Haskell Andrew, Kim Todd
1 Palo Alto Medical Foundation, San Carlos, CA, USA.
2 Palo Alto Medical Foundation, Burlingame, CA, USA.
Foot Ankle Int. 2018 May;39(5):517-521. doi: 10.1177/1071100717753967. Epub 2018 Jan 24.
The authors describe a method of collecting patient-reported outcomes (PROs) using computerized adaptive tests (CATs) in a high-volume orthopedic surgery practice with limited resources and no research coordinator.
Patient-Reported Outcomes Measurement Information System CATs were collected prospectively for all clinic patients using a tablet and recorded in the electronic medical record. Scores were compared with validated national norms using single-variable t tests. Linear regression was used to assess age effects. Preoperative and postoperative pain scales were compared using paired t tests.
In total, 4,524 CATs were administered during 10,719 visits (42%), reaching 70% as more tablets were introduced. Completing the CATs required 157 seconds. Older patients took more time than younger ones ( P < .05). Compared with normalized t scores of 50 ± 10 for the US population, pain intensity was 48.0 (95% confidence interval [CI], 47.8-48.2), pain interference 58.9 (95% CI, 58.6-59.1), physical function 40.1 (95% CI, 39.9-40.3), global physical health 43.4 (95% CI, 41.9-44.9), and global mental health 41.1 (95% CI, 40.89-41.4) ( P < .05 for all). Age had a small effect on all domains ( P < .05). Approximately 20 patients would be required to demonstrate a 15% change for a 2-tailed, paired study with α = 0.05 and 80% power. After surgery, pain intensity improved from 51.9 ± 8.2 to 44.1 ± 8.5, pain interference improved from 62.5 ± 6.9 to 55.7 ± 8.4, and physical function improved from 37.3 ± 8.9 to 41.5 ± 7.9 ( P < .05 for all).
Using tablets to administer CATs and entering the data in the electronic medical record for later retrieval was an effective technique to collect PROs. An adequate number of tablets are needed for acceptable completion rates. Modest sample size requirements for comparative studies highlight the potential of these tools and techniques.
Level II, Prospective Comparative Study.
作者描述了一种在资源有限且没有研究协调员的高容量骨科手术实践中，使用计算机自适应测试（CAT）收集患者报告结局（PRO）的方法。
使用平板电脑前瞻性地收集所有门诊患者的患者报告结局测量信息系统CAT，并记录在电子病历中。使用单变量t检验将分数与经过验证的全国标准进行比较。使用线性回归评估年龄的影响。使用配对t检验比较术前和术后疼痛量表。
在10719次就诊期间共进行了4524次CAT（占42%），随着引入更多平板电脑，这一比例达到了70%。完成CAT需要157秒。老年患者比年轻患者花费的时间更多（P < 0.05）。与美国人群标准化t分数50±10相比，疼痛强度为48.0（95%置信区间[CI]，47.8 - 48.2），疼痛干扰为58.9（95%CI，58.6 - 59.1），身体功能为40.1（95%CI，39.9 - 40.3），总体身体健康为43.4（95%CI，41.9 - 44.9），总体心理健康为41.1（95%CI，40.89 - 41.4）（所有P < 0.05）。年龄对所有领域有较小影响（P < 0.05）。对于α = 0.05、检验效能为80%的双尾配对研究，大约需要20名患者才能证明有15%的变化。手术后，疼痛强度从51.9±8.2改善至44.1±8.5，疼痛干扰从62.5±6.9改善至55.7±8.4，身体功能从37.3±8.9改善至41.5±7.9（所有P < 0.05）。
使用平板电脑进行CAT并将数据录入电子病历以便后续检索是收集PRO的有效技术。需要足够数量的平板电脑以获得可接受的完成率。比较研究所需的适度样本量突出了这些工具和技术的潜力。
二级，前瞻性比较研究。
