Responsiveness of the PROMIS-29 Scales in Individuals With Chronic Low Back Pain

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

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.

A 3-Year Study Investigating the Utility of Patient-Reported Outcomes Measurement Information System-29 for Long-Term Follow-Up in Adult Spinal Deformity

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.

The Impact of Mind-Body Medicine on Patient-Reported Outcomes in the Management of Chronic Pelvic Pain

Background Recent research has suggested a role for mindfulness-based therapy for patients with chronic medical conditions, but there is limited data on pelvic pain. We aim to determine if mindfulness improves patient-reported outcomes in pelvic pain and to determine the feasibility of implementation of this program. Methodology This is a pilot feasibility trial consisting of women with chronic pelvic pain at a single academic tertiary referral clinic. A convenience sample of 15 subjects was enrolled. Subjects were scheduled for three 60-minute virtual mind-body sessions with a certified counselor. Baseline scores were obtained using the Patient-Reported Outcomes Measurement Information System-Computer Adaptive Testing (PROMIS-CAT) platform. They were repeated three months and six months after enrollment. Descriptive statistics were performed. Results A total of 15 patients were enrolled in the study. Among the 13 patients who completed the three-month PROMIS-CAT scores, seven had a clinically significant 5-point improvement in sleep disturbance T-score. At least a 5-point improvement in fatigue, pain interference, and ability to participate in social roles and activities T-scores were observed in six patients each. There was a 40% dropout rate. Conclusions A formal mind-body counseling program can support patients with chronic pelvic pain. Our trial demonstrated the feasibility of establishing a program and modest improvement in patient-reported quality of life.

Minimal important change thresholds change over time after knee and hip arthroplasty

OBJECTIVES

The minimal important change (MIC) reflects what patients, on average, consider the smallest improvement in a score that is important to them. MIC thresholds may vary across patient populations, interventions used, posttreatment time points and derivation methods. We determine and compare MIC thresholds for the Oxford Knee Score and Oxford Hip Score (OKS/OHS) at 3 months postoperatively to 12- and 24-month thresholds in patients undergoing knee or hip arthroplasty.

STUDY DESIGN AND SETTING

This cohort study used data from patients undergoing total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA), or total hip arthroplasty (THA) at a public hospital between February 2016 and February 2023. At 3, 12, and 24 months postoperatively, patients responded to the OKS/OHS and a 7-point anchor question determining experienced changes in knee or hip pain and functional limitations. We used the adjusted predictive modeling method that accounts for the proportion improved and the reliability of the anchor question to determine MIC thresholds and their mean differences between time points.

RESULTS

Complete data were obtained from 695/957 (73%), 1179/1703 (69%), and 1080/1607 (67%) patients undergoing TKA, 474/610 (78%), 438/603 (73%), and 355/507 (70%) patients undergoing UKA, and 965/1315 (73%), 978/1409 (69%), and 1059/1536 (69%) patients undergoing THA at 3, 12, and 24 months, respectively. The median age ranged from 68 to 70 years and 55% to 60% were females. The proportions improved ranged between 83% and 95%. The OKS/OHS MIC thresholds were 0.1, 4.2, and 5.1 for TKA, 1.8, 5.6, and 3.4 for UKA, and 1.3, 6.1, and 6.0 for THA at 3, 12, and 24 months postoperatively, respectively. The reliability ranged between 0.64 and 0.82, and the MIC values increased between three and 12 months but not between 12 and 24 months.

CONCLUSION

Any absence of deterioration in pain and function is considered important at 3 months after knee or hip arthroplasty. Increasing thresholds over time suggest patients raise their standards for what constitutes a minimal important improvement over the first postoperative year. Besides improving our understanding of patients' views on postoperative outcomes, these clinical thresholds may aid in interpreting registry-based treatment outcome evaluations.

Functional Outcomes and Health-Related Quality of Life of Adults With Congenital Below-Elbow Amputation in North America

PURPOSE

Congenital below-elbow amputation (BEA) is a common upper-extremity anomaly and generally encompasses 2 diagnoses, symbrachydactyly and transverse deficiency. Little is known about the physical, mental, and social well-being of adults with congenital BEA. A deeper understanding of longitudinal outcomes within this population may help guide family conversations and counseling for patients with congenital BEA.

