Nwachukwu Benedict U, Chang Brenda, Beck Edward C, Neal William H, Movassaghi Kamran, Ranawat Anil S, Nho Shane J
1Hospital for Special Surgery, New York, NY USA.
2Department of Orthopedics, Rush University Medical Center, Chicago, IL USA.
HSS J. 2019 Jul;15(2):103-108. doi: 10.1007/s11420-018-9646-0. Epub 2018 Nov 15.
There is increased emphasis on efficiently administering patient-reported outcome measures (PROMs). The International Hip Outcome Tool-12 (iHOT-12) is a short-form version of the iHOT-33, and relatively little is known about clinically significant outcomes using the iHOT-12.
QUESTIONS/PURPOSES: The purpose of this study was to define minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) for the iHOT-12 and to identify predictors for achieving these psychometric end points in patients undergoing arthroscopic treatment of femoroacetabular impingement (FAI).
Data was prospectively collected and retrospectively analyzed as part of an institutional hip preservation repository. One hundred and twenty patients were included; mean age and body mass index (BMI) were 38.7 years and 25.9, respectively. A majority of patients were female (67.5%) and white (81.7%) and participated in recreational sports (79.2%). The iHOT-12 was administered pre-operatively and at 1-year follow-up to patients undergoing primary hip arthroscopy for FAI. The following anchor question was also asked at 1-year follow-up: "Taking into account all the activities you have during your daily life, your level of pain, and also your functional impairment, do you consider that your current state is satisfactory?" MCID was calculated using a distribution-based method. Receiver-operating characteristic analysis with area under the curve was used to confirm the significance of the PASS threshold.
Mean iHOT-12 scores improved from 35.6 at pre-operative assessment to 70.7 at 1-year follow-up. Patients indicating satisfaction with their outcome improved from 37.5 pre-operatively to 79.0 at 1-year follow-up. MCID value for the iHOT-12 was 13.0. The PASS threshold was 63.0, indicating an excellent predictive value that patients scoring above this threshold were likely to have met an acceptable symptom state. Worker's compensation patients and those with increased BMI were less likely to achieve PASS; lower pre-operative iHOT-12 score was predictive for achieving MCID, and achieving MCID was predictive for achieving PASS.
This is the first study to define PASS and MCID for the iHOT-12, which measures clinically significant outcome improvement comparably to that of other commonly used hip PROMs. As its use becomes more widespread, the iHOT-12 data-points presented in this study can be used to determine clinically significant improvement of patient-reported outcomes.
目前越来越强调高效管理患者报告的结局指标（PROMs）。国际髋关节结局工具-12（iHOT-12）是iHOT-33的简版，关于使用iHOT-12的临床显著结局了解相对较少。
问题/目的：本研究的目的是确定iHOT-12的最小临床重要差异（MCID）和患者可接受的症状状态（PASS），并确定在接受关节镜治疗股骨髋臼撞击症（FAI）的患者中实现这些心理测量终点的预测因素。
作为机构髋关节保留资料库的一部分，前瞻性收集数据并进行回顾性分析。纳入120例患者；平均年龄和体重指数（BMI）分别为38.7岁和25.9。大多数患者为女性（67.5%）和白人（81.7%），并参加休闲运动（79.2%）。对接受初次髋关节镜检查治疗FAI的患者在术前和术后1年随访时使用iHOT-12进行评估。在术后1年随访时还询问了以下锚定问题：“考虑到你日常生活中的所有活动、疼痛程度以及功能障碍，你认为你目前的状态令人满意吗？”使用基于分布的方法计算MCID。采用曲线下面积的受试者工作特征分析来确认PASS阈值的显著性。
iHOT-12平均得分从术前评估时的35.6提高到术后1年随访时的70.7。表示对结局满意的患者从术前的37.5%提高到术后1年随访时的79.0%。iHOT-12的MCID值为13.0。PASS阈值为63.0，表示得分高于该阈值的患者很可能达到可接受症状状态的预测价值极佳。工伤赔偿患者和BMI较高的患者不太可能达到PASS；术前iHOT-12得分较低是实现MCID的预测因素，而实现MCID是达到PASS的预测因素。
这是第一项为iHOT-12定义PASS和MCID的研究，该工具测量的临床显著结局改善与其他常用的髋关节PROMs相当。随着其应用越来越广泛，本研究中呈现的iHOT-12数据点可用于确定患者报告结局的临床显著改善。
