1
|
Karlsson C, Carlsson E, Åkerstedt J, Lilja P, von Essen C, Tabatabaei P, Wänman J. Outcomes after selective nerve root blockade for lumbar radicular pain from lumbar disc hernia or lumbar spinal stenosis assessed by the PROMIS-29 - a prospective observational cohort study. Acta Neurochir (Wien) 2024; 166:306. [PMID: 39052107 PMCID: PMC11272668 DOI: 10.1007/s00701-024-06196-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 07/07/2024] [Indexed: 07/27/2024]
Abstract
PURPOSE Selective nerve root blocks (SNRB) are used both as a therapeutic and diagnostic tool for lumbar radicular pain. Most studies evaluate the effect of SNRB simply by its relation to pain reduction. It is well known that pain is associated with other factors such as depression, anxiety, inactivity and sleeping disorders, but these patient-related outcomes are seldom evaluated. This study evaluated the influence of SNRB on pain-related outcomes including depression, anxiety, fatigue, pain interference, activity and sleep. METHODS One hundred three patients with lumbar radicular pain were treated with a SNRB. Patient-reported outcome measures (PROMs) were assessed with the PROMIS-29 for 12 weeks (84 days) following the SNRB. Patients were stratified based on their pain reduction at the 14-day follow up as responders (≥ 30% pain reduction) and non-responders (< 30% pain reduction). Post-treatment duration was estimated with the Kaplan-Meier analysis with return to baseline as an event. A paired t-test was used to compare pre- and post-treatment responses at specific time intervals. RESULTS Forty-four percent (n = 45) of the patients were responders and showed significant improvement in all parameters throughout the 84-days follow-up, the exception was sleep that lost significance at day 70. The mean post-treatment duration among responders was 59 (52-67) days. Non-responders showed significant improvements in pain interference and pain intensity until day 35 and in ability for social participation until 21-day. CONCLUSION SNRB can improve pain intensity, pain interference, physical function, fatigue, anxiety, depression, sleep disturbance and the ability to participate in social roles.
Collapse
Affiliation(s)
- Caroline Karlsson
- Department of Diagnostics and Intervention, Umeå University, Umeå, Sweden
| | - Erik Carlsson
- Department of Diagnostics and Intervention, Umeå University, Umeå, Sweden
| | - Josefin Åkerstedt
- Department of Diagnostics and Intervention, Umeå University, Umeå, Sweden
| | - Petrus Lilja
- Department of Diagnostics and Intervention, Umeå University, Umeå, Sweden
| | - Christoffer von Essen
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institute, Stockholm, Sweden
| | - Pedram Tabatabaei
- Department of Clinical Sciences, Neurosurgery, Umeå University, Umeå, Sweden
| | - Johan Wänman
- Department of Diagnostics and Intervention, Umeå University, Umeå, Sweden.
| |
Collapse
|
2
|
Azam F, Shukla I, Hicks WH, Anand S, Furtado K, Smith PD, Hall K, Akbik OS, Bagley CA. A 3-Year Study Investigating the Utility of Patient-Reported Outcomes Measurement Information System-29 for Long-Term Follow-Up in Adult Spinal Deformity. World Neurosurg 2024; 186:e506-e513. [PMID: 38583560 DOI: 10.1016/j.wneu.2024.03.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Adult spinal deformity (ASD) significantly impacts the quality of life due to three-dimensional spinal abnormalities. Patient-reported outcome measures, such as the Patient-Reported Outcomes Measurement Information System (PROMIS-29), play a crucial role in assessing postoperative outcomes. This study aims to investigate trends in PROMIS-29 scores over 36 months in patients undergoing long-segment thoracolumbar fusion for ASD and provide insights into its long-term utility. METHODS A retrospective study including 163 ASD patients undergoing long-segment thoracolumbar fusion was conducted. PROMIS-29 scores were collected at baseline and at postoperative (0-), 3-, 6-, 12-, 18-, 24-, 30-, and 36-month follow-ups. Statistical analyses was performed to assess significant score changes from baseline and in consecutive recordings. RESULTS Significant improvements in all PROMIS-29 categories were observed at 36 months, with the greatest changes in pain intensity (-35.19%, P < 0.001), physical function (+29.13%, P < 0.001), and pain interference (-28.8%, P < 0.001). Between the 0 and 3 month mark, the greatest significant changes were recorded in pain intensity (-26.5%, P < 0.001), physical function (+24.3%, P < 0.001), and anxiety (-16.9%, P < 0.018). However, scores plateaued after the 3-month mark, with zero categories showing significant changes with subsequent consecutive recordings. CONCLUSIONS PROMIS-29 scores demonstrated notable improvements in ASD patients particularly in pain intensity, pain interference, and physical function. However, scores plateaued beyond the 3-month mark, suggesting PROMIS-29's limited sensitivity to nuanced changes in long-term patient recovery. Future investigations exploring optimal combinations of patient reported outcome measures for comprehensive short- and long-term outcome assessments in ASD surgery would be beneficial.
Collapse
Affiliation(s)
- Faraaz Azam
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ishav Shukla
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - William H Hicks
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Soummitra Anand
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kailee Furtado
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Parker D Smith
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kristen Hall
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Omar S Akbik
- Department of Neurological Surgery, CHI Health, Omaha, NE, USA; Department of Neurological Surgery, Saint Luke's Neurological & Spine Surgery, Kansas City, MO, USA
| | - Carlos A Bagley
- Department of Neurological Surgery, Saint Luke's Neurological & Spine Surgery, Kansas City, MO, USA.
| |
Collapse
|
3
|
Chakravarti S, Kuo CC, Kazemi F, Kang A, Lucas CH, Croog V, Kamson D, Schreck KC, Holdhoff M, Bettegowda C, Mukherjee D. Preoperative patient-reported physical health-related quality of life predicts short-term postoperative outcomes in brain tumor patients. J Neurooncol 2024; 167:477-485. [PMID: 38436894 DOI: 10.1007/s11060-024-04627-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 02/29/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are increasingly used to assess patients' perioperative health. The PROM Information System 29 (PROMIS-29) is a well-validated global health assessment instrument for patient physical health, though its utility in cranial neurosurgery is unclear. OBJECTIVE To investigate the utility of preoperative PROMIS-29 physical health (PH) summary scores in predicting postoperative outcomes in brain tumor patients. METHODS Adult brain tumor patients undergoing resection at a single institution (January 2018-December 2021) were identified and prospectively received PROMIS-29 surveys during pre-operative visits. PH summary scores were constructed and optimum prediction thresholds for length of stay (LOS), discharge disposition (DD), and 30-day readmission were approximated by finding the Youden index of the associated receiver operating characteristic curves. Bivariate analyses were used to study the distribution of low (z-score≤-1) versus high (z-score>-1) PH scores according to baseline characteristics. Logistic regression models quantified the association between preoperative PH summary scores and post-operative outcomes. RESULTS A total of 157 brain tumor patients were identified (mean age 55.4±15.4 years; 58.0% female; mean PH score 45.5+10.5). Outcomes included prolonged LOS (24.8%), non-routine discharge disposition (37.6%), and 30-day readmission (19.1%). On bivariate analysis, patients with low PH scores were significantly more likely to be diagnosed with a high-grade tumor (69.6% vs 38.85%, p=0.010) and less likely to have elective surgery (34.8% vs 70.9%, p=0.002). Low PH score was associated with prolonged LOS (26.1% vs 22%, p<0.001), nonroutine discharge (73.9% vs 31.3%, p<0.001) and 30-day readmission (43.5% vs 14.9%, p=0.003). In multivariate analysis, low PH scores predicted greater LOS (odds ratio [OR]=6.09, p=0.003), nonroutine discharge (OR=4.25, p=0.020), and 30-day readmission (OR=3.93, p=0.020). CONCLUSION The PROMIS-29 PH summary score predicts short-term postoperative outcomes in brain tumor patients and may be incorporated into prospective clinical workflows.
