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Xing H, Liu N, Li K, Cui G, Biering-Sørensen F. Translation and validation of the Chinese self-report version of Spinal Cord Independence Measure (SCIM-SR): Rasch psychometric analysis and online application. Comput Struct Biotechnol J 2024; 24:258-263. [PMID: 38623183 PMCID: PMC11016810 DOI: 10.1016/j.csbj.2024.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 04/17/2024] Open
Abstract
Spinal Cord Independence Measure (SCIM) was an important functional outcome measure specifically designed for spinal cord injury (SCI) patients, with the self-reported version of SCIM (SCIM-SR) published in 2013. This study aims to translate the SCIM-SR into Chinese, and to investigate the validity of Chinese SCIM-SR among SCI patients. This Chinese version of SCIM-SR was translated into Chinese in a standardized approach, and then filled out by a sample of patients with SCI (n = 205) within 3 days after admission. Validity of Chinese SCIM-SR was then analyzed using Rasch analysis and principal component analysis. The subscale Selfcare and subscale Mobility showed good fit to the Rasch model, with no significance found in Chi-square test results for item-trait interaction, using Bonferroni adjustment for the significant level (χ2 =18.125, P = 0.111; χ2 =33.629, P = 0.006). Mean fit residual for items and persons of each subscale were within ± 2.5. The model fit of the subscale of Respiration and Sphincter Management was not satisfactory even after deleting one item and merging two items with local dependence. However, Kaiser-Meyer-Olkin test was > 0.50 in total score and all the subscales of Chinese SCIM-SR, and P < 0.05 in the Bartlett's test. There was no differential item functioning for gender, time post injury, age, and etiology in any of the three subscales. An online version of Chinese SCIM-SR was also developed. It is concluded that the SCIM-SR in Chinese is valid for application in individuals with SCI. SCIM-SR is considered as an important tool for self-reporting functional status from SCI individuals' perspective.
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Affiliation(s)
- Huayi Xing
- Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, China
| | - Nan Liu
- Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, China
| | - Kun Li
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Guoqing Cui
- Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, China
| | - Fin Biering-Sørensen
- Department of Clinical Medicine, University of Copenhagen, and Department of Brain- and Spinal Cord Injuries, Copenhagen University Hospital, Bodil Eskesen Center, Rigshospitalet, Copenhagen, Denmark
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Alabdallat YJ, Schroeder GD, Siddiqui S, Åkerstedt J, Aly MM. How reliable is the distinction between thoracolumbar AO type A3 and A4 fractures? A systematic literature review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:3663-3676. [PMID: 39030322 DOI: 10.1007/s00586-024-08381-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 04/13/2024] [Accepted: 06/17/2024] [Indexed: 07/21/2024]
Abstract
PURPOSE The AOSpine classification divides thoracolumbar burst fractures into A3 and A4 fractures; nevertheless, past research has found inconsistent interobserver reliability in detecting those two fracture patterns. This systematic analysis aims to synthesize data on the reliability of discriminating between A3 and A4 fractures. METHODS We searched PubMed, Scopus, and the Web of Science for studies reporting the inter- and intra-observer reliability of detecting thoracolumbar AO A3 and A4 fractures using computed tomography (CT). The search spanned 2013 to 2023 and included both primarily reliability and observational comparative studies. We followed the PRISMA guidelines and used the modified COSMIN checklist to assess the studies' quality. Kappa coefficient (k) values were categorized according to Landis and Koch, from slight to excellent. RESULTS Of the 396 identified studies, nine met the eligibility criteria; all were primarily reliability studies except one observational study. Interobserver k values for A3/A4 fractures varied widely among studies (0.19-86). The interobserver reliability was poor in two studies, fair in one study, moderate in four studies, and excellent in two studies. Only two studies reported intra-observer reliability, showing fair and excellent agreement. The included studies revealed significant heterogeneity in study design, sample size, and interpretation methods. CONCLUSION Considerable variability exists in interobserver reliability for distinguishing A3 and A4 fractures from slight to excellent agreement. This variability might be attributed to methodological heterogeneity among studies, limitations of reliability analysis, or diagnostic pitfalls in differentiating between A3 and A4. Most observational studies comparing the outcome of A3 and A4 fractures do not report interobserver agreement, and this should be considered when interpreting their results.
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Affiliation(s)
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Josefin Åkerstedt
- Department of Diagnostics and Intervention, Orthopedics and Spine, Umeå University, Umeå, Sweden
| | - Mohamed M Aly
- Department of Neurosurgery, Prince Mohammed Bin Abdulaziz Hospital, P.O Box 54146, 11514, Riyadh, Saudi Arabia.
- Department of Neurosurgery, Mansoura University, Mansoura, Egypt.
