Countess of Chester Hospital, Chester, UK.
J Shoulder Elbow Surg. 2013 Mar;22(3):312-7. doi: 10.1016/j.jse.2012.09.003. Epub 2013 Jan 10.
Responsiveness and floor and ceiling effect are important parameters for evaluating the sensitivity of an outcome instrument in detecting the changes in the clinical condition of patients after an intervention as well as evaluating the content validity of the instrument. The aim of this prospective observational study was to assess these parameters for the Liverpool Elbow Score (LES) in total elbow replacement (TER).
The study included 121 cemented TER cases with linked elbow prosthesis (Discovery Elbow, Biomet Orthopaedics, Swindon, UK) for various conditions, including inflammatory arthritis, noninflammatory arthritis, trauma, and loosening. The proportion of patients with the lowest score (0 points; floor effect) and maximum score (10 points; ceiling effect) was checked preoperatively and 1 year postoperatively. Distribution-based methods (effect size [ES], standardized response mean [SRM], Guyatt responsiveness ratio [GRR]) and anchor-based methods (receiver operating characteristic [ROC] curve and Spearman correlation coefficient) were used to assess responsiveness. Patient satisfaction after TER was used as an external anchor.
Patients were a mean age of 63 years (range, 20-86 years). Large ES (1.64), SRM (1.25), and GRR (1.69) were found during the follow-up period. Area under the ROC curve was 0.71 (95% confidence interval, 0.56-0.87; P = .03). There was significant positive correlation (Spearman correlation coefficient, 0.35; P = .004) between changes in LES and satisfaction level. LES showed no floor and ceiling effect preoperatively and at 1 year postoperatively.
LES is a responsive measure and has no floor and ceiling effect.
This encourages its use as an outcome instrument for TER. Basic Science Study, Development or Validation of Outcome Instruments.
反应度和天花板效应及地板效应是评估干预后患者临床状况变化的工具敏感性以及评估工具内容效度的重要参数。本前瞻性观察研究旨在评估全肘关节置换术(TER)中利物浦肘评分(LES)的这些参数。
该研究纳入了 121 例因各种原因行骨水泥固定 TER 的患者,包括炎症性关节炎、非炎症性关节炎、创伤和松动。术前和术后 1 年检查得分最低(0 分;地板效应)和最高(10 分;天花板效应)的患者比例。使用基于分布的方法(效应量[ES]、标准化反应均值[SRM]、Guyatt 反应比[GRR])和基于锚定的方法(受试者工作特征[ROC]曲线和斯皮尔曼相关系数)评估反应度。TER 后患者满意度作为外部锚定。
患者平均年龄为 63 岁(20-86 岁)。随访期间 ES(1.64)、SRM(1.25)和 GRR(1.69)较大。ROC 曲线下面积为 0.71(95%置信区间,0.56-0.87;P =.03)。LES 变化与满意度之间存在显著正相关(斯皮尔曼相关系数,0.35;P =.004)。术前和术后 1 年均无 LES 地板效应和天花板效应。
LES 是一种敏感的测量方法,无地板效应和天花板效应。
鼓励将其作为 TER 的结果评估工具。基础科学研究,结果评估工具的开发或验证。