Traditional assessment of health outcome following total knee arthroplasty was confounded by response shift phenomenon
Traditional assessment of health outcome following total knee arthroplasty was confounded by response shift phenomenon
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DOI：
10.1016/j.jclinepi.2008.08.004
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发表时间：
2009-01-01
影响因子：
7.2
通讯作者：
Finkelstein, Joel A.
中科院分区：
文献类型：
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作者：
Razmjou, Helen;Schwartz, Carolyn E.;Finkelstein, Joel A.
目的：检查初次全膝关节置换术 (TKA) 后 6 个月和 1 年时通过西安大略大学和麦克马斯特大学骨关节炎指数 (WOMAC) 总分和 SF-36 身体和精神成分评分域衡量的反应转变的存在、方向和效果。 研究设计和设置：连续候选人参加该研究。根据Then-test设计，术后6个月和1年完成两组问卷。根据最小临床重要差异（MCID）将患者分为三组。使用参数和非参数统计以及广义混合效应模型。结果：236 名患者完成了研究。 SF-36 身体和心理成分评分的反应变化幅度随着时间的推移而增加。传统的未经调整的术前和术后1年评估未能显示任何心理健康改善，而调整后的治疗效果显示出统计上显着的变化。结论：接受骨科干预的患者的反应转变现象随着时间的推移而增加。关节置换手术的传统术前和术后评估可能会因接受手术的患者的观点和内部测量标准的变化而混淆。反应转变对衡量该人群的恢复情况具有重大影响。 (c) 2008 Elsevier Inc. 保留所有权利。
Objectives: To examine the existence, direction, and effect of response shift as measured by the total score of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and SF-36 physical and mental component score domains at 6 months and 1 year after primary total knee arthroplasty (TKA).Study Design and Setting: Consecutive candidates participated in the study. In line with the Then-test design, two sets of questionnaires were completed at 6 months and 1 year postoperatively. Patients were divided into three groups on the basis of minimal clinically important differences (MCIDs). Parametric and nonparametric statistics and generalized mixed effects models were used.Results: Two hundred and thirty-six patients completed the study. The magnitude of response shift increased over time for SF-36 physical and mental component scores. The traditional unadjusted presurgical and 1-year postsurgical assessment failed to reveal any mental health improvement, whereas the adjusted treatment effect demonstrated statistically significant changes.Conclusion: Response shift phenomenon increases with time in patients undergoing orthopedic interventions. The traditional pre- and post-assessment of joint replacement surgery may be confounded by a change in perspective and in internal standards of measurement in patients undergoing surgery. Response shift has substantial impact on measuring recovery in this population. (c) 2008 Elsevier Inc. All rights reserved.