The Need of Validated Disease-Specific Outcome Instruments for Spine Trauma

Reliability and Validity of the German Version of the AO Spine Patient Reported Outcome Spine Trauma Questionnaire

STUDY DESIGN

A single-center validation study.

OBJECTIVE

To translate and cross-culturally adapt the AO Spine PROST (Patient Reported Outcome Spine Trauma) into German, and to test its psychometric properties among German-speaking Swiss spine trauma patients.

METHODS

Patients were recruited from a level-1 Swiss trauma center. Next to the AO Spine PROST, the EQ-5D-3L questionnaire was used for concurrent validity. Questionnaires were filled out at two-time points for test-retest reliability. Patient characteristics were analyzed using descriptive statistics. For content validity, floor, and ceiling effects, as well as any irrelevant and missing questions were analyzed. Construct validity of the AO Spine PROST questionnaire to the EQ-5D-3L was tested using Spearman correlation tests.

RESULTS

The AOSpine PROST was translated and adapted into German using established guidelines. We included 179 patients. The floor effect for all items was well within the optimal range (below 15%), while the ceiling effect of seven items was within the optimal range. None of the items displayed a problematic floor or ceiling effect. The overall test-retest reliability of the total PROST score was excellent, with an ICC of .83 (95% CI .69-.91). The Spearman correlation coefficient between the total PROST summary score and EQ-5D-3 L was ρ = .63.

CONCLUSIONS

The German version of the AO Spine PROST questionnaire demonstrated very good validity and reliability results.

Validation of the AO Spine CROST (Clinician Reported Outcome Spine Trauma) in the clinical setting

PURPOSE

To evaluate feasibility, internal consistency, inter-rater reliability, and prospective validity of AO Spine CROST (Clinician Reported Outcome Spine Trauma) in the clinical setting.

METHODS

Patients were included from four trauma centers. Two surgeons with substantial amount of experience in spine trauma care were included from each center. Two separate questionnaires were administered at baseline, 6-months and 1-year: one to surgeons (mainly CROST) and another to patients (AO Spine PROST-Patient Reported Outcome Spine Trauma). Descriptive statistics were used to analyze patient characteristics and feasibility, Cronbach's α for internal consistency. Inter-rater reliability through exact agreement, Kappa statistics and Intraclass Correlation Coefficient (ICC). Prospective analysis, and relationships between CROST and PROST were explored through descriptive statistics and Spearman correlations.

RESULTS

In total, 92 patients were included. CROST showed excellent feasibility results. Internal consistency (α = 0.58-0.70) and reliability (ICC = 0.52 and 0.55) were moderate. Mean total scores between surgeons only differed 0.2-0.9 with exact agreement 48.9-57.6%. Exact agreement per CROST item showed good results (73.9-98.9%). Kappa statistics revealed moderate agreement for most CROST items. In the prospective analysis a trend was only seen when no concerns at all were expressed by the surgeon (CROST = 0), and moderate to strong positive Spearman correlations were found between CROST at baseline and the scores at follow-up (rs = 0.41-0.64). Comparing the CROST with PROST showed no specific association, nor any Spearman correlations (rs = -0.33-0.07).

CONCLUSIONS

The AO Spine CROST showed moderate validity in a true clinical setting including patients from the daily clinical practice.

Inter-rater reliability of a newly developed gait analysis and motion score

Background:

Gait analysis constitutes an essential part of orthopedic rehabilitation assessment. Previous studies indicate that observational-based gait analysis lacks reliability and requires extensive clinical training. Therefore, gait analysis in the clinical practice heavily relies on technical aids. The aim of the present study is to develop a reliable gait analysis assessment tool that can accurately assess clinically relevant gait cycle parameters in daily clinical practice.

Methods:

In this pilot study, a new gait analysis and motion score (GAMS), comprising 10 observational and 5 technically measured (e.g. pressure plate) gait parameters, was developed. The parameters were dichotomously operationalized, reflecting pathological versus physiological manifestations of the parameters. The rating algorithm was administered by 12 raters using videotaped treadmill sessions of 10 orthopedic subjects ( n = 120 ratings). Inter-rater reliability was calculated using the intraclass correlation coefficient (ICC) and the percentage of rating agreement.

Results:

The mean (standard deviation (SD)) GAMS ratings ranged from 10.0 (1.1) to 21.5 (1.3) points. The overall GAMS ICC was 0.98 (95% confidence interval (CI) 0.96–1.00), whereas the ICC of observational parameters alone was 0.97 (95% CI 0.93–0.99). The mean (SD) percentage of rating agreement was 86.1% (3.3%). For the observational parameters, the mean (SD) rating agreement was 82.5% (4.5%).

Conclusion:

This new GAMS shows excellent overall inter-rater reliability for a continuum of functional gait statuses. The new score may be an appropriate clinical tool to objectively evaluate patients’ gait patterns. Furthermore, the GAMS may find application as a clinician-reported outcome measure in orthopedic rehabilitation. Further studies are required to verify the validity and accuracy of the new GAMS and its functionality in assessing clinical changes in gait patterns.

Reliability and Validity of the English Version of the AOSpine PROST (Patient Reported Outcome Spine Trauma)

STUDY DESIGN

Multicenter validation study.

OBJECTIVE

The aim of this study was to translate and adapt the AOSpine PROST (Patient Reported Outcome Spine Trauma) into English, and test its psychometric properties among North-American spine trauma patients.

SUMMARY OF BACKGROUND DATA

In the absence of an outcome instrument specifically designed and validated for traumatic spinal column injury patients, it is difficult to measure the effect size of various treatment options. The AOSpine Knowledge Forum Trauma initiated a project and developed the AOSpine PROST consisting of 19 items.

METHODS

Patients were recruited from two level-1 North-American trauma centers. For concurrent validity, next to AOSpine PROST also 36-item Short-Form Health Survey (SF-36) was filled out by patients. Patient characteristics were analyzed using descriptive statistics. Floor and ceiling effects as well as the number of inapplicable and missing questions were analyzed for content validity. Cronbach α and item-total correlation coefficients (ITCCs) were calculated for internal consistency. Spearman correlation tests were performed within AOSpine PROST items and in correlation to SF-36. Test-retest reliability was assessed using intraclass correlation coefficients (ICCs). Factor analysis was performed to explore any dimensions within AOSpine PROST.

RESULTS

The AOSpine PROST was translated adapted into English using established guidelines. Of 196 enrolled patients, 162 (82.7%) met the inclusion criteria and provided sufficient data. Content validity showed good results, and no floor and ceiling effects were seen. The internal consistency was excellent (Cronbach α = 0.97; ITCC 0.50-0.90) as well as test-retest reliability (ICC = 0.97). Spearman correlations were good (0.29-0.85). The strongest correlations of AOSpine PROST with SF-36 were seen with the physical components (0.69-0.82; P < 0.001). Factor analysis revealed two possible dimensions (Eigen values >1), explaining 75.7% of variance.

CONCLUSION

The English version of AOSpine PROST showed very good validity and reliability. It is considered as a valuable tool, and has the potential to contribute to the reduction of ongoing controversies in spine trauma care.

LEVEL OF EVIDENCE

2.