Midwest Orthopaedics at Rush, Chicago, IL, USA.
Midwest Orthopaedics at Rush, Chicago, IL, USA.
J Shoulder Elbow Surg. 2021 Oct;30(10):2231-2239. doi: 10.1016/j.jse.2021.03.147. Epub 2021 Apr 18.
Since its introduction, the Patient-Reported Outcomes Measurement Information System Upper Extremity (PROMIS UE) assessment has been increasingly used in shoulder arthroplasty outcome measurement. However, determination of clinically significant outcomes using the PROMIS UE has yet to be investigated following reverse total shoulder arthroplasty (RTSA). We hypothesized that we could establish clinically significant outcomes of the PROMIS UE outcome assessment in patients undergoing primary RTSA and identify significant baseline patient factors associated with achievement of these measures.
Consecutive patients undergoing primary RTSA between 2018 and 2019 who received preoperative baseline and follow-up PROMIS UE assessments at 12 months after surgery were retrospectively reviewed. Domain-specific anchor questions pertaining to pain and function assessed at 12 months after surgery were used to determine minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) values for the PROMIS UE using receiver operating characteristic curve and area-under-the-curve (AUC) analysis. Univariate logistic regression analysis was then performed to identify significant patient factors associated with achieving the MCID, SCB, or PASS.
A total of 95 patients met all inclusion criteria and were included in the analysis. By use of an anchor-based method, the PASS value was 36.68 (sensitivity, 0.795; specificity, 0.765; AUC, 0.793) and the SCB value was 11.62 (sensitivity, 0.597; specificity, 1.00; AUC, 0.806). By use of a distribution-based method, the MCID value was calculated to be 4.27. Higher preoperative PROMIS UE scores were a positive predictor in achievement of the PASS (odds ratio [OR], 1.107; P = .05), whereas lower preoperative PROMIS UE scores were associated with obtaining SCB (OR, 0.787; P < .001). Greater baseline forward flexion was negatively associated with achievement of the PASS (OR, 0.986; P = .033) and MCID (OR, 0.976, P = .013). Of the patients, 83.2%, 69.5%, and 47.4% achieved the MCID, PASS, and SCB, respectively.
This study defines the MCID, SCB, and PASS for the PROMIS UE outcome assessment in patients undergoing primary RTSA, of whom the majority achieved meaningful outcome improvement at 12 months after surgery. These values may be used in assessing the outcomes and extent of functional improvement following RTSA.
自引入以来，患者报告的结果测量信息系统上肢（PROMIS UE）评估已越来越多地用于肩部关节置换术后的结果测量。然而，在接受反向全肩关节置换术（RTSA）后，使用 PROMIS UE 确定临床显著结果尚未得到研究。我们假设，我们可以确定接受原发性 RTSA 的患者的 PROMIS UE 结果评估的临床显著结果，并确定与这些指标的实现相关的重要基线患者因素。
回顾性分析了 2018 年至 2019 年期间接受原发性 RTSA 且在术后 12 个月接受术前基线和随访 PROMIS UE 评估的连续患者。使用与术后 12 个月的疼痛和功能相关的特定域锚定问题，使用接收者操作特征曲线和曲线下面积（AUC）分析确定 PROMIS UE 的最小临床重要差异（MCID）、显著临床获益（SCB）和患者可接受的症状状态（PASS）值。然后进行单变量逻辑回归分析，以确定与实现 MCID、SCB 或 PASS 相关的重要患者因素。
共有 95 名患者符合所有纳入标准，并纳入分析。使用基于锚定的方法，PASS 值为 36.68（敏感性，0.795；特异性，0.765；AUC，0.793），SCB 值为 11.62（敏感性，0.597；特异性，1.00；AUC，0.806）。使用基于分布的方法，计算出 MCID 值为 4.27。较高的术前 PROMIS UE 评分是实现 PASS 的正预测因子（比值比[OR]，1.107；P =.05），而较低的术前 PROMIS UE 评分与获得 SCB 相关（OR，0.787；P <.001）。基线时更大的前屈与实现 PASS（OR，0.986；P =.033）和 MCID（OR，0.976，P =.013）的能力降低相关。在这些患者中，83.2%、69.5%和 47.4%分别达到了 MCID、PASS 和 SCB。
本研究确定了接受原发性 RTSA 的患者的 PROMIS UE 结果评估的 MCID、SCB 和 PASS，其中大多数患者在手术后 12 个月后实现了有意义的结果改善。这些值可用于评估 RTSA 后的结果和功能改善程度。
