Schafer Kevin A, Minaie Arya, Nepple Jeffrey J
Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO.
J Pediatr Orthop. 2020 Aug;40(7):e616-e620. doi: 10.1097/BPO.0000000000001508.
A modified version of the International Knee Documentation Committee (IKDC), the Pedi-IKDC, is a validated patient-reported outcome measure in pediatric patients with knee pain. However, this questionnaire is lengthy and can fatigue patients, leading to inconsistent outcome collection. Thus, we sought to compare more easily attainable Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive testing patient reported outcomes to the gold standard Pedi-IKDC.
We prospectively collected PROMIS scores and Pedi-IKDC scores in 100 new, consecutive patients presenting with knee pain to a pediatric sports medicine practice. Patients were excluded if they provided an incomplete Pedi-IKDC, had prior ipsilateral lower extremity surgery, or significant associated medical comorbidities. PROMIS domains including Mobility, Pain Interference, and Upper Extremity (control) were compared with the Pedi-IKDC with Pearson correlations. The number of questions in each metric was analyzed. Floor and ceiling effects of each test were also assessed.
The average age of the study cohort was 14 years (range, 7 to 18 y) with 53% female and 47% male. 70% of patients completed the Pedi-IKDC questionnaire, compared with 100% with PROMIS tests. The average Pedi-IKDC score was 48.8±22.3 (range, 5.4 to 100). Mean scores for Mobility, Pain Interference, and Upper Extremity domains were 38.4±10.1, 53.5±10.3, and 49.7±8.7, respectively. All tests demonstrated similar and acceptable floor and ceiling effects (<15%). The length of the Pedi-IKDC (22 questions) was roughly double that of combined PROMIS Pain Interference and Mobility tests (11.9±2.3 questions). Pedi-IKDC scores correlated with tested PROMIS measures (Mobility/Pain Interference, r=0.42/-0.49). When 7 highly functional patients with significant pain symptoms were removed for a secondary analysis, Mobility and Pain correlations improved to 0.69 and -0.67, respectively.
PROMIS Mobility and Pain scores demonstrate moderate correlations with the Pedi-IKDC, highlighting these tests are not capturing the same patient experiences. These correlations are weakened by a small group of painful yet highly functioning patients. The Pedi-IKDC was significantly longer and had a much lower completion rate than PROMIS tests, highlighting a need for a validated computer adaptive testing in evaluating pediatric patients with knee pain.
Level II.
国际膝关节文献委员会（IKDC）的改良版——儿童IKDC（Pedi - IKDC），是一种经过验证的、用于评估膝关节疼痛儿科患者的患者报告结局指标。然而，该问卷篇幅较长，可能使患者感到疲劳，导致结局收集不一致。因此，我们试图将更容易获得的患者报告结局测量信息系统（PROMIS）计算机自适应测试患者报告结局与金标准Pedi - IKDC进行比较。
我们前瞻性地收集了100例连续就诊于儿科运动医学门诊的新发膝关节疼痛患者的PROMIS评分和Pedi - IKDC评分。如果患者提供的Pedi - IKDC不完整、既往有同侧下肢手术史或有明显的相关内科合并症，则将其排除。将包括活动能力、疼痛干扰和上肢（控制）在内的PROMIS领域与Pedi - IKDC进行Pearson相关性分析。分析了每个指标中的问题数量。还评估了每个测试的地板效应和天花板效应。
研究队列的平均年龄为14岁（范围7至18岁），女性占53%，男性占47%。70%的患者完成了Pedi - IKDC问卷，而PROMIS测试的完成率为100%。Pedi - IKDC的平均评分为48.8±22.3（范围5.4至100）。活动能力、疼痛干扰和上肢领域的平均得分分别为38.4±10.1、53.5±10.3和49.7±8.7。所有测试均显示出相似且可接受的地板效应和天花板效应（<15%）。Pedi - IKDC的长度（22个问题）约为PROMIS疼痛干扰和活动能力测试组合长度（11.9±2.3个问题）的两倍。Pedi - IKDC评分与测试的PROMIS指标相关（活动能力/疼痛干扰，r = 0.42 / - 0.49）。在剔除7例有明显疼痛症状但功能良好的患者进行二次分析时，活动能力和疼痛的相关性分别提高到0.69和 - 0.67。
PROMIS活动能力和疼痛评分与Pedi - IKDC呈中度相关，突出表明这些测试并未捕捉到相同的患者体验。一小部分疼痛但功能良好的患者削弱了这些相关性。Pedi - IKDC明显更长，完成率远低于PROMIS测试，这突出表明在评估膝关节疼痛的儿科患者时需要一种经过验证的计算机自适应测试。
二级。
