患者报告结局与韧带重建肌腱间置术患者满意度的关系。
The Relationship Between Patient-Reported Outcomes and Patient Satisfaction With Ligament Reconstruction Tendon Interposition.
机构信息
Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT.
Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT.
出版信息
J Hand Surg Am. 2023 Dec;48(12):1218-1228. doi: 10.1016/j.jhsa.2023.08.010. Epub 2023 Sep 22.
PURPOSE
Achieving the minimal clinically important difference (MCID) on an outcomes instrument and reporting satisfaction with surgical outcomes are not equivalent. We hypothesized that improvement exceeding the QuickDASH and PROMIS UE CAT MCID is associated with a greater likelihood of reporting satisfaction with ligament reconstruction tendon interposition (LRTI) treatment. Our secondary hypothesis was that a subset of patients failing to meet MCID would still be satisfied.
METHODS
Patients ≥1 year after LRTI at one academic tertiary institution were included. QuickDASH and UE CAT v1.2 scores were obtained before and after surgery. Postoperative satisfaction and levels of improvement in pain and function were also obtained.
RESULTS
A total of 93 patients completed the QuickDASH, and of those, 90 also completed the UE CAT. At a mean of 2.6 ± 1.0 years after surgery, QuickDASH and UE CAT score improvement exceeded the previously published MCID estimates of 8.8 and 4.8. Although 90% (84/93) of the patients reported satisfaction, only 85% (72/93) and 72% (59/90) achieved MCID on the QuickDASH and UE CAT, respectively. Using the MCID estimate of 8.8, 96% (72/75) of the patients meeting the MCID were satisfied with their treatment. Those failing to achieve MCID reported significantly less physical function and pain improvement; however, most were satisfied nonetheless (68% [13/19] for QuickDASH, 77% [23/30] for UE CAT).
CONCLUSIONS
Achieving published MCID thresholds on the QuickDASH and PROMIS UE CAT v1.2 was predictive of patients reporting general satisfaction with their LRTI outcome ≥1 year after surgery. Most patients failing to achieve MCID still reported satisfaction with their LRTI. Achieving MCID thresholds alone should not be used as a surrogate for patient satisfaction with their treatment. Patient satisfaction is a complicated construct that is potentially very different from that of high-quality care.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.
目的
在结局评估工具上达到最小临床重要差异（MCID）与报告对手术结局的满意度并不等同。我们假设，在 QuickDASH 和 PROMIS UE CAT 上的改善程度超过 MCID 与更有可能报告对韧带重建肌腱间置（LRTI）治疗满意相关。我们的次要假设是，未达到 MCID 的一部分患者仍会满意。
方法
纳入一家学术三级医疗机构 LRTI 后 1 年以上的患者。在术前和术后获得 QuickDASH 和 UE CAT v1.2 评分。还获得术后满意度以及疼痛和功能改善水平。
结果
共有 93 例患者完成了 QuickDASH，其中 90 例也完成了 UE CAT。在术后平均 2.6 ± 1.0 年后，QuickDASH 和 UE CAT 评分改善超过了之前发表的 MCID 估计值 8.8 和 4.8。尽管 90%（84/93）的患者报告了满意度，但只有 85%（72/93）和 72%（59/90）的患者在 QuickDASH 和 UE CAT 上达到 MCID。使用 MCID 估计值 8.8，达到 MCID 的 96%（72/75）的患者对其治疗满意。未达到 MCID 的患者报告的身体功能和疼痛改善明显较少；然而，大多数仍满意（QuickDASH 为 68%[13/19]，UE CAT 为 77%[23/30]）。
结论
在 QuickDASH 和 PROMIS UE CAT v1.2 上达到已发表的 MCID 阈值可预测患者在术后 1 年以上对 LRTI 结果报告的总体满意度。大多数未达到 MCID 的患者仍对 LRTI 满意。单独达到 MCID 阈值不应作为患者对其治疗满意度的替代指标。患者满意度是一个复杂的概念，可能与高质量护理的满意度有很大不同。
研究类型/证据水平：预后 IV 级。
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