Accurately Measuring Outcomes After Surgery for Adult Chiari I Malformation: Determining the Most Valid and Responsive Instruments
Accurately Measuring Outcomes After Surgery for Adult Chiari I Malformation: Determining the Most Valid and Responsive Instruments
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DOI：
10.1227/neu.0b013e3182897341
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发表时间：
2013-05-01
期刊：
影响因子：
4.8
通讯作者：
McGirt, Matthew J.
中科院分区：
文献类型：
--
作者：
Godil, Saniya S.;Parker, Scott L.;McGirt, Matthew J.
背景：已经过渡到使用患者报告的结果工具（PROi）来评估手术效果。然而，这些工具都没有被证实为成人I型Chiari畸形（CMI）的结果。目的：本研究的目的是确定各种PROi在测量CMI手术后预后方面的相对有效性和反应性。方法：对50例接受枕下开颅手术治疗成人CMI的患者进行1年的前瞻性随访。基线和1年患者报告的结果（头痛视觉模拟量表和颈部疼痛视觉模拟量表、颈部残疾指数[NDI]、头痛残疾指数、SF-12、Zung抑郁自评量表和EuroQol-5D [EQ-5D]）进行评估。术后总体健康水平的改善被定义为有意义的改善。生成接受者-工作特征曲线来评估PROi的有效性，以区分有意义的改善和无意义的改善。报告有意义改善的患者与未报告有意义改善的患者的标准化反应均值（SRMs）之间的差异计算，以确定每个结果工具的相对反应性。结果：对于疼痛和残疾，NDI是有意义有效性的最准确判别指标（曲线下面积：0.90），也是对术后改善最敏感的指标（标准化反应均值差：1.87）。在总体健康和生活质量方面，sf - 12pcs、EQ-5D和Zung抑郁自评量表均为准确的判别因子；然而，SF-12物理成分量表（sf - 12pcs）和EQ-5D最准确。sf - 12pcs也是反应最灵敏的。结论：对于疼痛和残疾，NDI是CMI术后最有效和最有效的改善措施。对于健康相关的生活质量，sf - 12pcs和EQ-5D是最有效和最有效的措施。NDI联合SF-12或EQ-5D对CMI患者最有效，应在成本-效果研究中予以考虑。
BACKGROUND: There has been a transition to using patient-reported outcome instruments (PROi) to assess surgical effectiveness. However, none of these instruments have been validated for outcomes of adult Chiari I malformation (CMI).OBJECTIVE: The aim of this study was to determine the relative validity and responsiveness of various PROi in measuring outcomes after surgery for CMI.METHODS: Fifty patients undergoing suboccipital craniotomy for adult CMI were prospectively followed for 1 year. Baseline and 1-year patient-reported outcomes (visual analog scale for head pain and visual analog scale for neck pain, Neck Disability Index [NDI], Headache Disability Index, SF-12, Zung Self-Rating Depression Scale, and EuroQol-5D [EQ-5D]) were assessed. A level of improvement in general health after surgery was defined as meaningful improvement. Receiver-operating characteristic curves were generated to assess the validity of PROi to discriminate between meaningful improvement and not. The difference between standardized response means (SRMs) in patients reporting meaningful improvement vs not as calculated to determine the relative responsiveness of each outcome instrument.RESULTS: For pain and disability, the NDI was the most accurate discriminator of meaningful effectiveness (area under the curve: 0.90) and also most responsive to postoperative improvement (standardized response means difference: 1.87). For general health and quality of life, the SF-12 PCS, EQ-5D, and Zung Self-Rating Depression Scale were all accurate discriminators; however, SF-12 Physical Component Scale (SF-12 PCS) and EQ-5D were most accurate. SF-12 PCS was also most responsive.CONCLUSION: For pain and disability, NDI is the most valid and responsive measure of improvement after surgery for CMI. For health-related quality of life, SF-12 PCS and EQ-5D are the most valid and responsive measures. NDI with SF-12 or EQ-5D is the most valid in patients with CMI and should be considered in cost-effectiveness studies.