METHODS

The Shriners Hospitals for Children Health Outcomes Network was queried to identify all patients currently >18 years of age who had been seen as a child between 1975 and 2019 for congenital BEA at 1 of 20 Shriners Hospitals across North America. A unique health survey examining physical functioning, mental health, social outcomes, and health-related quality of life was constructed and sent by mail or in electronic form to eligible patients.

RESULTS

A total of 64 questionnaires were completed. Patients ranged between 18 and 34 years of age, and 70% were female. Nearly two-thirds of patients (64%) reported that a prosthesis was not required and only 14% reported daily prosthetic use. Although respondents reported below-average Patient-Reported Outcomes Measurement Information System (PROMIS) upper-extremity scores, there were no differences in Short-Form 12 or Quick Disabilities of the Arm, Shoulder, and Hand scores relative to the US general population. Study participants had lower PROMIS Pain Intensity and higher PROMIS satisfaction with social roles and activities scores than the US general population, translating to clinically meaningful differences.

CONCLUSIONS

Although adults with congenital BEA report lower upper-extremity functional scores than the general population, they report no clear differences from normative values in self-efficacy, psychosocial well-being, health-related quality of life, or global life satisfaction.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognostic IV.

Examining the Relationship Between Individual Patient Factors and Substantial Clinical Benefit From Telerehabilitation Among Patients With Chronic Low Back Pain

OBJECTIVE

The coronavirus disease-2019 pandemic has facilitated the emergence of telerehabilitation, but it is unclear which patients are most likely to respond to physical therapy provided this way. The purpose of this study was to examine the relationship between individual patient factors and substantial clinical benefit from telerehabilitation among a cohort of patients with chronic low back pain (LBP).

METHODS

This is a secondary analysis of data collected during a prospective longitudinal cohort study. Patients with chronic LBP (N = 98) were provided with a standardized physical therapy protocol adapted for telerehabilitation. We examined the relationship between patient factors and substantial clinical benefit with telerehabilitation, defined as a ≥50% improvement in disability at 10 weeks, measured using the Oswestry Disability Index.

RESULTS

Sixteen (16.3%) patients reported a substantial clinical benefit from telerehabilitation. Patients reporting substantial clinical benefit from telerehabilitation had lower initial pain intensity, lower psychosocial risk per the STarT Back Screening Tool, higher levels of pain self-efficacy, and reported higher therapeutic alliance with their physical therapist compared to other patients.

CONCLUSION

Patients with lower psychosocial risk and higher pain-self efficacy experienced substantial clinical benefit from telerehabilitation for chronic LBP more often than other patients in our cohort. Therapeutic alliance was higher among patients who experienced a substantial clinical benefit compared to those who did not.

IMPACT

This study indicates that psychosocial factors play an important role in the outcomes of patients receiving telerehabilitation for chronic LBP. Baseline psychosocial screening may serve as a method for identifying patients likely to benefit from this approach.

Identifying Correlation Among Patient-Reported Outcome Measures: A Study of PROMIS-29, ODI, and VAS in Adult Spinal Deformity Patients

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.

Real World Characterization of Chronic Pain, Success Rates and Implant Rates: Evidence from a Digital Health Platform of Patients Undergoing Spinal Cord Stimulation Evaluations

Spinal cord stimulation is an effective treatment for those experiencing chronic back and leg pain but requires a temporary evaluation period (SCSeval) before permanent implantation. We present real-world data from 7,000 patients who underwent SCSeval while utilizing a mobile digital health platform for education, feedback, and outcomes collection during their surgical journey. We analyzed preoperative patient demographics, characterized patient pain profiles using the patient-reported outcomes measurement information system-29 surveys, and calculated the rates of conversion from temporary to permanent spinal cord stimulation (SCS) implantation. Between August 1, 2021, and March 2, 2023, 7,000 patients (mean age 59.1, 59.6% female) underwent SCSeval procedures while utilizing a mobile application. Patients commonly experienced aching, sharp, stabbing, tingling, numb, and burning pain. Patients had tried multiple prior therapies and wanted to reduce their use of opioids and pain medications. Overall, 90.1% of the patients had a successful SCSeval, and 80.4% of those converted to permanent implant, with the highest rates among those who underwent SCSeval in a hospital setting. There was a significant improvement in all domains of pain as evaluated by pre and postoperative patient-reported outcomes measurement information system-29 surveys. This study supports the use of digital health technology as part of the SCS journey to improve the patient experience and allow for robust patient-reported outcomes collection. The overall rate of SCSeval to permanent SCS in our study of 72.4% was higher than national rates of 64%, suggesting that an app may allow clinicians to better quantify changes in chronic pain and provide more insight into choosing to implant SCS permanently. PERSPECTIVE: This article presents real-world evidence from a digital health platform for therapy education and outcomes collection from patients undergoing spinal cord stimulation evaluation procedures. Such tools could allow for better pain characterization and allow for more nuanced tracking of patient outcomes among those with chronic pain.

