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Adindu E, Singh D, Geck M, Stokes J, Truumees E. How Minimal Clinically Important Difference and Patient Acceptable Symptom State Relate to Patient Expectations and Satisfaction in Spine Surgery: A Review. Clin Spine Surg 2024; 37:323-328. [PMID: 39072525 DOI: 10.1097/bsd.0000000000001672] [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: 09/07/2023] [Accepted: 06/28/2024] [Indexed: 07/30/2024]
Abstract
This narrative review seeks to enhance our comprehension of how Minimal Clinically Important Difference (MCID) and Patient Acceptable Symptom State (PASS) values in established Patient Reported Outcome Measures (PROMs) for spine surgery correspond with patient preoperative expectations and postoperative satisfaction. Through our literature search, we found that both MCID and PASS serve as dependable indicators of patient expectations. However, MCID may be more susceptible to a floor effect. This implies that PASS may offer a more accurate reflection of how patients anticipate surgery to address their symptoms. Nevertheless, it is crucial to recognize that achieving MCID or PASS may not be an absolute prerequisite for patients to be satisfied with their treatment.
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Affiliation(s)
- Ebubechi Adindu
- Department of Surgery and Perioperative Care, The University of Texas Dell Medical School
| | - Devender Singh
- Department of Spine Surgery, Ascension Texas Spine and Scoliosis
| | - Matthew Geck
- Department of Spine Surgery, The University of Texas Dell Medical School, Ascension Texas Spine and Scoliosis
| | - John Stokes
- Department of Spine Surgery, Ascension Texas Spine and Scoliosis
| | - Eeric Truumees
- Department of Spine Surgery, The University of Texas Dell Medical School, Ascension Texas Spine and Scoliosis, Austin, TX
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Campbell D, Yielder P, Ambalavanar U, Haavik H, Murphy B. The cervico-ocular reflex changes following treatment in individuals with subclinical neck pain: a randomized control trial. Exp Brain Res 2024:10.1007/s00221-024-06915-7. [PMID: 39261352 DOI: 10.1007/s00221-024-06915-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Accepted: 08/29/2024] [Indexed: 09/13/2024]
Abstract
Individuals with subclinical neck pain (SCNP) exhibit altered cerebellar processing, likely due to disordered sensorimotor integration of inaccurate proprioceptive input. This association between proprioceptive feedback and SMI has been captured in cervico-ocular reflex (COR) differences where SCNP showed higher gain than healthy participants. Previous neurophysiological research demonstrated improved cerebellar processing in SCNP participants following a single treatment session, but it is unknown whether these neurophysiological changes transfer to cerebellar function. In a parallel group, randomized control trial conducted at Ontario Tech University, 27 right-hand dominant SCNP participants were allocated to the 8-week chiropractic care (n = 15; 7M & 8 F) or 8-week control (n = 12; 6M & 6 F) group. COR gain (ratio of eye movement to trunk movement) was assessed using an eye-tracking device at baseline and at post 8-weeks (treatment vs. no treatment). COR gain (10 trials): participants gazed at a circular target that disappeared after 3 s, while a motorized chair rotated their trunk at a frequency of 0.04 Hz, with an amplitude of 5º, for 2 minutes. A 2 × 2 repeated measures ANOVA was performed. COR gain was significantly reduced following 8-weeks of chiropractic care compared to the SCNP control (8-weeks of no treatment) group (p = 0.012, ηp2 = 0.237). The decrease in COR gain following treatment is likely due to normalized proprioceptive feedback from the neck, enabling improved processing and integration within the flocculonodular lobe of the cerebellum.
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Affiliation(s)
- Devonte Campbell
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe St North, Oshawa, ON, L1G 0C5, Canada
| | - Paul Yielder
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe St North, Oshawa, ON, L1G 0C5, Canada
| | - Ushani Ambalavanar
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe St North, Oshawa, ON, L1G 0C5, Canada
| | - Heidi Haavik
- Center of Chiropractic Research, New Zealand College of Chiropractic, Mount Wellington, Auckland, New Zealand
| | - Bernadette Murphy
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe St North, Oshawa, ON, L1G 0C5, Canada.