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Häckel S, Oswald KAC, Koller L, Benneker LM, Benneker LA, Sadiqi S, Oner FC, Deml MC. Reliability and Validity of the German Version of the AO Spine Patient Reported Outcome Spine Trauma Questionnaire. Global Spine J 2024; 14:1771-1777. [PMID: 36751047 PMCID: PMC11268291 DOI: 10.1177/21925682231156124] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
STUDY DESIGN A single-center validation study. OBJECTIVE To translate and cross-culturally adapt the AO Spine PROST (Patient Reported Outcome Spine Trauma) into German, and to test its psychometric properties among German-speaking Swiss spine trauma patients. METHODS Patients were recruited from a level-1 Swiss trauma center. Next to the AO Spine PROST, the EQ-5D-3L questionnaire was used for concurrent validity. Questionnaires were filled out at two-time points for test-retest reliability. Patient characteristics were analyzed using descriptive statistics. For content validity, floor, and ceiling effects, as well as any irrelevant and missing questions were analyzed. Construct validity of the AO Spine PROST questionnaire to the EQ-5D-3L was tested using Spearman correlation tests. RESULTS The AOSpine PROST was translated and adapted into German using established guidelines. We included 179 patients. The floor effect for all items was well within the optimal range (below 15%), while the ceiling effect of seven items was within the optimal range. None of the items displayed a problematic floor or ceiling effect. The overall test-retest reliability of the total PROST score was excellent, with an ICC of .83 (95% CI .69-.91). The Spearman correlation coefficient between the total PROST summary score and EQ-5D-3 L was ρ = .63. CONCLUSIONS The German version of the AO Spine PROST questionnaire demonstrated very good validity and reliability results.
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Affiliation(s)
- Sonja Häckel
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital Bern, University Bern, Bern, Switzerland
| | - Katharina A. C. Oswald
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital Bern, University Bern, Bern, Switzerland
| | - Leonie Koller
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital Bern, University Bern, Bern, Switzerland
| | | | - Layla A. Benneker
- Department for Mathematics and Statistics, University of Bern, Bern, Switzerland
| | - Said Sadiqi
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - F. Cumhur Oner
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Moritz C. Deml
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital Bern, University Bern, Bern, Switzerland
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Sadiqi S, de Gendt EEA, Muijs SPJ, Post MWM, Benneker LM, Holas M, Tee JW, Albers CE, Häckel S, Svac J, Bransford RJ, El-Sharkawi MM, Kandziora F, Rajasekaran S, Schnake KJ, Vaccaro AR, Oner FC. Validation of the AO Spine CROST (Clinician Reported Outcome Spine Trauma) in the clinical setting. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:1607-1616. [PMID: 38367026 DOI: 10.1007/s00586-024-08145-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/19/2023] [Accepted: 01/13/2024] [Indexed: 02/19/2024]
Abstract
PURPOSE To evaluate feasibility, internal consistency, inter-rater reliability, and prospective validity of AO Spine CROST (Clinician Reported Outcome Spine Trauma) in the clinical setting. METHODS Patients were included from four trauma centers. Two surgeons with substantial amount of experience in spine trauma care were included from each center. Two separate questionnaires were administered at baseline, 6-months and 1-year: one to surgeons (mainly CROST) and another to patients (AO Spine PROST-Patient Reported Outcome Spine Trauma). Descriptive statistics were used to analyze patient characteristics and feasibility, Cronbach's α for internal consistency. Inter-rater reliability through exact agreement, Kappa statistics and Intraclass Correlation Coefficient (ICC). Prospective analysis, and relationships between CROST and PROST were explored through descriptive statistics and Spearman correlations. RESULTS In total, 92 patients were included. CROST showed excellent feasibility results. Internal consistency (α = 0.58-0.70) and reliability (ICC = 0.52 and 0.55) were moderate. Mean total scores between surgeons only differed 0.2-0.9 with exact agreement 48.9-57.6%. Exact agreement per CROST item showed good results (73.9-98.9%). Kappa statistics revealed moderate agreement for most CROST items. In the prospective analysis a trend was only seen when no concerns at all were expressed by the surgeon (CROST = 0), and moderate to strong positive Spearman correlations were found between CROST at baseline and the scores at follow-up (rs = 0.41-0.64). Comparing the CROST with PROST showed no specific association, nor any Spearman correlations (rs = -0.33-0.07). CONCLUSIONS The AO Spine CROST showed moderate validity in a true clinical setting including patients from the daily clinical practice.
