School of Public Health and Preventive Medicine and School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia.
South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
J Bone Joint Surg Am. 2022 Jun 1;104(11):980-987. doi: 10.2106/JBJS.21.00741. Epub 2022 Feb 22.
For patient-reported outcome measures (PROMs) to provide meaningful information to support clinical care, we need to understand the magnitude of change that matters to patients. The aim of this study was to estimate minimal clinically important changes (MCICs) for the 12-item Hip disability and Osteoarthritis Outcome Score (HOOS-12) and Knee injury and Osteoarthritis Outcome Score (KOOS-12) among people undergoing joint replacement for osteoarthritis.
Individual-level data from the Australian Orthopaedic Association National Joint Replacement Registry's pilot PROMs program were used for this analysis. Preoperative and 6-month postoperative HOOS-12 and KOOS-12 domain and summary impact scores plus a rating of patient-perceived change after surgery (on a 5-point scale ranging from "much worse" to "much better") were available. Three anchor-based approaches-mean change, receiver operating characteristics (ROC) based on Youden's J statistic, and predictive modeling using a binary logistic regression model-were used to calculate MCICs based on patient-perceived change.
Data were available for 1,490 patients treated with total hip replacement (THR) (mean age, 66 years; 54% female) and 1,931 patients treated with total knee replacement (TKR) (mean age, 66 years; 55% female). Using the mean change method, the MCIC ranged from 24.0 to 27.5 points for the HOOS-12 and 17.5 to 21.8 points for the KOOS-12. The ROC analyses generated comparable MCIC values (28.1 for HOOS-12 and a range of 15.6 to 21.9 for KOOS-12) with high sensitivity and specificity. Lower estimates were derived from predictive modeling following adjustment for the proportion of improved patients (range, 15.7 to 19.2 for HOOS-12 and 14.2 to 16.5 for KOOS-12).
We report MCIC values for the HOOS-12 and KOOS-12 instruments that we derived using 3 different methods. As estimates obtained using predictive modeling can be adjusted for the proportion of improved patients, these may be the most clinically applicable. These MCIC values can be used to interpret important changes in pain, function, and quality of life from the patient's perspective.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
为了使患者报告的结局测量（PROMs）能够为临床护理提供有意义的信息，我们需要了解对患者有重要意义的变化幅度。本研究旨在估计骨关节炎患者接受关节置换术后 12 项髋关节残疾和骨关节炎结局评分（HOOS-12）和膝关节损伤和骨关节炎结局评分（KOOS-12）的最小临床重要变化（MCICs）。
本分析使用了澳大利亚矫形协会全国关节置换登记处试点 PROMs 计划的个体水平数据。可获得术前和术后 6 个月的 HOOS-12 和 KOOS-12 域和综合影响评分，以及术后患者自我评估的变化评分（5 分制，范围为“差很多”到“好很多”）。基于患者自我评估的变化，使用 3 种基于锚定的方法（平均变化、基于 Youden 的 J 统计量的接收器工作特征（ROC）和使用二元逻辑回归模型的预测建模）来计算 MCIC。
共纳入 1490 例全髋关节置换术（THR）患者（平均年龄 66 岁，54%为女性）和 1931 例全膝关节置换术（TKR）患者（平均年龄 66 岁，55%为女性）。使用平均变化法，HOOS-12 的 MCIC 范围为 24.0 至 27.5 分，KOOS-12 的 MCIC 范围为 17.5 至 21.8 分。ROC 分析产生了具有较高灵敏度和特异性的类似 MCIC 值（HOOS-12 为 28.1，KOOS-12 为 15.6 至 21.9）。通过对改善患者比例进行调整后（HOOS-12 为 15.7 至 19.2，KOOS-12 为 14.2 至 16.5），预测模型得出了较低的估计值。
我们报告了使用 3 种不同方法得出的 HOOS-12 和 KOOS-12 仪器的 MCIC 值。由于基于预测建模的估计值可以调整改善患者的比例，因此这些值可能最具临床适用性。这些 MCIC 值可用于从患者角度解释疼痛、功能和生活质量的重要变化。
预后 III 级。有关证据水平的完整描述，请参阅作者说明。
