建立肱二头肌肌腱固定术后患者报告结局测量信息系统的临床显著结局。
Establishing Clinically Significant Outcomes for Patient-Reported Outcomes Measurement Information System After Biceps Tenodesis.
机构信息
Rush University Medical Center, Chicago, Illinois, U.S.A.
Rush University Medical Center, Chicago, Illinois, U.S.A..
出版信息
Arthroscopy. 2021 Jun;37(6):1731-1739. doi: 10.1016/j.arthro.2020.12.236. Epub 2021 Jan 13.
PURPOSE
To establish thresholds for improvement in patient-reported outcome scores that correspond with clinically significant outcomes (CSOs) including the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) for Patient-Reported Outcomes Measurement Information System (PROMIS) upper extremity (UE) computer adaptive testing (CAT) and pain interference (PIF) CAT after biceps tenodesis (BT) and to assess patient variables that are associated with achieving these outcomes.
METHODS
After institutional review board approval was obtained, a prospectively maintained institutional database was queried for patients undergoing BT between December 2017 and August 2019. Patients undergoing BT in isolation or BT in conjunction with rotator cuff debridement, SLAP repair, subacromial decompression, or distal clavicle excision were included in the analysis. Anchor- and distribution-based methods were used to calculate the MCID whereas an anchor-based method was used to calculate SCB and the PASS for PROMIS UE CAT and PIF CAT.
RESULTS
A total of 112 patients (86.8% follow-up) who underwent BT were included for analysis. The MCID, net SCB, absolute SCB, and PASS for PROMIS UE CAT were 4.02, 9.25, 43.4, and 41.1, respectively. The MCID, net SCB, absolute SCB, and PASS for PROMIS PIF CAT were -4.12, -10.7, 52.4, and 52.4, respectively. Higher preoperative UE CAT and PIF CAT scores, preoperative opioid use, depression, and living alone were negative predictors of CSO achievement. Male sex and regular participation in exercise were positive predictors of CSO achievement.
CONCLUSIONS
Patients with higher preoperative UE scores were less likely to achieve the MCID (odds ratio [OR], 0.84), whereas patients with higher preoperative PIF scores were less likely to achieve absolute SCB and the PASS (OR, 0.83-0.89). Most patients achieved the MCID for PIF CAT (70.5%) and UE CAT (62.5%) at final follow-up. Male sex (OR, 4.38-9.15) and regular exercise participation (OR, 6.45-18.94) positively predicted CSO achievement, whereas preoperative opioid use (OR, 0.06), depression (OR, 0.23), and living alone (OR, 0.90) were negative predictors of CSO achievement.
LEVEL OF EVIDENCE
Level IV, case series.
目的
为患者报告的结局测量信息系统（PROMIS）上肢（UE）计算机自适应测试（CAT）和疼痛干扰（PIF）CAT 后的二头肌固定术（BT）建立与临床显著结局（CSO）相关的改善阈值，包括最小临床重要差异（MCID）、实质性临床获益（SCB）和患者可接受的症状状态（PASS），并评估与实现这些结局相关的患者变量。
方法
在获得机构审查委员会批准后，对 2017 年 12 月至 2019 年 8 月期间接受 BT 的患者进行前瞻性维护的机构数据库进行了查询。纳入单独接受 BT 或与肩袖清创术、SLAP 修复、肩峰下减压术或锁骨远端切除术联合接受 BT 的患者。使用锚定和分布基础方法计算 MCID，而使用锚定方法计算 PROMIS UE CAT 和 PIF CAT 的 SCB 和 PASS。
结果
共纳入 112 例（86.8%随访）接受 BT 的患者进行分析。PROMIS UE CAT 的 MCID、净 SCB、绝对 SCB 和 PASS 分别为 4.02、9.25、43.4 和 41.1，PROMIS PIF CAT 的 MCID、净 SCB、绝对 SCB 和 PASS 分别为-4.12、-10.7、52.4 和 52.4。较高的术前 UE CAT 和 PIF CAT 评分、术前使用阿片类药物、抑郁和独居是 CSO 实现的负预测因子。男性和定期参加运动是 CSO 实现的正预测因子。
结论
术前 UE 评分较高的患者不太可能达到 MCID（比值比[OR]，0.84），而术前 PIF 评分较高的患者不太可能达到绝对 SCB 和 PASS（OR，0.83-0.89）。大多数患者在最终随访时达到了 PIF CAT（70.5%）和 UE CAT（62.5%）的 MCID。男性（OR，4.38-9.15）和定期运动参与（OR，6.45-18.94）是 CSO 实现的正预测因子，而术前使用阿片类药物（OR，0.06）、抑郁（OR，0.23）和独居（OR，0.90）是 CSO 实现的负预测因子。
证据水平
IV 级，病例系列。
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