LIFE QUALITY EVALUATION USING “TIME TRADE OFF” METHOD FOR RHEUMATOID HANDS

ABSTRACT Objective: Rheumatoid arthritis is a prevalent disease in the population (range 0.5% to 1%) and involves both orthopedic and rheumatologic treatment. The Time Trade-Off (TTO) technique, which determines the number of years the patient or the professional would be allowed before a successful procedure in terms of life expectancy and value of the procedure, has been gaining ground in clinical protocols. From this standpoint, we sought to compare evaluations provided by the patients, orthopedists, and rheumatologists in determining the TTO and to correlate their responses with the clinical repercussions using previously established scores such as the Brief Michigan Hand Questionnaire and the Disease Activity Score-28 (DAS-28). Methods: A prospective study was conducted that involved 37 patients with rheumatoid arthritis, orthopedists, and rheumatologists. The TTO questionnaire was administered by an independent evaluator for evaluation using the DAS-28 and the Brief Michigan Hand Questionnaire. Results: The descriptive analysis revealed similar medians between the orthopedists, rheumatologists, and patients for single assessments. However, there was a weak correlation between the results from the patient and rheumatologist, the patient and Brief Michigan Questionnaire, and those of the orthopedic surgeon and the DAS-28. Conclusion: Similar median values demonstrated equivalent TTO among the orthopedist, rheumatologist, and patient. However, given the weak correlations between the scores, it was not possible to substitute results using a single evaluation scale. Level of Evidence II, Prognostic Studies.

摘要 研究目的：类风湿关节炎（rheumatoid arthritis）是人群中高发的疾病，发病率介于0.5%至1%之间，患者需接受骨科与风湿科联合诊疗。时间权衡（Time Trade-Off, TTO）技术通过评估患者或临床医师在预期寿命与手术价值层面可接受的术前时长，正逐渐在临床诊疗方案中得到推广应用。基于此，本研究旨在对比患者、骨科医师与风湿科医师对TTO的评估结果，并通过已确立的评分量表——如密歇根手功能简明问卷（Brief Michigan Hand Questionnaire）与28个关节疾病活动度评分（Disease Activity Score-28, DAS-28）——将评估结果与临床转归进行相关性分析。
研究方法：本研究为一项前瞻性研究，共纳入37例类风湿关节炎患者、骨科医师及风湿科医师。由独立评估者发放TTO问卷，并采用DAS-28与密歇根手功能简明问卷开展评估。
研究结果：描述性分析显示，骨科医师、风湿科医师与患者的单次评估中位数结果相近。不过，患者与风湿科医师的评估结果、患者与密歇根手功能简明问卷的结果、骨科医师与DAS-28的结果之间仅存在弱相关性。
研究结论：骨科医师、风湿科医师与患者的TTO评估中位数相近，表明三者的TTO结果具有等效性。但鉴于各评分间相关性较弱，无法通过单一评估量表替代其他评估结果。本研究证据水平为Ⅱ级，属于预后研究范畴。