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Cheema N, Yielder P, Sanmugananthan P, Ambalavanar U, Murphy B. Impact of subclinical neck pain on eye and hand movements in goal-directed upper limb aiming movements. Hum Mov Sci 2024; 96:103238. [PMID: 38824805 DOI: 10.1016/j.humov.2024.103238] [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: 10/26/2023] [Revised: 04/13/2024] [Accepted: 05/20/2024] [Indexed: 06/04/2024]
Abstract
Individuals with untreated, mild-to-moderate recurrent neck pain or stiffness (subclinical neck pain (SCNP)) have been shown to have impairments in upper limb proprioception, and altered cerebellar processing. It is probable that aiming trajectories will be impacted since individuals with SCNP cannot rely on accurate proprioceptive feedback or feedforward processing (body schema) for movement planning and execution, due to altered afferent input from the neck. SCNP participants may thus rely more on visual feedback, to accommodate for impaired cerebellar processing. This quasi-experimental study sought to determine whether upper limb kinematics and oculomotor processes were impacted in those with SCNP. 25 SCNP and 25 control participants who were right-hand dominant performed bidirectional aiming movements using two different weighted styli (light or heavy) while wearing an eye-tracking device. Those with SCNP had a greater time to and time after peak velocity, which corresponded with a longer upper limb movement and reaction time, seen as greater constant error, less undershoot in the upwards direction and greater undershoot in the downwards direction compared to controls. SCNP participants also showed a trend towards a quicker ocular reaction and movement time compared to controls, while the movement distance was fairly similar between groups. This study indicates that SCNP alters aiming performances, with greater reliance on visual feedback, likely due to altered proprioceptive input leading to altered cerebellar processing.
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Affiliation(s)
- Navika Cheema
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON L1G 0C5, Canada
| | - Paul Yielder
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON L1G 0C5, Canada
| | | | - Ushani Ambalavanar
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON L1G 0C5, Canada
| | - Bernadette Murphy
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON L1G 0C5, Canada.
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Streeter SR, Kush S, Cororaton A, Henry JK, Ellis SJ, Conti MS. Defining the patient acceptable symptom state using PROMIS following reconstruction of the progressive collapsing foot deformity. Foot Ankle Surg 2024; 30:504-509. [PMID: 38627109 DOI: 10.1016/j.fas.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/26/2024] [Accepted: 04/06/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND The patient acceptable symptom state (PASS) represents the threshold beyond which patients are satisfied with their outcome. This study aimed to define PASS thresholds for progressive collapsing foot deformity (PCFD) reconstruction using Patient-Reported Outcomes Measurement Information System (PROMIS) scores and anchor question responses. METHODS This retrospective study consisted of 109 patients who underwent flexible PCFD reconstruction, had preoperative and 2-year postoperative PROMIS scores, and 2-year postoperative anchor question responses. ROC curve analyses were performed to quantify PASS thresholds. RESULTS PASS thresholds for the PROMIS Physical Function (PF) and Pain Interference (PI) domains were found to be lower and higher, respectively, than population norms. Furthermore, patients with higher preoperative PROMIS PF scores or lower preoperative PROMIS PI scores had a significantly higher likelihood of achieving the PASS thresholds. CONCLUSION In addition to guiding future outcomes research, these results may help surgeons optimize treatment for PCFD and better manage patient expectations. LEVEL OF EVIDENCE III, retrospective cohort study.
