膝关节镜术中患者报告结局指标与临床显著结局阈值的合理选择指南
简介
这篇叙述性综述系统梳理了膝关节镜手术中常用的患者报告结局指标（PROMs），重点分析了各量表的心理测量学特性（信度、效度、反应性）以及最小临床重要差异、患者可接受症状状态和显著临床获益等临床意义阈值。文章指出，选择PROM时需考虑其天花板效应和人群特异性，统计显著性不等于临床意义，为临床医生根据不同病理类型和手术方式合理选择评估工具、正确解读患者结局提供了实…
英文摘要
Patient-reported outcome measures (PROMs) are vital tools to evaluate patient health status. Although a plethora of validated tools are available to evaluate common pathologies in knee arthroscopy, agreement on the most appropriate metrics for different populations and procedures has not been reached. Selection of an appropriate PROM requires consideration of its validity, clinically significant outcomes, and ceiling effects. The validation of an outcome measure encompasses three distinct psychometric properties: validity, reliability, and responsiveness, and the demonstration of appropriate psychometric validity lends credibility of the results derived from its use in clinical and research settings. Notably, statistical significance does not always translate to clinical significance. Minimal clinically important difference, patient-acceptable symptomatic state, and substantial clinical benefit are clinically significant outcomes that represent the spectrum of meaningful clinical impact for a patient. However, these metrics are population- and study-specific and should be interpreted at the individual level. Ceiling effects prevent differentiation between patients scoring at the upper extreme of the PROM and are an important limitation of several instruments used to evaluate patients undergoing orthopaedic sports medicine knee procedures. The purpose of this narrative review is to provide a comprehensive overview of popular PROMs used in the evaluation of orthopaedic sports medicine knee procedures and review their applicability to commonly encountered pathologies. The scoring, interpretation, and psychometric properties of each PROM are presented along with examples of minimal clinically important difference, substantial clinical benefit, and patient-acceptable symptomatic state values found for the specific cohorts in previous studies. LEVEL OF EVIDENCE: Level V, expert opinion.