PROMIS pain intensity and interference after pelvic organ prolapse surgery

INTRODUCTION AND HYPOTHESIS

Patient-Reported Outcome Measurement Information System (PROMIS) questionnaires provide valid comparisons across disciplines. Pain measures can be used to track functional outcomes. Limited PROMIS pain data exist in gynecological surgery. We sought to use pain intensity and pain interference short forms to assess pain and recovery after pelvic organ prolapse surgery.

METHODS

The PROMIS pain intensity and pain interference questionnaires were given to patients undergoing uterosacral ligament suspension (USLS), sacrospinous ligament fixation (SSLF) or minimally invasive sacrocolpopexy (MISC) at baseline, 1 week, and 6 weeks postoperatively. Clinical minimally important change was defined as a difference of 2-6 T-score points. Mean pain intensity and pain interference T-scores were compared at baseline, 1 week and 6 weeks with ANOVA. Multiple linear regression assessed 1-week scores adjusted for apical suspension type, advanced prolapse, concurrent hysterectomy, concurrent anterior or posterior repair, and concurrent sling.

RESULTS

At 1 week, all apical suspension groups showed minimally important change in pain intensity and pain interference T-scores. Between groups at 1 week, pain interference was higher in USLS (66.3±6.6) and MISC (65.5±5.9) than in SSLF (59.2±9.8), p=0.01. Multiple linear regression showed an association of hysterectomy with increases in pain intensity and pain interference. USLS had a higher proportion of concurrent hysterectomy (100%) than SSLF (0%) and MISC (30.8%), p<0.01. No difference was found based on apical suspension type alone.

CONCLUSIONS

No differences were found in PROMIS pain intensity and pain at 1 week postoperatively after apical suspension procedures.

The effectiveness of clinic versus home-based, artificial intelligence-guided therapy in patients with low back pain: Non-randomized clinical trial

BACKGROUND

Low back pain is a common cause of disability in the US with increasing financial burden on healthcare. A variety of treatment options exist to combat LBP. Home-based therapy is a low-cost option, but there is a lack of data on how it compares to therapy in clinical settings. It was hypothesized that when using artificial intelligence-guided therapy, supervised in-clinic interventions would have a greater influence on patient-reported outcomes and strength than unsupervised, home interventions.

METHODS

This is a non-randomized controlled trial of 51 patients (28 female, 23 male). The investigation compared an 8-week, core-focused exercise intervention in a Clinic (supervised) versus Home (unsupervised) setting. Outcome variables included measures of strength, performance, and patient-reported outcomes related to function. Generalized linear regression (p < 0.05) was used to evaluate outcomes were evaluated with respect to sex, intervention setting, and time.

FINDINGS

Male subjects exhibited greater strength (p ≤ 0.02) but not greater patient-reported outcomes (p ≥ 0.30) than females. The Clinic group exhibited slightly greater lateral pull-down strength (p = 0.002), greater eccentric phase range of motion during overhead press (p < 0.01), and shorter concentric phase duration during bench press (p < 0.01) than the Home group. Significance between groups was not observed in any other strength, performance, or patient-reported outcome (p ≥ 0.11).

INTERPRETATION

A lack of consistent significance indicated that the hypothesis was not supported. AI-guided, telehealth exercise produced comparable outcomes in both home and clinical settings. Telehealth options may offer a lower-cost alternative to clinic-based exercise therapy for patients with nonspecific lower back pain.

From numbers to meaningful change: Minimal important change by using PROMIS in a cohort of fracture patients

INTRODUCTION

use of the Patient-Reported Outcomes measurement Information System (PROMIS®) is slowly increasing in patients with a fracture. Yet, minimal important change of PROMIS in patients with fractures has been addressed in a very limited number of studies. As the minimal important change (MIC) is important to interpret PROMIS-scores, the goal is to estimate the MIC for PROMIS physical function (PF), PROMIS pain interference (PI) and PROMIS ability to participate in social roles and activities (APSRA) in patients with a fracture. Secondly, the smallest detectable change was determined.