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Affiliation(s)
- Stone R Streeter
- Weill Cornell Medical College, 1300 York Avenue, New York, NY 10021, USA.
| | - Sophie Kush
- Weill Cornell Medical College, 1300 York Avenue, New York, NY 10021, USA.
| | - Agnes Cororaton
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
| | - Jensen K Henry
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
| | - Scott J Ellis
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
| | - Matthew S Conti
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
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Shahi P, Maayan O, Subramanian T, Singh N, Singh S, Araghi K, Tuma O, Asada T, Korsun M, Sheha E, Dowdell J, Qureshi SA, Iyer S. Preoperative Disability Influences Effectiveness of Minimal Clinically Important Difference and Patient Acceptable Symptom State in Predicting Patient Improvement Following Cervical Spine Surgery. Global Spine J 2023:21925682231215765. [PMID: 37984881 DOI: 10.1177/21925682231215765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2023] Open
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE To compare the characteristics of the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) metrics when interpreting Neck Disability Index (NDI) following cervical spine surgery. METHODS Patients who underwent primary cervical fusion, discectomy, or laminectomy were included. NDI and global rating change (GRC) data at 6 months/1 year/2 years were analyzed. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of MCID and PASS in predicting improvement on GRC were calculated for the overall cohort and separately for patients with minimal (NDI <30), moderate (NDI 30 - 49), and severe (NDI ≥ 50) preoperative disability. Two groups with patients who achieved PASS but not MCID and patients who achieved MCID but not PASS were analyzed. RESULTS 141 patients (206 responses) were included. PASS had significantly greater sensitivity for the overall cohort (85% vs 73% with MCID, P = .02) and patients with minimal disability (96% vs 53% with MCID, P < .001). MCID had greater sensitivity for patients with severe disability (78% vs 57% with PASS, P = .05). Sensitivity was not significantly different for PASS and MCID in patients with moderate preoperative disability (83% vs 92%, P = .1). 17% of patients achieved PASS but not MCID and 9% of patients achieved MCID but not PASS. Most of these patients still reported improvement with no significant difference between the 2 groups (89% vs 72%, P = .13). CONCLUSION PASS and MCID are better metrics for patients with minimal and severe preoperative disability, respectively. Both metrics are equally effective for patients with moderate preoperative disability.
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Affiliation(s)
- Pratyush Shahi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Omri Maayan
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
- Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Tejas Subramanian
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
- Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Nishtha Singh
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Sumedha Singh
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Kasra Araghi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Olivia Tuma
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Tomoyuki Asada
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Maximilian Korsun
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Evan Sheha
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - James Dowdell
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Sheeraz A Qureshi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
- Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Sravisht Iyer
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
- Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, NY, USA
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Campbell D, Murphy BA, Burkitt J, La Delfa N, Sanmugananthan P, Ambalavanar U, Yielder P. Cervico-Ocular and Vestibulo-Ocular Reflexes in Subclinical Neck Pain and Healthy Individuals: A Cross-Sectional Study. Brain Sci 2023; 13:1603. [PMID: 38002562 PMCID: PMC10670025 DOI: 10.3390/brainsci13111603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/13/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023] Open
Abstract
Alterations in neck sensory input from recurrent neck pain (known as subclinical neck pain (SCNP)) result in disordered sensorimotor integration (SMI). The cervico-ocular (COR) and vestibulo-ocular (VOR) reflexes involve various neural substrates but are coordinated by the cerebellum and reliant upon proprioceptive feedback. Given that proprioception and cerebellar processing are impaired in SCNP, we sought to determine if COR or VOR gain is also altered. COR and VOR were assessed using an eye-tracking device in 20 SCNP (9 M and 11 F; 21.8 (SD = 2.35) years) and 17 control (7 M and 10 F; 22.40 (SD = 3.66) years) participants. COR gain (10 trials): A motorized chair rotated the trunk at a frequency of 0.04 Hz and an amplitude of 5° while participants gazed at a circular target that disappeared after three seconds. VOR gain (30 trials): Rapid bilateral head movements away from a disappearing circular target while eyes fixated on the last observed target. Independent t-tests on COR and VOR gain were performed. SCNP had a significantly larger COR gain (p = 0.006) and smaller VOR gain (p = 0.487) compared to healthy controls. The COR group differences suggest an association between proprioceptive feedback and SMI, indicating COR may be a sensitive marker of altered cerebellar processing.
