一种用于预测全膝关节置换术后 1 个月生活质量恢复延迟的临床预测规则：决策树模型。
A clinical prediction rule for predicting a delay in quality of life recovery at 1 month after total knee arthroplasty: A decision tree model.
机构信息
Division of Physical Therapy, School of Rehabilitation, Faculty of Health and Social Services, Kanagawa University of Human Services, Yokosuka, Japan; Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Kobe, Japan.
Department of Physical Therapy, Faculty of Health and Medical Sciences, Tokoha University, Hamamatsu, Japan.
出版信息
J Orthop Sci. 2021 May;26(3):415-420. doi: 10.1016/j.jos.2020.04.010. Epub 2020 Jun 2.
BACKGROUND
There is no clinical prediction rule for predicting the prognosis of quality of life after total knee arthroplasty and for assessing its accuracy. The study aimed to develop and assess a clinical prediction rule to predict decline in quality of life at 1 month after total knee arthroplasty.
METHODS
This study included 116 patients with total knee arthroplasty in Japan. Potential predictors such as sociodemographic factors, medical information, and motor functions were measured. Quality of life was measured using the Japanese Knee Osteoarthritis Measure at 1 day before surgery and 1 month after total knee arthroplasty. The classification and regression tree methodology was used for developing a clinical prediction rule.
RESULTS
The Japanese Knee Osteoarthritis Measure score pre-total knee arthroplasty (≦34.0 or >34.0) was the best single discriminator. Among those with the Japanese Knee Osteoarthritis Measure score pre-total knee arthroplasty ≦34.0, the next best predictor was knee flexor muscle strength on the affected side (≦0.45 or >0.45 N m/kg). Among those with knee flexor muscle strength on the affected side >0.45, the next predictor was knee flexion range of motion on the affected side (≦132.5°or >132.5°). The area under the receiver operating characteristic curves of the model was 0.805 (95% confidence interval, 0.701-0.909).
CONCLUSIONS
In this study, 4 variables were selected as the significant predictor. However, the results of knee flexor muscle strength and knee flexion range of motion were paradoxical. This result suggests that it should be careful to perform surgery to the patients with good preoperative knee function. The clinical prediction rule was developed for predicting quality of life decline 1 month after total knee arthroplasty, and the accuracy was moderate. This clinical prediction rule can be used for screening of patients with total knee arthroplasty.
背景
目前尚无临床预测规则可用于预测全膝关节置换术后生活质量的预后，并评估其准确性。本研究旨在制定和评估一种临床预测规则，以预测全膝关节置换术后 1 个月生活质量的下降。
方法
本研究纳入了日本的 116 例全膝关节置换术患者。测量了社会人口统计学因素、医疗信息和运动功能等潜在预测指标。使用日本膝关节骨关节炎量表在术前 1 天和全膝关节置换术后 1 个月测量生活质量。采用分类回归树方法制定临床预测规则。
结果
全膝关节置换术前日本膝关节骨关节炎量表评分（≦34.0 或 >34.0）是最佳的单一判别指标。在全膝关节置换术前日本膝关节骨关节炎量表评分≦34.0 的患者中，下一个最佳预测指标是患侧膝关节屈肌肌力（≦0.45 或 >0.45 N·m/kg）。在患侧膝关节屈肌肌力>0.45 的患者中，下一个预测指标是患侧膝关节活动度（≦132.5°或 >132.5°）。该模型的受试者工作特征曲线下面积为 0.805（95%置信区间，0.701-0.909）。
结论
在本研究中，选择了 4 个变量作为显著预测指标。然而，膝关节屈肌肌力和膝关节活动度的结果是矛盾的。这一结果表明，对于术前膝关节功能良好的患者，应谨慎进行手术。该临床预测规则是为预测全膝关节置换术后 1 个月生活质量下降而制定的，准确性中等。该临床预测规则可用于全膝关节置换术患者的筛选。
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