Skip to main content
Download PDF

Net Promoter Score: a prospective, single-centre observational study assessing if a single question determined treatment success after primary or revision hip arthroplasty

BMC Musculoskeletal Disorders volume 24, Article number: 849 (2023) Cite this article

Abstract

Background

Our study aimed to identify the relationship between treatment outcome assessed by patient-reported outcomes (PROMs) and satisfaction measured by calculation of the Net Promoter Score (NPS), which identifies promoters, following total hip arthroplasty (THA). The aim was to evaluate this association separately in primary and revision THA and to determine thresholds based on PROMs that identify detractors of the surgical procedure or the centre.

Methods

A total of 1,243 patients who underwent primary or revision THA at our hospital were asked to complete questionnaires of the Oxford Hip Score (OHS), Euroquol-5D (EQ-5D) and information on pain intensity preoperatively, three and 12 months after surgery. Postoperatively, the patients were additionally asked about their satisfaction with the procedure and the hospital by using three different NPS questions. The association between PROMs and NPS was evaluated based on group comparisons of primary or revision THA and receiver operating characteristics analysis (ROC) to determine threshold values.

Results

At 12 months the NPS of all three questions were invariably linked to treatment outcome in patients after primary THA and patients with a single revision. In these two treatment groups, promoters always showed significantly better PROM scores than detractors. The NPS score was always higher in the primary group in comparison to the single revision group, e.g. 66.4% would undergo the procedure again in the first group, while only 33.0% would opt for this in the latter group. The high thresholds for the PROMs at 12 months, that were calculated by ROC analysis to identify promoter/detractors, indicate that patients` satisfaction required very good joint function and pain relief. However, the NPS was not a suitable tool to identify patients who need further care in an early phase after surgery.

Conclusions

With NPS already a single question or a single parameter provides the desired information regarding patient satisfaction and also treatment success.

Trial registration

The study was approved by the Ethics Committee at the Medical Faculty of the University Rostock: “Ethikkommission an der Medizinischen Fakultät der Universität Rostock”, Address: St.-Georg Str. 108 18055 Rostock, Germany, reference number: A2015–0055.

Peer Review reports

Background

Quality assurance in arthroplasty depends on guideline-based patient care that aims for the best possible treatment outcome for the patient. After artificial joint replacement, main outcomes are restoring joint function, alleviating pain and as a result improving the patient’s quality of life. Whether these goals were achieved can be evaluated by clinical parameters, but also with the help of numerous, already successfully established, measuring instruments, so-called Patient-Reported Outcome Measures (PROMs) [1]. These are based on self-assessments by the patients. However, in addition to the evaluation of the treatment outcome, the evaluation of health care in terms of experiential quality is playing an increasingly important role. For this purpose, the Net Promoter Score (NPS) was developed for measuring satisfaction in economic research [2]. With a single question, e.g.: “How likely is it that you would recommend this service to a friend and colleague?“, so-called promoters or detractors can be identified, which either encourage or discourage others to use the respective service or product. In market research, the NPS is considered a predictor of growth [2].

While only occasionally used in Germany [3,4,5,6,7], internationally the NPS has already been established as a tool to assess health care quality [8]. However, the benefits in terms of measuring satisfaction with care have not yet been clearly proven [9, 10]. Based on the NPS, the government in England developed a general health care assessment and introduced in 2013 the “family and friends test (FFT)” [11]. As the FFT was criticised by both patients and healthcare professionals [11,12,13], it was revised so that new questions were established by the UK National Health Service (NHS) in 2020 [14].

The aim of the present study was to examine the extent to which NPS questions can be used as a measurement tool for patient satisfaction in the health care system. The influence of clinical outcome, which was measured by PROMs, on the recommendation of hip arthroplasty as assessed by NPS was to be investigated. The NPS questions were used to measure satisfaction and the recommendation rate, while the Oxford Hip Score (OHS) and the Euroquol-5D-3 L (European Quality of Life Scale − 3 level version (EQ-5D)) surveyed clinical outcome and quality of life of the patients, respectively. Our working group intended to establish a suitable tool to determine the achievement of the treatment goal of primary as well as revision hip arthroplasty postoperatively, which was to be evaluated simultaneously in accordance with patient satisfaction. Here, the focus is not only on comprehensive PROMs, but rather on a single question or measurement parameter, such as information on pain intensity or the visual analogue scale (VAS). Threshold values were determined for the PROMS as well as for the single measurement parameters, which, if falling below, indicate patient dissatisfaction.

