基于患者自评的成人髋关节功能评分系统的建立

Development on a hip functional score of adults based on patient-reported outcomes

目的构建一项针对成人髋部疾病功能重建疗效评价的简易自评评分系统。方法经文献查阅、小组讨论初筛用于患者自评的髋关节功能评估备选指标。采用两轮德尔菲咨询法，邀请专家对包括疼痛、日常生活能力、行动能力、劳动能力、患髋总体状况自评得分等方面筛选指标的重要程度及进行评判和打分，并说明熟悉程度以及判断依据。第二轮测评时增加了量表内容完整性、合理性评价等内容。根据指标重要程度（均值、满分频率、变异系数三个指标）界值确定最终入选指标，计算两轮专家积极系数、权威系数、协调系数，确定各指标权重赋分形成最终的评分量表。结果28位和25位专家德尔菲咨询后分别收回有效反馈25份和24份，两轮专家积极系数分别为89．3％（25／28）、96％（24／25）。一、二级指标专家权威系数普遍超过0．85；指标重要程度专家协调系数（Kendall’s系数）普遍超过0．3，且第二轮协调系数更高，一致性较好。行动能力中的“乘坐公交车”选项不符合重要性界值要求被剔除。最终确定该评分系统（上海第六人民医院髋关节评分）由两部分构成：第一部分包括疼痛、日常生活能力、行动能力、劳动能力等四个维度共10项指标，并确定其赋分权重分数分别为45、25、21、9分以及确定了具体10项指标权重分；第二部分为患者对患髋总体状况自评评分（VAS评分，满分100分）；最后完整得分为第一、二部分累加，其中第一、二部分最终权重占比分别为85％、15％。结论经德尔菲法确立的患者自评上海第六人民医院髋关节评分简单实用，可作为髋关节功能重建临床疗效评估的参考工具。

Objective To develop a simple and patient-reported scoring system for evaluating the efficacy of functional reconstruction of adult hip diseases. Methods A candidate indicators list to evaluate hip function was established through litera- tures review and panel discussion. Using two rounds of Delphi method, experts were invited to judge and score the importance of screening indicators including pain, daily living ability, activity level, labor ability and self-assessment score of the overall hip sta- tus,with explanation of the degree of similarity and the basis for determination. In the second round of consultation, the content of integrity and rationality of the scale were added for evaluation. The final indexes of the scale were determined according to the boundary value of the indexes （average value, full frequency, coefficient of variation）. The positive coefficient, authoritative coeffi- cient, and coordination coefficient of the two rounds were calculated, and then the weights of each index was identified to form the final rating scale. Results Two rounds of Delphi reclaimed 25 and 24 experts＇ responses, which from 28 and 25 questionnaires, and the positive coefficients of the two rounds experts were 89.3% and 96%, respectively. The authoritative coefficient of the first and second level indicators were generally above 0.85; and both of the expert coordination coefficient with the index importance （so called as Kendall coefficient） were above 0.3, and the second round of the coefficient was higher than the first one, and it indicated the final one was better at the consistency. The candidate index of ＂by bus＂ in the mobility was rejected in accordance with the threshold of the boundary value on the importance. Finally, it was determined that the hip scoring system （Shanghai Sixth People＇ s Hospital, SSPH） consisted of two parts： the first part had ten indicators out of four dimensions such as pain, daily living ability, activity level, and labor ability; and the weight scores of these four aspects were 45, 25, 21, 9, respectively. The second part was the patient self-evaluation score for the overall status of the hip （VAS, out of 100 points）; the total score was the sum of the twoparts, and the final weights accounted for 85% and 15% between the two parts respectively. Conclusion The SSPH hip score based on patient-reported outcomes formed by the Delphi is simple and feasible, and it can be used as a reference for evaluating the clinical efficacy of hip functional reconstruction.