Collapse
Affiliation(s)
- Sachiv Chakravarti
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Cathleen C Kuo
- Jacobs School of Medicine And Biomedical Sciences, Buffalo, NY, United States
| | - Foad Kazemi
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Ashley Kang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Calixto-Hope Lucas
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Victoria Croog
- Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - David Kamson
- Department of Medical Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Karisa C Schreck
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Matthias Holdhoff
- Department of Medical Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Debraj Mukherjee
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| |
Collapse
|
4
|
Azam F, Anand S, Dragun A, Furtado K, Nguyen M, Shukla I, Hicks WH, Hall K, Akbik OS, Bagley CA. Identifying Correlation Among Patient-Reported Outcome Measures: A Study of PROMIS-29, ODI, and VAS in Adult Spinal Deformity Patients. World Neurosurg 2024; 181:e1059-e1070. [PMID: 37967743 DOI: 10.1016/j.wneu.2023.11.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Adult spinal deformity (ASD) is becoming increasingly common in aging populations. Patient-reported outcome measures (PROMs) are self-reported patient surveys administered pre- and postoperatively that provide insight into patient improvement. We aim to compare 3 of the most utilized PROMs: PROMIS-29, Oswestry Disability Index (ODI), and Visual Analogue Scale (VAS), to investigate whether they provide unique and independent assessments of patient outcomes when assessed longitudinally. METHODS We retrospectively reviewed a database of ASD at UT Southwestern Medical Center between 2016 and 2021. Adult patients (>18 years old) were included if they underwent long-segment (>4 levels) thoracolumbar fusion. PROMIS-29, ODI, and VAS scores were collected preoperatively and at 3-, 6-, 12-, 18-, 24-, 30-, and 36-month follow-ups. Scores were recorded ±1 month of the time points. Pearson correlation coefficients for each PROM were then calculated in a pairwise fashion. RESULTS A total of 163 patients were included in our analysis. ODI and VAS showed significant covariance, with VAS Neck and VAS Back having Pearson coefficients of 0.95 and 0.94, respectively. ODI and PROMIS-29 also showed significant covariance, with Physical Function and ODI showing a Pearson coefficient of 0.95. PROMIS-29 and VAS demonstrated less correlation regarding Pain and Physical Function; however, they showed a significantly high Pearson coefficient when comparing VAS Back with PROMIS-29 Sleep and Pain Intensity (r = 0.97 and r = 0.96, respectively). CONCLUSIONS All 3 PROMs demonstrated significant correlation over 36 months, indicating that simultaneous administration of each during follow-up is redundant. The measure that provided the least unique information was ODI, as both VAS and PROMIS-29 demonstrated similar progression and assessed additional metrics. PROMIS-29 provided the same information as VAS and ODI, with extra facets of patient-reported outcomes, indicating that it may be a more comprehensive measure of longitudinal patient improvement.
Collapse
Affiliation(s)
- Faraaz Azam
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Soummitra Anand
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Anthony Dragun
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kailee Furtado
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Madelina Nguyen
- Department of Neurological Surgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - Ishav Shukla
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - William H Hicks
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kristen Hall
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Omar S Akbik
- Department of Neurological Surgery, CHI Health, Omaha, Nebraska, USA
| | - Carlos A Bagley
- Department of Neurological Surgery, Saint Luke's Neurological & Spine Surgery, Kansas City, Missouri, USA.
| |
Collapse
|
5
|
Nagy Z, Kiss N, Szigeti M, Áfra J, Lekka N, Misik F, Mucsi I, Banczerowski P. Construct validity of the Hungarian Version of the Patient-Reported Outcomes Measurement Information System-29 Profile Among Patients with Low Back Pain. World Neurosurg 2024; 181:e55-e66. [PMID: 37385441 DOI: 10.1016/j.wneu.2023.06.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVE We aim to evaluate the psychometric properties of the Hungarian version of the patient-reported outcomes measurement information system (PROMIS)-29 profile domains among patients with chronic low back pain. METHODS We used a convenience, cross-sectional sampling of patients recruited at our neurosurgical institution. The participants completed paper-pencil version of the PROMIS-29 profile in addition to validated legacy questionnaires, including the Oswestry disability index, Research and Development Corporation 36-item short-form survey, 7-item general anxiety disorder scale, 9-item patient health questionnaire. Reliability was evaluated by calculating the internal consistency (Cronbach's α). Test-retest reliability was assessed using the intraclass correlation coefficient. The structural validity of PROMIS-29 was assessed using a confirmatory factor analysis. Construct validity was assessed by evaluating convergent and discriminant validity using Spearman's rank correlation. To further corroborate the construct validity, we also performed known-group comparisons. RESULTS The mean age of the 131 participants was 54 ± 16 years. Of the 131 patients, 62% were women. The internal consistency of each PROMIS domain was high (Cronbach's α >0.89 for all). The test-retest reliability was excellent (intraclass correlation >0.97). The confirmatory factor analysis showed good structural validity (comparative fit index >0.96; standardized root mean square residual <0.026 for all domains). All measured PROMIS scores correlated strongly with the scores obtained using the corresponding primary legacy instrument, indicating excellent convergent validity. The known-group comparisons demonstrated differences as hypothesized. CONCLUSIONS We present data supporting the validity and reliability of the Hungarian PROMIS-29 profile short forms for patients with low back pain. This instrument will be useful for research and clinical applications in spine care.
Collapse
Affiliation(s)
- Zoltán Nagy
- Department of Neurology and Neurosurgery, National Institute of Mental Health, Budapest, Hungary; Department of Neurosurgery, Semmelweis University, Budapest, Hungary.
| | - Nóra Kiss
- Department of Neurosurgery, Semmelweis University, Budapest, Hungary
| | - Mátyás Szigeti
- Imperial Clinical Trials Unit, Imperial College London, London, United Kingdom; Physiological Controls Research Center, Obuda University, Budapest, Hungary
| | - Judit Áfra
- Department of Neurology and Neurosurgery, National Institute of Mental Health, Budapest, Hungary
| | - Norbert Lekka
- Department of Neurology and Neurosurgery, National Institute of Mental Health, Budapest, Hungary
| | - Ferenc Misik
- Department of Neurology and Neurosurgery, National Institute of Mental Health, Budapest, Hungary
| | - István Mucsi
- Ajmera Transplant Center, University Health Network, Toronto, Ontario, Canada; Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
| | - Péter Banczerowski
- Department of Neurology and Neurosurgery, National Institute of Mental Health, Budapest, Hungary; Department of Neurosurgery, Semmelweis University, Budapest, Hungary
| |
Collapse
|
6
|
Abd-Elsayed A, Fishman MA, Larson L. Measuring outcomes. RADIOFREQUENCY ABLATION TECHNIQUES 2024:209-212. [DOI: 10.1016/b978-0-323-87063-4.00028-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
|
7
|
Smitheman HP, Lundberg M, Härnesand M, Gelfgren S, Grävare Silbernagel K. Putting the fear-avoidance model into practice - what can patients with chronic low back pain learn from patients with Achilles tendinopathy and vice versa? Braz J Phys Ther 2023; 27:100557. [PMID: 37952338 PMCID: PMC10682544 DOI: 10.1016/j.bjpt.2023.100557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 02/02/2023] [Accepted: 10/25/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Fear-avoidance variables are present in patients with musculoskeletal pain conditions, such as chronic low back pain (CLBP) and Achilles tendinopathy (AT) and can lead to reduced function and recovery. It is unknown how these variables relate in populations with different etiologies but similar pain provocation mechanisms. OBJECTIVE To compare kinesiophobia, pain catastrophizing, and disability between these two groups. METHODS Patients with CLBP and those with AT were included. Tampa Scale of Kinesiophobia (TSK-17) and Pain Catastrophizing Scale (PCS-13) were evaluated in both groups. The CLBP group completed the Oswestry Disability Index (ODI) and the AT group completed the PROMIS-29 questionnaire. Gait speed was calculated for each group. Disability outcomes were normalized between groups. RESULTS 119 patients in the CLBP group (64 female, 46 ± 8 years) and 83 patients in the AT group (42 female, 48 ± 12 years) were included. Both groups (CLBP, AT) presented with high prevalence of kinesiophobia (67%, 55%) but the CLBP group presented with higher prevalence of pain catastrophizing (22%, 2%). The CLBP group demonstrated higher levels of disability via normalized ODI (MD= 12.4, 95% CI: 9.2, 15.5) but the AT group demonstrated slower gait speed (MD= 0.1 m/s, 95% CI: 0.0, 0.2). CONCLUSION Similarly high prevalence of kinesiophobia was found in patients with CLBP and patients with AT. While the CLBP group reported greater prevalence of catastrophizing thoughts and greater disability, the AT group had slower gait speed. Overall, these findings demonstrate that CLBP and AT have similarities that may allow clinicians to learn from one to inform treatment of the other. CLINICAL TRIAL REGISTRATION NUMBERS NCT03523325, ISRCTN17115599.