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Affiliation(s)
- Said Sadiqi
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Erin E A de Gendt
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sander P J Muijs
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marcel W M Post
- Rehabilitation Center 'De Hoogstraat', Utrecht, The Netherlands
- Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, Groningen, The Netherlands
| | - Lorin M Benneker
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital Bern, University Bern, Bern, Switzerland
| | - Martin Holas
- Department of Trauma Surgery, Slovak Medical University, F. D. Roosevelt University General Hospital, Banska Bystrica, Slovakia
| | - Jin W Tee
- Department of Neurosurgery, Alfred Hospital, Melbourne, VIC, Australia
- Department of Surgery, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Christoph E Albers
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital Bern, University Bern, Bern, Switzerland
| | - Sonja Häckel
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital Bern, University Bern, Bern, Switzerland
| | - Juraj Svac
- Department of Trauma Surgery, Slovak Medical University, F. D. Roosevelt University General Hospital, Banska Bystrica, Slovakia
| | - Richard J Bransford
- Department of Orthopaedics and Sports Medicine, University of Washington/Harborview Medical Center, Seattle, WA, USA
| | - Mohammad M El-Sharkawi
- Department of Orthopaedic and Trauma Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | | | - Klaus J Schnake
- Center for Spinal and Scoliosis Surgery, Malteser Waldkrankenhaus St. Marien, Erlangen, Germany
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - F Cumhur Oner
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands
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Vercoulen TF, Niemeyer MJ, Peuker F, Verlaan JJ, Oner FC, Sadiqi S. Surgical treatment of traumatic fractures of the thoracic and lumbar spine: A systematic review. BRAIN & SPINE 2024; 4:102745. [PMID: 38510618 PMCID: PMC10951763 DOI: 10.1016/j.bas.2024.102745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/27/2023] [Accepted: 01/03/2024] [Indexed: 03/22/2024]
Abstract
Introduction The treatment of traumatic thoracic and lumbar spine fractures remains controversial. To date no consensus exists on the correct choice of surgical approach and technique. Research question to provide a comprehensive up-to-date overview of the available different surgical methods and their quantified outcomes. Methods PubMed and EMBASE were searched between 2001 and 2020 using the term 'spinal fractures'. Inclusion criteria were: adults, ≥10 cases, ≥12 months follow-up, thoracic or lumbar fractures, and surgery <3 weeks of trauma. Studies were categorized per surgical technique: Posterior open (PO), posterior percutaneous (PP), stand-alone vertebral body augmentation (SA), anterior scopic (AS), anterior open (AO), posterior percutaneous and anterior open (PPAO), posterior percutaneous and anterior scopic (PPAS), posterior open and anterior open (POAO) and posterior open and anterior scopic (POAS). The PO group was used as a reference group. Results After duplicate removal 6042 articles were identified. A total of 102 articles were Included, in which 137 separate surgical technique cohorts were described: PO (n = 75), PP, (n = 39), SA (n = 12), AO (n = 5), PPAO (n = 1), PPAS (n = 1), POAO (n = 2) and POAS (n = 2). Discussion and conclusion For type A3/A4 burst fractures, without severe neurological deficit, posterior percutaneous (PP) technique seems the safest and most feasible option in the past two decades. If needed, PP can be combined with anterior augmentation to prevent secondary kyphosis. Furthermore, posterior open (PO) technique is feasible in almost all types of fractures. Also, this technique can provide for an additional posterior decompression or fusion. Overall, no neurologic deterioration was reported following surgical intervention.
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Affiliation(s)
- Timon F.G. Vercoulen
- Diakonessenhuis, Department of Orthopedic Surgery, Bosboomstraat 1, 3582, KE, Utrecht, the Netherlands
- University Medical Center Utrecht, Department of Orthopedic Surgery, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
| | - Menco J.S. Niemeyer
- University Medical Center Utrecht, Department of Orthopedic Surgery, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
| | - Felix Peuker
- University Medical Center Utrecht, Department of Orthopedic Surgery, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
| | - Jorrit-Jan Verlaan
- University Medical Center Utrecht, Department of Orthopedic Surgery, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
| | - F. Cumhur Oner
- University Medical Center Utrecht, Department of Orthopedic Surgery, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
| | - Said Sadiqi
- University Medical Center Utrecht, Department of Orthopedic Surgery, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
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Hakbijl-van der Wind AJ, Post MWM, van Diemen T, Schnake KJ, Benneker LM, Kandziora F, Rajasekaran S, Schroeder GD, Vaccaro AR, Öner FC, Sadiqi S. Health professionals' perspective on the applicability of AO Spine PROST (patient reported outcome Spine trauma) in people with a motor-complete traumatic or non-traumatic spinal cord injury. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:2120-2130. [PMID: 37031293 DOI: 10.1007/s00586-023-07676-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 03/02/2023] [Accepted: 03/22/2023] [Indexed: 04/10/2023]
Abstract
PURPOSE The AO Spine PROST (Patient Reported Outcome Spine Trauma) was developed for people with spine trauma and minor or no neurological impairment. The purpose is to investigate health professionals' perspective on the applicability of the AO Spine PROST for people with motor-complete traumatic or non-traumatic spinal cord injury (SCI), using a discussion meeting and international survey study. METHODS A discussion meeting with SCI rehabilitation physicians in the Netherlands was performed, followed by a worldwide online survey among the AO Spine International community, involved in the care of people with SCI. Participants rated the comprehensibility, relevance, acceptability, feasibility and completeness of the AO Spine PROST on a 1-5 point scale (5 most positive). Comments could be provided per question. RESULTS The discussion meeting was attended by 13 SCI rehabilitation physicians. The survey was completed by 196 participants. Comprehensibility (mean ± SD: 4.1 ± 0.8), acceptability (4.0 ± 0.8), relevance (3.9 ± 0.8), completeness (3.9 ± 0.8), and feasibility (4.1 ± 0.7) of the AO Spine PROST were rated positively for use in people with motor-complete traumatic or non-traumatic SCI. Only a few participants questioned the relevance of items on the lower extremities (e.g., walking) or missed items on pulmonary functioning and complications. Some recommendations were made for improvement in instructions, terminology and examples of the tool. CONCLUSION Health professionals found the AO Spine PROST generally applicable for people with motor-complete traumatic or non-traumatic SCI. This study provides further evidence for the use of the AO Spine PROST in spine trauma care, rehabilitation and research, as well as suggestions for its further development.
