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Nakajima Y, Nagai S, Michikawa T, Hachiya K, Ito K, Takeda H, Kawabata S, Yoshioka A, Ikeda D, Kaneko S, Hachiya Y, Fujita N. Predictors of Patient Dissatisfaction after Lumbar Spinal Canal Stenosis Surgery: A Multicenter Retrospective Study. Spine Surg Relat Res 2024; 8:322-329. [PMID: 38868782 PMCID: PMC11165491 DOI: 10.22603/ssrr.2023-0256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/25/2023] [Indexed: 06/14/2024] Open
Abstract
Introduction Recently, patient satisfaction has gained prominence as a crucial measure for ensuring patient-centered care. Furthermore, patient satisfaction after lumbar spinal canal stenosis (LCS) surgery is an important metric for physician's decision of surgical indication and informed consent to patient. This study aimed to elucidate how patient satisfaction changed after LCS surgery to identify factors that predict patient dissatisfaction. Methods We retrospectively reviewed time-course data of patients aged ≥40 years who underwent LCS surgery at multiple hospitals. The participants completed the Zurich Claudication Questionnaire (ZCQ) and the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) before surgery and then 6 months and 1 year postsurgery. Patient satisfaction was categorized according to the postoperative score of the satisfaction domain of the ZCQ: satisfied, score ≤2.0; moderately satisfied, 2.0< score ≤2.5; and dissatisfied, score >2.5. Results The study enrolled 241 patients. Our data indicated a satisfaction rate of around 70% at 6 months and then again 1 year after LCS surgery. Among those who were dissatisfied 6 months after LCS surgery, 47.6% were more satisfied 1 year postsurgery. Furthermore, 86.2% of those who were satisfied 6 months after LCS surgery remained satisfied at 1 year. Multivariable analysis revealed that age (relative risk, 0.5; 95% confidence interval, 0.2-0.8) and preoperative score of psychological disorders on the JOABPEQ (relative risk, 0.2; 95% confidence interval, 0.03-0.08) were significantly associated with LCS surgery dissatisfaction. In addition, the receiver operating characteristic curve analysis revealed that the cutoff value for the preoperative score of psychological disorder of the JOABPEQ was estimated at 40 for LCS surgery dissatisfaction. Conclusions Age and psychological disorders were identified as significant predictors of dissatisfaction, with a JOABPEQ cutoff value providing potential clinical applicability.
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Affiliation(s)
- Yukio Nakajima
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Sota Nagai
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Takehiro Michikawa
- Department of Environmental and Occupational Health, School of Medicine, Toho University, Tokyo, Japan
| | - Kurenai Hachiya
- Department of Orthopaedic Surgery, Hachiya Orthopaedic Hospital, Nagoya, Japan
| | - Kei Ito
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Hiroki Takeda
- Department of Spine and Spinal Cord Surgery, Fujita Health University, Toyoake, Japan
| | - Soya Kawabata
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Atsushi Yoshioka
- Department of Orthopaedic Surgery, Hachiya Orthopaedic Hospital, Nagoya, Japan
| | - Daiki Ikeda
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Shinjiro Kaneko
- Department of Spine and Spinal Cord Surgery, Fujita Health University, Toyoake, Japan
| | - Yudo Hachiya
- Department of Orthopaedic Surgery, Hachiya Orthopaedic Hospital, Nagoya, Japan
| | - Nobuyuki Fujita
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Toyoake, Japan
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Veihelmann A, Beck F, Birkenmaier C. HADS and SOMS-2 brief score evaluation can prevent unnecessary minimal invasive spine interventions - a prospective blinded observational clinical trial. Arch Orthop Trauma Surg 2024; 144:1575-1584. [PMID: 38386066 DOI: 10.1007/s00402-024-05257-x] [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: 03/13/2023] [Accepted: 02/18/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION To test the hypothesis, whether HADS/SOMS is practical in a spine surgery consultation setting and that patients with CLBP, but a high-risk of psychic comorbidities using above screenings will not improve after minimal-invasive spine interventions (MIS). METHODS n = 150 completed HADS and SOMS prior to the acquisition of history and examination. Primary outcome was improvement by numeric rating scale (NRS), Pain disability index (PDI) and oswestry disability index (ODI) at baseline and 6 months after intervention. In case of sciatica due to disc herniation epidural neurolysis, for facet or SI-joint-syndrome, radiofrequency and for discogenic pain intradiscal electrothermal therapy (IDET) was performed. RESULTS 6 months after interventions, pat. with a high-risk of anxiety or depression showed no clinically important improvements in NRS, PDI and ODI, whereas in the low-risk group all 3 parameters were significantly reduced. We found a statistically significant difference in the improvement of NRS (p < 0·05), PDI (p < 0·001), ODI (p < 0·001) between high- and low-risk HADS-anxiety and depression groups and in the improvement of NRS and PDI (p < 0·05) between high- and low-risk SOMS-2-subgroups. CONCLUSIONS In this group of CLBP patients, the easy-to-administer HADS/SOMS reliably predicted outcome after MIS due to the detection of somatoform comorbidities. Thus, 30 out of 150 patients were invasively treated without improvement. This is alarming not only because of unnecessary MIS being performed on these individuals, but also because it represents an inefficient allocation of increasingly limited healthcare funds. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Andreas Veihelmann
- Department of Orthopaedics, Physical Medicine & Rehabilitation, Ludwig-Maximilians- University of Munich, Munich, Germany.