Collapse
Affiliation(s)
| | - Mari Lundberg
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden; University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Malin Härnesand
- Department of Health and Rehabilitation, University of Gothenburg, Göteborg, Sweden
| | - Sara Gelfgren
- Department of Health and Rehabilitation, University of Gothenburg, Göteborg, Sweden
| | | |
Collapse
|
8
|
Staszkiewicz R, Ulasavets U, Dobosz P, Drewniak S, Niewiadomska E, Grabarek BO. Assessment of quality of life, pain level and disability outcomes after lumbar discectomy. Sci Rep 2023; 13:6009. [PMID: 37045989 PMCID: PMC10097864 DOI: 10.1038/s41598-023-33267-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 04/11/2023] [Indexed: 04/14/2023] Open
Abstract
This study aimed to assess the quality of life of 113 Caucasian patients with intervertebral disc (IVD) degeneration of the lumbosacral (L/S) spine who qualified for microdiscectomy during a 12-month period after surgery. Based on magnetic resonance imaging before the surgery, the degree of radiological advancement of the degenerative changes was determined according to the Pfirrmann grading scale from 1 to 5. To assess pain intensity, the Visual Analog Scale (VAS) was used; the Satisfaction with Life Scale (SWLS) was used to evaluate quality of life; and to assess the degree of ability, the Oswestry Low Back Pain Disability Questionnaire (ODI) was employed. The level of pain, assessed using the VAS, significantly changed in the months following the surgery, with the highest values noted before surgery and the lowest a year after. In turn, the results of the SWLS questionnaire revealed a significant increase in satisfaction with life in the subsequent stages of the study. The conducted correlation analysis revealed significant dependencies in terms of quality of life in regard to pain as well as degree of disability. The level of pain and degree of disability were closely related to the degree of radiological advancement of degenerative changes according to the Pfirrmann grading scale.
Collapse
Affiliation(s)
- Rafał Staszkiewicz
- Department of Neurosurgery, 5th Military Clinical Hospital with the SP ZOZ Polyclinic in Krakow, 30-901, Krakow, Poland.
- Department of Histology, Cytophysiology and Embryology, Faculty of Medicine in Zabrze, Academy of Silesia, 4-055, Katowice, Poland.
| | - Uladzislau Ulasavets
- Department of Neurosurgery, 5th Military Clinical Hospital with the SP ZOZ Polyclinic in Krakow, 30-901, Krakow, Poland
| | - Paweł Dobosz
- Department of Laryngology, 5th Military Clinical Hospital with the SP ZOZ Polyclinic in Krakow, 30-901, Kraków, Poland
| | - Szymon Drewniak
- Department of Anesthetics, 5th Military Clinical Hospital with the SP ZOZ Polyclinic in Krakow, 30-901, Kraków, Poland
| | - Ewa Niewiadomska
- Department of Epidemiology and Biostatistics, School Health Sciences in Bytom, Medical University of Silesia, 41-902, Bytom, Poland
| | - Beniamin Oskar Grabarek
- Department of Neurosurgery, 5th Military Clinical Hospital with the SP ZOZ Polyclinic in Krakow, 30-901, Krakow, Poland
- Department of Histology, Cytophysiology and Embryology, Faculty of Medicine in Zabrze, Academy of Silesia, 4-055, Katowice, Poland
- Laboratory of Molecular Biology and Virology, 40-851, Katowice, Poland
| |
Collapse
|
9
|
Oskouie IM, Rostami M, Moosavi M, Zarei M, Jouibari MF, Ataie H, Jafarieh A, Moghadam N, Kordi R, Khadivi M, Mazloumi A. Translation, cross-cultural adaptation and validation of the Persian version of selected PROMIS measures for use in lumbar canal stenosis patients. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:99. [PMID: 37288413 PMCID: PMC10243446 DOI: 10.4103/jehp.jehp_668_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/03/2022] [Indexed: 06/09/2023]
Abstract
BACKGROUND The National Institutes of Health (NIH) developed a new measurement system called the Patient-Reported Outcomes Measurement Information System (PROMIS) which can be used for multiple health conditions. The 29-item short form (PROMIS-29) with seven domains was more often used by clinical researchers to measure the physical function, mood and sleeping status of patients with low back pain (LBP). Translation of the PROMIS into multiple languages and adaptation of its application in different cultural diversities can help to further standardize clinical research studies and make them comparable to each other. This study aimed to cross-culturally adapt the PROMIS-29 into Persian (P-PROMIS-29) and evaluate the construct validity and reliability of the translated questionnaire among patients with lumbar canal stenosis. MATERIALS AND METHODS The translation was conducted by using the multilingual translation methodology guideline. Construct validity, internal consistency, and test-retest reliability at a two-week interval for the P-PROMIS-29 were calculated. Construct validity was assessed by calculating correlations between the P-PROMIS-29 with Oswestry Disability Index (ODI) and Roland-Morris results. RESULTS The study sample included 70 participants with lumbar canal stenosis. Internal consistencies were moderate to good with Cronbach's alpha ranging from 0.2 to 0.94. The test-retest reliability evaluation was excellent with intraclass correlation coefficients (ICCs) ranging from 0.885 to 0.986. Construct validity of different domains of P-PROMIS-29 were moderate to good, with Pearson's correlation coefficient results ranging from 0.223 to 0.749. CONCLUSION Our results showed that P-PROMIS-29 is a valid and reliable measurement tool for evaluation of patients with lumbar canal stenosis.
