Anderson Michael R, Houck Jeff R, Saltzman Charles L, Hung Man, Nickisch Florian, Barg Alexej, Beals Timothy, Baumhauer Judith F
1 University of Rochester, Rochester NY, USA.
2 George Fox University, Newberg, OR, USA.
Foot Ankle Int. 2018 Jul;39(7):763-770. doi: 10.1177/1071100718765225. Epub 2018 Apr 5.
A recent publication reported preoperative Patient-Reported Outcomes Measurement Instrumentation System (PROMIS) scores to be highly predictive in identifying patients who would and would not benefit from foot and ankle surgery. Their applicability to other patient populations is unknown. The aim of this study was to assess the validation and generalizability of previously published preoperative PROMIS physical function (PF) and pain interference (PI) threshold t scores as predictors of postoperative clinically meaningful improvement in foot and ankle patients from a geographically unique patient population.
Prospective PROMIS PF and PI scores of consecutive patient visits to a tertiary foot and ankle clinic were obtained between January 2014 and November 2016. Patients undergoing elective foot and ankle surgery were identified and PROMIS values obtained at initial and follow-up visits (average, 7.9 months). Analysis of variance was used to assess differences in PROMIS scores before and after surgery. The distributive method was used to estimate a minimal clinically important difference (MCID). Receiver operating characteristic curve analysis was used to determine thresholds for achieving and failing to achieve MCID. To assess the validity and generalizability of these threshold values, they were compared with previously published threshold values for accuracy using likelihood ratios and pre- and posttest probabilities, and the percentages of patients identified as achieving and failing to achieve MCID were evaluated using χ analysis.
There were significant improvements in PF ( P < .001) and PI ( P < .001) after surgery. The area under the curve for PF (0.77) was significant ( P < .01), and the thresholds for achieving MCID and not achieving MCID were similar to those in the prior study. A significant proportion of patients (88.9%) identified as not likely to achieve MCID failed to achieve MCID ( P = .03). A significant proportion of patients (84.2%) identified as likely to achieve MCID did achieve MCID ( P < .01). The area under the curve for PROMIS PI was not significant.
PROMIS PF threshold scores from published data were successful in classifying patients from a different patient and geographic population who would improve with surgery. If functional improvement is the goal, these thresholds could be used to help identify patients who will benefit from surgery and, most important, those who will not, adding value to foot and ankle health care.
Level II, Prospective Comparative Study.
最近一项研究报告称，术前患者报告结局测量工具系统（PROMIS）评分在识别哪些患者会从足踝手术中获益、哪些患者不会从中获益方面具有很高的预测性。其在其他患者群体中的适用性尚不清楚。本研究的目的是评估先前发表的术前PROMIS身体功能（PF）和疼痛干扰（PI）阈值t评分作为来自地理位置独特患者群体的足踝患者术后临床意义上改善的预测指标的有效性和普遍性。
获取2014年1月至2016年11月期间连续就诊于一家三级足踝诊所患者的前瞻性PROMIS PF和PI评分。确定接受择期足踝手术的患者，并在初次就诊和随访时（平均7.9个月）获取PROMIS值。采用方差分析评估手术前后PROMIS评分的差异。采用分布法估计最小临床重要差异（MCID）。采用受试者工作特征曲线分析确定达到和未达到MCID的阈值。为评估这些阈值的有效性和普遍性，使用似然比、检验前概率和检验后概率将其与先前发表的阈值进行准确性比较，并使用χ分析评估被确定为达到和未达到MCID的患者百分比。
术后PF（P <.001）和PI（P <.001）有显著改善。PF的曲线下面积（0.77）具有显著性（P <.01），达到MCID和未达到MCID的阈值与先前研究相似。被确定为不太可能达到MCID的患者中有很大比例（88.9%）未达到MCID（P =.03）。被确定为可能达到MCID的患者中有很大比例（84.2%）确实达到了MCID（P <.01）。PROMIS PI的曲线下面积无显著性。
已发表数据中的PROMIS PF阈值评分成功地对来自不同患者和地理位置群体且手术会改善的患者进行了分类。如果功能改善是目标，这些阈值可用于帮助识别将从手术中获益的患者，最重要的是，识别那些不会获益的患者，为足踝医疗保健增添价值。
二级，前瞻性比较研究。
