■尽管全膝关节置换术(TKA)的总体患病率和成功率,相当一部分患者对其结果不满意.
■评估TKA术后患者的2种患者报告结局指标(PROM)-膝关节损伤和骨关节炎结局评分-关节置换(KOOS-JR)和患者报告结局测量信息系统Global-10(PROMIS10)-的反应性并确定最小重要差异(MID)。
■队列研究(诊断);证据水平,3.
■包括从2015年8月至2019年8月接受TKA并完成基线和术后KOOS-JR和PROMIS10调查的患者。PROMIS10包括两个领域:身体健康和心理健康。可靠变化指数(RCI)和MID的估计,使用基于锚和基于分布的方法,对每个PROM进行了计算。回归模型用于确定患者和临床因素是否预测MID阈值或MID成就。
■共纳入1315例患者。基于分布的MID,使用各种方法从基线分数计算,KOOS-JR的范围从19.3到31,RCI为4.38。在这些病人中,293(22.3%)表现出轻微或中度改善,并且该队列包括在基于锚的MID的计算中。在3个月和1年的随访中,基于锚的MID分别为16.9和24.3,分别,66%的患者在12个月时达到了MID。术前PROM评分较高,男性,非白人种族,和当前的吸烟者状态预示着术后1年KOOS-JR未能达到基于锚的MID(P<0.05)。较高的术前PROM评分和任何90天的不良事件预示了基于锚的MID的重要变化的较低阈值。较高的基线PROM分数,年龄较小,男性,非白人种族,高等美国麻醉医师学会分类,术前使用麻醉剂,不吸烟,且住院时间延长均与KOOS-JR或PROMIS10分量表达到MID的几率较低相关.
■研究结果证明了解释KOOS-JR和PROMIS10的相关值。虽然患者人口统计学无法准确预测哪些患者会达到MID,确定了一些预测TKA后患者报告结局成功的潜在因素.
UNASSIGNED: Despite the overall prevalence and success of total knee arthroplasty (TKA), a significant portion of patients are dissatisfied with their outcomes.
UNASSIGNED: To assess the responsiveness and determine the minimally important difference (MID) of 2 patient-reported outcome measures (PROMs)-the Knee injury and Osteoarthritis Outcome Score-Joint Replacement (KOOS-JR) and the Patient-Reported Outcomes Measurement Information System Global-10 (PROMIS 10)-in patients after TKA.
UNASSIGNED: Cohort study (diagnosis); Level of evidence, 3.
UNASSIGNED: Included were patients who underwent TKA from August 2015 through August 2019 and completed baseline and postoperative KOOS-JR and PROMIS 10 surveys. The PROMIS 10 consists of 2 domains: physical health and mental health. Estimates for the reliable change index (RCI) and MID, using anchor-based and distribution-based methods, were calculated for each PROM. Regression modeling was used to determine whether patient and clinical factors predicted MID thresholds or MID achievement.
UNASSIGNED: A total of 1315 patients were included. Distribution-based MIDs, calculated using various methods from baseline scores, ranged from 19.3 to 31 for the KOOS-JR, and the RCI was 4.38. Of these patients, 293 (22.3%) demonstrated small or moderate improvement, and this cohort was included in the calculation of anchor-based MIDs. The anchor-based MIDs were 16.9 and 24.3 at 3-month and 1-year follow-up, respectively, and 66% of patients achieved the MID at 12 months. Higher preoperative PROM score, male sex, non-White race, and current smoker status were predictive of failing to achieve the anchor-based MID for KOOS-JR at 1 year postoperatively (P < .05). Higher preoperative PROM score and any 90-day adverse event predicted lower thresholds of important change in anchor-based MIDs. Higher baseline PROM scores, younger age, male sex, non-White ethnicity, higher American Society of Anesthesiologists classification, preoperative narcotics use, not smoking, and longer hospital stay were all associated with lower odds of achieving the MID on the KOOS-JR or either of the PROMIS 10 subscales.
UNASSIGNED: The study results demonstrated relevant values for interpretation of the KOOS-JR and PROMIS 10. While patient demographics did not accurately predict which patients would achieve the MID, some potential factors predicting successful patient-reported outcomes after TKA were identified.