MATERIALS AND METHODS

A longitudinal cohort study on patients ≥ 18 years receiving surgical or non-surgical care for fractures was conducted. Patients completed PROMIS PF V1.1, PROMIS PI V1.1 and PROMIS APSRA V2.0. For follow-up, patients completed three additional anchor questions evaluating patient-reported improvement on a seven point rating scale. The predictive modeling method was used to estimate the MIC value of all three PROMIS questionnaires.

RESULTS

Hundred patients with a mean age of 55.4 ± 12.6 years were included of which sixty (60%) were female. Seventy-two (72%) patients were recovering from a surgical procedure. PROMIS-CAT T-scores of all PROMIS measures showed significant correlations with their anchor questions. The predictive modeling method showed a MIC value of +2.4 (n = 98) for PROMIS PF, -2.9 (n = 96) for PROMIS PI and +3.2 (n = 91) for PROMIS APSRA.

CONCLUSION

By using the anchor based predictive modeling method, PROMIS MIC-values for improvement of respectively +2.4 points on a T-score metric for PROMIS-PF, -2.9 for PROMIS-PI and +3.2 for PROMIS APSRA give the impression of being meaningful to patients. These values can be used in clinical practice for managing patient expectations; to inform on treatment results; and to assess if patients experience significant change. This in order to encourage patient centered care.

The Effectiveness and Adverse Events of Cannabidiol and Tetrahydrocannabinol Used in the Treatment of Anxiety Disorders in a PTSD Subpopulation: An Interim Analysis of an Observational Study

Background: Anxiety is a condition for which current treatments are often limited by adverse events (AEs). Components of medicinal cannabis, cannabidiol (CBD) and tetrahydrocannabinol (THC), have been proposed as potential treatments for anxiety disorders, specifically posttraumatic stress disorder (PTSD). Objective: To evaluate quality-of-life outcomes after treatment with various cannabis formulations to determine the effectiveness and associated AEs. Methods: An interim analysis of data collected between September 2018 and June 2021 from the CA Clinics Observational Study. Patient-Reported Outcomes Measurement Information System-29 survey scores of 198 participants with an anxiety disorder were compared at baseline and after treatment with medicinal cannabis. The data of 568 anxiety participants were also analyzed to examine the AEs they experienced by the Medical Dictionary for Regulatory Activities organ system class. Results: The median doses taken were 50.0 mg/day for CBD and 4.4 mg/day for THC. The total participant sample reported significantly improved anxiety, depression, fatigue, and ability to take part in social roles and activities. Those who were diagnosed with PTSD (n = 57) reported significantly improved anxiety, depression, fatigue, and social abilities. The most common AEs reported across the whole participant cohort were dry mouth (32.6%), somnolence (31.3%), and fatigue (18.5%), but incidence varied with different cannabis formulations. The inclusion of THC in a formulation was significantly associated with experiencing gastrointestinal AEs; specifically dry mouth and nausea. Conclusions: Formulations of cannabis significantly improved anxiety, depression, fatigue, and the ability to participate in social activities in participants with anxiety disorders. The AEs experienced by participants are consistent with those in other studies.

Holistic Treatment Response: An International Expert Panel Definition and Criteria for a New Paradigm in the Assessment of Clinical Outcomes of Spinal Cord Stimulation

BACKGROUND

Treatment response to spinal cord stimulation (SCS) is focused on the magnitude of effects on pain intensity. However, chronic pain is a multidimensional condition that may affect individuals in different ways and as such it seems reductionist to evaluate treatment response based solely on a unidimensional measure such as pain intensity.

AIM

The aim of this article is to add to a framework started by IMMPACT for assessing the wider health impact of treatment with SCS for people with chronic pain, a "holistic treatment response".

DISCUSSION

Several aspects need consideration in the assessment of a holistic treatment response. SCS device data and how it relates to patient outcomes, is essential to improve the understanding of the different types of SCS, improve patient selection, long-term clinical outcomes, and reproducibility of findings. The outcomes to include in the evaluation of a holistic treatment response need to consider clinical relevance for patients and clinicians. Assessment of the holistic response combines two key concepts of patient assessment: (1) patients level of baseline (pre-treatment) unmet need across a range of health domains; (2) demonstration of patient-relevant improvements in these health domains with treatment. The minimal clinical important difference (MCID) is an established approach to reflect changes after a clinical intervention that are meaningful for the patient and can be used to identify treatment response to each individual domain. A holistic treatment response needs to account for MCIDs in all domains of importance for which the patient presents dysfunctional scores pre-treatment. The number of domains included in a holistic treatment response may vary and should be considered on an individual basis. Physiologic confirmation of therapy delivery and utilisation should be included as part of the evaluation of a holistic treatment response and is essential to advance the field of SCS and increase transparency and reproducibility of the findings.