Collapse
Affiliation(s)
- Iman M. Oskouie
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Rostami
- Spine Center of Excellence, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mersad Moosavi
- Spine Center of Excellence, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Zarei
- Spine Center of Excellence, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Orthopedic Surgery, Imam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Morteza Faghih Jouibari
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hosienali Ataie
- Department of Anesthesiology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Jafarieh
- Department of Anesthesiology, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Navid Moghadam
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Kordi
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Spine Center of Excellence, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Khadivi
- Spine Center of Excellence, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Adel Mazloumi
- Department of Occupational Health, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
10
|
Arciero E, Desai S, Coury J, Gupta P, Trofa DP, Sardar Z, Lombardi J. Comparison of Psychometric Properties of Patient-Reported Outcomes Measurement Information System With Traditional Outcome Metrics in Spine Surgery. JBJS Rev 2023; 11:01874474-202303000-00006. [PMID: 36947636 DOI: 10.2106/jbjs.rvw.22.00193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
OBJECTIVE Patient-Reported Outcomes Measurement Information System (PROMIS) was developed to address certain shortcomings of traditional, or legacy patient-reported outcome measures (PROMs). Because the use of PROMIS across orthopedic populations continues to increase, the purpose of this study was to provide a comprehensive overview of the use and validation of PROMIS in spine surgery. METHODS PubMed and Google Scholar were searched for relevant articles reporting on the use and validation of PROMIS in spine surgery. The PROMIS formats and individual domains used by investigators were noted. Additionally, psychometric properties reported in validation studies were evaluated. RESULTS Both individual studies and systematic reviews have demonstrated the convergent validity of PROMIS domains, reporting moderate-to-strong correlations with legacy measures in a variety of spine patient populations. Across spine surgery patient populations, PROMIS instruments are consistently efficient, demonstrating decreased question burden compared with legacy PROMs. PROMIS domains overall exhibit responsiveness comparable with legacy measures, and the normalization of PROMIS scores to a general population allows for broad coverage, resulting in acceptable floor and ceiling effects. Despite the many strengths of PROMIS, there remain some populations where PROMIS is not suited to be used in isolation. CONCLUSIONS PROMIS is widely used as an outcome measure in spine surgery and has been validated in a range of patient populations. Although PROMIS domains cannot fully replace legacy measures in spine patients, they can be used in certain settings to provide an efficient and psychometrically sound PROM.
Collapse
Affiliation(s)
- Emily Arciero
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | | | | | | | | | | | | |
Collapse
|
11
|
Wanner JP, Pennings JS, Nian H, Sivaganesan A, Gupta R, Asher AL, Bydon M, Abtahi A, Zuckerman SL, Devin C, Archer KR, Stephens BF. Rating Spine Surgeons: Physician Review Websites Versus a Patient-reported Outcomes-derived Ranking. Clin Spine Surg 2022; 35:E643-E648. [PMID: 35509107 DOI: 10.1097/bsd.0000000000001333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 03/01/2022] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was an observational study. OBJECTIVES This study aims to determine the correlation between patient-reported outcomes (PROs) pulled from a national spine registry and physician ratings from physician review websites (PRWs). SUMMARY OF BACKGROUND DATA PRWs are frequently utilized by patients to make health care decisions; however, many PRWs appear to incorporate subjective experiences unrelated to a surgeon's clinical performance into ratings. As such, their utility as a health care decision-making tool remains unclear. MATERIALS AND METHODS This study evaluated 8834 patients from the Quality Outcomes Database (QOD) who underwent 1-level elective lumbar spine surgery. The lumbar module of QOD was queried to rank 124 surgeons using PROs (Oswestry Disability Index, EuroQOL, Numerical Rating Scale-back/leg pain, and patient satisfaction). The QOD PRO-ranking system was compared against PRWs including Healthgrades, Vitals, WebMD, and Google. The Spearman correlation coefficients, Kruskal-Wallis tests, and multiple linear regression models were used for statistical comparison. The primary outcome was the correlation between PRW scores and PROs. RESULTS Surgeon PRO-derived ranking showed high intercorrelational congruence with coefficients between the 3 PROs (Oswestry Disability Index, EuroQOL, Numerical Rating Scale back/leg) ranging between 0.70 and 0.88. Low correlations were observed between PRO-derived rankings and PRWs, ranging from 0.23 to 0.37. Healthgrades performed most similarly to PRO-derived rankings, correlating best with patient satisfaction, though the correlation was low (ρ=0.37). CONCLUSIONS While PRWs are often used to evaluate surgeon competency, these results demonstrate they poorly correlate with a surgeon's clinical ability measured by PROs. PRWs should be used with caution when making health care decisions by patients, payers, and administrators. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
| | | | | | | | - Rishabh Gupta
- Departments of Orthopedic Surgery
- Neurosurgery, Vanderbilt University, Nashville, TN
| | | | - Mohamad Bydon
- Department of Neurosurgery, Mayo Clinic, Rochester, MN
| | | | | | - Clinton Devin
- Departments of Orthopedic Surgery
- Steamboat Orthopedic and Spine Institute, Steamboat Springs, CO
| | - Kristin R Archer
- Departments of Orthopedic Surgery
- Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, TN
| | | |
Collapse
|
12
|
Niazi SK, Greenberg-Worisek AJ, Smith J, Matthews A, Boyum PP, Nordan L, Brennan E, Spaulding A, Cheville A. Exploring the Patient Experience with Patient-Reported Outcomes: A Qualitative, Multistakeholder Study. South Med J 2022; 115:653-657. [PMID: 36055651 DOI: 10.14423/smj.0000000000001438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Although the literature provides guidance regarding patient-reported outcome (PRO) implementation barriers, patients' perspectives are underreported. This study aimed to improve the understanding of patient experiences with PRO tools through examining perceptions of and attitudes toward PROs and expectations of data use after collection. METHODS Ethnographic human-centered design approaches were used to conduct free-form interviews. Two case studies of existing PRO use in clinics also were examined. Unstructured thematic analyses were performed using notes taken during these interviews. RESULTS Patients generally reported a good understanding of the need for PRO collection, both for research and clinical use. Many expected that results would be acted upon by the clinicians promptly. Thematic analyses identified the following patient perception topics: transparency, individualization to patient needs, timely response, different "identities" while accessing care locally compared with at a destination center, and preference for brief PROs. CONCLUSIONS Design and implementation of PRO assessments into patient care should include the patients as key end users. Transparency of the purpose for data collection is critical for broader patient adoption. Ensuring that only necessary and sufficient data are collected for clinical action, and associated research may help minimize burden and maximize patient participation.
