精神健康对全膝关节置换术最小临床重要差异的影响。
Mental Health Effects on the Minimal Clinically Important Difference in Total Joint Arthroplasty.
机构信息
From the Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School (Salimy, Paschalidis, Dunahoe, Alpaugh, Bedair, and Melnic), the Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (Chen), and the Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA (Bedair, and Melnic).
出版信息
J Am Acad Orthop Surg. 2024 Apr 1;32(7):e321-e330. doi: 10.5435/JAAOS-D-23-00538. Epub 2024 Jan 9.
INTRODUCTION
The effect of mental health on patient-reported outcome measures is not fully understood in total joint arthroplasty (TJA). Thus, we investigated the relationship between mental health diagnoses (MHDs) and the Minimal Clinically Important Difference for Improvement (MCID-I) and Worsening (MCID-W) in primary TJA and revision TJA (rTJA).
METHODS
Retrospective data were collected using relevant Current Procedural Terminology and MHDs International Classification of Diseases, 10th Revision, codes with completed Hip Disability and Osteoarthritis Outcome Score-Physical Function Short Form, Knee Injury and Osteoarthritis Outcome Score-Physical Function Short Form, Patient-reported Outcomes Measurement Information System (PROMIS)-Physical Function Short Form 10a, PROMIS Global-Mental, or PROMIS Global-Physical questionnaires. Logistic regressions and statistical analyses were used to determine the effect of a MHD on MCID-I/MCID-W rates.
RESULTS
Data included 4,562 patients (4,190 primary TJAs/372 rTJAs). In primary total hip arthroplasty (pTHA), MHD-affected outcomes for Hip Disability and Osteoarthritis Outcome Score-Physical Function Short Form (MCID-I: 81% versus 86%, P = 0.007; MCID-W: 6.0% versus 3.2%, P = 0.008), Physical Function Short Form 10a (MCID-I: 68% versus 77%, P < 0.001), PROMIS Global-Mental (MCID-I: 38% versus 44%, P = 0.009), and PROMIS Global-Physical (MCID-I: 61% versus 73%, P < 0.001; MCID-W: 14% versus 7.9%, P < 0.001) versus pTHA patients without MHD. A MHD led to lower rates of MCID-I for PROMIS Global-Physical (MCID-I: 56% versus 63%, P = 0.003) in primary total knee arthroplasty patients. No effects from a MHD were observed in rTJA patients.
DISCUSSION
The presence of a MHD had a prominent negative influence on pTHA patients. Patients who underwent rTJA had lower MCID-I rates, higher MCID-W rates, and lower patient-reported outcome measure scores despite less influence from a MHD.
LEVEL OF EVIDENCE
Level III, retrospective comparative study.
简介
心理健康对全关节置换术（TJA）患者报告结局测量的影响尚不完全清楚。因此，我们研究了精神健康诊断（MHD）与原发性 TJA 和翻修 TJA（rTJA）中改善的最小临床重要差异（MCID-I）和恶化的最小临床重要差异（MCID-W）之间的关系。
方法
使用相关的当前程序术语和 MHD 的国际疾病分类，第 10 修订版代码，以及完整的髋关节残疾和骨关节炎结局评分-物理功能简短形式、膝关节损伤和骨关节炎结局评分-物理功能简短形式、患者报告的结果测量信息系统（PROMIS）-物理功能简短形式 10a、PROMIS 全球-心理或 PROMIS 全球-物理问卷收集回顾性数据。使用逻辑回归和统计分析来确定 MHD 对 MCID-I/MCID-W 率的影响。
结果
数据包括 4562 名患者（4190 例原发性 TJA/372 例 rTJA）。在原发性全髋关节置换术（pTHA）中，MHD 影响髋关节残疾和骨关节炎结局评分-物理功能简短形式（MCID-I：81%对 86%，P=0.007；MCID-W：6.0%对 3.2%，P=0.008）、物理功能简短形式 10a（MCID-I：68%对 77%，P<0.001）、PROMIS 全球-心理（MCID-I：38%对 44%，P=0.009）和 PROMIS 全球-物理（MCID-I：61%对 73%，P<0.001；MCID-W：14%对 7.9%，P<0.001）的结果，而 pTHA 患者无 MHD。MHD 导致原发性全膝关节置换术患者 PROMIS 全球-物理（MCID-I：56%对 63%，P=0.003）的 MCID-I 率降低。rTJA 患者中未观察到 MHD 的影响。
讨论
MHD 的存在对 pTHA 患者产生了显著的负面影响。接受 rTJA 的患者尽管受 MHD 的影响较小，但 MCID-I 率较低，MCID-W 率较高，患者报告的结局测量评分较低。
证据水平
III 级，回顾性比较研究。
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