Functional improvement after total knee arthroplasty revision: new observations on the dimensional nature of outcome.
Functional improvement after total knee arthroplasty revision: new observations on the dimensional nature of outcome.
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DOI：
10.1186/1749-799x-2-25
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发表时间：
2007-12-07
影响因子：
2.6
通讯作者：
Saleh KJ
中科院分区：
文献类型：
--
作者：
Mulhall KJ;Ghomrawi HM;Bershadsky B;Saleh KJ
尽管描述了许多结果测量，但仍不清楚患者结果的哪些方面对于确定全膝关节置换术翻修（TKAR）后的实际改善很重要。我们对 TKAR 进行了一项前瞻性队列研究，以确定临床改善的组成部分以及它们之间的相关性和最佳衡量方式。利用来自 186 名连续 TKAR 患者的 SF-36 身体 (PCS) 和精神 (MCS) 组成部分、西安大略和麦克马斯特大学骨关节炎 (WOMAC) 指数、膝关节协会评分 (KSS)、新型活动量表 (AS) 以及术前和术后 6 个月随访时医生得出的严重性评估量表的数据，设计了改进量表。使用因子分析来分析每个分数的变化，得出综合改进量表。所有仪器在 TKAR 后都显示出统计上显着更好的分数（SF-36 MCS 除外）。此外，分数之间的所有显着相关性均为正相关。统计因素分析表明，分数可以分为 4 个相关因素分组，具有较高的内部一致性（Cronbach Alpha = 0.7）。因素 1 反映患者感知的功能结果，因素 2 反映活动水平，因素 3 反映 MCS，因素 4 反映 KSS。本研究表明 TKAR 后的改进具有多维结构。改进量表代表了先前分散的 TKAR 结果分析的更加协调的方法。这将改进对 TKAR 对患者实际有效性的评估以及哪些方面的改进最为关键。
Despite the numerous outcomes measures described it remains unclear what aspects of patient outcome are important in determining actual improvement following total knee arthroplasty revisions (TKAR). We performed a prospective cohort study of TKAR to determine the components of clinical improvement and how they are related and best measured. An improvement scale was devised utilizing data from 186 consecutive TKAR patients on SF-36 physical (PCS) and mental (MCS) components, Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index, Knee Society Score (KSS), a novel Activity Scale (AS) and a physician derived severity assessment scale performed both preoperatively and at 6 month post-operative follow-up. The change in each of these scores was analyzed using factor analysis, deriving a composite improvement scale. All the instruments demonstrated statistically significantly better scores following TKAR (except the SF-36 MCS). Furthermore, all significant correlations between the scores were positive. Statistical factor analysis demonstrated that scores could be arranged into 4 related factor groupings with high internal consistency (Cronbach Alpha = 0.7). Factor 1 reflected patient perceived functional outcomes, Factor 2 activity levels, Factor 3 the MCS and Factor 4 the KSS. This study demonstrates that improvement following TKAR has a multidimensional structure. The improvement scales represent a more coordinated method of the previously fragmented analysis of TKAR outcomes. This will improve assessment of the actual effectiveness of TKAR for patients and what aspects of improvement are most critical.