Methods

The present follow-up study is prospective. In the period from February 2015 to February 2021, a total of 1,690 consecutive hip arthroplasty patients attended our university hospital in Germany. The patients were classified according to the surgical procedures: primary hip arthroplasty (THA, Group 1) and total hip arthroplasty revision (Groups 2 and 3). A revision was defined as the replacement or removal of at least one prosthesis component. Group 2 included patients who had a revision procedure for the first time at our institution. Group 3 included patients with more than one inpatient stay with revision surgery at our centre. Exclusion criteria are listed in Fig. 1. The surgeries were performed exclusively by experienced specialists who operate on at least 50 arthroplasties per year. The data were collected and analysed independently by the clinical research department. Ethical approval was obtained (reference number: A2015-0055).

Fig. 1
figure 1

Inclusion criteria

Full size image

In total, data from 1,525 patients were screened. At the time of diagnosis, the patients were informed about the study participation and consented to it accordingly. However, as not all patients completed the questionnaires, the number of patients included for data collection was lower. The number of cases who filled the respective scores and the resulting response rates are shown in Fig. 1.

Evaluation of PROM questionnaires

For the self-assessment of the state of health, the joint-specific OHS, the health-related quality of life-related EQ-5D including the EQ-5D VAS, and information on pain intensity (0–10, 0 = no pain) were completed at the time of diagnosis as well as three and 12 months after surgery. The questionnaires were provided to the patients in paper form. At the time of diagnosis, the patients completed the questionnaires directly in our hospital, while 3 and 12 months after surgery they were sent by mail. The questionnaires were completed by the patients themselves without the involvement of third parties. The analysis of the EQ-5D was performed according to the German algorithm.

After three and 12 months, the patients were additionally asked to rate their general satisfaction with or give a recommendation of the joint surgery performed and the clinic on a five-point scale (1 yes, definitely, 2 probably yes, 3 uncertain, 4 probably not, 5 definitely not). These questions were developed in accordance with the NPS. Patients were asked if:

  1. a.

    in hindsight they would undergo joint operation again,

  2. b.

    they would recommend the joint operation they underwent to another person,

  3. c.

    they would recommend the centre where the joint operation was performed.

A NP score of 1 is classified as promoter (supporter), 2 as passive (undecided) and 3–5 as detractor (critic). The total score is the relative percentage of detractors subtracted from the relative percentage of promoters as a percentage. An NPS of over 50% indicates a high level of satisfaction and a good performance of the clinic [15].

Each of the three NPS questions as well as the information on pain intensity were evaluated separately. The OHS was scored according to the recommended procedure by Murray et al. [16] including the approach to missing data. For subscale analysis of “pain” and “function” the adjusted scoring scheme from 0 (worst result) to 100 (best result) by Harris et al. [17] was used.

Statistical analysis

The statistical programme SPSS 27.0 (IBM Germany, Ehningen) was used for the statistical analysis. Statistical analysis was performed independently for the three time points and the different PROMS to ensure that the maximum number of fully completed questionnaires was evaluated. However, this resulted in a different number of patients being included in the performed comparisons (see Tables).

As Shapiro-Wilk test revealed that the data were not normally distributed, the variables were reported as median values and interquartile ranges (IQRs). Differences in PROMs by net promoter classification were assessed using the Kruskall-Wallis test with Bonferroni’s post hoc test or Mann-Whitney U test. A Chi2 test was performed to check the distribution of promoters, passives and detractors over both time points. Generally, p < 0.05 was considered to be statistically significant.

Receiver operating characteristic (ROC) analysis was used to determine threshold values for the respective PROMs, which predict the detractors (= anchors) if they fall below. The promoters were set as the positive value of the state variables, while the detractors were set as negative state variables. The area under the ROC curve (AUC) was used as a measure of the quality of the predictions.

Results

While in Group 1 and Group 2 man and woman were nearly equally distributed with a slightly higher percentage of women (Group 1 53.6% and 2 54.4%), men were overrepresented in Group 3 (58.1%). The average age and body mass index (BMI) of the patient of each group was similar between the groups (Group 1: 69 years (SD 12.2), BMI 28.8 (SD 5.2), Group 2: 72 years (SD 10.8), BMI 28.1 (SD 5,7), Group 3: 71 years (SD 10,3), BMI 29.5 (SD 6.4)). However, there was a significant difference in the age between Group 1 and 2 (p = 0.008). The ASA classification showed significant differences for all three groups (p < 0.001) and ranged from 2.2 (SD 0.6) (Group 1), over 2.5 (SD 0.6) (Group 2) to 2.7 (SD 0.6) (Group 3).

The NPS of Question A was 61.3% for all patients after three months and 61.8% after one year. According to the NPS of Question B, 61.6% of patients would recommend hip arthroplasty to another person after three months and 62.2% after one year. The NPS was highest with regard to Question C, with 69.9% after three months and 69.4% after one year.

