外周动脉疾病或糖尿病导致的主要下肢截肢的患者报告结局测量指标：系统评价。
Patient Reported Outcome Measures for Major Lower Limb Amputation Caused by Peripheral Artery Disease or Diabetes: A Systematic Review.
机构信息
Centre for Surgical Research, University of Bristol, UK; North Bristol NHS Trust, Bristol, UK.
Centre for Surgical Research, University of Bristol, UK; North Bristol NHS Trust, Bristol, UK.
出版信息
Eur J Vasc Endovasc Surg. 2021 Mar;61(3):491-501. doi: 10.1016/j.ejvs.2020.11.043. Epub 2020 Dec 30.
OBJECTIVE
Most major lower limb amputations are related to peripheral artery disease (PAD) or diabetes. Just 40% of patients who undergo major lower limb amputation will use a prosthesis yet measures of surgical success commonly focus on prosthesis use. Patient reported outcome measures (PROMs) are valuable to comprehensively evaluate health related quality of life (HRQL) after surgery. This systematic review aimed to identify and describe PROMs available to assess HRQL in patients after amputation for PAD or diabetes.
METHODS
A search was conducted based on the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) for systematic reviews of PROMs. Ovid MEDLINE, Ovid EMBASE, PsycINFO, CINAHL, and Cochrane CENTRAL were also searched from inception until August 2019. Included were articles describing the development, measurement properties, or evaluation of HRQL via a PROM in adult patients after amputation for PAD or diabetes. Studies of amputation exclusively for trauma or malignancy were excluded. Data were collected on study characteristics, PROM characteristics (generic/disease specific), and properties of amputation specific PROMs.
RESULTS
Of 3 317 abstracts screened, 111 full text articles were assessed for eligibility and 64 included. Fifty-six studies evaluated HRQL, with 23 (46%) of these using an amputation specific PROM to do so. Eleven different amputation specific PROMs were identified, 10 (91%) of which were developed only for prosthesis users. One measure was suitable for use in all patients after amputation. This "Amputee single item mobility measure" includes a single item evaluating mobility. Nine studies reported some psychometric testing of an amputation specific PROM.
CONCLUSION
A well tested, multidimensional PROM applicable to wheelchair and prosthetic users after amputation is lacking and urgently needed for studies in this field. Future work to develop an appropriate measure is required.
目的
大多数主要下肢截肢与外周动脉疾病（PAD）或糖尿病有关。只有 40%接受大截肢的患者会使用假肢，但手术成功的衡量标准通常侧重于假肢的使用。患者报告的结果测量（PROM）对于全面评估手术后与健康相关的生活质量（HRQL）非常有价值。本系统评价旨在确定和描述可用于评估 PAD 或糖尿病截肢患者 HRQL 的 PROM。
方法
根据共识基础选择健康测量工具（COSMIN）的系统评价，对 PROM 进行了搜索。还在 Ovid MEDLINE、Ovid EMBASE、PsycINFO、CINAHL 和 Cochrane CENTRAL 上进行了搜索，时间从创建到 2019 年 8 月。纳入的文章描述了通过 PROM 在接受 PAD 或糖尿病截肢的成年患者中评估 HRQL 的发展、测量特性或评估。专门用于创伤或恶性肿瘤的截肢研究被排除在外。收集了研究特征、PROM 特征（通用/疾病特异性）和截肢特异性 PROM 特性的数据。
结果
在筛选的 3317 篇摘要中，有 111 篇全文文章符合纳入标准，并进行了评估，其中 64 篇纳入。56 项研究评估了 HRQL，其中 23 项（46%）使用截肢特异性 PROM 进行评估。确定了 11 种不同的截肢特异性 PROM，其中 10 种（91%）仅为使用假肢的患者开发。有一种测量方法适用于所有截肢后的患者。这种“截肢者单项移动性测量”包括评估移动性的单项。有 9 项研究报告了对截肢特异性 PROM 的一些心理测试。
结论
缺乏经过充分测试、适用于截肢后轮椅和假肢使用者的多维 PROM，这是该领域研究急需的。需要开展进一步的工作来开发合适的测量方法。
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