识别择期膝关节置换术后患者报告结局（PROMs）不同趋势的亚组患者。
Identifying patient subgroups with different trends of patient-reported outcomes (PROMs) after elective knee arthroplasty.
机构信息
Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum - University of Bologna, Via San Giacomo 12, Bologna, 40126, Italy.
IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, Bologna, 40136, Italy.
出版信息
BMC Musculoskelet Disord. 2023 Jun 3;24(1):453. doi: 10.1186/s12891-023-06373-2.
BACKGROUND
Patient-reported outcome measures (PROMs) are increasingly being used to assess the effectiveness of elective total knee arthroplasty (TKA). However, little is known about how PROMs scores change over time in these patients. The aim of this study was to identify the trajectories of quality of life and joint functioning, and their associated demographic and clinical features in patients undergoing elective TKA.
METHODS
A prospective, cohort study was conducted, in which PROMs questionnaires (Euro Quality 5 Dimensions 3L, EQ-5D-3L, and Knee injury and Osteoarthritis Outcome Score Patient Satisfaction, KOOS-PS) were administered to patients at a single center undergoing elective TKA before surgery, and at 6 and 12 months after surgery. Latent class growth mixture models were used to analyze the patterns of change in PROMs scores over time. Multinomial logistic regression was used to investigate the association between patient characteristics and PROMs trajectories.
RESULTS
A total of 564 patients were included in the study. The analysis highlighted differential patterns of improvement after TKA. Three distinct PROMs trajectories were identified for each PROMs questionnaire, with one trajectory indicating the most favorable outcome. Female gender appears to be associated with a presentation to surgery with worse perceived quality of life and joint function than males, but also more rapid improvement after surgery. Having an ASA score greater than 3 is instead associated with a worse functional recovery after TKA.
CONCLUSION
The results suggest three main PROMs trajectories in patients undergoing elective TKA. Most patients reported improved quality of life and joint functioning at 6 months, which then stabilized. However, other subgroups showed more varied trajectories. Further research is needed to confirm these findings and to explore the potential clinical implications of these results.
背景
患者报告的结局测量（PROMs）越来越多地被用于评估择期全膝关节置换术（TKA）的效果。然而，对于这些患者的 PROMs 评分随时间的变化知之甚少。本研究旨在确定接受择期 TKA 的患者生活质量和关节功能的轨迹及其相关的人口统计学和临床特征。
方法
进行了一项前瞻性队列研究，在单一中心对接受择期 TKA 的患者在术前、术后 6 个月和 12 个月进行 PROMs 问卷（欧洲健康五个维度 3L 量表，EQ-5D-3L，膝关节损伤和骨关节炎结果评分患者满意度，KOOS-PS）。使用潜在类别增长混合模型分析 PROMs 评分随时间的变化模式。使用多项逻辑回归来研究患者特征与 PROMs 轨迹之间的关联。
结果
共纳入 564 例患者。分析突出了 TKA 后改善的不同模式。每个 PROMs 问卷都确定了三种不同的 PROMs 轨迹，其中一种轨迹表示最佳结局。女性性别似乎与比男性更差的生活质量和关节功能有关，但手术后的改善也更快。ASA 评分大于 3 与 TKA 后功能恢复较差有关。
结论
结果表明，接受择期 TKA 的患者有三种主要的 PROMs 轨迹。大多数患者在术后 6 个月报告生活质量和关节功能改善，然后稳定。然而，其他亚组显示出更多不同的轨迹。需要进一步研究来证实这些发现，并探讨这些结果的潜在临床意义。
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