Department of Anesthesiology, Flinders Medical Centre, Adelaide, South Australia, Australia.
College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
Health Qual Life Outcomes. 2023 May 10;21(1):41. doi: 10.1186/s12955-023-02126-w.
PURPOSE: To evaluate the Oxford Knee Score (OKS), EQ-5D-5L utility index and EQ-5D visual analogue scale (EQ-VAS) for health-related quality of life outcome measurement in patients undergoing elective total knee arthroplasty (TKA) surgery. METHODS: In this prospective multi-centre study, the OKS and EQ-5D-5L index scores were collected preoperatively, six weeks (6w) and six months (6 m) following TKA. The OKS, EQ-VAS and EQ-5D-5L index were evaluated for minimally important difference (MID), concurrent validity, predictive validity (Spearman's Rho of predicted and observed values from a generalised linear regression model (GLM)), responsiveness (effect size (ES) and standard response mean (SRM)). The MID for the individual patient was determined utilising two approaches; distribution-based and anchor-based. RESULTS: 533 patients were analysed. The EQ-5D-5L utility index showed good concurrent validity with the OKS (r = 0.72 preoperatively, 0.65 at 6w and 0.69 at 6 m). Predictive validity for the EQ-5D-5L index was lower than OKS when regressed. Responsiveness was large for all fields at 6w for the EQ-5D-5L and OKS (EQ-5D-5L ES 0.87, SRM 0.84; OKS ES 1.35, SRM 1.05) and 6 m (EQ-5D-5L index ES 1.31, SRM 0.95; OKS ES 1.69, SRM 1.59). The EQ-VAS returned poorer results, at 6w an ES of 0.37 (small) and SRM of 0.36 (small). At 6 m, the EQ-VAS had an ES of 0.59 (moderate) and SRM of 0.47 (small). It, however, had similar predictive validity to the OKS, and better than the EQ-5D-5L index. MID determined using anchor approach, was shown that for OKS at 6 weeks it was 8.84 ± 9.28 and at 6 months 13.37 ± 9.89. For the EQ-5D-5L index at 6 weeks MID was 0.23 ± 0.39, and at 6 months 0.26 ± 0.36. CONCLUSIONS: The EQ-5D-5L index score and the OKS demonstrate good concurrent validity. The EQ-5D-5L index demonstrated lower predictive validity at 6w, and 6 m than the OKS, and both PROMs had adequate responsiveness. The EQ-VAS had poorer responsiveness but better predictive validity than the EQ-5D-5L index. This article includes MID estimates for the Australian knee arthroplasty population.
目的：评估牛津膝关节评分（OKS）、EQ-5D-5L 效用指数和 EQ-5D 视觉模拟量表（EQ-VAS）在接受择期全膝关节置换术（TKA）的患者中测量与健康相关的生活质量结局。
方法：在这项前瞻性多中心研究中，在 TKA 术前、术后 6 周（6w）和 6 个月（6m）收集 OKS 和 EQ-5D-5L 指数评分。评估 OKS、EQ-VAS 和 EQ-5D-5L 指数的最小重要差异（MID）、同时效度、预测效度（广义线性回归模型（GLM）中预测值和观察值之间的 Spearman 相关系数）、反应性（效应量（ES）和标准反应均值（SRM））。使用两种方法（基于分布和基于锚定的方法）确定个体患者的 MID。
结果：分析了 533 名患者。EQ-5D-5L 效用指数与 OKS 具有良好的同时效度（术前 r=0.72，6w 时 r=0.65，6m 时 r=0.69）。EQ-5D-5L 指数回归时的预测效度较低。EQ-5D-5L 和 OKS 在 6w 时（EQ-5D-5L ES 0.87，SRM 0.84；OKS ES 1.35，SRM 1.05）和 6m（EQ-5D-5L 指数 ES 1.31，SRM 0.95；OKS ES 1.69，SRM 1.59）时的所有领域均具有较大的反应性。EQ-VAS 的结果较差，6w 时 ES 为 0.37（小），SRM 为 0.36（小）。在 6m 时，EQ-VAS 的 ES 为 0.59（中等），SRM 为 0.47（小）。然而，它与 OKS 具有相似的预测效度，优于 EQ-5D-5L 指数。使用锚定方法确定的 MID 表明，OKS 在 6 周时为 8.84±9.28，在 6 个月时为 13.37±9.89。对于 EQ-5D-5L 指数，6 周时的 MID 为 0.23±0.39，6 个月时为 0.26±0.36。
结论：EQ-5D-5L 指数评分和 OKS 表现出良好的同时效度。EQ-5D-5L 指数在 6w 和 6m 时的预测效度均低于 OKS，两种 PROMs 均具有足够的反应性。EQ-VAS 的反应性较差，但预测效度优于 EQ-5D-5L 指数。本文包括澳大利亚膝关节置换人群的 MID 估计值。
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