What is the Forgotten Joint Score (FJS) and When is it Used?
Awareness Over Pain
Created in 2012, the Forgotten Joint Score (FJS) is a patient-reported outcome measure intended to determine a patient’s ability to “forget” about their affected joint after surgery or treatment (H, JM, K, & MS, 2014). Currently, the FJS is available for use on hip, knee, and shoulder replacements. What makes the Forgotten Joint Score different from other total joint PROs is that it focuses on awareness of the joint instead of pain.
How is the Forgotten Joint Score “Scored”?
The Forgotten Joint Score assessment consists of 12 questions and is scored on a 0-100 scale. The higher the score, the less the patient is aware of their affected joint when performing daily activities (Rosinsky et al., 2019). The minimal important difference for the Forgotten Joint Score is 10.8 points, meaning this is the minimal score improvement that a patient must make in order to represent a meaningful difference in their outcome (Holtz N, Hamilton DF, Giesinger JM, Jost B, Giesinger K.) The creators of FJS are currently working to develop an item bank to allow the Forgotten Joint Score to be used with a Computer Adaptive Test (CAT).
Strengths of the Forgotten Joint Score
FJS has been shown to be easier for patients to understand and less time-consuming for them to complete when compared to the Oxford Hip Score (OHS). Additionally, according to the creators of the FJS it can differentiate between both “good” and “bad” outcomes, and can also differentiate between “good”, “very good”, and “excellent” outcomes (Behrend, Giesinger, Giesinger, & Kuster, 2012). Recently, the FJS has been validated against the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). A study has found that the FJS outperformed the WOMAC in regards to detecting a forgotten joint and that the FJS and WOMAC performed equally well at detecting a Patient Acceptable Symptom State (PASS) Wang, Z., Deng, W., Shao, H., Zhou, Y., & Li, H. (2020). Finally, the Forgotten Joint Score has been shown to have less ceiling effects when compared to the Oxford Hip Score.
Considerations when Choosing FJS
As with any PRO tool, there are a few considerations when using the Forgotten Joint Score. FJS is better suited for more active patients with good to excellent outcomes and is more focused on post-op outcomes. The Forgotten Joint Score is also less suitable than other PROs to predict the need for a revision procedure due to its floor effect (Larsson et al., 2019). According to a study performed by Hamilton et al. in 2017, 22% of THA patients scored the minimum score of zero when completing the FJS preoperatively, compared to 0% of THA patients scoring zero on the OHS (Hamilton et al., 2017). Finally, another consideration to review is that there is a cost for the license and use of the FJS assessment.
So – Should You Use It?
Overall, the Forgotten Joint Score is a great PRO for measuring postoperative outcomes, specifically how able the patient is to forget about their affected joint. The FJS is easier for patients to understand and less time-consuming for them to complete. While this measure is also less suitable to predict the need for a revision, it is still considered a great alternative to the Oxford Hip Score. To learn more about the FJS you can visit their website.
If you are interested in learning more about collecting patient-reported outcomes or would like to implement the Forgotten Joint Score in your current PROs program, We’d love to talk!