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Affiliation(s)
- Aline J Hakbijl-van der Wind
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht and De Hoogstraat Rehabilitation, P.O. Box 85238, 3508 AE, Utrecht, The Netherlands.
| | - Marcel W M Post
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht and De Hoogstraat Rehabilitation, P.O. Box 85238, 3508 AE, Utrecht, The Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Tijn van Diemen
- Department of spinal cord injury Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Klaus J Schnake
- Center for Spine and Scoliosis Surgery, Malteser Waldkrankenhaus St. Marien, Erlangen, Germany
- Department of Orthopeadics and Traumatology, Paracelsus Private Medical University Nuremberg, Nuremberg, Germany
| | - Lorin M Benneker
- Center for Spine Surgery and Neurotraumatology, BG Unfallklinik Frankfurt am Main, Frankfurt, Germany
| | - Frank Kandziora
- Center for Spine Surgery and Neurotraumatology, BG Unfallklinik Frankfurt am Main, Frankfurt, Germany
| | | | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - F Cumhur Öner
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Said Sadiqi
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands
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Sadiqi S, Oner FC. A disease-specific patient reported outcome instrument for spine trauma is developed, validated and available! Re: Andrzejowski et al. Measuring functional outcomes in major trauma: can we do better? Eur J Trauma Emerg Surg 2023; 49:1605-1606. [PMID: 36378305 PMCID: PMC10229709 DOI: 10.1007/s00068-022-02167-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/04/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Said Sadiqi
- Department of Orthopaedics, University Medical Center Utrecht, HP G05.228, P.O. Box 85500, 3508GA, Utrecht, The Netherlands.
| | - F Cumhur Oner
- Department of Orthopaedics, University Medical Center Utrecht, HP G05.228, P.O. Box 85500, 3508GA, Utrecht, The Netherlands
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Long-Term Reliability and Validity of the AO Spine PROST (Patient-Reported Outcome Spine Trauma). Spine (Phila Pa 1976) 2022; 47:E562-E569. [PMID: 35853155 DOI: 10.1097/brs.0000000000004379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/14/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cross-sectional validation study. OBJECTIVE The aim was to validate the AO Spine Patient-Reported Outcome Spine Trauma (PROST) at a minimum of 12 months posttrauma and to evaluate patient characteristics, types of spine fractures, and treatment strategies as determinants of AO Spine PROST scores. SUMMARY OF BACKGROUND DATA The reliability and validity of the AO Spine PROST as a measure of health-related quality of life for more than 12 months after onset of spine trauma is unclear. MATERIALS AND METHODS Patients with a traumatic spine injury were recruited from a level-1 trauma center. They were asked to complete the AO Spine PROST, EuroQoL 5D-5L (EQ-5D-5L), and either Oswestry disability index (ODI) or neck disability index (NDI) for concurrent validity. Internal consistency was assessed by calculating the Cronbach α and item-total correlation coefficients. Test-retest reliability was evaluated using intraclass correlation coefficients. Spearman correlation tests were performed for the AO Spine PROST in correlation with the EQ-5D-5L, and either ODI or NDI. Determinants for AO Spine PROST score were analyzed using multivariate regression models. RESULTS A total of 175 patients participated in the cross-sectional arm and 49 in the test-retest arm of the study. Median duration of follow-up was 94.5 months. No floor or ceiling effects were seen. Internal consistency was excellent (α=0.98, item-total correlation coefficient: 0.73-0.91) as well as test-retest reliability (intraclass correlation coefficient=0.81). Satisfactory correlations were seen for the EQ-5D-5L (0.76; P <0.001), ODI (0.69; P <0.001), and NDI (0.68; P <0.001) with the AO Spine PROST. Multivariate linear regression models showed that having ≥1 comorbidities, duration of return to work within the range of 7 to 43 months and no return to work were significant independent determinants for a worse AO Spine PROST score. CONCLUSIONS Very good long-term reliability and validity results were found for the AO Spine PROST.
