全髋关节置换术后 1 年达到 EuroQol-5 维度患者可接受症状状态的外部验证。
External Validation of Achieving the Patient Acceptable Symptom State for the EuroQol-5 Dimension 1 Year After Total Hip Arthroplasty.
机构信息
Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts.
Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark.
出版信息
J Bone Joint Surg Am. 2021 Jan 20;103(2):e5. doi: 10.2106/JBJS.20.00184.
BACKGROUND
Patient acceptable symptom state (PASS) thresholds for the EuroQol-5 Dimension-3 Level (EQ-5D-3L) questionnaire have been established for patients being evaluated 1 year following total hip arthroplasty (THA) but with varying derivation cohorts and methods. The aim of this study was to (1) generate an EQ-5D PASS threshold 1 year following THA on the basis of an international patient cohort, (2) validate preexisting and newly generated PASS thresholds 1 year following THA using the institutional registry of an academic care center, and (3) assess whether THA PASS thresholds vary by patient age and sex.
METHODS
The derivation cohort for the THA PASS threshold consisted of 774 patients (after exclusions) who were enrolled in an international, multicenter study from 2007 to 2012 and who completed the EQ-5D and a numerical rating scale (NRS) for satisfaction 1 year postoperatively. With the NRS dichotomized at 2.5 as the anchor, a PASS cutoff for the EQ-5D was generated using the 80% specificity method. The Youden method and 75th percentile approach served as sensitivity analyses. The external validation cohort comprised 1,472 patients who had undergone THA. PASS thresholds were used to dichotomize the external validation sample. The ability of the threshold to predict satisfaction was evaluated with receiver operating characteristic (ROC) curve analysis. Patient subcohorts were stratified by age (>65 and ≤65 years) and sex.
RESULTS
Three THA PASS thresholds of 0.77 (our newly defined threshold), 0.82, and 0.92 were validated in this study. The EQ-5D PASS threshold of 0.77 (area under the curve [AUC] = 0.816) best predicted satisfaction 1 year after THA. Subcohort analyses yielded comparable 1-year PASS thresholds for THA between age cohorts and between sex cohorts.
CONCLUSIONS
This study identifies PASS thresholds that best predict patient satisfaction 1 year following THA. Although the varied methodology and patient cohorts used to derive PASS values complicate the comparison of these thresholds, this analysis can help surgeons understand the level of health-related quality of life associated with patient satisfaction following THA.
LEVEL OF EVIDENCE
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
背景
已经为接受全髋关节置换术（THA）治疗 1 年的患者建立了 EuroQol-5 维度-3 级（EQ-5D-3L）问卷的可接受症状状态（PASS）阈值，但不同的衍生队列和方法。本研究的目的是：（1）基于国际患者队列生成 THA 后 1 年的 EQ-5D PASS 阈值；（2）使用学术护理中心的机构登记处验证 THA 后 1 年的现有和新生成的 PASS 阈值；（3）评估 THA PASS 阈值是否因患者年龄和性别而异。
方法
THA PASS 阈值的推导队列包括 774 名患者（排除后），他们于 2007 年至 2012 年参加了一项国际多中心研究，并在术后 1 年完成了 EQ-5D 和数字评分量表（NRS）用于满意度。使用 NRS 二分法 2.5 作为锚点，使用 80%特异性方法生成 EQ-5D 的 PASS 截止值。Youden 方法和第 75 百分位法作为敏感性分析。外部验证队列包括 1472 名接受 THA 的患者。使用 PASS 阈值对外部验证样本进行二分。使用接受者操作特征（ROC）曲线分析评估阈值预测满意度的能力。根据年龄（>65 岁和≤65 岁）和性别对患者亚组进行分层。
结果
本研究验证了三个 THA PASS 阈值，分别为 0.77（我们新定义的阈值）、0.82 和 0.92。THA 后 1 年，EQ-5D PASS 阈值为 0.77（曲线下面积[AUC]=0.816）可最好预测满意度。亚组分析显示，在年龄队列和性别队列之间，THA 的 1 年 PASS 阈值相似。
结论
本研究确定了预测 THA 后 1 年患者满意度的最佳 PASS 阈值。尽管用于推导 PASS 值的方法和患者队列各不相同，这使得这些阈值的比较变得复杂，但本分析可以帮助外科医生了解与 THA 后患者满意度相关的健康相关生活质量水平。
证据水平
治疗水平 IV。有关证据水平的完整描述，请参阅作者说明。
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