Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, 2635 Laurel Street, Vancouver, British Columbia, V5Z 1M9, Canada.
Department of Community Health Sciences, Arthur JE Child Chair in Rheumatology Research, University of Calgary, Calgary, Alberta, Canada.
Osteoarthritis Cartilage. 2018 Mar;26(3):370-382. doi: 10.1016/j.joca.2017.10.020. Epub 2017 Dec 30.
To develop quality indicators (QIs) reflecting the minimum acceptable standard of rehabilitation care before and after elective total hip arthroplasty (THA) and total knee arthroplasty (TKA) for osteoarthritis (OA).
Informed by high quality evidence and using a modified RAND-UCLA Delphi approach, an 18-member Canadian panel of clinicians, researchers and patients considered 81 proposed QIs (40 for THA, 42 for TKA) addressing rehabilitation before and after elective THA and TKA. Panelists rated QIs for their importance and validity on a 9-point Likert scale through two rounds of online rating interspersed with a moderated and anonymous online discussion forum. Those QIs with median ratings of ≥7 for importance and validity with no disagreement based on the inter-percentile range adjusted for symmetry were included in the final sets.
Fifteen panelists from seven provinces and varied practice settings completed the Delphi process. Of the 81 plus one additional QIs (total of 82), 67 (82%) were rated as both important and valid (31 for THA, 36 for TKA). For THA, 14 pre-op, six acute and eight post-acute QIs were accepted. For TKA, 16 pre-op, 10 acute and eight post-acute indicators were accepted. Two of three 'across-continuum' QIs were rated appropriate for both procedures.
This work represents the first QIs with which to measure, report and benchmark quality of care in patients receiving rehabilitation before and after THA/TKA surgery. The QIs will be further tested for reliability and feasibility before being widely disseminated in clinical settings and used to assess care gaps.
制定反映择期全髋关节置换术（THA）和全膝关节置换术（TKA）治疗骨关节炎（OA）前后康复护理最低可接受标准的质量指标（QIs）。
在高质量证据的指导下，采用改良的 RAND-UCLA Delphi 方法，由 18 名加拿大临床医生、研究人员和患者组成的小组对 81 项拟议的 QIs（40 项用于 THA，42 项用于 TKA）进行了评估，这些 QIs 涉及择期 THA 和 TKA 前后的康复问题。小组成员通过两轮在线评分，对 QIs 的重要性和有效性进行 9 分制的 Likert 评分，并穿插一个有主持人的匿名在线讨论论坛。那些重要性和有效性的中位数评分≥7 分，且基于中位数评分的百分位区间调整后的对称性无分歧的 QIs 被纳入最终的 QIs 集。
来自七个省和不同实践环境的 15 名小组成员完成了 Delphi 流程。在 81 项外加一项 QIs（共计 82 项）中，有 67 项（82%）被评为重要且有效（THA 为 31 项，TKA 为 36 项）。THA 接受了 14 项术前、6 项急性和 8 项术后 QIs；TKA 接受了 16 项术前、10 项急性和 8 项术后指标。三项“跨连续体”QIs 中有两项被认为适用于两种手术。
这是第一个用于衡量、报告和比较接受 THA/TKA 手术前后康复护理质量的 QIs。在广泛应用于临床环境并用于评估护理差距之前，将进一步对这些 QIs 的可靠性和可行性进行测试。