Collapse
Affiliation(s)
- Shehzad K Niazi
- From the Department of Psychiatry & Psychology, the Division of Health Care Delivery Research, and Strategic Alliances, Mayo Clinic, Jacksonville, Florida, the Department of Health Sciences Research, Innovation & Design, and the Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - Alexandra J Greenberg-Worisek
- From the Department of Psychiatry & Psychology, the Division of Health Care Delivery Research, and Strategic Alliances, Mayo Clinic, Jacksonville, Florida, the Department of Health Sciences Research, Innovation & Design, and the Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - Jennifer Smith
- From the Department of Psychiatry & Psychology, the Division of Health Care Delivery Research, and Strategic Alliances, Mayo Clinic, Jacksonville, Florida, the Department of Health Sciences Research, Innovation & Design, and the Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - Allison Matthews
- From the Department of Psychiatry & Psychology, the Division of Health Care Delivery Research, and Strategic Alliances, Mayo Clinic, Jacksonville, Florida, the Department of Health Sciences Research, Innovation & Design, and the Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - Patricia Patty Boyum
- From the Department of Psychiatry & Psychology, the Division of Health Care Delivery Research, and Strategic Alliances, Mayo Clinic, Jacksonville, Florida, the Department of Health Sciences Research, Innovation & Design, and the Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - Lisa Nordan
- From the Department of Psychiatry & Psychology, the Division of Health Care Delivery Research, and Strategic Alliances, Mayo Clinic, Jacksonville, Florida, the Department of Health Sciences Research, Innovation & Design, and the Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - Emily Brennan
- From the Department of Psychiatry & Psychology, the Division of Health Care Delivery Research, and Strategic Alliances, Mayo Clinic, Jacksonville, Florida, the Department of Health Sciences Research, Innovation & Design, and the Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - Aaron Spaulding
- From the Department of Psychiatry & Psychology, the Division of Health Care Delivery Research, and Strategic Alliances, Mayo Clinic, Jacksonville, Florida, the Department of Health Sciences Research, Innovation & Design, and the Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - Andrea Cheville
- From the Department of Psychiatry & Psychology, the Division of Health Care Delivery Research, and Strategic Alliances, Mayo Clinic, Jacksonville, Florida, the Department of Health Sciences Research, Innovation & Design, and the Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
13
|
Thompson NR, Lapin BR, Steinmetz MP, Benzel EC, Katzan IL. Mapping PROMIS physical function and pain interference to the modified low back pain disability questionnaire. Qual Life Res 2022; 31:3467-3482. [PMID: 35794422 DOI: 10.1007/s11136-022-03174-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE The Modified Low Back Pain Disability Questionnaire (MDQ) is a commonly used tool to assess functioning of patients with low back pain (LBP). Recently, the Patient-Reported Outcomes Measurement Information System (PROMIS) was suggested as an alternative platform to assess LBP patient-reported health. We sought to map between the MDQ and PROMIS Physical Function (PROMIS-PF) and Pain Interference (PROMIS-PI) scales using multiple methods. METHODS In a retrospective analysis of LBP patients seen at Cleveland Clinic 11/14/18-12/11/19, T-scores from each PROMIS scale were mapped to MDQ total score individually and together. MDQ item and total scores were mapped to each PROMIS scale. Linear regression as well as linear and equipercentile equating were used. Split sample internal validation using root mean squared error (RMSE), mean absolute error (MAE), and correlations were used to assess accuracy of mapping equations. RESULTS 13585 patients completed the three scales. In the derivation cohort, average age was 59.0 (SD = 15.8); 53.3% female and 82.9% white. Average MDQ total, PROMIS-PF, and PROMIS-PI T-scores were 40.3 (SD = 19.0), 37.2 (SD = 7.6), and 62.9 (SD = 7.2), respectively. For estimating MDQ total scores, methods that used both PROMIS-PF and PROMIS-PI had closest estimated means, lowest RMSE and MAE, and highest correlations. For estimating each of PROMIS-PF and PROMIS-PI T-scores, the best performing method was equipercentile equating using the MDQ items. CONCLUSIONS We created and internally validated maps between MDQ and PROMIS-PF and PROMIS-PI using linear regression, linear and equipercentile equating. Our equations can be used by researchers wishing to translate scores between these scales.
Collapse
Affiliation(s)
- Nicolas R Thompson
- Department of Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Avenue, JJN3-1, Cleveland, OH, 44195, USA. .,Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Brittany R Lapin
- Department of Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Avenue, JJN3-1, Cleveland, OH, 44195, USA.,Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Michael P Steinmetz
- Center for Spine Health, Cleveland Clinic, Cleveland, OH, USA.,Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, USA.,Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Edward C Benzel
- Center for Spine Health, Cleveland Clinic, Cleveland, OH, USA
| | - Irene L Katzan
- Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
14
|
Construct Validity and Item Response Theory Analysis of the PROMIS-29 v2.0 in Recipients of Lumbar Spine Surgery. Spine (Phila Pa 1976) 2021; 46:1721-1728. [PMID: 34818268 DOI: 10.1097/brs.0000000000004085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Observational cohort design involving measurement property assessment. OBJECTIVES The aim of this study was to assess construct validity through hypothesis testing and to examine reliability and discrimination of the PROMIS-29 v2.0 using item response theory (IRT) analyses. SUMMARY OF BACKGROUND DATA Patient-Reported Outcomes Measurement Information System (PROMIS) 29.0 version 2.0 includes 28 questions for the seven domains of Physical function, Anxiety, Depression, Fatigue, Sleep disturbance, Social role, and Pain interference, and one item related to pain intensity. To date, the tool has not been tested for construct validity for selected concepts, nor has it been evaluated using IRT in a population of spine surgery recipients. METHODS Using the Quality Outcomes Dataset lumbar registry, we evaluated the construct validity of the PROMIS-29 v2.0 against pain intensity measures for back and leg, the Oswestry Disability Index, the EQ5D 3L-visual analog scale (quality of life) and proxy measures of activities, mobility and self-care. IRT was used to test PROMIS-29 v2.0 assumptions and fit. RESULTS The sample included 652 surgery recipients (mean age = 60.1, SD = 14.0) who had a high level of baseline disability. Hypothesis testing confirmed direction and magnitude of correlation between the PROMIS and legacy measures in 10 of the 12 hypotheses. IRT identified three misfit items, but otherwise adequate scale reliability and unidimensionality. CONCLUSION The PROMIS-29 v2.0 measures several different constructs pertinent to a patient's health and recovery during spine surgery. We feel that the PROMIS-29 v2.0 tool is a useful and effective outcome measure for populations who receive spine surgery.Level of Evidence: 4.
Collapse
|
15
|
Master H, Castillo R, Wegener ST, Pennings JS, Coronado RA, Haug CM, Skolasky RL, Riley LH, Neuman BJ, Cheng JS, Aaronson OS, Devin CJ, Archer KR. Role of psychosocial factors on the effect of physical activity on physical function in patients after lumbar spine surgery. BMC Musculoskelet Disord 2021; 22:883. [PMID: 34663295 PMCID: PMC8522146 DOI: 10.1186/s12891-021-04622-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/16/2021] [Indexed: 11/23/2022] Open
Abstract
Background The purpose of this study was to investigate the longitudinal postoperative relationship between physical activity, psychosocial factors, and physical function in patients undergoing lumbar spine surgery. Methods We enrolled 248 participants undergoing surgery for a degenerative lumbar spine condition. Physical activity was measured using a triaxial accelerometer (Actigraph GT3X) at 6-weeks (6wk), 6-months (6M), 12-months (12M) and 24-months (24M) following spine surgery. Physical function (computerized adaptive test domain version of Patient-Reported Outcomes Measurement Information System) and psychosocial factors (pain self-efficacy, depression and fear of movement) were assessed at preoperative visit and 6wk, 6M, 12M and 24M after surgery. Structural equation modeling (SEM) techniques were utilized to analyze data, and results are represented as standardized regression weights (SRW). Overall SRW were computed across five imputed datasets to account for missing data. The mediation effect of each psychosocial factor on the effect of physical activity on physical function were computed [(SRW for effect of activity on psychosocial factor X SRW for effect of psychosocial factor on function) ÷ SRW for effect of activity on function]. Each SEM model was tested for model fit by assessing established fit indexes. Results The overall effect of steps per day on physical function (SRW ranged from 0.08 to 0.19, p<0.05) was stronger compared to the overall effect of physical function on steps per day (SRW ranged from non-existent to 0.14, p<0.01 to 0.3). The effect of steps per day on physical function and function on steps per day remained consistent after accounting for psychosocial factors in each of the mediation models. Depression and fear of movement at 6M mediated 3.4% and 5.4% of the effect of steps per day at 6wk on physical function at 12M, respectively. Pain self-efficacy was not a statistically significant mediator. Conclusions The findings of this study suggest that the relationship between physical activity and physical function is stronger than the relationship of function to activity. However, future research is needed to examine whether promoting physical activity during the early postoperative period may result in improvement of long-term physical function. Since depression and fear of movement had a very small mediating effect, additional work is needed to investigate other potential mediating factors such as pain catastrophizing, resilience and exercise self-efficacy. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04622-w.