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Hakbijl AJ, van Diemen T, Dompeling S, Oner FC, Post MWM, Sadiqi S. Applicability of the AO Spine Patient Reported Outcome Spine Trauma (PROST) in people with motor-complete spinal cord injury: a cognitive interview study. Spinal Cord 2022; 60:911-916. [PMID: 35798872 PMCID: PMC9261216 DOI: 10.1038/s41393-022-00829-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN This is a cognitive interview study. OBJECTIVES To examine the applicability of the Patient Reported Outcome Spine Trauma (AO Spine PROST) in people with motor-complete traumatic or non-traumatic spinal cord injury (SCI). SETTING Two rehabilitation centers in The Netherlands. METHOD Semi-structured cognitive interviews were conducted with 29 adults with a motor-complete SCI (AISA Impairment Scale A or B). Participants were asked to complete the AO Spine PROST and four additional evaluation questions rated on a 1-5-point Likert scale (5 most positive), while verbalizing their thoughts about their answers. Interviews were audio-recorded and transcribed. Codes were identified and linked to a coding scheme. Qualitative data were used to interpret the quantitative results. RESULTS Almost three-quarters of the participants (71.4%) had a traumatic SCI. Positive ratings of the measure were obtained regards comprehensibility (mean 4.0), non-offensiveness (4.6), relevance (4.2), and completeness (3.6). A question about the emotional impact of SCI was indicated to be missing. How using an assistive device should weigh in the score was a recurring topic. The use of multiple examples per item raised uncertainty, mostly solved by averaging their score. Some individuals indicated that the possibility to express even better function compared to before the onset of injury would be valuable. CONCLUSIONS Overall, the AO Spine PROST appears applicable in adults with a motor-complete traumatic or non-traumatic SCI. Recommendations are made for improvement in instructions, terminology, and examples used in the tool. This study contributes to the further development of the AO Spine PROST in spine trauma care and research.
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Affiliation(s)
- Aline J Hakbijl
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.
| | - Tijn van Diemen
- Department of Spinal Cord Injury Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Stephanie Dompeling
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - F Cumhur Oner
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marcel W M Post
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Said Sadiqi
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands
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Greenberg JK, Otun A, Ghogawala Z, Yen PY, Molina CA, Limbrick DD, Foraker RE, Kelly MP, Ray WZ. Translating Data Analytics Into Improved Spine Surgery Outcomes: A Roadmap for Biomedical Informatics Research in 2021. Global Spine J 2022; 12:952-963. [PMID: 33973491 PMCID: PMC9344511 DOI: 10.1177/21925682211008424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
STUDY DESIGN Narrative review. OBJECTIVES There is growing interest in the use of biomedical informatics and data analytics tools in spine surgery. Yet despite the rapid growth in research on these topics, few analytic tools have been implemented in routine spine practice. The purpose of this review is to provide a health information technology (HIT) roadmap to help translate data assets and analytics tools into measurable advances in spine surgical care. METHODS We conducted a narrative review of PubMed and Google Scholar to identify publications discussing data assets, analytical approaches, and implementation strategies relevant to spine surgery practice. RESULTS A variety of data assets are available for spine research, ranging from commonly used datasets, such as administrative billing data, to emerging resources, such as mobile health and biobanks. Both regression and machine learning techniques are valuable for analyzing these assets, and researchers should recognize the particular strengths and weaknesses of each approach. Few studies have focused on the implementation of HIT, and a variety of methods exist to help translate analytic tools into clinically useful interventions. Finally, a number of HIT-related challenges must be recognized and addressed, including stakeholder acceptance, regulatory oversight, and ethical considerations. CONCLUSIONS Biomedical informatics has the potential to support the development of new HIT that can improve spine surgery quality and outcomes. By understanding the development life-cycle that includes identifying an appropriate data asset, selecting an analytic approach, and leveraging an effective implementation strategy, spine researchers can translate this potential into measurable advances in patient care.
