使用区域和疾病特定的患者报告结局测量信息系统（PROMIS）工具，评估腕管松解术中PROMIS身体功能、上肢功能及疼痛干扰的最小临床重要差异。

Minimal Clinically Important Differences for PROMIS Physical Function, Upper Extremity, and Pain Interference in Carpal Tunnel Release Using Region- and Condition-Specific PROM Tools.

作者信息

Bernstein David N, Houck Jeff R, Mahmood Bilal, Hammert Warren C

机构信息

University of Rochester School of Medicine and Dentistry, Rochester, NY.

George Fox University, Newberg, OR.

出版信息

J Hand Surg Am. 2019 Aug;44(8):635-640. doi: 10.1016/j.jhsa.2019.04.004. Epub 2019 May 22.

DOI:10.1016/j.jhsa.2019.04.004

PMID:31126813

Abstract

PURPOSE

Uncertainty exists about what change in Patient-Reported Outcomes Measurement Information System (PROMIS) scores represents a clinically relevant improvement (minimal clinically important difference [MCID]) in hand surgery care. Using a region-specific patient-reported outcome measure (PROM) (Michigan Hand Question [MHQ]) and a condition-specific PROM (Boston Carpal Tunnel Questionnaire [BCTQ]), MCID values were determined for PROMIS Physical Function (PF), Upper Extremity (UE), and Pain Interference (PI) computerized adaptive testing among patients undergoing carpal tunnel release (CTR).

METHODS

Patients undergoing CTR with a single surgeon from November 2014 to April 2017 were asked to complete the BCTQ, MHQ, and PROMIS PF, UE, and PI at each visit. Patients who had completed questionnaires both at a preoperative and either a 6-week or a 3-month postoperative visit were included. The PROMIS PF, UE, and PI MCID values were calculated using previously determined MCID estimates in the literature with both region- (ie, MHQ) and condition-specific (ie, BCTQ) PROM anchors. The PROMIS domain MCID estimates were also determined using the distribution-based method.

RESULTS

A total of 70 patients fit our inclusion criteria. Using MHQ Function and Pain, PROMIS UE, PF, and PI MCIDs were 6.3, 1.8, and -8.9, respectively. Using the average of the 2 BCTQ domains, PROMIS UE, PF, and PI MCIDs were 8.0, 2.8, and -9.7, respectively. Using the distribution-based method, PROMIS UE, PF, and PI MCIDs were 4.2, 2.7, and -4.1, respectively.

CONCLUSIONS

Using region- and condition-specific PROMs, we were able to provide MCID estimates of PROMIS UE, PF, and PI for patients undergoing CTR.

CLINICAL RELEVANCE

Estimating PROMIS UE, PF, and PI MCIDs in CTR using validated region- and condition-specific PROMs provides hand surgeons a way to evaluate CTR outcomes not previously described in the literature. Surgeons should understand that these values are only estimates and future work is needed to verify whether they reflect clinical improvement.

摘要

目的

患者报告结局测量信息系统（PROMIS）评分的何种变化代表手部手术护理中具有临床意义的改善（最小临床重要差异[MCID]）尚不确定。使用特定区域的患者报告结局测量指标（PROM）（密歇根手部问题[MHQ]）和特定疾病的PROM（波士顿腕管综合征问卷[BCTQ]），确定了接受腕管松解术（CTR）患者的PROMIS身体功能（PF）、上肢（UE）和疼痛干扰（PI）计算机自适应测试的MCID值。

方法

2014年11月至2017年4月接受同一位外科医生进行CTR手术的患者在每次就诊时均被要求完成BCTQ、MHQ以及PROMIS PF、UE和PI的测评。纳入术前及术后6周或3个月就诊时均完成问卷的患者。使用文献中先前确定的MCID估计值以及特定区域（即MHQ）和特定疾病（即BCTQ）的PROM锚定指标来计算PROMIS PF、UE和PI的MCID值。还使用基于分布的方法确定PROMIS领域的MCID估计值。

结果

共有70例患者符合纳入标准。使用MHQ功能和疼痛指标时，PROMIS UE、PF和PI的MCID分别为6.3、1.8和-8.9。使用2个BCTQ领域的平均值时，PROMIS UE、PF和PI的MCID分别为8.0、2.8和-9.7。使用基于分布的方法时，PROMIS UE、PF和PI的MCID分别为4.2、2.7和-4.1。