From the Department of Anaesthesiology and Perioperative Medicine (M.A.S.) the Department of Anaesthesiology and Perioperative Medicine (P.S.M.), Alfred Hospital and Monash University, Melbourne, Victoria, Australia the School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (J.K.).
Anesthesiology. 2020 Jun;132(6):1362-1370. doi: 10.1097/ALN.0000000000003240.
The World Health Organization Disability Assessment Schedule 2.0 has been used to measure postoperative disability in several clinical trials and cohort studies. It is uncertain what the minimal clinically important difference or patient-acceptable symptom state scores are for this scale in patients recovering from surgery.
The authors analyzed prospectively collected data from three studies that measured disability 3 and 6 months after surgery. Three distribution-based methods (0.3 multiplied by SD, standard error of the measurement, and 5% range) and two anchor-based methods (anchored to two patient-rated health status questions and separately to unplanned hospital readmission) were averaged to estimate the minimal clinically important difference for the World Health Organization Disability Assessment Schedule 2.0 score converted to a percentage scale. Scores consistent with a patient-acceptable symptom state and clinically significant disability were determined by an anchored 75th centile method.
Data from 4,361 patients were analyzed. The average minimal clinically important difference estimate for the World Health Organization Disability Assessment Schedule 2.0 was 5%, with similar estimates in patients with or without preoperative disability. The patient-acceptable symptom state score was 16%, and the score consistent with at least moderate clinically significant disability was 35%. Using these estimates, between baseline and 6 months after surgery, 21% of patients had a significant increase in disability, and 73% achieved a patient-acceptable symptom state.
A change in World Health Organization Disability Assessment Schedule 2.0 score of 5% or more after surgery is consistent with a clinically important change in disability. Patients with a score less than 16% after surgery have an acceptable symptom state and can be considered as disability-free, whereas patients with a score of 35% or more can be considered as having at least moderate clinically significant disability.
世界卫生组织残疾评估表 2.0 已被用于多项临床试验和队列研究来衡量术后残疾。但尚不清楚该量表在术后康复患者中的最小临床重要差异或患者可接受的症状状态评分是多少。
作者对三项研究中的前瞻性收集数据进行了分析，这些研究在术后 3 个月和 6 个月测量了残疾情况。三种基于分布的方法（0.3 乘以标准差、测量误差标准和 5%范围）和两种基于锚定的方法（分别锚定到两个患者自评健康状况问题和非计划性住院再入院）被平均化，以估计世界卫生组织残疾评估表 2.0 评分转换为百分比量表的最小临床重要差异。通过锚定的第 75 百分位数方法确定与患者可接受的症状状态和具有临床意义的残疾相一致的评分。
共分析了 4361 名患者的数据。世界卫生组织残疾评估表 2.0 的平均最小临床重要差异估计值为 5%，在术前有或无残疾的患者中相似。患者可接受的症状状态评分为 16%，与至少中度具有临床意义的残疾相一致的评分为 35%。使用这些估计值，在基线和术后 6 个月之间，21%的患者残疾程度显著增加，73%的患者达到了患者可接受的症状状态。
手术后世界卫生组织残疾评估表 2.0 评分变化 5%或以上与残疾的临床重要变化一致。手术后评分低于 16%的患者具有可接受的症状状态，可以被视为无残疾，而评分达到或高于 35%的患者可以被视为具有至少中度具有临床意义的残疾。
