血友病儿童膝关节挛缩康复治疗效果的最小临床重要差异  

The minimum clinically-important difference in rehabilitation for children with haemophilic knee joint contracture

作　　者：张厚强 刘淑芬 史明楠 石伟宏 陈丽霞 Zhang Houqiang;Liu Shufen;Shi Mingnan;Shi Weihong;Chen Lixia(Institute of Nursing and Rehabilitation,North China University of Science and Technology,Tangshan 063210,China;Department of Rehabilitation Medicine,Peking Union Medical College Hospital,Chinese Academy of Medical Science,Beijing 100730,China)

机构地区：[1]华北理工大学护理与康复学院,唐山063210 [2]中国医学科学院北京协和医院康复医学科,北京100730

出　　处：《中华物理医学与康复杂志》2022年第12期1095-1099,共5页Chinese Journal of Physical Medicine and Rehabilitation

基　　金：中央高水平医院临床科研专项(2022-PUMCH-A-140)。

摘　　要：目的探讨血友病儿童膝关节挛缩康复治疗效果的最小临床重要差异(MCID)。方法回顾性收集2018年1月至2022年8月在北京协和医院康复医学科接受康复治疗10次及以上的血友病儿童的膝关节挛缩相关资料。患儿康复治疗效果以膝关节血友病关节健康评分(HJHS)为量化指标,采用均数差法、多元线性回归法、受试者工作特征曲线和分布法综合估计血友病患儿康复治疗后膝关节HJHS改善的MCID。结果共纳入28例符合标准的血友病膝关节挛缩患儿,平均年龄(13.89±3.00)岁。膝关节HJHS的均数差法MCID估计值为5.13,95%置信区间(CI)为(4.18,6.07),多元线性回归MCID估计值为4.31,95%CI为(3.64,4.98),受试者工作特征曲线MCID估计值为3.50,分布法MCID估计值为1.64;综合以上估计值,患儿康复治疗后膝关节HJHS改善的MCID为4.31。结论血友病膝关节挛缩患儿康复治疗后膝关节HJHS改善的MCID为4.31。当膝关节HJHS改善的MCID高于4.31时,改善有临床意义。Objective To determine the minimum clinically-important difference(MCID)in the rehabilitation effect among children with haemophilic knee joint contracture.Methods The data describing 28 children with an average age of 13.89±3.00 years and haemophilic knee joint contracture who received no less than 10 sessions of physiotherapy in the Department of Rehabilitation Medicine at the Peking Union Medical College Hospital were analyzed.The therapeutic effect of the treatement was quantified in terms of Haemophilia Joint Health Scores(HJHSs)for their knees.The MCID after the therapy was evaluated using the mean change method,multivariate linear regression,receiver operating characteristics,and the distribution-based method.Results The MCID for the improvement of knee HJHS was 5.13 by the mean change method,4.31 by multivariate linear regression,3.50 according to the ROC curve and 1.64 by the distribution-based method.Taking all of them into consideration,4.31 was found to be an appropriate value.Conclusions The MCID after physical therapy for the improvement in knee HJHS for a child with haemophilic knee contracture is 4.31.Improvements greater than 4.31 can be considered clinically significant.

关 键 词：血友病 康复治疗 最小临床重要差异 血友病关节健康评分 

分 类 号：R725.5[医药卫生—儿科]