Responsiveness and minimal important change of seven PROMIS computerized adaptive tests (CAT) in patients with advanced chronic kidney disease

BACKGROUND

The Patient-Reported Outcomes Measurement Information System (PROMIS®) has the potential to harmonize the measurement of health-related quality of life (HRQL) across medical conditions. We evaluated responsiveness and minimal important change (MIC) of seven Dutch-Flemish PROMIS computerized adaptive tests (CAT) in Dutch patients with advanced chronic kidney disease (CKD).

METHODS

CKD patients (eGFR < 30 ml/min.1.73m²) completed at baseline and after 6 months seven PROMIS CATs (assessing physical function, pain interference, fatigue, sleep disturbance, anxiety, depression, and ability to participate in social roles and activities), Short Form Health Survey 12 (SF-12), PROMIS Pain Intensity single item, Dialysis Symptom Index (DSI), and Global Rating Scales (GRS) of change. Responsiveness was assessed by testing predefined hypotheses about expected correlations among measures, area under the ROC Curve, and effect sizes. MIC was determined with predictive modelling.

RESULTS

207 patients were included; 186 (90%) completed the follow-up. Most results were in accordance with expectations (70-91% of hypotheses confirmed), with some exceptions for PROMIS Anxiety and Ability to Participate (60% and 42% of hypotheses confirmed, respectively). For PROMIS Anxiety and Depression correlations with the GRS were too low (0.04 and 0.20, respectively) to calculate a MIC. MIC values, representing minimal important deterioration, ranged from 0.4 to 2.5 T-score points for the other domains.

CONCLUSION

We found sufficient responsiveness of PROMIS CATs Physical Function, Fatigue, Sleep Disturbance, and Depression. The results for PROMIS CATs Pain Interference were almost sufficient, but some results for Anxiety and Ability to Participate in Social Roles and Activities were not as expected. Reported MIC values should be interpreted with caution because most patients did not change.

Physical clinical care and artificial-intelligence-guided core resistance training improve endurance and patient-reported outcomes in subjects with lower back pain

BACKGROUND

Low back pain is an extremely prevalent issue with an extensive impact, ranging from decreased quality of life to lost years of productivity. Many interventions have been developed to alleviate chronic lower back pain, yet it remains a widespread problem. The objective of this study was to examine the role of artificial intelligence guided resistance training relative to clinical variables in subjects experiencing lower back pain.

METHODS

69 out of 108 enrolled and 92 accrued subjects completed the 8-week intervention. Subjects were randomized into four groups (Control, Training, Clinical, or Combined). The Training cohort received supervised artificial-intelligence-guided core-focused resistance training while the Clinical group received clinical care. The Combined group received both clinical care and artificial-intelligence-guided training and the Control group received no treatment. Participants were evaluated using functional testing and patient-reported outcomes at baseline, 4 weeks, and 8 weeks.

FINDINGS

In the clinical tests, the Clinical and Combined cohorts showed increased total time for isometric extensor endurance and the Clinical cohort increased total distance traveled in the 6-min walk test at 8 weeks. The Training, Clinical, and Combined groups showed improvements in Patient-reported outcomes after 8 weeks. Most of the significant improvements were only seen at the 8-week evaluation for both the clinical evaluations and Patient-reported outcomes. The Control group did not show significant improvements in any outcome measures.

INTERPRETATION

The present data indicate that core-focused interventions, including artificial-intelligence-guided moderate-resistance exercise, can increase objective functional outcomes and patient satisfaction using Patient-reported outcomes in individuals with lower back pain.

Hungarian PROMIS-29+2: psychometric properties and population reference values

OBJECTIVES

This study aims to assess psychometric properties of the Hungarian PROMIS-29+2 profile measure and provide general population reference values for Hungary.

