1. CORRELATION OF MSTS 87 & TESS FUNCTIONAL EVALUATION SCORES FOLLOWING ENDOPROSTHETIC REPLACEMENT FOR BONE SARCOMAS A Mahendra 1, AM Griffin 1, C Yu 1, Y Gortzak 1, RS Bell 1, PC Ferguson 1, JS Wunder 1, AM Davis 2 1. University Musculoskeletal Oncology Unit, Mount Sinai Hospital, University of Toronto, Toronto, Canada 2. Toronto Western Research Institute and the University of Toronto, Toronto, Canada

2. INTRODUCTION ► Several outcome measures (symptoms, ROM, ADL) used to document function following limb preservation surgery ► Outcomes conceptualize function differently ► ‘Causal indicators’ : occurrence of these outcomes can cause a change in function or QOL (Fayers, Qual Life Res. 1997)

3. International Classification of Functioning (WHO, 2001) Impairment Activities Participation (Function/Structure) (Activity Limitation) (Participation Restriction) Health Condition (disorder/disease) Environmental Personal Factors

4. Functional Outcomes MSTS 87 MSTS 87 ► Measure of mainly impairment ► Various items assessed include:  pain, range of motion, strength, joint stability, deformity, emotional acceptance of the surgical procedure, and general functional ability. ► Clinician perspective TESS ► Measure of disability / activity limitation ► Developed for patients having undergone limb salvage surgery ► Patient perspective

5. Purpose ► Are specific impairments (MSTS 87) associated with activity limitations (TESS)?

6. Methods: Patients ► Bone sarcoma patients with EPR ► Data from sarcoma database (clinical, demographic & functional) – 1989 to 2006

7. Methods: Eligibility criteria ► Patients with primary lower extremity bone sarcoma ► >2 years follow up ► Evaluated by both MSTS 87 & TESS ► No local recurrence, metastasis or major complication for at least 2 years prior to the follow up

8. Methods: Analysis ► Descriptive statistics for demographic & tumour characteristics ► We controlled for the following: Demographic variables  Age  Gender Tumour variables  Anatomical site  Histological type  Size of tumour  Chemotherapy  Pathological fracture  Wound closure

9. Methods: Analysis cont. ► Pearson’s correlation coefficients: for each of the MSTS 1987 items & the TESS ► Prior to testing which MSTS items were independent predictors: Univariable linear regression models conducted. ► Variables significant at p<0.05 were included in the multivariable model evaluating the association of MSTS items with TESS

10. Results ► 111 out of 255 met inclusion criteria ► Average age 33.6 yrs (range 13 to 74) ► 65 males & 46 females ► Anatomical site :  distal femur 61  proximal tibia 26

11. Results (cont.) ► Histological type  Osteosarcoma 60  Chondrosarcoma 15 ► Pathological fracture : 11 ► 72 out of 111 patients received chemotherapy ► Wound closure:  Primary - 78  Rotational or a free flap - 33

12. Results : MSTS & TESS descriptive scores Variables Available range Range Mean, SD MSTS 87 Pain Pain ROM ROM Strength Strength Stability Stability Deformity Deformity Functions Functions Acceptance Acceptance 0 – 35 0 - 5 0 – 5 0 - 5 9 – 33 0 – 5 1 – 5 0 – 5 3 - 5 26.02, 5.53 3.6, 1.4 3.8, 1.3 2.4, 1.4 4.2, 1.3 4.1, 1.2 2.8, 1.03 4.9, 0.3 TESS 0 - 100 34.5 - 100 80, 14.95

13. Results: MSTS 87 impairments impacting on TESS Impairment variable Pearson’s correlation with TESS PainROMStrengthStabilityDeformityFunctionsAcceptance 0.525 ** 0.496 ** 0.354 ** 0.393 ** 0.213 * 0.641 ** 0.279 ** ** Correlation significant at 0.01 level (2 – tailed) * Correlation significant at 0.05 level (2 – tailed)

14. Results: Multivariable Model Variable Standardized Beta coefficients SEP-value PainROMStabilityFunction0.2910.2380.2030.4211.0031.0201.0211.5540.0030.0100.0230.0001 Dependent variable : TESS

15. Conclusions ► Pain, ROM, stability & function have a significant correlation with the disability as measured by TESS following EPR for bone sarcoma ► Decreased strength, acceptance & deformity have little impact on disability or activity limitation

16. Conclusions (contd) ► Effective compensatory mechanisms may allow them to function well during their daily routine ► Future research needs to more fully explore the inter-relationships of different aspects of function to identify potentially modifiable components that may allow individuals to improve their daily functioning

17. Acknowledgments This work was supported by an Interdisciplinary Health Research Team Grant from the Canadian Institutes of Health Research. This work was supported by an Interdisciplinary Health Research Team Grant from the Canadian Institutes of Health Research.