Collapse
Affiliation(s)
- Hiral Master
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1215 21st Ave South, Nashville, TN, 37232, USA.,Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Renan Castillo
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stephen T Wegener
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Jacquelyn S Pennings
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1215 21st Ave South, Nashville, TN, 37232, USA
| | - Rogelio A Coronado
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1215 21st Ave South, Nashville, TN, 37232, USA.,Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christine M Haug
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1215 21st Ave South, Nashville, TN, 37232, USA
| | - Richard L Skolasky
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Lee H Riley
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Brian J Neuman
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Joseph S Cheng
- Department of Neurological Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Oran S Aaronson
- Howell Allen Clinic, Saint Thomas Medical Partners, Nashville, TN, USA
| | - Clinton J Devin
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1215 21st Ave South, Nashville, TN, 37232, USA.,Steamboat Orthopedic and Spine Institute, Steamboat Springs, CO, USA
| | - Kristin R Archer
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1215 21st Ave South, Nashville, TN, 37232, USA. .,Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
| |
Collapse
|
16
|
Tang X, Schalet BD, Hung M, Brodke DS, Saltzman CL, Cella D. Linking Oswestry Disability Index to the PROMIS pain interference CAT with equipercentile methods. Spine J 2021; 21:1185-1192. [PMID: 33610807 PMCID: PMC8273094 DOI: 10.1016/j.spinee.2021.02.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 01/29/2021] [Accepted: 02/15/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT When different health care providers use different patient-reported outcome (PRO) instruments, it is challenging to integrate findings that describe particular patient groups or to establish treatment effectiveness across studies. It is therefore critical to develop accurate ways to convert scores between various instruments for clinicians and researchers to make comparisons across health outcomes. PURPOSE To develop a common metric so that scores on the Oswestry Disability Index (ODI) and scores on the PROMIS Physical Function can be converted interchangeably. STUDY DESIGN/SETTING Data were collected from a prospective study. A single-group linking design was used. PATIENT SAMPLE The study population included 9020 patients presented to an orthopedic spine clinic from November 2013 to March 2019. OUTCOME MEASURES Patients completed the ODI and the PROMIS Pain Interference scale delivered by Computerized Adaptive Testing (CAT) at the same time prior to their visit with a spine clinician. METHODS Equipercentile linking methods based on log-linear smoothing approach and non-smoothing approach were used to establish a common metric across the two measures. RESULTS The two measures assess the similar contruct of pain. The correlation between the scores of the ODI and the PROMIS PI was 0.81. The standardized Root Expected Mean Square Difference (REMSD) values for gender, ethnic, and racial groups ranged from 3.55% to 4.81%. Hence, the assumptions for the equipercentile linking method were met. The crosswalk derived linked scores based on the log-linear smoothing method yielded small deviations (Δ = 0.09) from the observed scores. We then identified linked PROMIS-PI scores corresponding to the benchmark ODI scores for the five disability levels and for various categories of patients. CONCLUSIONS This study is the first to create crosswalks to interchangeably convert scores between the ODI to the PROMIS-PI in a large population of spine patients using the equipercentile linking method. The results of this study provide confidence in the validity and usefulness of the derived crosswalks based on the equipercentile linking approach. The crosswalks are helpful for comparing new and old studies on the two measures and identifying benchmark scores for various diseases and disability levels.
Collapse
Affiliation(s)
- Xiaodan Tang
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
| | - Benjamin D Schalet
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Man Hung
- Roseman University of Health Sciences, College of Dental Medicine, South Jordan, UT 84095, USA; Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA
| | - Darrel S Brodke
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA
| | - Charles L Saltzman
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA
| | - David Cella
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| |
Collapse
|
17
|
Ponder M, Venkatraman V, Charalambous L, Ansah-Yeboah AA, Adil SM, Antezana LA, Dharmapurikar R, Gellad ZF, Lad SP, Hwang ES, Plichta JK. Mobile Health Application for Patients Undergoing Breast Cancer Surgery: Feasibility Study. JCO Oncol Pract 2021; 17:e1344-e1353. [PMID: 34097502 DOI: 10.1200/op.20.01026] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Contemporary breast cancer surgery often requires hospital stays of 1 day or less, presenting challenges to delivery of high-quality care. Without sufficient time for proper education and guidance, patients may delay seeking care, experience anxiety, or seek unnecessary care, leading to poorer outcomes and increased costs. To address this, we evaluated the feasibility of a planning-, outcomes-, and analytics-based mobile health application called Manage My Surgery (MMS) for patients undergoing elective breast cancer surgery. METHODS Patients undergoing breast cancer surgery at an academic health center were invited to use MMS. Those who used the application received pre- and postoperative surveys, which recorded and reported patient satisfaction and outcomes related to the application. RESULTS Thirty-three female patients undergoing elective breast cancer surgery used MMS. The median age was 58 years. Nineteen patients underwent lumpectomy, and 14 underwent mastectomy. Users logged on to the application an average of 3.5 times. The median number of questions viewed was 12 (range 2-35). Of 17 patients who completed the feedback survey, 100% said that MMS was helpful during preparation for surgery, 82.3% said that MMS was helpful postoperatively, and 94.1% would recommend MMS to others. Preliminary data on patient-reported outcomes collected by MMS suggest improvements in anxiety and depression over time. CONCLUSION Implementation of a digital care navigation tool in breast cancer surgery patients is feasible. Patients found the tool helpful in both the pre- and postoperative period. Additional ongoing work will focus on patients' self-management skills, long-term outcomes, and health system costs.
Collapse
Affiliation(s)
| | | | | | | | - Syed M Adil
- Department of Neurosurgery, Duke University Medical Center, Durham, NC
| | | | | | | | - Shivanand P Lad
- Department of Neurosurgery, Duke University Medical Center, Durham, NC
| | - E Shelley Hwang
- Department of Surgery, Duke University Medical Center, Durham, NC
| | | |
Collapse
|
18
|
Li QP, Li J, Pan HY. Effects of Online Home Nursing Care Model Application on Patients with Traumatic Spinal Cord Injury. Risk Manag Healthc Policy 2021; 14:1703-1709. [PMID: 33935524 PMCID: PMC8079355 DOI: 10.2147/rmhp.s301874] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/20/2021] [Indexed: 12/15/2022] Open
Abstract
Objective This study aims to explore the effects of an online home nursing care model application on patients with traumatic spinal cord injury (TSCI). Methods Eighty patients with TSCI discharged from the hospital between January 2015 and January 2018 were included in the study. The patients were randomly divided into two groups: the control group and the observation group (n = 40, each). The patients in the control group were given routine discharge guidance, while the patients in the observation group were given online home nursing care. The Oswestry Disability Index (ODI), Medical Outcomes Study 36-item short-form health survey (MOS SF-36), and complication-incidence rate were used to evaluate the efficiency of the online home nursing care model. Results There were no differences in the ODI and MOS SF-36 scores between the two groups at discharge. However, the ODI and MOS SF-36 scores in the observation group showed significant improvement compared with the control group (p < 0.05) during the most recent follow-up. The incidence of complications, such as constipation, joint stiffness, muscle atrophy, foot drop, and pressure sores, were significantly lower in the observation group than in the control group (p < 0.05). Conclusion The online home nursing care model can reduce complication incidence, alleviate dysfunction, and improve the quality of life of patients with TSCI.
