Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, New York, USA.
Am J Sports Med. 2020 Nov;48(13):3280-3287. doi: 10.1177/0363546520960461. Epub 2020 Oct 19.
Threshold values for patient-reported outcome measures, such as the minimum clinically important difference (MCID) and patient acceptable symptomatic state (PASS), are important for relating postoperative outcomes to meaningful functional improvement.
To determine the PASS and MCID after hip arthroscopy for femoroacetabular impingement using the Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaire.
Cohort study (diagnosis); Level of evidence, 3.
A consecutive series of patients undergoing primary hip arthroscopy for femoroacetabular impingement were administered preoperative and minimum 1-year postoperative PROMIS surveys focusing on physical function (PF) and pain interference (PI). External anchor questions for the MCID and PASS were given with the postoperative PROMIS survey. Receiver operator curves were constructed to determine the threshold values for the MCID and PASS. Curves were generated for the study population as well as separate cohorts segregated by median baseline PF or PI scores and preoperative athletic participation. A multivariate post hoc analysis was then constructed to evaluate factors associated with achieving the PASS or MCID.
There were 113 patients (35% male; mean ± SD age, 32.8 ± 12.5 years; body mass index, 25.8 ± 4.8 kg/m), with 60 (53%) reporting preoperative athletic participation. Survey time averaged 77.5 ± 49.2 seconds. Anchor-based MCID values were 5.1 and 10.9 for the PF and PI domains, respectively. PASS thresholds were 51.8 and 51.9 for the PF and PI, respectively. PASS values were not affected by baseline scores, but athletic patients had a higher PASS threshold than did those not participating in a sport (53.1 vs 44.7). MCID values were affected by preoperative baseline scores but were largely independent of sports participation. A post hoc analysis found that 94 (83%) patients attained the MCID PF while 66 (58%) attained the PASS PF. A multivariate nominal logistic regression found that younger patients ( = .01) and athletic patients ( = .003) were more likely to attain the PASS.
The PROMIS survey is an efficient metric to evaluate preoperative disability and postoperative function after primary hip arthroscopy for femoroacetabular impingement. The MCID and PASS provide surgeons with threshold values to help determine PROMIS scores that are clinically meaningful to patients, and they can assist with therapeutic decision making as well as expectation setting.
患者报告结局测量（如最小临床重要差异（MCID）和患者可接受的症状状态（PASS））的阈值对于将术后结果与有意义的功能改善相关联非常重要。
使用患者报告结局测量信息系统（PROMIS）问卷确定髋关节镜检查治疗股骨髋臼撞击症后的 PASS 和 MCID。
队列研究（诊断）；证据水平，3 级。
对连续系列接受初次髋关节镜治疗股骨髋臼撞击症的患者进行了术前和至少 1 年的术后 PROMIS 调查，重点关注躯体功能（PF）和疼痛干扰（PI）。在术后 PROMIS 调查中给出了 MCID 和 PASS 的外部锚定问题。构建受试者工作特征曲线以确定 MCID 和 PASS 的阈值。为研究人群以及按中位数基线 PF 或 PI 评分和术前运动参与情况分层的单独队列生成了曲线。然后进行了多变量事后分析，以评估与达到 PASS 或 MCID 相关的因素。
共有 113 例患者（35%为男性；平均±标准差年龄为 32.8±12.5 岁；体重指数为 25.8±4.8kg/m2），其中 60 例（53%）报告术前运动参与。调查时间平均为 77.5±49.2 秒。基于锚定的 MCID 值分别为 PF 和 PI 域的 5.1 和 10.9。PASS 阈值分别为 PF 和 PI 的 51.8 和 51.9。PASS 值不受基线评分的影响，但运动患者的 PASS 阈值高于不参加运动的患者（53.1 比 44.7）。MCID 值受术前基线评分的影响，但在很大程度上独立于运动参与。事后分析发现，94 例（83%）患者达到了 PF 的 MCID，而 66 例（58%）患者达到了 PF 的 PASS。多变量名义逻辑回归发现，年轻患者（P=.01）和运动患者（P=.003）更有可能达到 PASS。
PROMIS 调查是评估原发性髋关节镜治疗股骨髋臼撞击症术前残疾和术后功能的有效指标。MCID 和 PASS 为外科医生提供了阈值，以帮助确定对患者有临床意义的 PROMIS 评分，并有助于治疗决策和期望设定。