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Affiliation(s)
| | - Bernadette Ann Murphy
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON L1G 0C5, Canada; (D.C.); (J.B.); (N.L.D.); (P.S.); (U.A.); (P.Y.)
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Li Y, Wu B, Li M, Pang X, Yang L, Dai C, Peng B. Patient-Reported Outcome Measures following Coblation Nucleoplasty for Cervical Discogenic Dizziness. J Clin Med 2023; 12:4413. [PMID: 37445446 DOI: 10.3390/jcm12134413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/25/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND There is little research in the literature comparing the efficacy of coblation nucleoplasty with conservative treatment in the treatment of cervical discogenic dizziness and reporting the achieved rate of minimal clinically important differences (MCID) and patient acceptable symptom state (PASS) after surgery. This retrospective study aims to explore the patient-reported outcome measures (PROM) following coblation nucleoplasty for cervical discogenic dizziness and to compare the therapeutic effect of coblation nucleoplasty with prolonged conservative treatment. METHODS Sixty-one patients with cervical discogenic dizziness and a positive intradiscal diagnostic test eligible for single-level cervical coblation nucleoplasty were included in the study. Among these 61 patients, 40 patients underwent cervical coblation nucleoplasty, while the remaining 21 patients refused surgery and received continued conservative treatment. The primary PROMs were the intensity and frequency of dizziness and secondary PROMs were related to the neck disability index (NDI) and visual analog scale (VAS) for neck pain (VAS-neck) during a 12-month follow-up period. Moreover, the achieved rate of MCID and PASS in both groups was assessed 12 months after surgery. RESULTS Dizziness intensity, dizziness frequency, VAS-neck score, and NDI score were significantly improved from the baseline at all follow-up time points in both treatment groups, except for showing no significant improvement in dizziness frequency in the conservative treatment group at 6 and 12 months after surgery. However, at each follow-up time point, the above indexes were lower in the surgery group than in the conservative treatment group. In addition, the achieved rates for PASS and MCID in all indexes in the surgery group were significantly higher than those in the conservative treatment group at 12 months after surgery. CONCLUSIONS Cervical coblation nucleoplasty significantly improved the intensity and frequency of dizziness, neck pain, and NDI in patients with cervical discogenic dizziness, and the results were superior to those from prolonged conservative treatment. Meanwhile, cervical coblation nucleoplasty is a good choice for patients with chronic neck pain and refractory cervical discogenic dizziness who have not demonstrated the indications for open surgery and have not responded well to conservative treatment.
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Affiliation(s)
- Yongchao Li
- Department of Orthopedics, The Third Medical Centre of Chinese PLA General Hospital, Beijing 100039, China
| | - Bing Wu
- Department of Orthopedics, The Third Medical Centre of Chinese PLA General Hospital, Beijing 100039, China
| | - Mao Li
- Department of Surgery, Peking University Hospital, Beijing 100034, China
| | - Xiaodong Pang
- Department of Orthopedics, The Third Medical Centre of Chinese PLA General Hospital, Beijing 100039, China
| | - Liang Yang
- Department of Orthopeadics, Featured Medical Center of Chinese People's Armed Police Forces, Tianjin 300162, China
| | - Chen Dai
- Department of Orthopedics, The Third Medical Centre of Chinese PLA General Hospital, Beijing 100039, China
| | - Baogan Peng
- Department of Orthopedics, The Third Medical Centre of Chinese PLA General Hospital, Beijing 100039, China
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Goh GS, Tarabichi S, Baker CM, Qadiri QS, Austin MS. Should We Aim to Help Patients "Feel Better" or "Feel Good" After Total Hip Arthroplasty? Determining Factors Affecting the Achievement of the Minimal Clinically Important Difference and Patient Acceptable Symptom State. J Arthroplasty 2023; 38:293-299. [PMID: 35964857 DOI: 10.1016/j.arth.2022.