The Achilles tendon Total Rupture Score is a responsive primary outcome measure: an evaluation of the Dutch version incl
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The Achilles tendon Total Rupture Score is a responsive primary outcome measure: an evaluation of the Dutch version including minimally important change Olivier C. Dams1 · Inge H. F. Reininga2 · Johannes Zwerver3,4 · Ronald L. Diercks1 · Inge van den Akker‑Scheek1 Received: 22 October 2019 / Accepted: 25 February 2020 © The Author(s) 2020
Abstract Purpose Aim of this study was to evaluate the responsiveness of the Dutch version of the Achilles tendon Total Rupture Score (ATRS-NL). Methods Patients (N = 47) completed the ATRS-NL at 3 and 6 months after Achilles tendon rupture (ATR). Additionally, they filled out the Euroqol-5D-5L (EQ-5D-5L) and Global Rating of Change Score (GRoC). Effect sizes (ES) and standardized response means (SRM) were calculated. The anchor-based method for determining the minimally important change (MIC) was used. GRoC and improvement on the items mobility and usual activities on the EQ-5D-5L served as external criteria. The scores on these anchors were used to categorize patients’ physical functioning as improved or unchanged between 3 and 6 months after ATR. Receiver operating curve (ROC) analysis was performed, with the calculation of the area under the ROC curve (AUC) and the estimation of MIC values using the optimal cut-off points. Results There was a large change (ES: 1.58) and good responsiveness (SRM: 1.19) of the ATRS-NL between 3 and 6 months after ATR. Using ROC analysis, the MIC values ranged from 13.5 to 28.5 for reporting improvement on EQ-5D-5L mobility and GRoC, respectively. The AUC of improvement on mobility and improvement on GRoC were > 0.70. Conclusion The ATRS-NL showed good responsiveness in ATR patients between 3 and 6 months after injury. Use of this questionnaire is recommended in clinical follow-up and longitudinal research of ATR patients. MIC values of 13.5 and 28.5 are recommended to consider ATR patients as improved and greatly improved between 3 and 6 months after ATR. Level of evidence II. Keywords Achilles tendon rupture · PROM · Questionnaire · Epidemiology · ATRS · Dutch · Responsiveness · Minimally important change · Follow-up
Introduction
* Olivier C. Dams [email protected] 1
Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
2
Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
3
Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
4
Sports Valley, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP Ede, The Netherlands
Patient-reported outcome measures (PROMs) provide the patient’s perception of the recovery and outcome of treatment [1]. To be applicable and useful in research, PROMs must show adequate measurement properties [2]. Traditionally, validity and reliability were considered the fundamental characteristics of a measurement instru
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