METHODS

An adult general population sample (n = 1700) completed PROMIS-29+2 v2.1 in an online survey. The following psychometric properties were assessed: floor and ceiling effect, convergent validity with SF-36v1 domains, internal consistency (McDonald's omega), unidimensionality, local independence, monotonicity, graded response model (GRM) fit and differential item functioning (DIF). Age- and gender-specific reference values were established using the US item calibrations.

RESULTS

Depending on scale orientation, high floor or ceiling effects were observed for all domains (25.2-60.7%) except for sleep disturbance. McDonald's omega for domains ranged from 0.87-0.97. Unidimensionality, local independence and monotonicity were supported and the GRM adequately fitted for all but one domains. The sleep disturbance domain demonstrated item misfit, response level disordering and low discrimination ability, particularly for item Sleep116 ('refreshing sleep'). Strong correlations were observed between PROMIS-29+2 and corresponding SF-36 domains (r_s=│0.60│ to │0.78│). No DIF was detected for most sociodemographic characteristics. Problems with physical function, pain interference and social roles tended to increase, whereas problems with anxiety, depression, fatigue and cognitive function declined with age (p < 0.01). In all domains except for cognitive function, more health problems occurred in females than in males (p < 0.001).

CONCLUSION

The Hungarian PROMIS-29+2 shows satisfactory psychometric properties; however, the sleep disturbance domain substantially underperforms that requires further attention. Population reference values were generated that facilitate the interpretation of health outcomes in various patient populations.

The Canadian version of the National Institutes of Health minimum dataset for chronic low back pain research: reference values from the Quebec Low Back Pain Study

ABSTRACT

The National Institutes of Health (NIH) minimum dataset for chronic low back pain (CLBP) was developed in response to the challenge of standardizing measurements across studies. Although reference values are critical in research on CLBP to identify individuals and communities at risk of poor outcomes such as disability, no reference values have been published for the Quebec (Canada) context. This study was aimed to (1) provide reference values for the Canadian version of the NIH minimum dataset among individuals with CLBP in Quebec, both overall and stratified by gender, age, and pain impact stratification (PIS) subgroups, and (2) assess the internal consistency of the minimum data set domains (pain interference, physical function, emotional distress or depression, sleep disturbance, and PIS score). We included 2847 individuals living with CLBP who completed the baseline web survey of the Quebec Low Back Pain Study (age: 44.0 ± 11.2 years, 48.1% women) and were recruited through social media and healthcare settings. The mean score was 6.1 ± 1.8 for pain intensity. Pain interference, physical function, emotional distress or depression, sleep disturbance, and PIS scores were 12.9 ± 4.1, 14.4 ± 3.9, 9.8 ± 4.4, 13.0 ± 3.6, and 26.4 ± 6.6, respectively. Emotional distress or depression showed floor effects. Good-to-excellent internal consistency was found overall and by language, gender, and age subgroups for all domains (alpha: 0.81-0.93) and poor-to-excellent internal consistency for PIS subgroups (alpha: 0.59-0.91). This study presents reference values and recommendations for using the Canadian version of the NIH minimum dataset for CLBP that can be useful for researchers and clinicians.

The Effects of Combined Respiratory-Gated Auricular Vagal Afferent Nerve Stimulation and Mindfulness Meditation for Chronic Low Back Pain: A Pilot Study

OBJECTIVE

Respiratory-gated Auricular Vagal Afferent Nerve stimulation (RAVANS) is a safe nonpharmacological approach to managing chronic pain. The purpose of the current study was to examine (1) the feasibility and acceptability of RAVANS, combined with mindful meditation (MM) for chronic low back pain (CLBP), (2) the potential synergy of MM+RAVANS on improving pain, and (3) possible moderators of the influence of MM+RAVANS on pain.

DESIGN

Pilot feasibility and acceptability study.

SETTING

Pain management center at large academic medical center.

SUBJECTS

Nineteen adults with CLBP and previous MM training.

METHODS

Participants attended two sessions during which they completed quantitative sensory testing (QST), rated pain severity, and completed a MM+stimulation session. Participants received RAVANS during one visit and sham stimulation during the other, randomized in order. Following intervention, participants repeated QST.

RESULTS

MM+RAVANS was well tolerated, acceptable, and feasible to provide relief for CLBP. Both MM+stimulation sessions resulted in improved back pain severity, punctate pain ratings, and pressure pain threshold. Individuals with greater negative affect showed greater back pain improvement from MM+RAVANS while those with greater mindfulness showed greater back pain improvement from MM+sham.