Influence of treatment success as reported by PROM results on NPS

In order to assess whether the classification of patients into promoters, passives or detractors depended on the clinical outcome of the performed surgical procedure we compared the PROM scores of OHS, EQ-5D and a pain scale in these three NPS groups. While PROMs evaluate the success of the intervention from the patient’s perspective, the correlation between the selected PROM scores in this study andthe surgeon-assessed treatment success was shown by us in a previous publication [18]. As there were differences in the NPS due to the performed surgical procedure (Table 1), the comparisons were performed separately for patients who underwent primary hip arthroplasty, first revision arthroplasty or repeated revisions. The results from the comparisons are presented in Tables 2, 3, 4, 5, 6 and 7.

Table 1 Calculation of the NPS separately for patients with THA, single revision or multiple revisions at 3- and 12-months postoperatively
Full size table
Table 2 Comparison of 3-months PROM scores in patients identified as promoters, passives and detractors according to NPS of Question A at 3-months postoperatively
Full size table

After three months the response of patients in Group1 and Group 2 to NPS questions A and B was clearly linked to the treatment success, since promoters had significantly better outcomes in all the PROM scores (Tables 2 and 3). While detractors in patients with multiple revisions (Group 3) also showed worse PROM results than promoters or passives, the differences did not become significant, probably due to the small number of patients and the inter-individual differences (Tables 2, 3 and 4). Only in patients with one hospital stay (Group 1) the recommendation of the centre (Question C) after three months did depend on the treatment success as determined in all PROMs (Table 4).

Table 3 Comparison of 3-months PROM scores in patients identified as promoters, passives and detractors according to NPS of Question B at 3-months postoperatively
Full size table
Table 4 Comparison of 3-months PROM scores in patients identified as promoters, passives and detractors according to NPS of Question C at 3-months postoperatively
Full size table

This difference between Questions A and B compared to Question C at three months was no longer apparent at 12 months postoperatively. At 12 months the NPS of all three questions were invariably linked to treatment outcome in Groups 1 and 2, since promoters always showed significantly better PROM scores than detractors in both groups (Tables 5, 6 and 7). At 12 months, promoters in Group 3 also displayed mostly better PROM scores than detractors, however, these differences were only significant for very few PROM scores (Tables 5 and 6: Pain intensity at 12 months), while a slightly higher number showed a statistical trend (0.05 < p < 0.1), e.g. OHS function at 12 months postoperatively for Questions A, B and C (Tables 5, 6 and 7). At 12 months postoperatively patients with multiple revisions (Group 3) had formed a firm opinion of whether they would undergo the procedure again or would recommend it to another person (Questions A and B) as they were either promoters or detractors. None of the patients in Group 3 were undecided (passives) at 12 months with regard to Question A and hardly any with regard to Question B (Tables 6 and 7).

Table 5 Comparison of 3-months and 12-months PROM scores in patients identified as promoters, passives and detractors according to NPS of Question A at 12-months postoperatively
Full size table
Table 6 Comparison of 3-months and 12-months PROM scores in patients identified as promoters, passives and detractors according to NPS of Question B at 12-months postoperatively
Full size table

There were no significant differences between promoters, passives or detractors when analysing the pre-operative PROM scores. This supports the notion that the identification of patients as promoters, passives or detractors according to Questions A, B and C is clearly outcome-related.

Comparison of the distribution of promoters, passives and detractors

As patient`s circumstance can change over time, for instance by further improvement of joint function but also deterioration of general health, we studied changes in the distribution of promoters, passives and detractors over both time points. Only patients that responded to the NPS questions at both time points were included in the analysis. The comparison of three and 12 months showed an overall increase in promoters at 12 months (Fig. 2A).

Fig. 2
figure 2

Distribution of promoters, passives and detractors over time. (A) Comparison of the total number of promoters, passives and detractors between 3- and 12-months. (B) Illustration of the change of opinion in patients at 12-months in relation to their NPS status at 3-months

Full size image
Table 7 Comparison of 3-months and 12-months PROM scores in patients identified as promoters, passives and detractors according to NPS of Question C at 12-months postoperatively
Full size table

However, the dynamic of these changes was more complex (Fig. 2B). For example, with Question A a total of 510 patients were identified as promoters at three months. Of these, 9.2% became passives and 3.3% became detractors at 12 months. At the same time, 62 patients were detractors at three months, of whom more than 22.6% were recovered as promoters and 14.5% as passives at 12 months. Finally, 62.9% of this group still remained as detractors after 12 months. Questions B and C also showed similar trends (Fig. 2B).

ROC-Analysis

The ROC analyses allowed the calculation of thresholds in the PROM scores that indicate whether patients identify as detractors for the respective NPS questions (Table 8; Fig. 3). Based on our ROC analyses, we can recommend all the measurement instruments examined, such as the OHS, including both subscores, the EQ-5D and also the pain intensity measure for predicting patient satisfaction after hip replacement. All scores show good (AUC > 0.7) to very good model qualities (AUC > 0.8) both after three and after 12 months [19].