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/04/2022] [Accepted: 08/07/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Recent attempts have been made to use preoperative patient-reported outcome measure (PROM) thresholds as prior authorization criteria based on the assumption that patients who have higher baseline scores are less likely to achieve the minimal clinically important difference (MCID). This study aimed to identify factors affecting the achievement of MCID and patient acceptable symptom state (PASS) after total hip arthroplasty (THA), and to determine the overlap between the two outcomes. METHODS We identified 3,581 primary, unilateral THAs performed at a single practice in 2015-2019. PROMs including Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS-JR) and 12-item Short Form Health Survey were collected preoperatively and 1-year postoperatively. The likelihood of attaining PASS according to attainment of MCID was assessed. Multivariable regression was used to identify independent predictors of MCID and PASS. RESULTS In total, 79.8% achieved MCID and 73.6% achieved PASS for HOOS-JR. Approximately 1 in 7 patients who achieved MCID did not eventually achieve PASS. Worse preoperative HOOS-JR (odd ratio 0.933) was associated with MCID attainment. Better preoperative HOOS-JR (odd ratio 1.015) was associated with PASS attainment. Men, lower body mass index, better American Society of Anesthesiologists score, and better preoperative 12-item Short Form Health Survey mental score were predictors of MCID and PASS. Age, race, ethnicity, Charlson Comorbidity Index, and smoking status were not significant predictors. CONCLUSION Preoperative PROMs were associated with achieving MCID and PASS after THA, albeit in opposite directions. Clinicians should strive to help patients "feel better" and "feel good" after surgery. Preoperative PROMs should not solely be used to prioritize access to care.
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Affiliation(s)
- Graham S Goh
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Saad Tarabichi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Colin M Baker
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Qudratullah S Qadiri
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Matthew S Austin
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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Shahi P, Vaishnav AS, Lee R, Mai E, Steinhaus ME, Huang R, Albert T, Iyer S, Sheha ED, Dowdell JE, Qureshi SA. Outcomes of cervical disc replacement in patients with neck pain greater than arm pain. Spine J 2022; 22:1481-1489. [PMID: 35405338 DOI: 10.1016/j.spinee.2022.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/19/2022] [Accepted: 04/03/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Although anterior cervical discectomy and fusion is believed to positively impact a patient's radicular symptoms as well as axial neck pain, the outcomes of cervical disc replacement (CDR) with regards to neck pain specifically have not been established. PURPOSE Primary: to assess clinical improvement following CDR in patients with neck pain greater than arm pain. Secondary: to compare the clinical outcomes between patients undergoing CDR for predominant neck pain (pNP), predominant arm pain (pAP), and equal neck and arm pain (ENAP). STUDY DESIGN Retrospective review of prospectively collected data. PATIENT SAMPLE Patients who had undergone one- or two-level CDR for the treatment of degenerative cervical pathology and had a minimum of 6-month follow-up were included and stratified into three cohorts based on their predominant location of pain: pNP, pAP, and ENAP. OUTCOME MEASURES Patient-reported outcomes: Neck Disability Index (NDI), Visual Analog Scale (VAS) neck and arm, Short Form 12-Item Physical Health Score (SF12-PHS), Short Form 12-Item Mental Health Score (SF12-MHS), minimal clinically important difference (MCID). METHODS Changes in Patient-reported outcomes from preoperative values to early (<6 months) and late (≥6 months) postoperative timepoints were analyzed within each of the three groups. The percentage of patients achieving MCID was also evaluated. RESULTS One hundred twenty-five patients (52 pNP, 30 pAP, 43 ENAP) were included. The pNP cohort demonstrated significant improvements in early and late NDI and VAS-Neck, early SF-12 MCS, and late SF-12 PCS. The pAP and ENAP cohorts demonstrated significant improvements in all PROMs, including NDI, VAS-Neck, VAS-Arm, SF-12 PCS, and SF-12 MCS, at both the early and late timepoints. No statistically significant differences were found in the MCID achievement rates for NDI, VAS-Neck, SF-12 PCS, and SF-12 MCS at the late timepoint amongst the three groups. CONCLUSIONS CDR leads to comparable improvement in neck pain and disability in patients presenting with neck pain greater than arm pain and meeting specific clinical and radiographic criteria.