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Affiliation(s)
- Jacob K. Greenberg
- Department of Neurological Surgery, Washington University School of Medicine,
St. Louis, MO, USA,Jacob K. Greenberg, Department of
Neurosurgery, Washington University School of Medicine, 660S. Euclid Ave., Box
8057, St. Louis, MO 63 110, USA.
| | - Ayodamola Otun
- Department of Neurological Surgery, Washington University School of Medicine,
St. Louis, MO, USA
| | - Zoher Ghogawala
- Department of Neurosurgery, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Po-Yin Yen
- Institute for Informatics, Washington University School of Medicine,
St. Louis, MO, USA
| | - Camilo A. Molina
- Department of Neurological Surgery, Washington University School of Medicine,
St. Louis, MO, USA
| | - David D. Limbrick
- Department of Neurological Surgery, Washington University School of Medicine,
St. Louis, MO, USA
| | - Randi E Foraker
- Institute for Informatics, Washington University School of Medicine,
St. Louis, MO, USA
| | - Michael P. Kelly
- Department of Orthopaedic Surgery, Washington University School of Medicine,
St. Louis, MO, USA
| | - Wilson Z. Ray
- Department of Neurological Surgery, Washington University School of Medicine,
St. Louis, MO, USA
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11
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Sadiqi S, Dvorak MF, Vaccaro AR, Schroeder GD, Post MW, Benneker LM, Kandziora F, Rajasekaran S, Schnake KJ, Vialle EN, Oner FC. Reliability and Validity of the English Version of the AOSpine PROST (Patient Reported Outcome Spine Trauma). Spine (Phila Pa 1976) 2020; 45:E1111-E1118. [PMID: 32355148 PMCID: PMC7439930 DOI: 10.1097/brs.0000000000003514] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 02/12/2020] [Accepted: 02/21/2020] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Multicenter validation study. OBJECTIVE The aim of this study was to translate and adapt the AOSpine PROST (Patient Reported Outcome Spine Trauma) into English, and test its psychometric properties among North-American spine trauma patients. SUMMARY OF BACKGROUND DATA In the absence of an outcome instrument specifically designed and validated for traumatic spinal column injury patients, it is difficult to measure the effect size of various treatment options. The AOSpine Knowledge Forum Trauma initiated a project and developed the AOSpine PROST consisting of 19 items. METHODS Patients were recruited from two level-1 North-American trauma centers. For concurrent validity, next to AOSpine PROST also 36-item Short-Form Health Survey (SF-36) was filled out by patients. Patient characteristics were analyzed using descriptive statistics. Floor and ceiling effects as well as the number of inapplicable and missing questions were analyzed for content validity. Cronbach α and item-total correlation coefficients (ITCCs) were calculated for internal consistency. Spearman correlation tests were performed within AOSpine PROST items and in correlation to SF-36. Test-retest reliability was assessed using intraclass correlation coefficients (ICCs). Factor analysis was performed to explore any dimensions within AOSpine PROST. RESULTS The AOSpine PROST was translated adapted into English using established guidelines. Of 196 enrolled patients, 162 (82.7%) met the inclusion criteria and provided sufficient data. Content validity showed good results, and no floor and ceiling effects were seen. The internal consistency was excellent (Cronbach α = 0.97; ITCC 0.50-0.90) as well as test-retest reliability (ICC = 0.97). Spearman correlations were good (0.29-0.85). The strongest correlations of AOSpine PROST with SF-36 were seen with the physical components (0.69-0.82; P < 0.001). Factor analysis revealed two possible dimensions (Eigen values >1), explaining 75.7% of variance. CONCLUSION The English version of AOSpine PROST showed very good validity and reliability. It is considered as a valuable tool, and has the potential to contribute to the reduction of ongoing controversies in spine trauma care. LEVEL OF EVIDENCE 2.