Collapse
Affiliation(s)
- Qiao-Ping Li
- Department of Spine Surgery, Lishui Central Hospital, Lishui, People's Republic of China
| | - Jing Li
- Department of Spine Surgery, Lishui Central Hospital, Lishui, People's Republic of China
| | - Hong-Ying Pan
- Department of Nursing, Lishui Central Hospital, Lishui, People's Republic of China
| |
Collapse
|
19
|
Lubelski D, Hersh A, Azad TD, Ehresman J, Pennington Z, Lehner K, Sciubba DM. Prediction Models in Degenerative Spine Surgery: A Systematic Review. Global Spine J 2021; 11:79S-88S. [PMID: 33890803 PMCID: PMC8076813 DOI: 10.1177/2192568220959037] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVES To review the existing literature of prediction models in degenerative spinal surgery. METHODS Review of PubMed/Medline and Embase databases was conducted to identify articles between January 1, 2000 and March 1, 2020 that reported prediction model performance for outcomes following elective degenerative spine surgery. RESULTS Thirty-one articles were included. Twenty studies were of thoracolumbar, 5 were of cervical, and 6 included all spine patients. Five studies were externally validated. Prediction models were developed using machine learning (42%) and logistic regression (42%) as well as other techniques. Web-based calculators were included in 45% of published articles. Various outcomes were investigated, including complications, infection, length of stay, discharge disposition, reoperation, readmission, disability score, back pain, leg pain, return to work, and opioid dependence. CONCLUSIONS Significant heterogeneity exists in methods used to develop prediction models of postoperative outcomes after degenerative spine surgery. Most internally validate their scores, but a few have been externally validated. Areas under the curve for most models range from 0.6 to 0.9. Techniques for development are becoming increasingly sophisticated with different machine learning tools. With further external validation, these models can be deployed online for patient, physician, and administrative use, and have the potential to optimize outcomes and maximize value in spine surgery.
Collapse
Affiliation(s)
- Daniel Lubelski
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew Hersh
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tej D. Azad
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeff Ehresman
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Kurt Lehner
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel M. Sciubba
- Johns Hopkins University School of Medicine, Baltimore, MD, USA,Daniel M. Sciubba, Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 5-185A, Baltimore, MD 21287, USA.
| |
Collapse
|
20
|
Karhade AV, Fogel HA, Cha TD, Hershman SH, Doorly TP, Kang JD, Bono CM, Harris MB, Schwab JH, Tobert DG. Development of prediction models for clinically meaningful improvement in PROMIS scores after lumbar decompression. Spine J 2021; 21:397-404. [PMID: 33130302 DOI: 10.1016/j.spinee.2020.10.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/11/2020] [Accepted: 10/26/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND The ability to preoperatively predict which patients will achieve a minimal clinically important difference (MCID) after lumbar spine decompression surgery can help determine the appropriateness and timing of surgery. Patient-Reported Outcome Measurement Information System (PROMIS) scores are an increasingly popular outcome instrument. PURPOSE The purpose of this study was to develop algorithms predictive of achieving MCID after primary lumbar decompression surgery. PATIENT SAMPLE This was a retrospective study at two academic medical centers and three community medical centers including adult patients 18 years or older undergoing one or two level posterior decompression for lumbar disc herniation or lumbar spinal stenosis between January 1, 2016 and April 1, 2019. OUTCOME MEASURES The primary outcome, MCID, was defined using distribution-based methods as one half the standard deviation of postoperative patient-reported outcomes (PROMIS physical function, pain interference, pain intensity). METHODS Five machine learning algorithms were developed to predict MCID on these surveys and assessed by discrimination, calibration, Brier score, and decision curve analysis. The final model was incorporated into an open access digital application. RESULTS Overall, 906 patients completed at least one PROMs survey in the 90 days before surgery and at least one PROMs survey in the year after surgery. Attainment of MCID during the study period by PROMIS instrument was 74.3% for physical function, 75.8% for pain interference, and 79.2% for pain intensity. Factors identified for preoperative prediction of MCID attainment on these outcomes included preoperative PROs, percent unemployment in neighborhood of residence, comorbidities, body mass index, private insurance, preoperative opioid use, surgery for disc herniation, and federal poverty level in neighborhood of residence. The discrimination (c-statistic) of the final algorithms for these outcomes was 0.79 for physical function, 0.74 for pain interference, and 0.69 for pain intensity with good calibration. The open access digital application for these algorithms can be found here: https://sorg-apps.shinyapps.io/promis_pld_mcid/ CONCLUSION: Lower preoperative PROMIS scores, fewer comorbidities, and certain sociodemographic factors increase the likelihood of achieving MCID for PROMIS after lumbar spine decompression.
Collapse
Affiliation(s)
- Aditya V Karhade
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Harold A Fogel
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Orthopedic Surgery, Newton Wellesley Hospital, Newton, MA, USA
| | - Thomas D Cha
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Orthopedic Surgery, Newton Wellesley Hospital, Newton, MA, USA
| | - Stuart H Hershman
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Terence P Doorly
- Department of Neurosurgery, North Shore Medical Center, Boston, MA, USA
| | - James D Kang
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Orthopedic Surgery, Brigham and Women's Faulkner Hospital, Boston, MA, USA
| | - Christopher M Bono
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mitchel B Harris
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph H Schwab
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Orthopedic Surgery, Newton Wellesley Hospital, Newton, MA, USA
| | - Daniel G Tobert
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Orthopedic Surgery, Newton Wellesley Hospital, Newton, MA, USA.
| |
Collapse
|
21
|
Pope JE, Fishman M, Chakravarthy K, Hanes M, Gerling M, Heros R, Falowski S, Shah J, Orhurhu V, Urits I, Deer TR. A Retrospective, Multicenter, Quantitative Analysis of Patients' Baseline Pain Quality (PROMIS-29) Entering into Pain and Spine Practices in the United States (ALIGN). Pain Ther 2021; 10:539-550. [PMID: 33624253 PMCID: PMC8119505 DOI: 10.1007/s40122-021-00238-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/27/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Multidisciplinary patient-reported outcomes are a critical part of assessing patients to better understand their well-being during treatment. The use of multidisciplinary patient-reported outcomes is recommended in many areas of medicine. The Patient-Reported Outcomes Measurement Information System-29 (PROMIS-29) has been utilized as a common measurement language across universally relevant domains, including pain, mood, sleep, social participation, and function. Methods Retrospective analysis of prospectively collected data was performed. Subjects were identified and consecutively enrolled upon entry into chronic pain centers across 24 sites in the United States. The PROMIS-29 v2.1 and the numerical rating scale (NRS) were recorded. The pain impact score and the Health Utilities Index Mark 3 (HUI-3) were calculated. Statistical differences were assessed between genders and among age groups comprising subjects less than 40, 41–60, 61–80, and over 80 years of age. Results A total of 19,546 patients were assessed over the enrollment period from 2018 to 2020. The PROMIS-29 v2.1 was evaluated across the seven domains, along with the numerical rating sale (NRS). The mean scores of the population for PROMIS SF v1.0 Pain Interference 4a, PROMIS SF v1.0 Sleep Disturbance 4a, PROMIS SF v1.0 Fatigue 4a, PROMIS SF v1.0 Anxiety 4a, PROMIS SF V1.0 Depression 4a, PROMIS SF v2.0 Ability to Participate in Social Roles and Activities 4a, and PROMIS SF v1.0 Physical Function 4a, measuring pain interference, sleep disturbance, fatigue, anxiety, depression, social participation, and physical function, were 64.61, 57.19, 58.50, 53.94, 54.45, 40.06, and 36.23, respectively. Pain intensity was 6.38 on an 11-point NRS scale. The pain impact score (PIS) and health utilities index mark 3 (HUI-3) scores, calculated across the designated age groups, were 33.19 and 0.67, respectively. Statistical differences were observed for the domains of sleep disturbance and physical function for age groups less than 40 and greater than 80 years of age. Conclusion This data set is the first published normative data set describing the PROMIS-29 assessment in the chronic pain population. The patient population is more homogeneous than expected, and females were found to have higher levels of dysfunction.
