Rheumatology Department, Royal North Shore Hospital, Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia.
Department of Musculoskeletal Imaging, Castlereagh Sports Imaging, St. Leonards, Sydney, Australia.
Osteoarthritis Cartilage. 2018 May;26(5):601-611. doi: 10.1016/j.joca.2018.01.021. Epub 2018 Feb 7.
The aims of this study were to systematically review clinimetrics of commonly assessed ultrasound pathologies in knee, hip and hand osteoarthritis (OA), and to conduct a meta-analysis for each clinimetric.
Medline, Embase, and Cochrane Library databases were searched from their inceptions to September 2016. According to the Outcome Measures in Rheumatology (OMERACT) Instrument Selection Algorithm, data extraction focused on ultrasound technical features and performance metrics. Methodological quality was assessed with modified 19-item Downs and Black score and 11-item Quality Appraisal of Diagnostic Reliability (QAREL) score. Separate meta-analyses were performed for clinimetrics: (1) inter-rater/intra-rater reliability; (2) construct validity; (3) criteria validity; and (4) internal/external responsiveness. Statistical Package for the Social Sciences (SPSS), Excel and Comprehensive Meta-analysis were used.
Our search identified 1126 records; of these, 100 were eligible, including a total of 8542 patients and 32,373 joints. The average Downs and Black score was 13.01, and average QAREL was 5.93. The stratified meta-analysis was performed only for knee OA, which demonstrated moderate to substantial reliability [minimum kappa > 0.44(0.15,0.74), minimum intraclass correlation coefficient (ICC) > 0.82(0.73-0.89)], weak construct validity against pain (r = 0.12 to 0.27), function (r = 0.15 to 0.23), and blood biomarkers (r = 0.01 to 0.21), but weak to strong correlation with plain radiography (r = 0.13 to 0.60), strong association with Magnetic Resonance Imaging (MRI) [minimum r = 0.60(0.52,0.67)] and strong discrimination against symptomatic patients (OR = 3.08 to 7.46). There was strong criterion validity against cartilage histology [r = 0.66(-0.05,0.93)], and small to moderate internal [standardized mean difference(SMD) = 0.20 to 0.58] and external (r = 0.35 to 0.43) responsiveness to interventions.
Ultrasound demonstrated strong criterion validity with cartilage histology, poor to strong correlation with patient findings and MRI, moderate reliability, and low responsiveness to interventions.
CRD42016039954.
本研究旨在系统综述膝关节、髋关节和手部骨关节炎（OA）中常用超声病变的临床计量学，并对每种临床计量学进行荟萃分析。
从各数据库建立起至 2016 年 9 月，检索 Medline、Embase 和 Cochrane 图书馆数据库。根据风湿病结局测量（OMERACT）仪器选择算法，数据提取侧重于超声技术特征和性能指标。使用改良的 19 项 Downs 和 Black 评分和 11 项诊断可靠性质量评估（QAREL）评分来评估方法学质量。分别对以下临床计量学进行荟萃分析：（1）观察者间/观察者内可靠性；（2）结构效度；（3）标准效度；（4）内部/外部反应性。使用社会科学统计软件包（SPSS）、Excel 和综合荟萃分析软件进行统计分析。
我们的搜索共确定了 1126 条记录；其中 100 条符合条件，共包括 8542 名患者和 32373 个关节。Downs 和 Black 评分的平均得分为 13.01，QAREL 的平均得分为 5.93。仅对膝关节 OA 进行了分层荟萃分析，结果显示其可靠性为中度至高度可靠[最小kappa 值>0.44（0.15，0.74），最小组内相关系数（ICC）>0.82（0.73-0.89]），与疼痛（r=0.12 至 0.27）、功能（r=0.15 至 0.23）和血液生物标志物（r=0.01 至 0.21）的结构效度较弱，与 X 线摄影（r=0.13 至 0.60）的相关性较弱至较强，与磁共振成像（MRI）（r=0.60[0.52，0.67]）的相关性较强，与症状性患者的相关性较强（OR=3.08 至 7.46）。与软骨组织学的标准相关性较强（r=0.66[-0.05，0.93]），对干预措施的内部[标准化均数差（SMD）=0.20 至 0.58]和外部（r=0.35 至 0.43）反应性较小。
超声与软骨组织学具有较强的标准相关性，与患者发现和 MRI 的相关性较弱至较强，可靠性中等，对干预措施的反应性较低。
PROSPERO 注册号：CRD42016039954。
