Which Is the Best Outcome Measure for Rotator Cuff Tears?
Which Is the Best Outcome Measure for Rotator Cuff Tears?
复制标题
DOI：
10.1097/corr.0000000000000800
复制
发表时间：
2019-08-01
影响因子：
4.2
通讯作者：
Jain, Nitin B.
中科院分区：
文献类型：
--
作者：
Dabija, Dominique, I;Pennings, Jacquelyn S.;Jain, Nitin B.
美国肩肘外科医生标准化肩关节量表（ASES）、肩关节疼痛和功能障碍指数（SPADI）以及手臂、肩关节和手功能障碍缩短量表（quickDASH）是患者报告的上肢特异性结局量表，目前用于评估肩袖撕裂患者。这种异质性不允许研究和患者护理的统一度量。问题/目的我们的目标是确定心理测量特性（信度，收敛和判别效度，反应）的五个常用的结果工具（ASES，SPADI，QuickDASH，SF-12，和EuroQol-5D）在一项对接受肩袖撕裂治疗的患者的纵向研究中。方法从2011年2月到2015年6月，120名患者完成了标准化病史、研究中的5个结局量表、体格检查和MRI。其中，47例（39%）在18个月前失访，另外24例（20%）在18个月时被解释，但在一个或多个早期预定的随访间隔（3、6或12个月）缺失数据。可靠性（受试者之间结果工具的可重复性;通过Cronbach's alpha测试），收敛效度和判别效度（确定哪些结果测量与其他结果测量最强相关;通过斯皮尔曼相关系数检验），和响应性（使用最小临床重要差异[MCID]和肩关节主观值，基于肩关节功能改善百分比的结局量表随时间的变化）结果所有结果测量的Cronbach's α均大于0.70（范围0.74-0.94），因此被认为是可靠的。收敛有效性得到证实，因为上限特异性指标（SPADI、ASES和quickDASH）彼此之间的相关性（rho = 0.74-0.81; p < 0.001）比与任何其他指标之间的相关性更强。判别有效性得到证明，因为斯皮尔曼的相关系数更强的上肢措施之间的关系相比，上肢措施和一般健康措施之间的相关性进行了比较的54个相关性的53。这些措施的内部和外部反应都得到了支持。与未达到MCID的患者相比，达到MCID且肩关节主观评分变化至少30%的患者的评分随时间推移发生了更积极的变化。混合模型线性回归显示，所有三种上肢特异性指标均与MCID的时间相互作用，表明与未达到MCID的患者相比，达到MCID的患者随时间的变化更大。结果显示，具有最佳组间区分或最佳内部反应性的测量是ASES（β =-8.26，95%置信区间[CI]，-11.39至-5.14; p < 0.001; eta（2）= 0.089）（β = 6.88，95%CI，3.78-9.97; p < 0.001; eta（2）= 0.088），然后是快速DASH（β = 3.43，95%CI，0.86-6.01; p = 0.009，eta（2）= 0.027）。最好的外部反应的措施遵循相同的模式results.Conclusions所有的上限特定规模有可接受的心理测量学特性。相关性很高，因此仅需要一个上限特定的工具进行结果评估。考虑到整体的心理测量评估，我们建议SPADI作为肩关节专用工具，用于评估肩袖撕裂患者的结局。
Background The American Shoulder and Elbow Surgeons Standardized Shoulder Form (ASES), the Shoulder Pain and Disability Index (SPADI), and the shortened Disability of the Arm, Shoulder, and Hand (quickDASH) are patient-reported upper extremity-specific outcome scales currently used to evaluate patients with rotator cuff tears. This heterogeneity does not allow for a uniform metric for research and patient care.Questions/purposes Our objective was to determine psychometric properties (reliability, convergent and discriminant validity, and responsiveness) of five commonly used outcome instruments (the ASES, the SPADI, the quickDASH, the SF-12, and the EuroQol-5D) in a longitudinal study of patients undergoing treatment for rotator cuff tears.Methods From February 2011 through June 2015, 120 patients completed a standardized history, the five outcome scales under study, a physical examination, and an MRI. Of these, 47 (39%) were lost to followup before 18 months, and another 24 (20%) were accounted for at 18 months but had missing data at one or more of the earlier prespecified followup intervals (3, 6, or 12 months). Reliability (the reproducibility of an outcome instrument between subjects; tested by Cronbach's alpha), convergent and discriminant validity (determining which outcome measures correlate most strongly with others; tested by Spearman's correlation coefficients), and responsiveness (the change in outcome scales over time based on percent improvement in shoulder functionality using the minimal clinically important difference [MCID] and the subjective shoulder value) were calculated.Results All outcomes measures had a Cronbach's alpha above 0.70 (range, 0.74-0.94) and therefore were considered reliable. Convergent validity was demonstrated as the upper extremity-specific measures (SPADI, ASES, and quickDASH) were more strongly correlated with each other (rho = 0.74-0.81; p < 0.001) than with any of the other measures. Discriminant validity was demonstrated because the Spearman's correlation coefficients were stronger for the relationships between upper extremity measures compared with the correlations between upper extremity measures and general health measures for 53 of the 54 correlations that were compared. Both internal and external responsiveness of the measures was supported. Patients who achieved the MCID and at least a 30% change on the subjective shoulder value had more positive change in scores over time compared with those who did not. Mixed model linear regressions revealed that all three upper extremity-specific measures had a group by time interaction for the MCID, indicating that patients who achieved the MCID had greater change over time compared with those who did not achieve the MCID. Results showed that the measure with the best discrimination between groups, or best internal responsiveness, was the ASES (beta = -8.26, 95% confidence interval [CI], -11.39 to -5.14; p < 0.001; eta(2) = 0.089) followed by the SPADI (beta = 6.88, 95% CI, 3.78-9.97; p < 0.001; eta(2) = 0.088) then the quickDASH (beta = 3.43, 95% CI, 0.86-6.01; p = 0.009, eta(2 )= 0.027). Measures with the best external responsiveness followed the same pattern of results.Conclusions All the upper extremity-specific scales had acceptable psychometric properties. Correlations were high and thus only one upper extremity-specific instrument is needed for outcome assessment. Given the overall psychometric assessment, we recommend SPADI be the shoulder-specific instrument used to assess outcomes in patients with rotator cuff tears.