Dawson J, Fitzpatrick R, Murray D, Carr A
Department of Public Health and Primary Care, Radcliffe Infirmary, Oxford, England, UK.
J Health Serv Res Policy. 1996 Oct;1(4):224-31. doi: 10.1177/135581969600100408.
To compare the performance of three types of patient-based health status instrument--generic, disease-specific and site-specific--in assessing changes resulting from total hip replacement (THR).
A two-stage prospective study of patients undergoing surgery for THR involving an assessment at a pre-surgical clinic and a follow-up clinic at 6 months. 173 patients with a diagnosis of arthritis and being admitted for unilateral THR were recruited in the outpatient departments of a specialist orthopaedic hospital and peripheral clinics within Oxfordshire. Patients' health status was assessed using the 12-item Oxford Hip Score, the Arthritis Impact Measurement Scales (AIMS) and SF-36 general health questionnaire together with their surgeons' assessment using Charnley hip score obtained before and 6 months after surgery.
Effect sizes, used to compare change scores, revealed that pain and function domains changed most following THR on both the AIMS and the SF-36. 71 patients (41%) were assessed as having symptoms or problems currently affecting lower limb joints other than the hip recently replaced. Change scores were compared between these patients and all other patients who reported no current problems with other joints. The Oxford Hip Score found no significant difference between change scores for these two groups of patients while both AIMS and SF-36 physical and pain dimensions recorded significant differences of similar magnitude (physical P < 0.01, pain P < 0.05). Likely reasons for this were apparent on closer inspection of the item content of each instrument.
Assessment of outcomes in THR is necessarily long-term. Within studies of this kind, a hip-specific instrument (Oxford Hip Score) is likely to be more able to distinguish between symptoms and functional impairment produced by the index joint, as compared with other joints and conditions, than either a disease-specific instrument (AIMS) or a generic health status measure (SF-36). This is important given the high probability of existing and subsequent co-morbidity affecting such populations of patients. This consideration is likely to be relevant to any long-term assessment programme following treatment for a condition which threatens bilateral expression over time.
比较三种基于患者的健康状况评估工具——通用型、疾病特异性和部位特异性——在评估全髋关节置换术（THR）所导致的变化方面的性能。
对接受THR手术的患者进行两阶段前瞻性研究，包括在术前诊所进行评估以及在6个月后的随访诊所进行评估。在牛津郡的一家专业骨科医院的门诊部和周边诊所招募了173例诊断为关节炎并接受单侧THR手术的患者。使用12项牛津髋关节评分、关节炎影响测量量表（AIMS）和SF - 36一般健康问卷对患者的健康状况进行评估，并结合外科医生使用术前和术后6个月获得的查恩利髋关节评分进行评估。
用于比较变化分数的效应量显示，在AIMS和SF - 36上，THR术后疼痛和功能领域的变化最大。71例患者（41%）被评估为目前有症状或问题影响除最近置换的髋关节以外的下肢关节。比较了这些患者与所有其他报告目前其他关节无问题的患者之间的变化分数。牛津髋关节评分发现这两组患者的变化分数无显著差异，而AIMS以及SF - 36身体和疼痛维度记录了相似幅度的显著差异（身体方面P < 0.01，疼痛方面P < 0.05）。仔细检查每种工具的项目内容后，其可能原因显而易见。
THR结局的评估必然是长期的。在这类研究中，与疾病特异性工具（AIMS）或通用健康状况测量工具（SF - 36）相比，髋关节特异性工具（牛津髋关节评分）可能更能够区分由目标关节产生的症状和功能损害与其他关节及病症所导致的情况。鉴于现有和后续合并症很可能影响这类患者群体，这一点很重要。这种考虑可能与任何针对随着时间推移可能影响双侧的病症进行治疗后的长期评估计划相关。
