PROMIS tool a 10- items 5 points Likert Scale which is used to have a feedback from patients on how health services delivery and intervention have affected their quality of life, daily function and symptoms of severity. Demographic data such as age and gender were collected. Internal reliability was measured using Cronbach‟s alpha and validity tested using principal components analysis. The association between patient satisfaction and other categorical variables was analyzed and tested using Kruskal Wallis test. A comparison using T-test was performed for locked-nail and other methods. Results: A total of 83 patients operated for femur shaft fractures were included in the study. The mean age of patients was 30.8 (std dev 7.8) years, Male to female ratio was 3.6:1, All the 10 items of PROMIS had positive inter-items correlation ranging from 0.3 to 0.9 (mean 0.53) with high internal consistency reliability (Cronbach alpha 0.933); two principal components had eigenvalues greater than 1 and explained 75% and more of the variation in the data. The overall patient‟s satisfaction was very good with mean total scores of 43.7/50, with male slightly more satisfied than female (mean total scores of >45, 44 out of 50 respectively) but this was not statistically significant. Preoperative immobilization with traction; reduced preoperative waiting time; surgery with closed method locked intramedullary nail were factors associated with better patient reported outcome. Conclusion: The patient reported outcome after femur shaft fracture surgery is very good with overall satisfaction 43.7/50 and PROMIS is a valid and reliable tool for patient reported outcome in our settings and our findings are consistent with most of published studies. Implementation or routine use of this tool will improve the patient-centered care based on perception of outcome.