Department of Statistics and Probability, Michigan State University, 619 Red Cedar Road, C423 Wells Hall, East Lansing, MI, 48824, USA,
Clin Orthop Relat Res. 2013 Nov;471(11):3489-95. doi: 10.1007/s11999-013-3028-1.
The evaluation of the outcomes of total knee arthroplasty requires measurement tools that are valid, reliable, and responsive to change. However, the accuracy of any outcome measurement is determined by the validity and reliability of the instrument used. To ensure this accuracy, it is imperative that each instrument used in orthopaedics is free of biases leading to inaccurate estimates of treatment effects. WHERE ARE WE NOW?: Many patient-derived outcome instruments have been developed and tested through the application of the standard assessments that form the basis of classical test theory: validity, reliability, and responsiveness. These assessments determine if the instrument reliably measures what it is intended to measure, and if it captures differences among groups of patients or changes over time. WHERE DO WE NEED TO GO?: Thorough evaluation of the outcome instruments used in orthopaedics is a critical prerequisite for the continued improvement of effective patient care. Additional steps of psychometric testing that are sometimes overlooked include testing for differential item functioning (DIF) and the effects of the mode of administration of the outcome instrument. The use of suitable approaches to test for these potential sources of bias would facilitate the development of more robust outcome assessment in research and clinical practice. HOW DO WE GET THERE?: Testing for DIF, including the effects of mode of administration, may be performed using several analytical approaches. This will allow optimal application of each outcome instrument with respect to patient characteristics, time and mode of the administration, and modification, as necessary.
全膝关节置换术的疗效评估需要使用有效、可靠且能反映变化的测量工具。然而，任何疗效测量的准确性都取决于所使用仪器的准确性和可靠性。为了确保这种准确性，至关重要的是，矫形外科中使用的每一种仪器都应避免导致治疗效果估计不准确的偏差。我们现在处于什么位置？许多基于患者的疗效评估工具已经开发并经过了标准评估的检验，这些评估是经典测试理论的基础：有效性、可靠性和敏感性。这些评估确定了仪器是否能可靠地测量其预期测量的内容，以及是否能捕捉到不同患者群体之间的差异或随时间的变化。我们需要去哪里？对矫形外科中使用的疗效评估工具进行彻底评估是持续改善有效患者护理的关键前提。有时会忽略一些额外的心理计量学测试步骤，包括测试项目间功能差异（DIF）和疗效评估工具的管理模式的影响。使用合适的方法来测试这些潜在的偏差源将有助于在研究和临床实践中开发更强大的疗效评估。我们如何到达那里？测试 DIF，包括管理模式的影响，可以使用几种分析方法。这将允许根据患者特征、管理的时间和模式以及必要的修改，针对每个疗效评估工具进行最佳应用。
