图示化自主髋关节功能评分系统的应用研究

Application research of visual self-rating system for hip joint function evaluation

目的以Harris评分量表为标准,设计以图片、视频的多媒体呈现的图示化髋关节功能评分,应用于患者自我测评,验证其可行性及准确性。方法选取2020年1月至2023年12月于中山大学孙逸仙纪念医院行单侧髋关节置换术或髓芯减压术的出院患者进行观察性的随机交叉设计研究,排除严重老年痴呆或其他精神疾病、资料不全等。通过方差分析、Kendall秩相关分析、Bland-Altman图评估Harris评分、简版Harris评分和图示化髋关节评分的一致性,并通过评估过程耗时及应答率分析图示化患者自我测评的可行性。结果同为患者自主测评,较之简版Harris评分相比,图示化髋关节评分值更集中地分布在95%一致性界限(-4.25,9.47);基于图示化髋关节评分进行的等级评定较简版Harris评分,误判率更低(38%vs.23%,χ^(2)=4.309,P=0.038);评估耗时显示图示化评分操作耗时较Harris评分量表法缩短(F=19.753,P<0.001);满意度问卷调查显示图示化评分法最高(F=20.659,P<0.001)。结论患者自我测评的图示化髋关节评分与Harris评分存在一致性及高度相关性,且其等级评定较既往患者自我测评使用的简版Harris评分更准确,且具良好可及性,能满足精确便利的患者自我评估而更好促进远程随访的开展。

Objective To design a visual hip joint function rating system presented through pictures and videos for self-evaluation by patients based on the Harris score,and to verify its feasibility and accuracy.Methods An observational randomized crossover design study was conducted on patients discharged from hospital after unilateral hip replacement or core decompression at Sun Yat-sen Memorial Hospital from January 2020 to December 2023.Severe senile dementia or other psychological diseases,and incompleted data were excluded.The consistency of the Harris score,simplified Harris score,and visual hip joint score were evaluated by analysis of variance,Kendall rank correlation analysis,and Bland-Altman plot.The feasibility of visual hip joint sore by patients was assessed through analysis of evaluation process time and response rate.Results Compared to the simplified Harris score,the visual hip joint score had a more concentrated distribution of scores within the 95%consistency limits(-4.25,9.47).The visual hip joint score had lower misjudgment rate compared to the simplified Harris score(38%vs.23%,χ^(2)=4.309,P=0.038)in terms of grade assessment.The evaluation process time for the visual hip joint score was shorter than that for the Harris score(F=19.753,P<0.001).The satisfaction survey showed the highest satisfaction with the visual hip joint score(F=20.659,P<0.001).Conclusions The visual hip joint score for self-evaluation by patients is consistent and highly correlated with the Harris score.It provides more accurate grade assessment compared to the simplified Harris score previously used for self-evaluation by patients,and has good accessibility.It can meet the needs of accurate and convenient self-assessment by patients and better promote the development of remote follow-up.