Monash University, Melbourne, Victoria, Australia.
St John of God Hospital and Deakin University, Geelong, Victoria, Australia, and Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia.
Arthritis Care Res (Hoboken). 2024 Jun;76(6):895-903. doi: 10.1002/acr.25304. Epub 2024 Feb 15.
We evaluated the measurement properties of the Oxford Shoulder Score (OSS) and estimated the minimal clinically important change (MCIC) in patients undergoing primary total shoulder replacement in Australia.
Deidentified data from the Australian Orthopaedic Association National Joint Replacement Registry were used for this analysis. Pre- and 6-month postoperative OSS scores were used, with the 5-level EuroQoL quality of life instrument and shoulder pain scores used as comparators. Floor and ceiling effects, internal consistency reliability, construct validity, and responsiveness to change were evaluated using standard psychometric methods. Mean change and predictive modeling approaches (with and without adjustment for the proportion of improved patients) were used to calculate MCIC thresholds, with patient-perceived improvement after surgery as the anchor.
Preoperative OSS data were available for 1,117 patients (59% female; 90% aged ≥60 years) undergoing primary total shoulder replacement. No floor or ceiling effects were observed pre- or postoperatively. The OSS showed high internal consistency reliability (Cronbach alpha >0.89), good construct validity, and high responsiveness to change (effect size 1.88). The MCIC derived from the mean change method was 6.50 points (95% confidence interval [95% CI] 4.41-8.61). The predictive modeling approach produced an MCIC estimate of 8.42 points (95% CI 5.68-12.23) after adjustment.
The OSS has good measurement properties to capture pain and function outcomes after shoulder replacement procedures and is highly responsive to change. Based on robust methods, an increase in OSS scores of at least eight points can be considered as meaningful improvement after surgery from the patient's perspective.
我们评估了牛津肩部评分（OSS）的测量特性，并估计了澳大利亚接受初次全肩关节置换术的患者的最小临床重要变化（MCIC）。
本分析使用了澳大利亚矫形协会国家关节置换登记处的匿名数据。使用术前和术后 6 个月的 OSS 评分，并将 5 级欧洲生活质量量表和肩部疼痛评分作为对照。使用标准心理测量方法评估地板和天花板效应、内部一致性可靠性、结构有效性和对变化的反应性。使用平均变化和预测模型方法（包括和不包括调整改善患者比例）来计算 MCIC 阈值，以手术后患者的自我感知改善为锚点。
共有 1117 例（59%为女性；90%年龄≥60 岁）接受初次全肩关节置换术的患者可获得术前 OSS 数据。术前和术后均未观察到地板或天花板效应。OSS 显示出较高的内部一致性可靠性（Cronbach alpha >0.89）、良好的结构有效性和对变化的高反应性（效应量 1.88）。基于平均变化方法得出的 MCIC 值为 6.50 分（95%置信区间 [95%CI] 4.41-8.61）。调整后预测模型方法得出的 MCIC 估计值为 8.42 分（95%CI 5.68-12.23）。
OSS 具有良好的测量特性，可用于捕捉肩部置换手术后的疼痛和功能结果，并且对变化高度敏感。基于可靠的方法，从患者的角度来看，OSS 评分至少增加 8 分可以被认为是手术后有意义的改善。
