Bodendorfer Blake M, DeFroda Steven F, Clapp Ian M, Newhouse Alexander, Nwachukwu Benedict U, Nho Shane J
Department of Orthopaedic Surgery, Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois, USA.
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA.
Am J Sports Med. 2021 Jul;49(9):2457-2465. doi: 10.1177/03635465211015687. Epub 2021 Jun 7.
Although minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and substantial clinical benefit (SCB) have been defined for hip-specific legacy patient-reported outcome measures, these metrics have not been defined for the Patient-Reported Outcomes Measurement Information System (PROMIS) instruments for patients undergoing hip arthroscopy.
To define the MCID, PASS, and SCB thresholds for the PROMIS Physical Function (PF) computerized adaptive test (CAT) and PROMIS Pain Interference (PI) instruments in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS).
Cohort study (Diagnosis); Level of evidence, 2.
Patients undergoing primary hip arthroscopy between August 2018 and January 2019 for the treatment of FAIS were retrospectively analyzed. Patients were administered the PROMIS-PF, PROMIS-PI, Hip Outcome Score (HOS)-Activities of Daily Living, HOS-Sports Subscale, modified Harris Hip Score, and International Hip Outcome Tool-12 preoperatively and at 1 year postoperatively. MCID was calculated using the distribution method, whereas PASS and SCB were calculated using an anchor-based method. Patients achieving clinically significant outcomes (CSOs) were compared with those who did not achieve CSOs via chi-square and independent-samples tests, and a multivariate logistic regression was conducted to determine predictors of CSO achievement.
124 patients with a mean age of 32.7 ± 12.3 years were included in the analysis. The threshold scores required to achieve MCID, PASS, and SCB, respectively, were as follows: PROMIS-PI (-3.1, 53.7, 51.9) and PROMIS-PF (3.3, 47.0, 49.9). Patients achieved any MCID, PASS, and SCB for PROMIS scores at a rate of 89.0%, 71.8%, and 62.1%, respectively, compared with 87.1%, 76.6%, and 71.8% for legacy patient-reported outcome measurements. For PROMIS-PF, higher preoperative PROMIS-PF score was a positive predictor of CSO achievement, and patients achieving SCB were significantly younger (30.3 ± 12 vs 35.6 ± 12 years; = .017) with significantly lower body mass index (BMI) (24.7 ± 6.4 vs 27.9 ± 7; = .009). Preoperative chronic pain and history of orthopaedic surgery were negative predictors of PROMIS-PI CSO achievement, whereas higher (worse) preoperative PROMIS-PI scores were a positive predictor.
Our study defined the MCID, PASS, and SCB for the PROMIS-PF CAT and PROMIS-PI CAT at 1 year postoperatively. Patients with higher preoperative PROMIS scores, younger age, and lower BMI were more likely to achieve CSO, whereas preoperative chronic pain and history of orthopaedic surgery were negative predictors of CSO achievement.
尽管针对传统的髋关节特异性患者报告结局测量指标已经定义了最小临床重要差异（MCID）、患者可接受症状状态（PASS）和显著临床获益（SCB），但对于接受髋关节镜检查的患者，患者报告结局测量信息系统（PROMIS）工具尚未定义这些指标。
确定接受髋关节镜检查治疗股骨髋臼撞击综合征（FAIS）的患者中，PROMIS身体功能（PF）计算机自适应测试（CAT）和PROMIS疼痛干扰（PI）工具的MCID、PASS和SCB阈值。
队列研究（诊断）；证据等级，2级。
对2018年8月至2019年1月期间因治疗FAIS接受初次髋关节镜检查的患者进行回顾性分析。患者在术前和术后1年接受PROMIS-PF、PROMIS-PI、髋关节结局评分（HOS）-日常生活活动、HOS-运动亚量表、改良Harris髋关节评分和国际髋关节结局工具-12评估。使用分布法计算MCID，而使用基于锚定的方法计算PASS和SCB。通过卡方检验和独立样本检验比较达到临床显著结局（CSO）的患者与未达到CSO的患者，并进行多因素逻辑回归以确定CSO达成的预测因素。
124例平均年龄为32.7±12.3岁的患者纳入分析。达到MCID、PASS和SCB所需的阈值分数分别如下：PROMIS-PI（-3.1、53.7、51.9）和PROMIS-PF（3.3、47.0、49.9）。与传统患者报告结局测量指标的87.1%、76.6%和71.8%相比，患者达到PROMIS评分的任何MCID、PASS和SCB的比例分别为89.0%、71.8%和62.1%。对于PROMIS-PF，术前较高的PROMIS-PF评分是CSO达成的阳性预测因素，达到SCB的患者明显更年轻（30.3±12岁对35.6±12岁；P = 0.017），体重指数（BMI）明显更低（24.7±6.4对27.9±7；P = 0.009）。术前慢性疼痛和骨科手术史是PROMIS-PI CSO达成的阴性预测因素，而术前较高（更差）的PROMIS-PI评分是阳性预测因素。
我们的研究定义了术后1年PROMIS-PF CAT和PROMIS-PI CAT的MCID、PASS和SCB。术前PROMIS评分较高、年龄较小和BMI较低的患者更有可能实现CSO，而术前慢性疼痛和骨科手术史是CSO达成的阴性预测因素。