Table 8 ROC analyses of NPS questions A, B and C at 3- and 12-months postoperatively
Full size table
Fig. 3
figure 3

ROC-curve Question B 12-months postoperatively

Full size image

After 12 months, the thresholds of all PROM scores apart from EQ-5D VAS at Question C were higher compared to those at three months. Interestingly, for pain intensity, where lower values indicate an improvement, threshold values either remained stable (Questions A and C) or increased (Question B) from three to 12 months.

Discussion

Our study results showed that after 12 months, the NPS questions used here were associated with treatment outcome after primary THA care (Group 1) as well as after a single revision (Group 2). In both treatment groups, promoters showed significantly better PROM scores than detractors. To complement this, we determined threshold values for the PROMs studied here that predict the so-called promoters, consequently satisfied patients with very good joint function and pain relief.

While the use of the NPS as a benchmarking system for customer satisfaction is widespread in the market economy, this score is hardly used in the German health care system. In England, on the other hand, the NPS is an unambiguous signpost for patients [20]. The NPS of hospitals are mostly between 65 and 80 [21]. Satisfaction rates of primary hip arthroplasty are generally high with approximately 90% of patients reporting to be satisfied with their operation [22,23,24]. NPS was previously used in two studies to specifically asses patient satisfaction in primary THA, but not in revision. The studies of Hamilton et al. [15] and Lynskey et al. [25] used questions similar to Question B – “Would you recommend this operation to someone else?” or “how likely is it that you would recommend this procedure to a friend or family?“, respectively – to calculate the NPS. Compared to their NPS results of 71 and 79 after 1 year or 1–5 years, respectively, the NPS of Question B in Group 1 was slightly lower in our centre at three months, but improved to a similar value at 12 months. To our knowledge, however, this is the first study to use NPS to assess patient satisfaction after revision arthroplasty of the hip. The NPS of the revision patients were still favourable to excellent, but the values were markedly lower and, contrary to primary THA, values decreased over time for all three questions. This is in accordance with previous reports that showed that functional outcome, quality of life, but also satisfaction were lower after revision THA compared to primary THA [26,27,28]. Eisler et al. [26] reported with 63% only moderate satisfaction after revision THA compared to the 90% recorded in studies of primary THA [22,23,24]. Similar results were also observed by Lübbecke et al. [27] in a direct comparison five years after revision and primary THA with satisfaction rates of 67% and 84%, respectively. Several of these studies reported a correlation between satisfaction rating and disease-specific PROMs [23, 26, 29]. Therefore, we also analysed PROM results in relation to NPS classification.

When relating the satisfaction of patients to the preoperative, 3-months and 12-months PROM results, the observation by Judge et al. [30] that preoperative OHS scores did not allow the prediction of satisfied or dissatisfied patients, was confirmed by the results from our study. There were no differences in preoperative PROM scores according to NPS classification. For the postoperative PROM scores, it was more apparent at 12 months than at three months, that the identification of patients as promoters, passives and detractors depended on clinical outcome and quality of life. The relationship between NPS classification and success of intervention was in accordance to Hamilton et al. [15] who reported that a model of four variables including the satisfaction with pain relief, meeting of expectations, and the hospital experience predicted 95% of NPS responses. Similarly, Anakwe et al. [31] found the highest correlations to overall satisfaction for the individual factors “relief of pain” and “meeting patient expectation”, closely followed by “increased activity” as a functional outcome. The importance of pain relief for patient satisfaction was also highlighted by the study of Halawi et al. [32]. This is interesting with regard to our study, since in patients with a single revision, classification according to NPS of Question C after three months was related to both pain scores but not to the functional outcome. Even in Group 3 after 12 months, pain intensity was the only measure that was significantly different between promoters and detractors, thus highlighting relief of pain as the most sensitive factor for patient satisfaction, in particular in revision patients.

Over time, more patients became promoters, but also the number of detractors increased. Consequently, only the number of passives declined over both measurement time points, indicating that patients` opinion regarding their surgery consolidated from three to 12 months. This is reflected by the ROC calculated thresholds. Apart from pain intensity all other outcome measures showed higher thresholds, i.e. a demand for more beneficial outcomes, at 12 months compared to three months. This suggests increased expectations at 12 months after surgery, probably also due to improved functional outcome and quality of life.