CONCLUSIONS

Results suggest that for CLBP patients with prior MM training, the analgesic effects of MM may have overshadowed effects of RAVANS given the brief single session MM+RAVANS intervention. However, those with greater negative affect may benefit from combined MM+RAVANS.

Responsiveness of the UW Concerns About Pain Scale and UW Pain-Related Self-Efficacy Scale in Individuals With Chronic Low Back Pain

OBJECTIVES

The aim was to examine the responsiveness, presence of floor or ceiling effects, and minimal clinically important differences (MCIDs) for 2 new measures of pain-related catastrophizing and self-efficacy in individuals with chronic low back pain.

METHODS

A total of 183 individuals with chronic low back pain recruited from physical therapy clinics in Thailand completed the Thai versions of the 6-item University of Washington Concerns About Pain scale (T-UW-CAP6) and 6-item University of Washington Pain-Related Self-Efficacy scale (T-UW-PRSE6) at baseline and at 4 weeks follow-up. Perceived change in low back symptom was assessed at 4 weeks using a 7-point measure of Global Perceived Effect (GPE). Responsiveness of the T-UW-CAP6 and the T-UW-PRSE6 scale scores were evaluated by computing the effect sizes and standardized response means for change over time, and examining these as a function of the GPE ratings. Floor and ceiling effects were examined by evaluating the score distributions. Scale core MCIDs were estimated by computing a half a SD and SE of measurement statistics for each scale.

RESULTS

Responsiveness of the scales to pain treatment was supported by differences found in the mean change scores as a function of the treatment response categories. No significant floor or ceiling effects were found for either measure. Changes of 4.38 and 3.68 appeared to be the smallest change score perceived as clinical meaningful for the T-UW-CAP6 and T-UW-PRSE 6 scale scores, respectively.

DISCUSSION

The T-UW-CAP6 and T-UW-PRSE6 demonstrated good ability to detect perceived changes over time in patients with chronic low back pain. The MCIDs values provide a benchmark for assessing individual improvement in this clinical context.

Microendoscopic Decompression for Lumbar Disc Herniations: An Analysis of Short and Long Term Patient Reported Outcome Measures

INTRODUCTION

Endoscopic spine surgery is increasingly being used, and techniques, platforms, and applications are rapidly evolving. Despite substantial enthusiasm surrounding these techniques, there is a dearth of longer term patient-reported clinical outcomes. Within the United States in particular, there are yet to be reported large cohort studies with a notable follow-up. We sought to characterize the clinical outcomes of patients undergoing microendoscopic decompression (MED) for lumbar disk herniations.

METHODS

The records of patients with symptomatic lumbar disk herniations who underwent MED from May 2018 to February 2021 within a single practice were reviewed. Paired outcomes scores were evaluated using Patient-Reported Outcomes Measurement Information System parameters. Basic perioperative data including length of stay, estimated blood loss, mean opioid use, complication rate, and rate of revision were tabulated. Paired sample Student t-tests and paired Wilcoxon sign tests were used to compare normally distributed and nonparametric data, respectively.

RESULTS

Thirty-five patients with complete paired patient-reported outcome measures data and a minimum 6-month follow-up were included; 65.7% of the patients were male with a mean age of 47.1 years (SE 1.8). The mean follow-up was 590.6 days (SE 47.7). In total, 34 of the 35 patients (97.1%) were discharged on the day of their procedure. The estimated blood loss was <25 mL for each procedure. The mean opioid use after extubation and before discharge was 10.4 morphine milligram equivalents. At the 2-week follow-up, there were notable improvements in pain metrics and global health components. At the final follow-up, nearly all parameters showed notable improvement that exceeded minimally clinical important difference values. For most parameters, preoperative values outside of the "normal" range were within normal limits on postoperative testing.

DISCUSSION

MED resulted in sustained notable improvement in patient-reported outcome measures that exceeded minimally clinical important difference values at the average follow-up approximating 2 years. These findings substantiate the utility of this technique and additional investment in endoscopic spine technology.

DATA AVAILABILITY

Not publicly available; available upon request.

Preliminary evaluation of the Chinese version of the patient-reported outcomes measurement information system 29-item profile in patients with aortic dissection

BACKGROUND

The Patient-Reported Outcomes Measurement Information System 29-item Profile (PROMIS-29) has been widely used to measure health outcomes from the patient's perspective. It has not been validated in adults with aortic disease. The aim of this study was to explore the reliability and validity of the Chinese PROMIS-29 among patients undergoing surgery for aortic dissection (AD).

