Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
Dept General Practice, Erasmus University Medical Center, Rotterdam, The Netherlands.
Br J Sports Med. 2022 Dec;56(24):1432-1444. doi: 10.1136/bjsports-2022-105497. Epub 2022 Aug 16.
We synthesised and assessed credibility (ie, trustworthiness) of thresholds that define meaningful scores for patient-reported outcome measures (PROMs) following interventions for anterior cruciate ligament (ACL) tear or traumatic meniscus injury.
Systematic review, narrative synthesis.
We searched five databases, handsearched references of included studies and tracked citations.
Included studies investigated: individuals with ACL tear or meniscus injury; mean age <35 years; and PROM thresholds calculated using any method to define a minimal important change (MIC) or a meaningful post-treatment score (Patient Acceptable Symptom State (PASS) or Treatment Failure).
We included 18 studies (15 ACL, 3 meniscus). Three different methods were used to calculate anchor-based MICs across 9 PROMs, PASS thresholds across 4 PROMs and treatment failure for 1 PROM. Credibility was rated 'high' for only one study-an MIC of 18 for the Knee injury and Osteoarthritis Outcome Score Quality-of-life (KOOS-QOL) subscale (using the MID Credibility Assessment Tool). Where multiple thresholds were calculated among 'low' credibility thresholds in ACL studies, MICs converged to within a 10-point range for KOOS-Symptoms (-1.2 to 5.4) and function in daily living (activities of daily living, ADL 0.5-8.1) subscales, and the International Knee Documentation Committee Subjective Knee Form (7.1-16.2). Other PROM thresholds differed up to 30 points. PASS thresholds converged to within a 10-point range in KOOS-ADL for ACL tears (92.3-100), and KOOS-Symptoms (73-78) and KOOS-QOL (53-57) in meniscus injuries.
Meaningful PROM thresholds were highly susceptible to study heterogeneity. While PROM thresholds can aid interpretability in research and clinical practice, they should be cautiously interpreted.
我们综合评估了用于定义前交叉韧带（ACL）撕裂或外伤性半月板损伤干预后患者报告结局测量（PROM）有意义评分的阈值的可信度（即可信度）。
系统评价，叙述性综合。
我们搜索了五个数据库，对手头研究的参考文献进行了手工搜索，并跟踪了引文。
入选研究纳入了 ACL 撕裂或半月板损伤的个体；平均年龄<35 岁；并且使用任何方法计算出最小有意义变化（MIC）或有意义的治疗后评分（患者可接受症状状态（PASS）或治疗失败）的 PROM 阈值。
我们纳入了 18 项研究（15 项 ACL，3 项半月板）。有 9 种 PROM 使用了 3 种不同的方法来计算基于锚定的 MIC，4 种 PROM 使用了 PASS 阈值，1 种 PROM 使用了治疗失败。仅有一项研究的可信度被评为“高”——膝关节损伤和骨关节炎结局评分生活质量（KOOS-QOL）亚量表的 18 分 MIC（使用 MID 可信度评估工具）。在 ACL 研究中，多个阈值的可信度较低，KOOS-症状（-1.2 至 5.4）和日常生活活动（ADL 0.5-8.1）功能子量表的 MIC 收敛到 10 分以内，国际膝关节文献委员会主观膝关节评分（7.1-16.2）。其他 PROM 阈值差异最大可达 30 分。在 ACL 撕裂的 KOOS-ADL 中，PASS 阈值收敛到 10 分以内（92.3-100），在 ACL 撕裂的 KOOS-症状（73-78）和 KOOS-QOL（53-57）中也是如此。
有意义的 PROM 阈值高度易受研究异质性的影响。虽然 PROM 阈值可以帮助在研究和临床实践中解释，但应谨慎解释。
