Gausden Elizabeth B, Levack Ashley, Nwachukwu Benedict U, Sin Danielle, Wellman David S, Lorich Dean G
1 Hospital for Special Surgery, New York, NY, USA.
2 Weill Cornell Medical College, New York Presbyterian Hospital, Hospital for Special Surgery, New York, NY USA.
Foot Ankle Int. 2018 Oct;39(10):1192-1198. doi: 10.1177/1071100718782487. Epub 2018 Jul 4.
Advantages of using computerized adaptive testing (CAT) include decreased survey-burden, diminished floor and ceiling effect, and improved ability to detect the minimal clinical significant difference (MCID) among patients. The goal of this study was to compare the legacy patient-reported outcome measures (PROMs) to the Patient-Reported Outcomes Measurement Information System (PROMIS) scores in terms of ability to detect clinically significant changes in patients who have undergone surgery for ankle fractures.
Patients who underwent osteosynthesis for an unstable ankle fracture between 2013-2016 and completed legacy outcome scores (Foot and Ankle Outcome Score [FAOS], Olerud and Molander Ankle Score [OMAS], and Weber Score) along with the PROMIS Physical Function (PF) and PROMIS Lower Extremity (LE) CATs postoperatively were included. Correlation between the scores at 3-month, 6-month, and 1-year intervals, as well as floor and ceiling effects, in addition to MCIDs were calculated for each instrument. A total of 132 patients were included in the study.
There was no observed floor or ceiling effect in either the PROMIS PF or the PROMIS LE scores. Clinically significant changes in the PROMIS LE score were detected in patients between 6-month and 12-month postoperative visits ( P = .0006), whereas the reported OMAS score and Weber scores did not identify a clinically significant difference between patients at their 6-month and 12-month visit.
The results of this study indicate that the PROMIS LE was superior for evaluating patients following ankle fracture surgery in terms of lower floor and ceiling effects and greater ability to distinguish clinically significant changes in patients between time points following surgery.
Level III, comparative study.
使用计算机自适应测试（CAT）的优点包括减轻调查负担、减少地板效应和天花板效应，以及提高检测患者之间最小临床显著差异（MCID）的能力。本研究的目的是比较传统的患者报告结局量表（PROMs）与患者报告结局测量信息系统（PROMIS）评分在检测踝关节骨折手术患者临床显著变化方面的能力。
纳入2013年至2016年间因不稳定踝关节骨折接受接骨术并在术后完成传统结局评分（足踝结局评分[FAOS]、奥勒鲁德和莫兰德踝关节评分[OMAS]以及韦伯评分）以及PROMIS身体功能（PF）和PROMIS下肢（LE）CATs的患者。计算每种工具在术后3个月、6个月和1年时评分之间的相关性，以及地板效应和天花板效应，此外还计算了MCID。本研究共纳入132例患者。
在PROMIS PF或PROMIS LE评分中均未观察到地板效应或天花板效应。在术后6个月至12个月的患者中检测到PROMIS LE评分有临床显著变化（P = .0006），而报告的OMAS评分和韦伯评分在患者术后6个月和12个月的访视中未发现临床显著差异。
本研究结果表明，PROMIS LE在评估踝关节骨折手术后的患者方面更具优势，其地板效应和天花板效应较低，并且在区分手术时间点之间患者的临床显著变化方面能力更强。
III级，比较研究。