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Affiliation(s)
- Said Sadiqi
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marcel F. Dvorak
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Marcel W. Post
- Rehabilitation Center ‘De Hoogstraat’, Utrecht, The Netherlands
- Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, Groningen, The Netherlands
| | - Lorin M. Benneker
- Department of Traumatology and Orthopaedic Surgery, Inselspital University of Bern, Bern, Switzerland
| | | | - S. Rajasekaran
- Department of Orthopaedic and Spine Surgery, Ganga Hospital, Coimbatore, India
| | - Klaus J. Schnake
- Center for Spinal Surgery, Schön Klinik Nürnberg Fürth, Fürth, Germany
| | | | - F. Cumhur Oner
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, the Netherlands
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12
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Sadiqi S, Post MW, Hosman AJ, Dvorak MF, Chapman JR, Benneker LM, Kandziora F, Rajasekaran S, Schnake KJ, Vaccaro AR, Oner FC. Reliability, validity and responsiveness of the Dutch version of the AOSpine PROST (Patient Reported Outcome Spine Trauma). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 30:2631-2644. [PMID: 32815075 DOI: 10.1007/s00586-020-06554-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 06/22/2020] [Accepted: 07/24/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To validate the Dutch version of AOSpine PROST (Patient Reported Outcome Spine Trauma). METHODS Patients were recruited from two level-1 trauma centers from the Netherlands. Next to the AOSpine PROST, patients also filled out SF-36 for concurrent validity. Descriptive statistics were used to analyze the characteristics. Content validity was assessed by evaluating the number of inapplicable or missing questions. Also floor and ceiling effects were analyzed. Internal consistency was assessed by calculating Cronbach's α and item-total correlation coefficients (itcc). Spearman correlation tests were performed within AOSpine PROST items and in correlation with SF-36. Test-retest reliability was analyzed using Intraclass Correlation Coefficients (ICC). Responsiveness was assessed by calculating effect sizes (ES) and standardized response mean (SRM). Factor analysis was performed to explore any dimensions within AOSpine PROST. RESULTS Out of 179 enrolled patients, 163 (91.1%) were included. Good results were obtained for content validity. No floor or ceiling effects were seen. Internal consistency was excellent (Cronbach's α = 0.96, itcc 0.50-0.86), with also good Spearman correlations (0.25-0.79). Compared to SF-36, the strongest correlation was seen for physical functioning (0.79; p < .001). Also test-retest reliability was excellent (ICC = 0.92). Concerning responsiveness analysis, very good results were seen with ES = 1.81 and SRM = 2.03 (p < 0.001). Factor analysis revealed two possible dimensions (Eigenvalues > 1), explaining 65.4% of variance. CONCLUSIONS Very satisfactory results were obtained for reliability, validity and responsiveness of the Dutch version of AOSpine PROST. Treating surgeons are encouraged to use this novel and validated tool in clinical setting and research to contribute to evidence-based and patient-centered care.
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Affiliation(s)
- Said Sadiqi
- Department of Orthopaedics, University Medical Center Utrecht, HP G05.228, P.O. Box 85500, 3508GA, Utrecht, The Netherlands.
| | - Marcel W Post
- Rehabilitation Center 'De Hoogstraat', Utrecht, The Netherlands.,Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, Groningen, The Netherlands
| | - Allard J Hosman
- Department of Orthopaedic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcel F Dvorak
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Jens R Chapman
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA
| | - Lorin M Benneker
- Department of Traumatology and Orthopaedic Surgery, Inselspital University of Bern, Bern, Switzerland
| | | | - S Rajasekaran
- Department of Orthopaedic and Spine Surgery, Ganga Hospital, Coimbatore, India
| | - Klaus J Schnake
- Center for Spinal Surgery, Schön Klinik Nürnberg Fürth, Fürth, Germany
| | - Alexander R Vaccaro
- Department of Orthopaedics, Thomas Jefferson University, Philadelphia, PA, USA
| | - F Cumhur Oner
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands
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Sadiqi S, Muijs SPJ, Renkens JJM, Post MW, Benneker LM, Chapman JR, Kandziora F, Schnake KJ, Vialle EN, Vaccaro AR, Oner FC. Development and reliability of the AOSpine CROST (Clinician Reported Outcome Spine Trauma): a tool to evaluate and predict outcomes from clinician's perspective. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:2550-2559. [PMID: 32632640 DOI: 10.1007/s00586-020-06518-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 05/28/2020] [Accepted: 06/20/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To report on the development of AOSpine CROST (Clinician Reported Outcome Spine Trauma) and results of an initial reliability study. METHODS The AOSpine CROST was developed using an iterative approach of multiple cycles of development, review, and revision including an expert clinician panel. Subsequently, a reliability study was performed among an expert panel who were provided with 20 spine trauma cases, administered twice with 4-week interval. The results of the developmental process were analyzed using descriptive statistics, the reliability per parameter using Kappa statistics, inter-rater rater agreement using intraclass correlation coefficient (ICC), and internal consistency using Cronbach's α. RESULTS The AOSpine CROST was developed and consisted of 10 parameters, 2 of which are only applicable for surgically treated patents ('Wound healing' and 'Implants'). A dichotomous scoring system ('yes' or 'no' response) was incorporated to express expected problems for the short term and long term. In the reliability study, 16 (84.2%) participated in the first round and 14 (73.7%) in the second. Intra-rater reliability was fair to good for both time points (κ = 0.40-0.80 and κ = 0.31-0.67). Results of inter-rater reliability were lower (κ = 0.18-0.60 and κ = 0.16-0.46). Inter-rater agreement for total scores showed moderate results (ICC = 0.52-0.60), and the internal consistency was acceptable (α = 0.76-0.82). CONCLUSIONS The AOSpine CROST, an outcome tool for the surgeons, was developed using an iterative process. An initial reliability analysis showed fair to moderate results and acceptable internal consistency. Further clinical validation studies will be performed to further validate the tool.
