The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD.
The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD; Georgetown University School of Medicine, Washington, DC.
J Hand Surg Am. 2024 Feb;49(2):185.e1-185.e7. doi: 10.1016/j.jhsa.2022.06.010. Epub 2022 Aug 5.
A patient-reported outcomes measure (PROM) is responsive if it is sensitive to clinical status changes. The minimal clinically important difference (MCID) is used to indicate meaningful change, helpful in designing studies and adding context to some study results, and is related to instrument responsiveness. Our purpose was to provide MCID estimates for the brief Michigan Hand Outcomes Questionnaire (bMHQ) and Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference (PI) in a hand and upper extremity surgery cohort within the context of varying patient-reported mental health.
Data were analyzed from 1,262 adult patients who received surgical care at a single center between January 1, 2018, and December 31, 2019. Patients completed PROMIS PI, PROMIS Global Health (including global mental health [GMH] component), bMHQ, and a pain-focused anchor question before each clinic visit. Data were collected 8 ± 2 weeks before and after surgery. A distribution-based MCID then was calculated for the general patient population, lowest 10th percentile of GMH scores, and top 10th percentile of GMH scores.
Minimal clinically important difference estimates were 10.4 for the bMHQ and 4.3 for PROMIS PI. Analysis of MCID across different GMH score groups showed a mean score of 11.5 for bMHQ for the lowest 10th percentile of GMH, 9.6 for bMHQ for the top 10th percentile, 4.5 for PI for the lowest 10th percentile, and 4.9 for PI for the top 10th percentile.
Analysis of subgroups stratified by preoperative patient-reported mental health condition found that preoperative mental health status, as indicated by GMH score, does not have a meaningful impact on responsiveness of bMHQ or PROMIS PI.
A patient's reported mental health condition does not meaningfully change how these common PRO instruments reflect the patient condition after hand and upper extremity surgery.
如果患者报告的结局测量（PROM）对临床状况变化敏感，则具有反应性。最小临床重要差异（MCID）用于表示有意义的变化，有助于研究设计，并为一些研究结果提供背景，且与仪器反应性有关。我们的目的是在不同患者报告的心理健康背景下，为手部和上肢手术患者中简短密歇根手结局问卷（bMHQ）和患者报告的测量信息系统（PROMIS）疼痛干扰（PI）提供 MCID 估计值。
分析了 2018 年 1 月 1 日至 2019 年 12 月 31 日期间在一家中心接受手术治疗的 1262 例成年患者的数据。患者在每次就诊前完成 PROMIS PI、PROMIS 全球健康（包括全球心理健康[GMH]成分）、bMHQ 和一个关注疼痛的锚定问题。数据在手术前 8±2 周和手术后收集。然后，为一般患者人群、GMH 评分最低的 10%和 GMH 评分最高的 10%计算基于分布的 MCID。
bMHQ 的 MCID 估计值为 10.4，PROMIS PI 的 MCID 估计值为 4.3。在不同 GMH 评分组中分析 MCID 显示，GMH 评分最低的 10%患者的 bMHQ 平均得分 11.5，GMH 评分最高的 10%患者的 bMHQ 平均得分 9.6，GMH 评分最低的 10%患者的 PI 平均得分 4.5，GMH 评分最高的 10%患者的 PI 平均得分 4.9。
按术前患者报告的心理健康状况进行亚组分析发现，术前心理健康状况（以 GMH 评分表示）对 bMHQ 或 PROMIS PI 的反应性没有明显影响。
患者报告的心理健康状况不会显著改变这些常见的 PRO 工具在手和上肢手术后如何反映患者状况。
