Kreibich D N, Vaz M, Bourne R B, Rorabeck C H, Kim P, Hardie R, Kramer J, Kirkley A
Division of Orthopaedic Surgery, University Hospital, London, Ontario, Canada.
Clin Orthop Relat Res. 1996 Oct(331):221-5. doi: 10.1097/00003086-199610000-00031.
Variable definitions of outcome have been used in the past to assess the results after total joint replacement surgery. These differ in their approach to the measurement of outcome but all must be valid (they measure what they are designed to measure), reliable (they consistently produce the same score), and responsive (able to detect changes that may occur during a period). Responsiveness is crucial to distinguish those patients who benefit from a procedure from those who do not, and a more responsive test will theoretically be able to identify more subtle changes in patient status. The responsiveness of 6 different scoring systems was compared. The results are based on a cohort of 71 patients undergoing total knee arthroplasty in a 7-month period. Responsiveness was determined by performing a paired t test among each patient's scores at 0, 3, and 6 months. The size of the resulting t value represented the comparative responsiveness of the 6 tests. The highest value achieved was with the Western Ontario and McMaster Universities osteoarthritis index and the Knee Society clinical rating scale. The worst scores were achieved by Short Form-36 and time trade off, a utility method of measurement. If small differences between groups of patients are to be shown, measures of outcome that are more responsive to patient change should be used.
过去曾采用不同的结局变量定义来评估全关节置换手术后的结果。这些定义在结局测量方法上存在差异，但都必须具备有效性（测量的是其设计要测量的内容）、可靠性（始终得出相同的分数）和反应性（能够检测出一段时间内可能发生的变化）。反应性对于区分从手术中获益的患者和未获益的患者至关重要，理论上，反应性更强的测试能够识别出患者状况更细微的变化。对6种不同评分系统的反应性进行了比较。结果基于71例在7个月内接受全膝关节置换术的患者队列。通过对每位患者在0、3和6个月时的评分进行配对t检验来确定反应性。所得t值的大小代表了这6种测试的相对反应性。得分最高的是西安大略和麦克马斯特大学骨关节炎指数以及膝关节协会临床评分量表。得分最差的是简短健康调查问卷36项简表和时间权衡法（一种效用测量方法）。如果要显示患者组之间的微小差异，应使用对患者变化反应更灵敏的结局测量方法。
