上肢主要肿瘤手术后 DASH（手臂、肩部和手部残疾）结果测量的关键差异。
The critical difference in the DASH (Disabilities of the Arm, Shoulder, and Hand) outcome measure after essential upper extremity tumor surgery.
机构信息
Department of Surgery, Orthopaedic Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Department of Surgery, Orthopaedic Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
出版信息
J Shoulder Elbow Surg. 2021 Sep;30(9):e602-e609. doi: 10.1016/j.jse.2020.11.027. Epub 2021 Jan 20.
BACKGROUND
The DASH (Disabilities of the Arm, Shoulder, and Hand) is a scored questionnaire that is widely used to evaluate the health-related quality of life of patients with upper limb musculoskeletal disorders. However, numerical changes in the measure scores lack clinical significance without meaningful threshold change values of outcome measures that are diagnostically specific. The minimal clinically important difference (MCID) is useful for the interpretation of scores by defining the smallest change that a patient would perceive. However, the MCIDs of the scores in orthopedic oncology patients has not been reported. We aimed to determine the MCIDs of the measure in orthopedic oncology patients.
METHODS
Data from our health-related quality of life database from 1999 to 2005 were retrospectively reviewed after institutional review board approval. Seventy-eight patients who underwent surgery and completed 2 surveys during postoperative follow-up were evaluated. Two different methods were used to estimate the MCIDs: distribution-based and anchor-based approaches (the latter used receiver operating characteristic analysis).
RESULTS
Using distribution-based methods, the MCIDs of the DASH questionnaire were 7.4 and 8.3 by half standard deviation and the 90% interval of minimal detectable change, respectively. By anchor-based method (receiver operating characteristic analysis), the MCID was 8.3.
CONCLUSION
The MCID values calculated by each method validates that the results for upper extremity oncology patients were similar to those reported in other orthopedic conditions. These results identify the threshold for meaningful improvements in DASH scores in orthopedic oncology patients and establish the reference to evaluate health-related quality of life and the outcomes of upper extremity oncology surgery. These data should be further refined for disease- and reconstruction-specific analyses.
背景
DASH（手臂、肩和手残疾）是一种评分问卷，广泛用于评估上肢肌肉骨骼疾病患者的健康相关生活质量。然而，如果没有针对特定诊断的有意义的结果测量值的阈值变化，该测量的数值变化就缺乏临床意义。最小临床重要差异（MCID）对于通过定义患者感知到的最小变化来解释分数很有用。然而，尚未报道过骨科肿瘤患者评分的 MCID。我们旨在确定骨科肿瘤患者评分的 MCID。
方法
在获得机构审查委员会批准后，回顾性地审查了我们 1999 年至 2005 年健康相关生活质量数据库中的数据。评估了 78 例接受手术并在术后随访期间完成了 2 次调查的患者。使用了两种不同的方法来估计 MCID：基于分布的方法和基于锚定的方法（后者使用接收者操作特征分析）。
结果
使用基于分布的方法，DASH 问卷的 MCID 通过半标准差和最小可检测变化的 90%区间分别为 7.4 和 8.3。通过基于锚定的方法（接收者操作特征分析），MCID 为 8.3。
结论
每种方法计算的 MCID 值验证了上肢肿瘤患者的结果与其他骨科条件报告的结果相似。这些结果确定了上肢肿瘤患者 DASH 评分有意义改善的阈值，并建立了评估上肢肿瘤手术健康相关生活质量和结果的参考标准。这些数据应进一步细化，以进行疾病和重建特异性分析。
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