In order to simplify the assessment of individual treatment success, it has been extensively discussed whether a single question, for example a NPS question, might be sufficient for evaluating the outcome after surgery. While some researchers promoted the idea of a single question [33], other were more critical as they saw no additional benefit in the use of the NPS with regard to patient experience [10]. When comparing the thresholds to identify patients who require further treatment after three month (34.50, 72.92 and 0.794 for OHS, OHS functional score and EQ-5D, respectively [18]) to the 3-months thresholds for identifying detractors, the latter are markedly lower. Therefore, at three months, patients were promoters even though they had comparatively poor scores, might not have reached the treatment goal and required further intervention. Consequently, the NPS is not a suitable tool to identify patients who need further care in an early phase after surgery. However, over time the thresholds, that separate promoters from detractors, increased and for example the value of 38.5 for OHS after 12 months for Questions A and B was the same as reported for satisfied patients after 12 month by Kjærgaard et al. [34] and similar to values reported for follow-up periods of 6 months or three years [35, 36]. The high thresholds of the present study at 12 months make it obvious that patients` satisfaction does require very good joint function and pain relief. The improvements over time including the higher expectations might also be based on our follow-up care algorithm that takes in account several patient factors [18, 37]. Hamilton et al. [38], who calculated ROC thresholds for “treatment success” based on OHS after 12 months, also suggested that a composite anchor criterion comprising patient satisfaction, functional improvement, pain relief, and willingness to undergo the same procedure again allows for a more detailed assessment of the individual patients. The number of patients in their study who reported a “successful outcome” due to the combined criterion was notably lower than the number of patients who reported being “satisfied”. Thus, more patients without a successful outcome can be identified by evaluating a combination of factors, instead of only asking for patients` satisfaction. Threshold values also varied when patients were grouped according to their preoperative PROM scores. This suggests that pain and physical restrictions due to comorbidities may influence any outcome score and NPS. Ellenrieder et al. [39] showed that coexistent lumbar spine disorders have a crucial impact on the clinical outcome (Short-Form-36) after total hip replacement. However, factors such as older age, lower preoperative function, and a higher number of medical or orthopaedic comorbidities impacted on outcome measures mainly after primary THA, while in revision THA these factors were only partly responsible for the worse outcome after revision surgery [27].

When comparing the three different NPS questions, it was Question C that always scored the highest, independent from the follow-up period or the treatment group. It is likely, that additional factors to the here studied pain relief, function and quality of life had a greater impact on the recommendation of the centre. Hamilton et al. [15] identified “hospital experience” as one of the crucial factors in NPS response even for the recommendation of the surgery to others. Hospital loyalty was strongly associated with waiting time experience, nursing care experience and the experienced communication with the physician [40]. The influence of these additional factors might make Question C less suitable in assessing treatment success.

Strengths and limitations

Our study allowed the assessment of patient satisfaction after THA over two different follow-up periods, an early time point of three months, when an intervention such as physical therapy might still be initiated to improve functional outcome, and a later time point of 12 months, when it is thought that recovery after surgery is complete. To our knowledge this is also the first study to use NPS to evaluate patient satisfaction in primary as well as in revision THA. While the further subdivision of revision THA in single and multiple revisions resulted in a low number of patients in Group 3 and thus limited the validity of the results for this group, we decided that the often very poor clinical outcome in this last group of patients necessitated subdivision. However it has to be noted that, when defining Group 2 and 3, it was not enquired whether any of these patients had already had one or more revision surgeries in other clinics.

As referred to in the discussion, hospital experience is an important factor for NPS response. Thus, a limitation regarding the interpretation of our results is that we did not collect any data about hospital experience. We also did not consider comorbidities or psychosocial or geriatric aspects.

Conclusion

NPS represent an easy-to-use tool to measure patients` satisfaction and thus treatment success after primary and revision hip arthroplasty. Their use considerably minimises the survey effort, both for the patients and for the medical institution. However, they lack the differentiated assessment provided by PROM scores that allows the identification of patients who require further care, especially early after surgery. Questions regarding recommendation to another person or to undergo the operation again are more suitable in assessing treatment success than recommendation of the centre. Pain relief was the most sensitive factor for patient satisfaction, in particular in revision patients.

Outlook

Various factors affect the PROM values three and 12 months postoperatively, but these are not necessarily reflected in patient satisfaction. Therefore, we want to examine the influence of comorbidities, gender, age, BMI, but also complications during the early postoperative phase until discharge on the NPS and the threshold values in further studies.

Data Availability

The datasets analysed during the current study are not publicly available due to the missing consent from all patients but are available in excerpts from the corresponding author on reasonable request.

Abbreviations

AUC:

area under the ROC curve

BMI:

body mass index

EQ-5D:

European Quality of Life Scale − 3 level version

FFT:

family and friends test

IQRs:

interquartile ranges

NHS:

National Health Service

NPS:

Net Promoter Score

OHS:

Oxford Hip Score

PROMs:

patient-reported outcomes

ROC:

Receiver operating characteristic

THA:

total hip arthroplasty

VAS:

visual analogue scale

References

  1. Okafor L, Chen AF. Patient satisfaction and total hip arthroplasty: a review. Arthroplasty. 2019;1:6. https://doi.org/10.1186/s42836-019-0007-3.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Reichheld FF. The one number you need to grow. Harv Bus Rev. 2003;81:46–54.