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Affiliation(s)
- Pratyush Shahi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Avani S Vaishnav
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Ryan Lee
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Eric Mai
- Weill Cornell Medical College, New York, NY, USA
| | - Michael E Steinhaus
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Russel Huang
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA
| | - Todd Albert
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA
| | - Sravisht Iyer
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA
| | - Evan D Sheha
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA
| | - James E Dowdell
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA
| | - Sheeraz A Qureshi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA.
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Goh GS, Baker CM, Tarabichi S, Clark SC, Austin MS, Lonner JH. The Paradox of Patient-Reported Outcome Measures: Should We Prioritize "Feeling Better" or "Feeling Good" After Total Knee Arthroplasty? J Arthroplasty 2022; 37:1751-1758. [PMID: 35436528 DOI: 10.1016/j.arth.2022.04.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/06/2022] [Accepted: 04/11/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The use of preoperative patient-reported outcome measure (PROM) thresholds for patient selection in arthroplasty care has been questioned recently. This study aimed to identify factors affecting achievement of the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) after total knee arthroplasty (TKA) and determine the overlap between the two outcomes. METHODS We identified 1,239 primary, unilateral TKAs performed at a single institution in 2015-2019. PROMs including the Knee injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR) and 12-item Short Form Health Survey (SF-12) were collected preoperatively and 1-year postoperatively. The likelihood of attaining PASS as per attainment of MCID was assessed. A multivariable regression was used to identify predictors of MCID and PASS. RESULTS In total, 71.3% achieved MCID and 75.5% achieved PASS for KOOS-JR. Only 7.7% achieved MCID but not PASS, whereas almost twice this number did not achieve MCID but did achieve PASS (11.9%). Poorer preoperative KOOS-JR (OR 0.925), better SF-12 physical (OR 1.025), and mental (OR 1.027) were associated with MCID attainment. In contrast, better preoperative KOOS-JR (OR 1.030) and SF-12 mental (OR 1.025) were associated with PASS attainment. Age, gender, race, ethnicity, body mass index, Charlson index, American Society of Anesthesiologists classification, and smoking status were not significant predictors. CONCLUSION Preoperative PROMs were associated with achieving MCID and PASS after TKA, albeit some positively and some negatively. In the era of value-based care, clinicians should not only strive to help patients "feel better" but also ensure that patients "feel good" after surgery. This study does not support the use of PROMs in prioritizing access to care.
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Affiliation(s)
- Graham S Goh
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Colin M Baker
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Saad Tarabichi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Sean C Clark
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Matthew S Austin
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Jess H Lonner
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
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Defining the patient acceptable symptom state for the American Orthopaedic Foot & Ankle Society score following hallux valgus surgery. Foot Ankle Surg 2021; 27:528-534. [PMID: 32653409 DOI: 10.1016/j.fas.2020.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 06/29/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study aimed to define the patient acceptable symptom state (PASS) for the American Orthopaedic Foot & Ankle Society score (AOFAS) following hallux valgus surgery. METHODS 548 patients underwent hallux valgus surgery and had AOFAS assessed preoperatively, 6 months and 2 years postoperatively. Responses to an anchor question were used as external criterion in receiver operating characteristics (ROC) analyses to define PASS thresholds. RESULTS In total, 429 patients (78.3%) reported their current state as acceptable. Areas under the curve (AUC) for ROCs were 0.71-0.81 for all analyses. PASS threshold was 88.5 at 2 years (sensitivity 64%, specificity 85%). Sensitivity analyses revealed that the threshold was robust. CONCLUSIONS Patients with an AOFAS of 88.5 consider their postoperative symptom state to be acceptable. This knowledge will enable clinicians to identify patients who have attained a satisfactory functional status after hallux valgus surgery.
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