Razmjou Helen, Rahnama Leila, Holtby Richard, Drosdowech Darren, Richards Robin
Department of Rehabilitation, Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
SAGE Open Med. 2020 Jul 27;8:2050312120946218. doi: 10.1177/2050312120946218. eCollection 2020.
It is important for clinicians involved in the care of patients with advanced glenohumeral osteoarthritis to determine clinically significant change when using outcome measures. There is little information on the amount of substantial clinical benefit in shoulder outcomes after shoulder arthroplasty. The purpose of this study was twofold: (1) to quantify substantial clinical benefit for the American Shoulder and Elbow Surgery score, the Constant Murley Score, and the Western Ontario Osteoarthritis of the Shoulder index and (2) to provide estimates of responsiveness and sensitivity to change for these measures following shoulder arthroplasty.
The study involved a secondary analysis of previously collected data. The substantial clinical benefit and responsiveness of the measures were calculated based on external anchors related to change in pain, range of motion, and ability to carry out activities of daily living. The areas under curve and standardized response mean represented responsiveness and sensitivity to change.
The data of 159 and 131 patients with complete follow-up at 6 months and 2 years were reviewed. The amount of substantial clinical benefit was dependent on the outcome measure and the external anchor and increased for all measures from 6 months to 2 years. Responsiveness was high (areas under curve > 0.80) at 6 months and further improved at 2 years (areas under curve > 0.88). The standardized response mean values of both time points were over 2.00, indicating high effect sizes. The standardized response means of the Constant Murley Score were statistically significantly higher than the standardized response means of the American Shoulder and Elbow Surgery and Western Ontario Osteoarthritis of the Shoulder.
Amount of substantial clinical improvement in pain, range of motion, and activities of daily living following shoulder arthroplasty depends on the type of outcome measure used. All three measures, the American Shoulder and Elbow Surgery, absolute and relative Constant Murley Score, and Western Ontario Osteoarthritis of the Shoulder, demonstrated good to excellent accuracy and optimal standardized response means.
Level III, Retrospective Cohort study.
对于参与晚期盂肱关节骨关节炎患者护理的临床医生而言，在使用疗效指标时确定具有临床意义的变化非常重要。关于肩关节置换术后肩部疗效中显著临床获益的程度，相关信息较少。本研究的目的有两个：（1）量化美国肩肘外科评分、Constant Murley评分和西 Ontario 肩关节炎指数的显著临床获益；（2）提供这些指标在肩关节置换术后对变化的反应性和敏感性估计。
本研究涉及对先前收集数据的二次分析。基于与疼痛、活动范围和日常生活活动能力变化相关的外部锚定因素，计算这些指标的显著临床获益和反应性。曲线下面积和标准化反应均值代表对变化的反应性和敏感性。
回顾了159例和131例分别在6个月和2年时完成随访的患者数据。显著临床获益的程度取决于疗效指标和外部锚定因素，所有指标从6个月到2年都有所增加。6个月时反应性较高（曲线下面积>0.80），2年时进一步改善（曲线下面积>0.88）。两个时间点的标准化反应均值均超过2.00，表明效应量较大。Constant Murley评分的标准化反应均值在统计学上显著高于美国肩肘外科评分和西 Ontario 肩关节炎指数的标准化反应均值。
肩关节置换术后疼痛、活动范围和日常生活活动的显著临床改善程度取决于所使用的疗效指标类型。所有三个指标，即美国肩肘外科评分、绝对和相对Constant Murley评分以及西 Ontario 肩关节炎指数，均显示出良好至优异的准确性和最佳标准化反应均值。
III级，回顾性队列研究。