METHODS

A cross-sectional design was applied. Eligible patients completed a questionnaire that contained the PROMIS-29 and legacy measures, including the Short Form-12 Health Survey (SF-12), 8-item Somatic Symptom Scale (SSS-8), Generalized Anxiety Disorder-2 (GAD-2), and Patient Health Questionnaire-2 (PHQ-2). The structural validity of the PROMIS-29 was evaluated using confirmatory factor analysis (CFA). Reliability was evaluated with Cronbach's α. Construct validity was assessed by calculating Spearman's rank correlations and comparing known-group differences.

RESULTS

In total, a sample of 327 AD patients was included in the final analysis. Most of them were male (89%) with a mean age of 52.7 (± 10.3). CFA revealed good model fit of the seven-factor structure within PROMIS-29, as well as most domains in single-factor analysis. Reliability was confirmed with Cronbach's α > 0.90. Correlations between comparable domains of the PROMIS-29 and those of legacy questionnaires and most know-group comparisons were observed as hypothesized.

CONCLUSIONS

This study found evidence for acceptable structural validity, construct validity and internal consistency of the PROMIS-29 in a sample of AD patients. It can be applied to AD survivors by researchers or clinicians, measuring outcomes after surgery and identifying those with worse health status.

The Norwegian PROMIS-29: psychometric validation in the general population for Norway

Background

The Patient Reported Outcome Measurement Information System profile instruments include “high information” items drawn from large item banks following the application of modern psychometric criteria. The shortest adult profile, PROMIS-29, looks set to replace existing short-form instruments in research and clinical practice. The objective of this study was to undertake the first psychometric evaluation of the Norwegian PROMIS-29, following a postal survey of a random sample of 12,790 Norwegians identified through the National Registry of the Norwegian Tax Administration. Confirmatory factor analysis was used to assess structural validity. Fit to the Rasch partial credit model and differential item functioning (DIF) were assessed in relation to age, gender, and education. PROMIS-29 scores were compared to those for the EQ-5D-5L and the Self-assessed Comorbidity Questionnaire (SCQ), for purposes of assessing validity based on a priori hypotheses.

Results

There were 3200 (25.9%) respondents with a mean age (SD) of 51 (20.7, range 18 to 97 years) and 55% were female. The PROMIS-29 showed satisfactory structural validity and acceptable fit to Rasch model including unidimensionality, and measurement invariance across age and education levels. One pain interference item had uniform DIF for gender but splitting gave satisfactory fit. Domain reliability estimates ranged from 0.85 to 0.95. Correlations between PROMIS-29 domain, SCQ and EQ-5D scores were largely as expected, the largest being for scores assessing very similar aspects of health.

Conclusions

The Norwegian version of the PROMIS-29 is a reliable and valid generic self-reported measure of health in the Norwegian general population. The instrument is recommended for further application, but the analysis should be replicated and responsiveness to change assessed in future studies before it can be recommended for clinical and health services evaluation in Norway.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41687-021-00357-3.

Minimal important change (MIC): a conceptual clarification and systematic review of MIC estimates of PROMIS measures

We define the minimal important change (MIC) as a threshold for a minimal within-person change over time above which patients perceive themselves importantly changed. There is a lot of confusion about the concept of MIC, particularly about the concepts of minimal important change and minimal detectable change, which questions the validity of published MIC values. The aims of this study were: (1) to clarify the concept of MIC and how to use it; (2) to provide practical guidance for estimating methodologically sound MIC values; and (3) to improve the applicability of PROMIS by summarizing the available evidence on plausible PROMIS MIC values. We discuss the concept of MIC and how to use it and provide practical guidance for estimating MIC values. In addition, we performed a systematic review in PubMed on MIC values of any PROMIS measure from studies using recommended approaches. A total of 50 studies estimated the MIC of a PROMIS measure, of which 19 studies used less appropriate methods. MIC values of the remaining 31 studies ranged from 0.1 to 12.7 T-score points. We recommend to use the predictive modeling method, possibly supplemented with the vignette-based method, in future MIC studies. We consider a MIC value of 2-6 T-score points for PROMIS measures reasonable to assume at this point. For surgical interventions a higher MIC value might be appropriate. We recommend more high-quality studies estimating MIC values for PROMIS.