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Affiliation(s)
- Said Sadiqi
- Department of Orthopaedics, University Medical Center Utrecht, HP G05.228, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - Sander P J Muijs
- Department of Orthopaedics, University Medical Center Utrecht, HP G05.228, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Jeroen J M Renkens
- Department of Orthopaedics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marcel W Post
- Rehabilitation Center 'De Hoogstraat', Utrecht, The Netherlands.,Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, Groningen, The Netherlands
| | - Lorin M Benneker
- Department of Traumatology and Orthopaedic Surgery, Inselspital University of Bern, Bern, Switzerland
| | - Jens R Chapman
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA
| | | | - Klaus J Schnake
- Center for Spinal Surgery, Schön Klinik Nürnberg Fürth, Fürth, Germany
| | | | - Alexander R Vaccaro
- Department of Orthopaedics, Thomas Jefferson University, Philadelphia, PA, USA
| | - F Cumhur Oner
- Department of Orthopaedics, University Medical Center Utrecht, HP G05.228, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
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Wijdicks SPJ, Dompeling SD, de Reuver S, Kempen DHR, Castelein RM, Kruyt MC. Reliability and Validity of the Adapted Dutch Version of the Early-Onset Scoliosis-24-Item Questionnaire (EOSQ-24). Spine (Phila Pa 1976) 2019; 44:E965-E973. [PMID: 31374000 DOI: 10.1097/brs.0000000000003017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Translation and validation of the Early Onset Scoliosis-24 Questionnaire (EOSQ-24). OBJECTIVE To cross-culturally adapt the English version of the EOSQ-24 to the Dutch language and to assess the questionnaire's reliability and validity. SUMMARY OF BACKGROUND DATA Early-onset scoliosis (EOS) has a profound impact on health-related quality of life. The EOSQ-24 is health-related quality of life questionnaire filled in by parents of children with EOS. The EOSQ-24 was already translated into multiple languages and its application was confirmed in clinical studies. However, the EOSQ-24 is not yet translated and validated for the Dutch population. METHODS The adaption of the EOSQ-24 for the Dutch population was done in three steps: 1) translation to the Dutch language, 2) cross-cultural adaptation, and 3) cross-cultural validation. To ensure that the Adapted Dutch EOSQ-24 is applicable for clinical use, the measurement properties were tested in four steps: 1) floor and ceiling effects, 2) validation, 3) reliability, and 4) discriminative ability. One hundred three parents completed the Adapted Dutch EOSQ-24, the Child Health Questionnaire (CHQ-28 PF), and the Scoliosis Research Society Questionnaire (SRS-22r). A second EOSQ-24 was completed for test-retest reproducibility. RESULTS The EOSQ-24 was successfully translated, adapted, and validated for the Dutch language. Almost all response items showed a normal distribution. The EOSQ-24 showed excellent reliability (Cronbach α of 0.950). The EOSQ-24 was successfully validated against the CHQ-28-PF and the SRS-22r. Test-retest was excellent (ICC ≥ 0.8). Finally, The EOSQ-24 was found capable to discriminate patients with different curve severities (P = 0.003), diagnosis (P = 0.006), and ambulatory status (P < 0.001). CONCLUSION The current Dutch EOSQ-24 proved to be a valid and reliable quality of life assessment tool for patients with EOS. Currently, long follow-up studies using the EOSQ-24, including the Dutch EOSQ-24, are lacking and are needed to fully validate the EOSQ-24 for use in a clinical setting. LEVEL OF EVIDENCE 2.
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Affiliation(s)
- Sebastiaan P J Wijdicks
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stephanie D Dompeling
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Steven de Reuver
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - René M Castelein
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Moyo C Kruyt
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Abstract
This article focuses on patient-reported and clinician-reported outcome measures in spine trauma care. The measurement of the quality of care and functional and health-related quality of life outcomes of spine trauma patients has become increasingly important. However, no outcome instrument is specifically designed, validated, or universally adapted for this specific patient population. Issues specific to spinal trauma patients may not be adequately addressed by the instruments that are currently used in the literature and the daily clinical practice. The AOSpine Knowledge Forum Trauma initiated a project to develop and validate such instruments for spine trauma patients. To reflect the different perspectives of patients and the treating surgeons, 2 separate tools are being developed: the Patient Reported Outcome Spine Trauma (AOSpine PROST) and Clinician Reported Outcome Spine Trauma (AOSpine CROST). These tools hold promise, as useful instruments to measure the outcomes of spine trauma patients with and without neurological deficit, making it more feasible for clinical use as well. Treating surgeons around the world are encouraged to use the AOSpine PROST and AOSpine CROST in daily clinical practice and for research purposes to create and contribute to evidence-based and patient-centered care. Using the same outcome measures that are specifically developed and validated for traumatic spine injuries will allow us to compare the outcomes of various treatments in a valid and reproducible fashion. This contributes to a reduction of the ongoing controversies and providing the best treatments for our patients.
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