Prodromidis Apostolos D, Thivaios Georgios C, Mourikis Anastasios, Erginousakis Ioannis D, Nikolaou Vasileios S, Vlamis John, Chronopoulos Efstathios
Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, Athens, GRC.
Orthopaedics and Trauma, Laiko General Hospital of Athens, Athens, GRC.
Cureus. 2024 Jul 15;16(7):e64546. doi: 10.7759/cureus.64546. eCollection 2024 Jul.
Patient-reported knee-related rating scores and scales are widely used in reporting the clinical outcomes of anterior cruciate ligament (ACL) surgery. Understanding the psychometric properties of such measures is vital to recognizing the limitations that such measures may confer. The aim of this study was to review the available evidence as to the psychometric properties of patient-reported outcome measures (PROMs) used in ACL surgery. Eleven studies were identified, the majority being prospective cohort studies. Eight English, ACL-specific patient-reported outcome measures were identified and evaluated: Lysholm score, Tegner Activity Scale (TAS), Cincinnati score, ACL-Quality of Life (QOL) score, International Knee Documentation Committee (IKDC) Subjective Knee Form (SKF), Knee Injury and Osteoarthritis Outcome Score (KOOS)-ACL score, and ACL-Return to Sport Injury (RSI) scale. Only the Lysholm score, ACL-QOL, IKDC SKF, and ACL-RSI were evaluated for internal consistency, having an acceptable Cronbach's α (α>0.70). Most of the scoring systems were assessed for test-retest reliability, with four of them (Lysholm score, TAS, Cincinnati score, and IKDC SKF) having acceptable intraclass correlation coefficient (ICC) values (ICC > 0.70). Criterion validity was assessed for most measures with a good correlation with the IKDC. Effect sizes and standardized response means were large for three instruments that measured responsiveness (Lysholm score, TAS, and Cincinnati score) and moderate for one (ACL-QOL). Evidence is stronger and more robust for the Lysholm score, TAS, ACL-QOL, and IKDC SKF. However, there is variation in their psychometric properties as well as the aspect of knee-related health they are assessing. Hence, none can be universally applicable to all patients with ACL injuries. Recognizing these parameters is vital when choosing which instrument to use in reporting the outcomes of ACL injury or ACL surgery studies.
患者报告的膝关节相关评分和量表被广泛用于报告前交叉韧带（ACL）手术的临床结果。了解这些测量方法的心理测量特性对于认识到这些测量方法可能带来的局限性至关重要。本研究的目的是回顾有关ACL手术中使用的患者报告结局测量（PROMs）心理测量特性的现有证据。共确定了11项研究，其中大多数是前瞻性队列研究。确定并评估了8种特定于ACL的英文患者报告结局测量方法：Lysholm评分、Tegner活动量表（TAS）、辛辛那提评分、ACL生活质量（QOL）评分、国际膝关节文献委员会（IKDC）主观膝关节表（SKF）、膝关节损伤和骨关节炎结局评分（KOOS）-ACL评分以及ACL恢复运动损伤（RSI）量表。仅对Lysholm评分、ACL-QOL、IKDC SKF和ACL-RSI进行了内部一致性评估，其Cronbach's α系数可接受（α>0.70）。大多数评分系统进行了重测信度评估，其中四项（Lysholm评分、TAS、辛辛那提评分和IKDC SKF）的组内相关系数（ICC）值可接受（ICC>0.70）。大多数测量方法的效标效度与IKDC有良好相关性。三种测量反应性的工具（Lysholm评分、TAS和辛辛那提评分）的效应量和标准化反应均值较大，一种工具（ACL-QOL）的效应量和标准化反应均值中等。Lysholm评分、TAS、ACL-QOL和IKDC SKF的证据更强、更可靠。然而，它们的心理测量特性以及所评估的膝关节相关健康方面存在差异。因此，没有一种测量方法可以普遍适用于所有ACL损伤患者。在选择用于报告ACL损伤或ACL手术研究结果的工具时，认识到这些参数至关重要。