    PubMed  Google Scholar 

  3. Zarbl J, Eimer E, Gigg C, Bendzuck G, Korinth M, Elling-Audersch C, et al. Remote self-collection of capillary blood using upper arm devices for autoantibody analysis in patients with immune-mediated inflammatory rheumatic Diseases. RMD Open. 2022. https://doi.org/10.1136/rmdopen-2022-002641.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Knitza J, Tascilar K, Vuillerme N, Eimer E, Matusewicz P, Corte G, et al. Accuracy and tolerability of self-sampling of capillary blood for analysis of inflammation and autoantibodies in rheumatoid arthritis patients-results from a randomized controlled trial. Arthritis Res Ther. 2022;24:125. https://doi.org/10.1186/s13075-022-02809-7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Meyer T, Maier A, Uzelac Z, Hagenacker T, Günther R, Schreiber-Katz O, et al. Treatment expectations and perception of therapy in adult patients with spinal muscular atrophy receiving nusinersen. Eur J Neurol. 2021;28:2582–95. https://doi.org/10.1111/ene.14902.

    Article  PubMed  Google Scholar 

  6. Meyer T, Funke A, Münch C, Kettemann D, Maier A, Walter B, et al. Real world experience of patients with Amyotrophic Lateral Sclerosis (ALS) in the treatment of spasticity using tetrahydrocannabinol:cannabidiol (THC:CBD). BMC Neurol. 2019;19:222. https://doi.org/10.1186/s12883-019-1443-y.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Meyer R, Spittel S, Steinfurth L, Funke A, Kettemann D, Münch C, et al. Patient-reported outcome of physical therapy in Amyotrophic Lateral Sclerosis: Observational Online Study. JMIR Rehabil Assist Technol. 2018;5:e10099. https://doi.org/10.2196/10099.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Wilberforce M, Poll S, Langham H, Worden A, Challis D. Measuring the patient experience in community mental health services for older people: a study of the net promoter score using the friends and Family Test in England. Int J Geriatr Psychiatry. 2019;34:31–7. https://doi.org/10.1002/gps.4978.

    Article  PubMed  Google Scholar 

  9. Leggat SG. Understanding the perspectives of health service staff on the friends and Family Test. Aust Health Rev. 2016;40:299–305. https://doi.org/10.1071/AH15034.

    Article  PubMed  Google Scholar 

  10. Krol MW, de Boer D, Delnoij DM, Rademakers JJDJM. The net promoter score–an asset to patient experience surveys? Health Expect. 2015;18:3099–109. https://doi.org/10.1111/hex.12297.

    Article  PubMed  Google Scholar 

  11. Manacorda T, Erens B, Black N, Mays N. The friends and Family Test in general practice in England: a qualitative study of the views of staff and patients. Br J Gen Pract. 2017;67:e370–6. https://doi.org/10.3399/bjgp17X690617.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Sizmur S, Graham C, Walsh J. Influence of patients’ age and sex and the mode of administration on results from the NHS friends and family test of patient experience. J Health Serv Res Policy. 2015;20:5–10. https://doi.org/10.1177/1355819614536887.

    Article  PubMed  Google Scholar 

  13. Robert G, Cornwell J, Black N. Friends and family test should no longer be mandatory. BMJ. 2018;360:k367. https://doi.org/10.1136/bmj.k367.

    Article  PubMed  Google Scholar 

  14. NHS England. Friends and Family Test. https://www.england.nhs.uk/fft/. Accessed 8 Aug 2022.

  15. Hamilton DF, Lane JV, Gaston P, Patton JT, Macdonald DJ, Simpson AHRW, Howie CR. Assessing treatment outcomes using a single question: the net promoter score. Bone Joint J. 2014;96–B:622–8. https://doi.org/10.1302/0301-620X.96B5.32434.

    Article  PubMed  Google Scholar 

  16. Murray DW, Fitzpatrick R, Rogers K, Pandit H, Beard DJ, Carr AJ, Dawson J. The use of the Oxford hip and knee scores. J Bone Joint Surg Br. 2007;89:1010–4. https://doi.org/10.1302/0301-620X.89B8.19424.

    Article  CAS  PubMed  Google Scholar 

  17. Harris KK, Price AJ, Beard DJ, Fitzpatrick R, Jenkinson C, Dawson J. Can pain and function be distinguished in the Oxford hip score in a meaningful way? An exploratory and confirmatory factor analysis. Bone Joint Res. 2014;3:305–9. https://doi.org/10.1302/2046-3758.311.2000313.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Osmanski-Zenk K, Klinder A, Ellenrieder M, Darowski M, Goosmann M, Mittelmeier W. Identifikation Von Potenziellen Risikopatienten auf basis Von PROMs in Einem Zertifizierten EndoProthetikZentrum am Beispiel Der Hüftendoprothetik. [Identification of potential high-risk patients on the basis of PROMs in a certified centre for joint replacement (EndoProthetikZentrum) using the Example of Hip Arthroplasty]. Z Orthop Unfall. 2022;160:442–54. https://doi.org/10.1055/a-1387-8162.

