36 项简明健康调查简表生理成分综合评分与全膝关节置换术后 2 年患者满意度及改善的相关性。

Association of the 36-Item Short Form Health Survey Physical Component Summary Score With Patient Satisfaction and Improvement 2 Years After Total Knee Arthroplasty.

机构信息

Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.

Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore.

出版信息

JAMA Netw Open. 2019 Feb 1;2(2):e190062. doi: 10.1001/jamanetworkopen.2019.0062.

DOI:10.1001/jamanetworkopen.2019.0062

PMID:30794301

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6484598/

Abstract

IMPORTANCE

Increases in total knee arthroplasty (TKA) utilization rates suggest that its indications have been expanded to include patients with less severe symptoms. A recent study challenged the cost-effectiveness of TKA in this group of patients.

OBJECTIVE

To determine the association of the 36-Item Short Form Health Survey physical component summary score (SF-36 PCS) with patient satisfaction 2 years after TKA.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study reviewed registry data from 2 years of follow-up of patients who underwent unilateral TKA from January 1, 2010, to December 31, 2014, at a single-center tertiary institution in Singapore. Data were acquired on April 27, 2017, and analyzed from August 15, 2017, to December 22, 2017.

MAIN OUTCOMES AND MEASURES

Patient satisfaction and SF-36 PCS. Preoperative disability and postoperative function as measured by the SF-36 PCS were correlated with Δ (2-year end point score minus baseline score) and patient satisfaction, scored on a 6-point Likert scale, with lower scores indicating greater satisfaction.

RESULTS

Of the 6659 patients, 5234 (78.6%) were female and 5753 (86.4%) were of Chinese ethnicity. Mean (SD) age was 67.0 (7.7) years, and mean (SD) body mass index (calculated as weight in kilograms divided by height in meters squared) was 27.7 (4.6). At 2-year follow-up, the mean (SD) SF-36 PCS score improved from 32.2 (10.1) to 48.2 (9.5) (P < .001). There were 1680 patients (25.2%) who described their satisfaction as excellent, 2574 (38.7%) very good, 1879 (28.2%) good, 382 (5.7%) fair, 96 (1.4%) poor, and 48 (0.7%) terrible. The minimal clinically important difference (change in SF-36 PCS of 10 from baseline) was met in 4515 patients (67.8%), and overall satisfaction was 97.8% (6515 patients). Covariance analysis showed significantly higher satisfaction in patients with preoperative scores of 40 to less than 50. Patients who were unlikely to meet the minimal clinically important difference compared with those who were likely to meet it (SF-36 PCS of ≥42.1 vs <42.1) had significantly higher 2-year satisfaction (mean [SD], 2.15 [0.9] vs 2.23 [1.0]; P = .009).

CONCLUSIONS AND RELEVANCE

The findings suggest that a general health score, such as SF-36, is not associated with patient satisfaction 2 years after TKA. Functional assessment, preoperative counseling, and modification of expectations appear to remain vital before TKA.

摘要

重要性

全膝关节置换术（TKA）使用率的增加表明其适应证已扩大到包括症状较轻的患者。最近的一项研究对这组患者接受 TKA 的成本效益提出了质疑。

目的

确定 36 项简短健康调查身体成分综合评分（SF-36 PCS）与 TKA 后 2 年患者满意度的关系。

设计、地点和参与者：本队列研究回顾了 2010 年 1 月 1 日至 2014 年 12 月 31 日在新加坡一家单中心三级医疗机构接受单侧 TKA 的患者 2 年随访的登记数据。数据于 2017 年 4 月 27 日采集，并于 2017 年 8 月 15 日至 2017 年 12 月 22 日进行分析。

主要结果和测量

患者满意度和 SF-36 PCS。术前残疾和术后功能由 SF-36 PCS 测量，与 2 年终点评分减去基线评分的Δ（2 年终点评分减去基线评分）和患者满意度相关，患者满意度以 6 分李克特量表评分，得分越低表示满意度越高。

结果

在 6659 名患者中，5234 名（78.6%）为女性，5753 名（86.4%）为华裔。平均（SD）年龄为 67.0（7.7）岁，平均（SD）体重指数（体重以千克为单位，除以身高以米为单位的平方）为 27.7（4.6）。在 2 年随访时，SF-36 PCS 评分从 32.2（10.1）改善至 48.2（9.5）（P < .001）。有 1680 名患者（25.2%）表示满意度为极好，2574 名患者（38.7%）非常好，1879 名患者（28.2%）好，382 名患者（5.7%）满意，96 名患者（1.4%）不满意，48 名患者（0.7%）极差。SF-36 PCS 基线变化 10 的最小临床重要差异（最小临床重要差异为 10 分）在 4515 名患者（67.8%）中得到满足，总体满意度为 97.8%（6515 名患者）。协方差分析显示，术前评分在 40 到小于 50 的患者满意度明显更高。与可能达到最小临床重要差异的患者相比，不太可能达到最小临床重要差异的患者（SF-36 PCS 评分≥42.1 与<42.1）的 2 年满意度明显更高（平均[SD]，2.15[0.9]与 2.23[1.0]；P = .009）。