University of Rochester School of Medicine and Dentistry.
Department of Orthopaedics and Physical Performance, University of Rochester Medical Center, Rochester, NY.
J Hand Surg Am. 2021 Jun;46(6):445-453. doi: 10.1016/j.jhsa.2021.02.011. Epub 2021 Apr 8.
We sought to determine whether subjective clinical improvement immediately after carpal tunnel release (CTR) was captured by Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity (UE), Physical Function (PF), Pain Interference (PI), and Depression.
Between September 2018 and January 2020, patients presenting to a single academic medical center hand clinic were asked to complete PROMIS UE, PF, PI, and Depression computer adaptive tests. In addition, patients who had CTR were asked to answer the following at their first postoperative clinic visit: "Since my last clinic visit, my condition is: (1) much better; (2) mildly better; (3) no change; (4) mildly worse; (5) much worse." For each patient, the last clinic visit was the final preoperative visit. The PROMIS domain scores were compared before and after surgery using paired t tests. The percentage of patients subjectively reporting better symptoms was calculated.
A total of 156 patients fit our inclusion criteria. The average number of days between the final preoperative visit and CTR was 7 (range, 0-30), and the average number of days between CTR and the first postoperative visit was 9 (range, 3-21). A total of 116 patients (74%) reported their carpal tunnel syndrome was better at their first postoperative visit. However, PROMIS UE, PF, and PI scores were significantly worse at the first postoperative visit, although not at clinically appreciable levels. There was no statistical or clinical difference in PROMIS Depression scores from pre- to postoperative time points.
Nearly 75% of patients subjectively report their carpal tunnel syndrome is better at their first follow-up visit within 3 weeks of CTR; however, PROMIS does not capture this improvement.
Hand surgeons evaluating patients shortly following CTR should be aware of the potential limitation of PROMIS to accurately capture immediate postoperative clinical outcomes. Disease-specific Patient-Reported Outcome Measures, such as the Boston Carpal Tunnel Questionnaire, may be preferred during this immediate postoperative timeframe.
我们旨在确定腕管松解术后（CTR）即刻的主观临床改善是否能被患者报告的结局测量信息系统（PROMIS）上肢（UE）、躯体功能（PF）、疼痛干扰（PI）和抑郁维度捕捉。
2018 年 9 月至 2020 年 1 月，向在单一家属医学中心手诊所就诊的患者询问是否完成 PROMIS UE、PF、PI 和抑郁计算机自适应测试。此外，还要求接受 CTR 的患者在首次术后就诊时回答以下问题：“自上次就诊以来，我的病情是：（1）好很多；（2）稍有改善；（3）无变化；（4）稍有恶化；（5）差很多。”对于每位患者，末次就诊为最后一次术前就诊。使用配对 t 检验比较患者术前和术后的 PROMIS 域评分。计算主观报告症状改善的患者比例。
共纳入 156 例患者，末次术前就诊与 CTR 之间的平均天数为 7 天（范围 0-30 天），CTR 与首次术后就诊之间的平均天数为 9 天（范围 3-21 天）。首次术后就诊时，共有 116 例（74%）患者报告其腕管综合征症状有所改善。然而，UE、PF 和 PI 评分在首次术后就诊时显著下降，尽管没有达到临床可察觉的水平。从术前到术后时间点，PROMIS 抑郁评分没有统计学或临床差异。
近 75%的患者在 CTR 后 3 周内的首次随访中主观报告其腕管综合征有所改善；然而，PROMIS 并未捕捉到这一改善。
在 CTR 后不久评估患者的手外科医生应意识到 PROMIS 可能无法准确捕捉术后即刻的临床结果。在此术后即刻时间段内，可能更倾向于使用特定于疾病的患者报告结局测量工具，如波士顿腕管问卷。