    Article  PubMed  Google Scholar 

  19. Copay AG, Subach BR, Glassman SD, Polly DW, Schuler TC. Understanding the minimum clinically important difference: a review of concepts and methods. Spine J. 2007;7:541–6. https://doi.org/10.1016/j.spinee.2007.01.008.

    Article  PubMed  Google Scholar 

  20. custumer.guru. Healthcare / Hospitals and Care institutions Net Promoter Score 2022 benchmarks. https://customer.guru/net-promoter-score/industry/healthcare-hospitals-and-care-institutions. Accessed 9 Aug 2022.

  21. customer.guru. Healthcare / Hospitals and Care institutions companies with similar Net Promoter Score. https://customer.guru/net-promoter-score/new-cross-hospital-london. Accessed 9 Aug 2022.

  22. Mancuso CA, Salvati EA, Johanson NA, Peterson MG, Charlson ME. Patients’ expectations and satisfaction with total hip arthroplasty. J Arthroplasty. 1997;12:387–96. https://doi.org/10.1016/S0883-5403(97)90194-7.

    Article  CAS  PubMed  Google Scholar 

  23. Hamilton DF, Lane JV, Gaston P, Patton JT, Macdonald D, Simpson AHRW, Howie CR. What determines patient satisfaction with Surgery? A prospective cohort study of 4709 patients following total joint replacement. BMJ Open. 2013. https://doi.org/10.1136/bmjopen-2012-002525.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Harris IA, Harris AM, Naylor JM, Adie S, Mittal R, Dao AT. Discordance between patient and surgeon satisfaction after total joint arthroplasty. J Arthroplasty. 2013;28:722–7. https://doi.org/10.1016/j.arth.2012.07.044.

    Article  PubMed  Google Scholar 

  25. Lynskey SJ, Ling F, Greenberg AM, Penny-Dimri JC, Sutherland AG. The influence of patient resilience and health status on satisfaction after total hip and knee arthroplasty. Surgeon. 2021;19:8–14. https://doi.org/10.1016/j.surge.2020.02.007.

    Article  PubMed  Google Scholar 

  26. Eisler T, Svensson O, Tengström A, Elmstedt E. Patient expectation and satisfaction in revision total hip arthroplasty. J Arthroplasty. 2002;17:457–62. https://doi.org/10.1054/arth.2002.31245.

    Article  CAS  PubMed  Google Scholar 

  27. Lübbeke A, Katz JN, Perneger TV, Hoffmeyer P. Primary and revision hip arthroplasty: 5-year outcomes and influence of age and comorbidity. J Rheumatol. 2007;34:394–400.

    PubMed  Google Scholar 

  28. Patil S, Garbuz DS, Greidanus NV, Masri BA, Duncan CP. Quality of life outcomes in revision vs primary total hip arthroplasty: a prospective cohort study. J Arthroplasty. 2008;23:550–3. https://doi.org/10.1016/j.arth.2007.04.035.

    Article  PubMed  Google Scholar 

  29. Jibodh SR, Kandil AO, Malchau H, Estok DM. Do commonly reported outcome measures reflect patient satisfaction after revision hip arthroplasty? J Arthroplasty. 2010;25:41–5. https://doi.org/10.1016/j.arth.2008.10.016.

    Article  PubMed  Google Scholar 

  30. Judge A, Arden NK, Price A, Glyn-Jones S, Beard D, Carr AJ, et al. Assessing patients for joint replacement: can pre-operative Oxford hip and knee scores be used to predict patient satisfaction following joint replacement Surgery and to guide patient selection? J Bone Joint Surg Br. 2011;93:1660–4. https://doi.org/10.1302/0301-620X.93B12.27046.

    Article  CAS  PubMed  Google Scholar 

  31. Anakwe RE, Jenkins PJ, Moran M. Predicting dissatisfaction after total hip arthroplasty: a study of 850 patients. J Arthroplasty. 2011;26:209–13. https://doi.org/10.1016/j.arth.2010.03.013.

    Article  PubMed  Google Scholar 

  32. Halawi MJ, Jongbloed W, Baron S, Savoy L, Williams VJ, Cote MP. Patient dissatisfaction after primary total joint arthroplasty: the patient perspective. J Arthroplasty. 2019;34:1093–6. https://doi.org/10.1016/j.arth.2019.01.075.

