Squitieri Lee, Reichert Heidi, Kim H Myra, Chung Kevin C
University of Michigan Medical School, the Center for Statistical Consultation and Research, and the Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA.
J Hand Surg Am. 2010 Nov;35(11):1795-1805.e1. doi: 10.1016/j.jhsa.2010.07.013. Epub 2010 Oct 8.
In 2009, the World Health Organization published a conceptual outcome framework for evaluating upper extremity injury and disease, known as the Brief International Classification of Functioning, Disability, and Health (ICF) Core Set for Hand Conditions. The purpose of this study was to apply the ICF conceptual model to outcomes for distal radius fractures (DRFs) and determine the contribution of each ICF domain to patient satisfaction.
Patient-rated and objective functional outcome data were collected at 6 weeks, 3 months, and 6 months after surgery. We measured satisfaction using a subsection of the Michigan Hand Outcomes Questionnaire (MHQ) satisfaction score. Measured study variables were linked to their corresponding ICF domain (personal factors, environmental factors, activity and participation, and body function). We then used hierarchical regression to assess the contribution of each ICF domain to variation in overall patient satisfaction at each time point.
We enrolled 53 patients with unilateral DRFs treated with the volar locking plating system. Regression analysis indicated that measured study variables explain 93% (6 weeks), 98% (3 months), and 97% (6 months) of variation in patient satisfaction. For all 3 study assessment dates, activity and participation variables (MHQ-Activities of Daily Living, MHQ-Work, and Jebsen-Taylor Score) contributed the most to variation in patient satisfaction, whereas personal and environmental factors had a considerably smaller role in predicting changes in patient satisfaction.
The results demonstrated that it is possible to reliably model the relative contributions of each ICF domain to patient satisfaction over time, and the findings are consistent with previous research (ie, that most outcome variation is due to physical or functional factors). These results are strong enough to support continued use and further research using the ICF model for upper extremity outcomes.
2009年，世界卫生组织发布了一个用于评估上肢损伤和疾病的概念性结果框架，即手部疾病简要国际功能、残疾和健康分类（ICF）核心集。本研究的目的是将ICF概念模型应用于桡骨远端骨折（DRF）的结果，并确定每个ICF领域对患者满意度的贡献。
在手术后6周、3个月和6个月收集患者自评和客观功能结果数据。我们使用密歇根手部结果问卷（MHQ）满意度评分的一个子部分来测量满意度。测量的研究变量与其相应的ICF领域（个人因素、环境因素、活动和参与以及身体功能）相关联。然后，我们使用层次回归来评估每个ICF领域在每个时间点对总体患者满意度变化的贡献。
我们纳入了53例接受掌侧锁定钢板系统治疗的单侧DRF患者。回归分析表明，测量的研究变量解释了患者满意度变化的93%（6周）、98%（3个月）和97%（6个月）。在所有3个研究评估日期，活动和参与变量（MHQ-日常生活活动、MHQ-工作和Jebsen-Taylor评分）对患者满意度变化的贡献最大，而个人和环境因素在预测患者满意度变化方面的作用要小得多。
结果表明，可以可靠地模拟每个ICF领域随时间对患者满意度的相对贡献，并且这些发现与先前的研究一致（即大多数结果变化是由于身体或功能因素）。这些结果足以支持继续使用ICF模型并对上肢结果进行进一步研究。
