TÍTULO DE LA PUBLICACIÓN Publicado el 01/04/2012
Outcomes after total hip replacement based on patients' baseline status: what results can be expected?
AUTORES
Quintana JM, Aguirre U, Barrio I, Orive M, Garcia S, Escobar A.
Abstract
OBJECTIVE:
We evaluated patient satisfaction with total hip replacement
(THR) to establish cut points of sufficient improvement based on
the patient acceptable symptom state (PASS) and receiver operating
characteristic (ROC) curves, and compared them with measures
derived from the minimum clinically important difference (MCID),
taking into account patients' baseline status.
METHODS:
Two cohorts of prospectively recruited patients on waiting
lists for THR were studied. Sociodemographic data and comorbidities
were recorded. Patients completed the Western Ontario and McMaster
Universities Osteoarthritis Index (WOMAC) and other
patient-reported outcomes questionnaires before THR and 6 months
afterward. Cut points of sufficient improvement were established by
the PASS, ROC, and MCID and were compared.
RESULTS:
Patients satisfied with THR had, by preintervention WOMAC
tertiles, gains of 19.4, 34.1, and 49.3 in the WOMAC pain domain
and 17.8, 30.8, and 41.4 in the WOMAC functional limitation domain.
The PASS cut points determined were 20, 25, and 25 for
postintervention WOMAC pain and 28, 35, and 42 for functional
limitation. ROC cut points were 19, 25, and 25 for postintervention
pain and 26.4, 39, and 40 for functional limitation. Agreement
among cut points classifying patients as responders to THR was 1.0
for pain with both PASS and ROC, and 0.85 for functional
limitation; 0.6 for pain between MCID and PASS or ROC, and 0.58 and
0.60 for functional limitation.
CONCLUSION:
Cut points of expected gain after THR can help clinicians,
researchers, and managers to identify suitable candidates for THR,
although such measures must be used with caution.
Arthritis Care Res (Hoboken). 2012 Apr;64(4):563-72