Liu Di, Zhao Zhengye, Li Guozhuang, Yin Xiangjie, Zhu Yuanpeng, Liu Ze, Han Jialuo, Zhang Terry Jianguo, Wu Nan
Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
Key Laboratory of Big Data for Skeletal Deformities, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
J Bone Joint Surg Am. 2025 Aug 5;107(18):2023-30. doi: 10.2106/JBJS.24.01269.
The smallest worthwhile effect (SWE) enables patients to evaluate the expected value of a treatment by weighing its benefits, risks, and costs. It has emerged as an alternative to the minimal clinically important difference (MCID) for interpreting patient-reported outcome measures (PROMs). The purposes of this study were to determine the SWE estimates and MCID thresholds in patients undergoing surgery for adult idiopathic scoliosis (AdIS) and to verify whether meeting or exceeding the SWE estimates correlates with satisfaction at a minimum of 2 years postoperatively.
Patients with postoperative satisfaction measured at a minimum of 2 years were prospectively recruited between July 2017 and August 2022. The Scoliosis Research Society-22 revised (SRS-22r) questionnaire was preoperatively administered to estimate the SWE thresholds using the benefit-harm trade-off method. The baseline SRS-22r and the SRS-30 at a minimum of 2 years postoperatively were recorded to determine the MCID estimates using the anchor-based approach, with questions 24 to 30 of the SRS-30 used as anchors. A construct validity assessment was performed to evaluate the association between meeting or exceeding the 50th percentile of the SWE (SWE50) threshold and postoperative satisfaction (defined as a score of ≥4 on both SRS-22r satisfaction questions). Race and ethnicity data were collected from the medical records.
A total of 119 Asian participants (19 male and 100 female) with a mean age of 26.5 ± 7.2 years were included. The absolute SWE50 estimates for the SRS-22r were 0.8 (interquartile range [IQR], 0.6 to 1.2) for self-image, 0.0 (IQR, 0.0 to 0.2) for function, 0.0 (IQR, 0.0 to 0.6) for pain, 0.4 (IQR, 0.0 to 0.6) for mental health, and 0.4 (IQR, 0.2 to 0.6) for the total score. The MCID thresholds for the corresponding domains or total score were 0.7, 0.1, 0.1, 0.3, and 0.3, respectively. Achieving or exceeding the absolute SWE50 threshold for the total score (p < 0.001) or the self-image (chi-square, 11.3; p < 0.001), function (chi-square, 6.3; p = 0.012), or pain (chi-square, 5.7; p = 0.017) domain was significantly correlated with postoperative satisfaction at a minimum of 2 years.
The SWE could serve as an effective alternative to the MCID for interpreting PROMs at a minimum of 2 years postoperatively in patients with AdIS.
Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
最小有价值效应（SWE）使患者能够通过权衡治疗的益处、风险和成本来评估治疗的预期价值。它已成为解释患者报告结局指标（PROMs）的最小临床重要差异（MCID）的替代方法。本研究的目的是确定成人特发性脊柱侧凸（AdIS）手术患者的SWE估计值和MCID阈值，并验证达到或超过SWE估计值是否与术后至少2年的满意度相关。
在2017年7月至2022年8月期间前瞻性招募术后至少2年测量了满意度的患者。术前使用Scoliosis Research Society-22修订版（SRS-22r）问卷，采用利弊权衡法估计SWE阈值。记录术前SRS-22r和术后至少2年的SRS-30，采用基于锚定的方法确定MCID估计值，将SRS-30的问题24至30用作锚定。进行结构效度评估，以评估达到或超过SWE第50百分位数（SWE50）阈值与术后满意度（定义为SRS-22r满意度问题的得分均≥4）之间的关联。从病历中收集种族和民族数据。
共纳入119名亚洲参与者（19名男性和100名女性），平均年龄为26.5±7.2岁。SRS-22r的绝对SWE50估计值在自我形象方面为0.8（四分位间距[IQR]，0.6至1.2），功能方面为0.0（IQR，0.0至0.2），疼痛方面为0.0（IQR，0.0至0.6），心理健康方面为0.4（IQR，0.0至0.6），总分方面为0.4（IQR，0.2至0.6）。相应领域或总分的MCID阈值分别为0.7、0.1、0.1、0.3和0.3。总分（p<0.001）或自我形象（卡方值，11.3；p<0.001）、功能（卡方值，6.3；p=0.012）或疼痛（卡方值，5.7；p=0.017）领域达到或超过绝对SWE50阈值与术后至少2年的满意度显著相关。
在AdIS患者术后至少2年时，SWE可作为解释PROMs的MCID的有效替代方法。
预后II级。有关证据水平的完整描述，请参阅作者指南。
