目的:本研究的目的是检查报告的肩关节不稳手术后PROM的MCID和PASS值,并根据所进行的手术评估已发表值的变异性。其次,我们的目的是在已发表的文献中描述用于推导MCID和PASS值的方法,包括基于锚的,基于分布的,或其他方法,并评估MCID和PASS在肩关节不稳手术研究中的使用频率。
方法:Bankart之后对MCID和PASS值的系统回顾,Latarjet,根据系统评价和荟萃分析(PRISMA)的首选报告项目进行模板程序。Embase,Pubmed,从1985年到2023年,查询了Cochrane中央对照试验登记册(CENTRAL)数据库。纳入标准包括用英语写的研究,并研究报告Latarjet后患者报告结果测量(PROMS)的利用率MCID或PASS,Bankart,Remplissage方法用于肩部不稳定手术。提取的数据包括研究人群特征,干预特点,和感兴趣的结果。使用中位数和范围描述连续数据。分类变量,包括报告的PROM和MCID/PASS方法,用百分比来描述。由于MCID是患者级别的度量而不是组级别的度量,作者验证了所有纳入研究报告的受试者达到或超过MCID的比例(%).
结果:共筛选了174条记录,本综述纳入了8项研究.MCID是最广泛使用的结果阈值,在所有8项研究中都有报道,只有2项研究同时报告了MCID和PASS。研究最广泛的PROM是美国肩肘外科医生(ASES)(MCID分布范围为5.65-9.6,8.5锚杆MCID,86锚点通过);单一评估数字评估(SANE)(范围11.4-12.4分布MCID,82.5-87.5锚点PASS);视觉模拟量表(VAS)(范围1.1-1.7分布MCID,1.5-2.5通过);安大略省西部肩部不稳定指数(WOSI)(范围60.7-254.9分布MCID,126.43锚点MCID,571-619.5锚通过);和Rowe得分(范围为5.6-8.4分布MCID,9.7锚MCID)。值得注意的是,没有研究报告实质性临床获益(SCB)或最大结局改善(MOI).
结论:尽管评估肩关节不稳定手术结果的PROM种类繁多,临床显著结局阈值如MCID和PASS的可用性仍然相对有限.虽然MCID是最常报告的指标,在它们的值中观察到相当大的研究间差异。
结论:了解经常用于评估肱骨稳定手术结果的PROM的MCID和PASS等结果阈值是至关重要的,因为它们让我们知道什么是对患者的临床显着改善。
OBJECTIVE: The purpose of this study was to examine reported MCID and PASS values for
PROMs following shoulder instability surgery and assess variability in published values depending on the surgery performed. Secondarily, our aims were to describe the methods used to derive MCID and PASS values in the published literature, including anchor-based, distribution-based, or other approaches, and to assess the frequency of MCID and PASS usage in studies on shoulder instability surgery.
METHODS: A systematic review of MCID and PASS values following Bankart, Latarjet, and Remplissage procedures was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The Embase, Pubmed, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were queried from 1985 to 2023. Inclusion criteria included studies written in English, and studies reporting utilization MCID or PASS for patient reported outcome measures (PROMS) following Latarjet, Bankart, Remplissage approaches for shoulder instability surgery. Extracted data included study population characteristics, intervention characteristics, and outcomes of interest. Continuous data were described using median and range. Categorical variables, including
PROMs reported and MCID/PASS methods, were described using percentages. As MCID is a patient-level metric and not a group-level metric, the authors validated that all included studies reported proportions (%) of subjects that met or exceeded the MCID.
RESULTS: A total of 174 records were screened, and 8 studies were included in this review. MCID was the most widely utilized outcome threshold which was reported in all 8 studies, with only 2 studies reporting both the MCID and the PASS. The most widely studied
PROMs were the American Shoulder and Elbow Surgeons (ASES) (range 5.65-9.6 for distribution MCID, 8.5 anchor MCID, 86 anchor PASS); Single Assessment Numeric Evaluation (SANE) (range 11.4-12.4 distribution MCID, 82.5-87.5 anchor PASS); visual analog scale (VAS) (range 1.1-1.7 distribution MCID, 1.5-2.5 PASS); Western Ontario Shoulder Instability Index (WOSI) (range 60.7-254.9 distribution MCID, 126.43 anchor MCID, 571-619.5 anchor PASS); and Rowe scores (range 5.6-8.4 distribution MCID, 9.7 anchor MCID). Notably, no studies reported on substantial clinical benefit (SCB) or maximal outcome improvement (MOI).
CONCLUSIONS: Despite the wide array of available
PROMs for assessing shoulder instability surgery outcomes, the availability of clinically significant outcome thresholds such as MCID and PASS remains relatively limited. While MCID has been the most frequently reported metric, there is considerable inter-study variability observed in their values.
CONCLUSIONS: Knowing the outcome thresholds such as MCID and PASS of the
PROMs frequently used to evaluate the results of glenohumeral stabilization surgery is fundamental, since they allow us to know what is a clinically significant improvement for the patient.