Department of Orthopaedics, University of Rochester, Rochester, NY, USA.
Department of Physical Therapy, George Fox University, Newberg, OR, USA.
Foot Ankle Int. 2020 Feb;41(2):133-139. doi: 10.1177/1071100719886286. Epub 2019 Nov 8.
Prior studies have suggested preoperative patient-reported outcome scores could predict patients who would achieve a clinically meaningful improvement with hallux valgus surgery. Our goal was to determine bunionectomy-specific thresholds using Patient-Reported Outcomes Measurement Information System (PROMIS) values to predict patients who would or would not benefit from bunion surgery.
PROMIS physical function (PF), pain interference (PI), and depression assessments were prospectively collected. Forty-two patients were included in the study. Using preoperative and final follow-up visit scores, minimally clinically important differences (MCID), receiver operating characteristic (ROC) curves, and area under the curve (AUC) analyses were performed to determine if preoperative PROMIS scores predicted achieving MCID with 95% specificity or failing to achieve an MCID with 95% sensitivity.
PROMIS PF demonstrated a significant AUC and likelihood ratio. The preoperative threshold score for failing to achieve MCID for PF was 49.6 with 95% sensitivity. The likelihood ratio was 0.14 (confidence interval, 0.02-0.94). The posttest probability of failure to achieve an MCID for PF was 94.1%. PI and depression AUCs were not significant, and thus thresholds were not determined.
We identified a PF threshold of 49.6, which was nearly 1 standard deviation higher than previously published. If a patient is hoping to improve PF, a patient with a preoperative score >49.6 may not benefit from surgery. This study also suggests the need for additional research to delineate procedure-specific thresholds.
Level III, retrospective comparative series.
先前的研究表明，术前患者报告的结局评分可以预测接受拇外翻手术治疗后会获得临床显著改善的患者。我们的目标是使用患者报告结局测量信息系统（PROMIS）值确定特定于拇囊炎切除术的阈值，以预测患者是否会从拇囊炎手术中获益。
前瞻性收集 PROMIS 身体机能（PF）、疼痛干扰（PI）和抑郁评估。本研究纳入了 42 名患者。使用术前和最终随访评分，进行了最小临床重要差异（MCID）、受试者工作特征（ROC）曲线和曲线下面积（AUC）分析，以确定术前 PROMIS 评分是否可以预测达到 95%特异性的 MCID 或未能达到 95%敏感性的 MCID。
PROMIS PF 表现出显著的 AUC 和似然比。未能达到 PF 中 MCID 的术前阈值分数为 49.6，具有 95%的敏感性。似然比为 0.14（置信区间，0.02-0.94）。PF 未能达到 MCID 的后验概率为 94.1%。PI 和抑郁的 AUC 不显著，因此未确定阈值。
我们确定了 PF 阈值为 49.6，这比之前发表的数值高出近 1 个标准差。如果患者希望改善 PF，术前得分>49.6 的患者可能不会从手术中受益。本研究还表明需要进一步研究来划定特定手术的阈值。
III 级，回顾性比较系列。