    Article  PubMed  Google Scholar 

  33. Krueger DR, Leopold VJ, Schroeder JH, Perka C, Hardt S. Correlation of the subjective hip value with validated patient-reported outcome measurements for the hip. J Clin Med. 2020. https://doi.org/10.3390/jcm9072179.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Kjærgaard N, Kjærsgaard JB, Petersen CL, Jensen MU, Laursen MB. Thresholds for the Oxford hip score after total hip replacement Surgery: a novel approach to postoperative evaluation. J Orthop Traumatol. 2017;18:401–6. https://doi.org/10.1007/s10195-017-0465-8.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Judge A, Arden NK, Kiran A, Price A, Javaid MK, Beard D, et al. Interpretation of patient-reported outcomes for hip and knee replacement Surgery: identification of thresholds associated with satisfaction with Surgery. J Bone Joint Surg Br. 2012;94:412–8. https://doi.org/10.1302/0301-620X.94B3.27425.

    Article  CAS  PubMed  Google Scholar 

  36. Keurentjes JC, van Tol FR, Fiocco M, So-Osman C, Onstenk R, Koopman-Van Gemert AWMM, et al. Patient acceptable symptom states after totalhip or knee replacement at mid-term follow-up: thresholds of the Oxford hip and knee scores. Bone Joint Res. 2014;3:7–13. https://doi.org/10.1302/2046-3758.31.2000141.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Osmanski-Zenk K, Klinder A, Darowski M, Goosmann M, Mittelmeier W, Ellenrieder M. Identifikation Von Potenziellen Risikopatienten auf basis Von PROMs in Einem Zertifizierten EndoProthetikZentrum am Beispiel Der primären Knieendoprothetik. [Identification of potentially high-risk patients on the basis of PROMs in a certified centre for joint replacement (EndoProthetikZentrum) using the example of primary knee arthroplasty]. Z Orthop Unfall. 2022. https://doi.org/10.1055/a-1753-9968.

    Article  PubMed  Google Scholar 

  38. Hamilton DF, Loth FL, MacDonald DJ, Giesinger K, Patton JT, Simpson AH, et al. Treatment success following joint arthroplasty: defining thresholds for the Oxford hip and knee scores. J Arthroplasty. 2018;33:2392–7. https://doi.org/10.1016/j.arth.2018.03.062.

    Article  PubMed  Google Scholar 

  39. Ellenrieder M, Bader R, Bergschmidt P, Fröhlich S, Mittelmeier W. Coexistent lumbar spine disorders have a crucial impact on the clinical outcome after total hip replacement. J Orthop Sci. 2015;20:1046–52. https://doi.org/10.1007/s00776-015-0764-y.

    Article  PubMed  Google Scholar 

  40. Arslan T, Çandereli ZÖ, Kitapçi OC, Kitapçi NŞ, Kiliç Aksu P, Köksal L, et al. Do patient experiences have mediating roles on patient loyalty? J Patient Exp. 2022;9:23743735221103027. https://doi.org/10.1177/23743735221103027.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We would like to thank Dr Holger Haas (Bonn), who was involved in the development of the questionnaire, for including the NPS survey in 2015.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Open Access funding enabled and organized by Projekt DEAL.

Author information

Authors and Affiliations

  1. Orthopaedische Klinik und Poliklinik, Medizinischen Fakultät, Universitaetsmedizin Rostock, Universität Rostock, Doberaner Strasse 142, D-18057, Rostock, Deutschland

    Katrin Osmanski-Zenk, Martin Ellenrieder, Wolfram Mittelmeier & Annett Klinder

Authors
  1. Katrin Osmanski-Zenk
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Martin Ellenrieder
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wolfram Mittelmeier
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Annett Klinder
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

KOZ, AK: were responsible for data collection, analysis and interpretation of data, design of the work and revision. KOZ, AK were responsible for data revision. KOZ, ME, WM, AK approved the submitted version and agreed to be personally accountable for the author’s own contributions and ensured that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, were appropriately investigated, resolved, and the resolution documented in the literature. KOZ, ME, WM, AK have read and approved the final version of the manuscript.

Corresponding author

Correspondence to Katrin Osmanski-Zenk.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

The study was approved by the Ethics Committee at the Medical Faculty of the University Rostock: “Ethikkommission an der Medizinischen Fakultät der Universität Rostock”, Address: St.-Georg Str. 108 18055 Rostock, Germany, reference number: A2015–0055. In addition, the authors and the ethic committee confirm that all methods were carried out in accordance with relevant guidelines and regulations. All patients were informed about the possible participation in this study at the time of diagnosis and have consented accordingly. We clearly state that Informed consent to participate was obtained from all the participants in ethical approval.

Consent for publication

Not Applicable.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Osmanski-Zenk, K., Ellenrieder, M., Mittelmeier, W. et al. Net Promoter Score: a prospective, single-centre observational study assessing if a single question determined treatment success after primary or revision hip arthroplasty. BMC Musculoskelet Disord 24, 849 (2023). https://doi.org/10.1186/s12891-023-06981-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12891-023-06981-y

Keywords

BMC Musculoskeletal Disorders

ISSN: 1471-2474

Contact us