Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA.
Cleveland Clinic Orthopaedics Department, Cleveland, Ohio, USA.
Am J Sports Med. 2019 Apr;47(5):1159-1167. doi: 10.1177/0363546519831008. Epub 2019 Mar 18.
The length of most patient-reported outcome measures creates significant response burden, which hampers follow-up rates. The Patient Acceptable Symptom State (PASS) is a single-item, patient-reported outcome measure that asks patients to consider all aspects of life to determine whether the state of their joint is satisfactory; this measure may be viable for tracking outcomes on a large scale.
The PASS question would identify clinically successful anterior cruciate ligament reconstruction (ACLR) at 1-year follow-up with high sensitivity and moderate specificity. We defined "clinically successful" ACLR as changes in preoperative to postoperative scores on the Knee injury and Osteoarthritis Outcome Score (KOOS) pain subscale and the KOOS knee-related quality of life subscale in excess of minimal clinically important difference or final KOOS pain or knee-related quality of life subscale scores in excess of previously defined PASS thresholds.
Cohort study (diagnosis); Level of evidence, 2.
Patients enrolled in a prospective longitudinal cohort completed patient-reported outcome measures immediately before primary ACLR. At 1-year follow-up, patients completed the same patient-reported outcome measures and answered the PASS question: "Taking into account all the activity you have during your daily life, your level of pain, and also your activity limitations and participation restrictions, do you consider the current state of your knee satisfactory?"
A total of 555 patients enrolled in our cohort; 464 were eligible for this study. Of these, 300 patients (64.7%) completed 1-year follow-up, of whom 83.3% reported satisfaction with their knee after surgery. The PASS question demonstrated high sensitivity to identify clinically successful ACLR (92.6%; 95% CI, 88.4%-95.6%). The specificity of the question was 47.1% (95% CI, 35.1%-59.5%). The overall agreement between the PASS and our KOOS-based criteria for clinically successful intervention was 81.9%, and the kappa value indicated moderate agreement between the two methods (κ = 0.44).
The PASS question identifies individuals who have experienced clinically successful ACLR with high sensitivity. The limitation of the PASS is its low specificity, which we calculated to be 47.1%. Answering "no" to the PASS question meant that a patient neither improved after surgery nor achieved an acceptable final state of knee health. The brevity, interpretability, and correlation of the PASS question with significant improvements on various KOOS subscales make it a viable option in tracking ACLR outcomes on a national or global scale.
大多数患者报告的结果测量的长度会产生显著的反应负担，这会降低随访率。患者可接受的症状状态（PASS）是一个单一的项目，患者报告的结果测量，要求患者考虑生活的各个方面，以确定他们的关节状态是否满意；这种测量方法可能适用于大规模的跟踪结果。
PASS 问题将以高灵敏度和中等特异性在 1 年随访时识别出临床成功的前交叉韧带重建（ACL）。我们将“临床成功”的 ACLR 定义为术前至术后膝关节损伤和骨关节炎结果评分（KOOS）疼痛子量表和 KOOS 膝关节相关生活质量子量表的评分变化超过最小临床重要差异或最终 KOOS 疼痛或膝关节相关生活质量子量表评分超过先前定义的 PASS 阈值。
队列研究（诊断）；证据水平，2。
参加前瞻性纵向队列研究的患者在初次 ACLR 前立即完成患者报告的结果测量。在 1 年随访时，患者完成了相同的患者报告的结果测量，并回答了 PASS 问题：“考虑到您日常生活中的所有活动、您的疼痛程度以及您的活动限制和参与限制，您是否认为您目前的膝关节状况令人满意？”
共有 555 名患者参加了我们的队列；464 名患者符合本研究标准。其中，300 名患者（64.7%）完成了 1 年随访，其中 83.3%的患者报告术后对膝关节满意。PASS 问题对识别临床成功的 ACLR 具有很高的灵敏度（92.6%；95%CI，88.4%-95.6%）。该问题的特异性为 47.1%（95%CI，35.1%-59.5%）。PASS 与我们基于 KOOS 的临床成功干预标准之间的总体一致性为 81.9%，kappa 值表明两种方法之间存在中度一致性（κ=0.44）。
PASS 问题以高灵敏度识别经历过临床成功 ACLR 的个体。PASS 的局限性在于其特异性低，我们计算其特异性为 47.1%。对 PASS 问题回答“否”意味着患者术后既没有改善，也没有达到可接受的膝关节健康终末状态。PASS 问题的简洁性、可解释性以及与各种 KOOS 子量表的显著改善的相关性，使其成为在全国或全球范围内跟踪 ACLR 结果的可行选择。
