Relevant change in radiological progression in patients with hip osteoarthritis.: II.: Determination using an expert opinion approach
Relevant change in radiological progression in patients with hip osteoarthritis.: II.: Determination using an expert opinion approach
复制标题
DOI：
10.1093/rheumatology/41.2.148
复制
发表时间：
2002-02-01
期刊：
影响因子：
5.5
通讯作者：
Dougados, M
中科院分区：
文献类型：
--
作者：
Maillefert, JF;Nguyen, M;Dougados, M
瞄准以临床专家小组的评估为金标准，确定髋关节骨关节炎（OA）患者关节间隙宽度（JSW）进展的最小临床重要差异（MCID）。从一项多中心、前瞻性、纵向、3年随访研究中选择了298例髋关节OA患者。在入组时和3年后拍摄骨盆X线片。对于每个膜，使用0.1-mm刻度放大镜测量最大JSW。计算基线和3年随访JSW之间的差异。两名资深风湿病学家（骨关节炎专家）对每对胶片进行评价，并记录与基线相比，3年时骨关节炎分期是否发生临床相关恶化。观察者间的可靠性进行了评估，使用kappa系数和协议的比例。然后，对于JSW的每个测量差异（0.1 mm/0.1 mm），计算MCID的灵敏度和特异性，定义为专家1、专家2或两者的组合的评估。这使我们能够从正确分类概率的图形表示中获得最佳测量的JSW阈值，具有最大的真阳性和最小的假阳性结果。JSW的平均测量变化为-0.63 +/-0.74 mm。专家1和2分别认为122对（40.9%）和100对（33.6%）的JSW降低具有临床相关性。专家之间的协议比例为79.9%，Kappa系数为0.572。expert 1、expert 2和两者联合的最佳JSW阈值为-0.4 mm;敏感性和特异性分别为0.75和0.8、0.71和0.72、0.75和0.7。本研究表明，放射学JSW至少0.4 mm的变化可视为具有临床相关性。需要使用其他患者组和其他方法进行其他研究进行验证。
Aim. To determine the minimum clinically important difference (MCID) in joint space width (JSW) progression in patients with hip osteoarthritis (OA), based upon evaluation by a panel of clinical experts as a gold standard.Methods. A sample of 298 patients with hip OA was selected from a multicentre, prospective, longitudinal, 3-yr follow-up study. A pelvic radiograph was obtained at entry and after 3 yr. For each film, the narrowest JSW was measured using a 0.1-mm graduated magnifying glass. The difference between baseline and 3-yr follow-up JSW was calculated. Two senior rheumatologists, who were experts in osteoarthritis, evaluated each pair of films and noted whether a clinically relevant deterioration in osteoarthritis stage occurred at 3 yr compared with baseline. Interobserver reliabilities were evaluated using the kappa coefficient and proportions of agreements. Then, for each measured difference in JSW (0.1 mm per 0.1 mm), the sensitivity and specificity for MCID, defined as the assessment of expert 1, expert 2 or a combination of both, were calculated. This allowed us to obtain, from graphic representations of the correct classification probabilities, the best measured JSW threshold, with the maximal true positive and the minimal false positive results.Results. The mean measured change in JSW was -0.63+/-0.74 mm. Experts 1 and 2 considered the decrease in JSW to be clinically relevant in 122 (40.9%) and 100 pairs (33.6%) respectively. The proportion of agreements between the experts was 79.9%, with a kappa coefficient of 0.572. The best measured JSW threshold was -0.4 mm for expert 1, expert 2 and the combination of both; sensitivity and specificity were 0.75 and 0.8, 0.71 and 0.72, and 0.75 and 0.7 respectively.Conclusion. This study suggests that a change of at least 0.4 mm in the radiological JSW could be considered clinically relevant. Other studies using other sets of patients and other methods are needed for validation.