Goh Graham S, Liow Ming Han Lincoln, Chen Jerry Yongqiang, Tay Darren Keng-Jin, Lo Ngai-Nung, Yeo Seng-Jin
Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore.
Knee Surg Sports Traumatol Arthrosc. 2023 Mar;31(3):1113-1122. doi: 10.1007/s00167-021-06592-x. Epub 2021 Apr 28.
The patient acceptable symptom state (PASS) is a target value on a patient-reported outcome measures (PROM) scale beyond which patients deem themselves to have attained an acceptable outcome. This study aimed to define the PASS thresholds for generic and knee-specific PROMs at 2 years after unicompartmental knee arthroplasty (UKA).
Prospectively collected data of 955 patients who underwent UKA for medial osteoarthritis at a single institution was reviewed. Patients were assessed preoperatively and 2 years postoperatively using the Knee Society Knee Score (KSKS), Function Score (KSFS), Oxford Knee Score (OKS), SF-36 Physical Component Score (PCS) and Mental Component Score (MCS). Responses to an anchor question assessing patients' overall rating of treatment results were dichotomized and used to determine if PASS was achieved. PASS thresholds for each PROM were selected based on the Youden index on a receiver operating characteristics (ROC) curve. Sensitivity analyses were performed for different subgroups (by age, gender, BMI), baseline score tertiles and an alternate definition of PASS.
In total, 92.7% reported their current state as acceptable. The areas under the curve (AUC) for ROCs were 0.72-0.83, except for the SF-36 PCS (AUC 0.64), indicating good discriminative accuracy of the other PROMs. PASS thresholds were 85.5 for KSKS, 77.5 for KSFS, 41.5 for OKS, 49.9 for SF-36 PCS and 54.6 for SF-36 MCS. Sensitivity analyses revealed that the thresholds were robust. Patients who attained a PASS were at least 4-5 times more likely to be satisfied and have expectations fulfilled.
PASS thresholds can be used to define treatment success in future outcome studies. At the individual level, they provide clinically relevant benchmarks for surgeons when assessing postoperative recovery.
III.
患者可接受症状状态（PASS）是患者报告结局测量（PROM）量表上的一个目标值，超过该值患者认为自己已获得可接受的结局。本研究旨在确定单髁膝关节置换术（UKA）后2年通用型和膝关节特异性PROM的PASS阈值。
回顾了在单一机构接受UKA治疗内侧骨关节炎的955例患者的前瞻性收集数据。术前和术后2年使用膝关节协会膝关节评分（KSKS）、功能评分（KSFS）、牛津膝关节评分（OKS）、SF-36身体成分评分（PCS）和精神成分评分（MCS）对患者进行评估。对评估患者治疗结果总体评分的锚定问题的回答进行二分法处理，并用于确定是否达到PASS。根据受试者工作特征（ROC）曲线上的约登指数选择每个PROM的PASS阈值。对不同亚组（按年龄、性别、BMI）、基线评分三分位数和PASS的另一种定义进行了敏感性分析。
总体而言，92.7%的患者报告其当前状态可接受。除SF-36 PCS（AUC为0.64）外，ROC曲线下面积（AUC）为0.72 - 0.83，表明其他PROM具有良好的判别准确性。KSKS的PASS阈值为85.5，KSFS为77.5，OKS为41.5，SF-36 PCS为49.9，SF-36 MCS为54.6。敏感性分析表明这些阈值具有稳健性。达到PASS的患者满意度和期望达成度至少高出4 - 5倍。
PASS阈值可用于在未来结局研究中定义治疗成功。在个体层面，它们为外科医生评估术后恢复提供了临床相关的基准。
III级。