Collapse
Affiliation(s)
| | | | | | - Michael Hanes
- Jacksonville Spine and Pain Centers, Jacksonville, FL, USA
| | | | | | - Steven Falowski
- Argires Marotti Neurosurgical Associates of Lancaster, Lancaster, PA, USA
| | - Jay Shah
- SamWell Institute of Pain Management, Colonia, NJ, USA
| | | | - Ivan Urits
- Southcoast Health Physicians Group Pain Medicine, Wareham, MA, USA
| | - Timothy R Deer
- The Spine and Nerve Center of The Virginias, Charleston, WV, USA
| |
Collapse
|
22
|
Christian Z, Afuwape O, Johnson ZD, Adeyemo E, Barrie U, Dosselman LJ, Pernik MN, Hall K, Aoun SG, Bagley CA. Evaluating the Impact of Psychiatric Disorders on Preoperative Pain Ratings, Narcotics Use, and the PROMIS-29 Quality Domains in Spine Surgery Candidates. Cureus 2021; 13:e12768. [PMID: 33614357 PMCID: PMC7888361 DOI: 10.7759/cureus.12768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective We aimed to study the relationship between psychiatric Disorders (PD), preoperative pain, and opioid medication intake, as well as the quality of life patient-reported outcome measures using the Patient-Reported Outcomes Measurement Information System 29 (PROMIS-29) questionnaire, during the 30-day interval preceding surgery, in a consecutive series of patients who were scheduled to undergo surgical spine procedures. We hypothesized that PD could affect preoperative narcotic use and pain interference in a fashion that was not linearly associated with preoperative pain in spine surgery candidates. Methods The records of consecutive adult patients who underwent elective spinal surgery between October 2016 and August 2017 at a single institution were reviewed. We included patients who underwent preoperative pain assessment within 30 days prior to their planned surgery using the PROMIS-29 questionnaire. Patients with PD were compared to controls. Results A total of 117 patients matched our criteria. The average rating of pain intensity was notably higher in the PD group as compared to controls (p=0.004). The PD group had more patients complaining of high pain levels (>6) as compared to the control group (p=0.026). Controls with high pain levels had a greater incidence of preoperative narcotic use as compared to the low-pain cohort (p=0.029). However, there was no difference in the actual dose of daily narcotic medication taken between the PD and control groups (P=0.099) or between the low- and high pain score groups in the control (p=0.291) and PD (p=0.441) groups, respectively. Patients with PD and higher pain ratings seemed to have a higher incidence of anxiety (p=0.005) and depression (p<0.001). That was not the case for controls. Conclusions PDs may impact the degree of preoperative pain interference and the intake of narcotic medication independently from pain intensity ratings.
Collapse
Affiliation(s)
- Zachary Christian
- Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, USA
| | - Olusoji Afuwape
- Neurosurgery, University of Texas Southwestern Medical Center, Dallas, USA
| | - Zachary D Johnson
- Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, USA
| | - Emmanuel Adeyemo
- Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, USA
| | - Umaru Barrie
- Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, USA
| | - Luke J Dosselman
- Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, USA
| | - Mark N Pernik
- Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, USA
| | - Kristen Hall
- Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, USA
| | - Salah G Aoun
- Neurosurgery, University of Texas Southwestern Medical Center, Dallas, USA
| | - Carlos A Bagley
- Neurosurgery, University of Texas Southwestern Medical Center, Dallas, USA
| |
Collapse
|
23
|
Using PROMIS-29 to predict Neck Disability Index (NDI) scores using a national sample of cervical spine surgery patients. Spine J 2020; 20:1305-1315. [PMID: 32413486 DOI: 10.1016/j.spinee.2020.04.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 04/29/2020] [Accepted: 04/29/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Patient reported outcome measures (PROMs) are valuable tools for evaluating the success of spine surgery, with the Neck Disability Index (NDI) commonly used to assess pain-related disability. Recently, patient-reported outcomes measurement information system (PROMIS) has gained attention in its ability to measure PROs across general patient populations. However, PROMIS is not condition-specific so spine researchers are reluctant to incorporate it in place of common legacy measures. PURPOSE To compare the PROMIS-29 (v2.0) to the NDI and compute a conversion equation. STUDY DESIGN This study retrospectively analyzes prospectively collected data from the cervical module of national spine registry, the Quality Outcomes Database (QOD). PATIENT SAMPLE The QOD was queried for cervical spine surgery patients with PROMIS-29 and NDI scores. The cervical module of QOD includes patients undergoing primary or revision surgery for cervical degenerative spine diseases. Exclusion criteria included age under 18 years and diagnoses of infection, tumor, or trauma as the cause of cervical-related pain. OUTCOME MEASURES The outcome of interest for this study was a conversion equation from PROMIS-29 to NDI. METHODS The PROMIS-29 includes seven 4-item domains each rated on a 5-point scale: Physical function, depression, anxiety, fatigue, sleep disturbance, ability to participate in social roles and activities (social roles), and pain interference plus one stand-alone pain intensity item. The NDI contains 10 pain-related questions scored from 0 (no pain) to 5 (most severe pain). Outcomes were collected prior to surgery and at 3- and 12-month post surgery. Patients were included in the current analysis if they had outcome data available at one or more time points. Multivariable mixed effects regression models predicting NDI scores from PROMIS-29 domains were conducted in a development data set and validated in a separate data set. Predicted NDI scores were plotted against NDI scores to determine how well PROMIS-29 domains predicted NDI. Conversion equations were created from the PROMIS-29 regression coefficients. RESULTS 2,018 patients from 18 US hospitals were included (mean age=57 years (SD=12)) with 48% female, 87% Caucasian, and 11% had revision surgery. Strong correlations were found between NDI and pain interference (r=0.79), pain intensity (r=0.74), social roles (r=-0.71), physical function (r=-0.69), sleep disturbance (r=0.63), fatigue (r=0.63), and anxiety (r=0.54). Correlation between NDI and depression (r=0.49) was slightly weaker. The pattern of correlations was consistent across timepoints. Four conversion equations were created for NDI using (1) only pain interference, (2) only physical function, (3) pain interference and physical function, and (4) the five statistically significant domains of pain interference, physical function, social roles, sleep disturbance, and anxiety, plus the pain intensity item. Equations 1, 3, and 4 were the best predictors of NDI, predicting approximately 80% of NDI scores within 15 points in the validation data set. Equation 4 (NDI%=18.897+0.855*[pain interferenceraw]-0.694*[physical functionraw]+2.010*[pain intensityraw]-0.663*[social rolesraw]+0.732*[sleep disturbanceraw]+0.426*[anxietyraw]) predicted NDI most accurately with an R2 between the predicted and actual NDI scores of 0.72. Model 1 (R2 = 0.62; NDI%=-4.055+3.164*[pain interferenceraw])) and Model 3 (R2=0.65; NDI%=17.321+2.543*[pain interferenceraw]-1.012*[physical functionraw]) also had good accuracy. CONCLUSIONS Findings suggest accurate NDI scores can be derived from PROMIS-29 domains. Clinicians who want to move from NDI to PROMIS-29 can use this equation to obtain estimated NDI scores when only collecting PROMIS-29. These results support the use of PROMIS-29 in cervical surgery populations and underscore the idea that PROMIS-29 domains have the potential to replace disease-specific traditional PROMs.
Collapse
|
24
|
Yee TJ, Fearer KJ, Oppenlander ME, Kashlan ON, Szerlip N, Buckingham MJ, Swong K, Chang V, Schwalb JM, Park P. Correlation Between the Oswestry Disability Index and the North American Spine Surgery Patient Satisfaction Index. World Neurosurg 2020; 139:e724-e729. [DOI: 10.1016/j.wneu.2020.04.117] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/13/2020] [Accepted: 04/15/2020] [Indexed: 11/28/2022]
|