- Department for Spine Therapy, Sports Hospital Stuttgart, Stuttgart, Germany.
- SRH Health-center, Bad Herrenalb, Germany.
| | - Florian Beck
- Department of Orthopaedics, Physical Medicine & Rehabilitation, Ludwig-Maximilians- University of Munich, Munich, Germany
- Orthopaedie Centrum 30, Fellbach, Germany
| | - Christof Birkenmaier
- Department of Orthopaedics, Physical Medicine & Rehabilitation, Ludwig-Maximilians- University of Munich, Munich, Germany
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Abdelhadi O. The impact of psychological distress on quality of care and access to mental health services in cancer survivors. FRONTIERS IN HEALTH SERVICES 2023; 3:1111677. [PMID: 37405330 PMCID: PMC10316283 DOI: 10.3389/frhs.2023.1111677] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 05/29/2023] [Indexed: 07/06/2023]
Abstract
Introduction Psychological distress is highly prevalent among cancer survivors and significantly impacts their health outcomes. Our study aim is to examine the impact of psychological distress on the quality of care in cancer survivors. Methods We utilized longitudinal panels from the Medical Expenditure Panel Survey data spanning from 2016 to 2019 to estimate the impact of psychological distress on quality of care. We compared a sample of cancer survivors with psychological distress (N = 176) to a matched sample of cancer survivors without psychological distress (N = 2,814). We employed multivariable logistic regression models and Poisson regression models. In all models, we adjusted for age at the survey, sex, race/ethnicity, education, income, insurance, exercise, chronic conditions, body mass index, and smoking status. Descriptive statistics and regression models were performed using STATA software. Results Our findings revealed a higher prevalence of psychological distress among younger survivors, females, individuals with lower incomes, and those with public insurance. Cancer survivors with psychological distress reported more adverse patient experiences compared to those without distress. Specifically, survivors with distress had lower odds of receiving clear explanations of their care (OR: 0.40; 95% CI: 0.17-0.99) and lower odds of feeling respected in expressing their concerns (OR: 0.42; 95% CI: 0.18-0.99) by their healthcare providers. Furthermore, psychological distress was associated with increased healthcare utilization, as evidenced by a higher number of visits (p = 0.02). It also correlated with a decrease in healthcare service ratings (p = 0.01) and the affordability of mental health services (p < 0.01) for cancer survivors. Discussion These findings indicate that psychological distress can significantly impact the delivery of healthcare and the patient experience among cancer survivors. Our study underscores the importance of recognizing and addressing the mental health needs of cancer survivors. It provides insights for healthcare professionals and policymakers to better understand and cater to the mental health needs of this population.
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Hiranaka Y, Miyazaki S, Yurube T, Kuroshima K, Ryu M, Inoue S, Kakutani K, Tadokoro K. Influence of the Preoperative Duration of Symptoms on Patients' Clinical Outcomes after Minimally Invasive Surgery-Transforaminal Lumbar Interbody Fusion for Degenerative Lumbar Spinal Diseases. MEDICINA (KAUNAS, LITHUANIA) 2022; 59:medicina59010022. [PMID: 36676647 PMCID: PMC9867228 DOI: 10.3390/medicina59010022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/06/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
Background and Objectives: The impact of the duration of symptoms (DOS) on postoperative clinical outcomes of patients with degenerative lumbar spinal diseases is important for determining the optimal timing of surgical intervention; however, the timing remains controversial. This prospective case−control study aimed to investigate the influence of the preoperative DOS on surgical outcomes in minimally invasive surgery-transforaminal lumbar interbody fusion (MIS-TLIF). Materials and Methods: Patients who underwent single-level TLIF for lumbar degenerative diseases between 2017 and 2018 were reviewed. Only patients with full clinical data during the 1-year follow-up period were included. The patients were divided into two groups (DOS < 12 months, group S; DOS ≥ 12 months, group L). The clinical outcomes, including the Oswestry disability index (ODI) and visual analog scale (VAS) for lower back pain, leg pain, and numbness, were investigated preoperatively and at 1, 3, and 6 months, as well as 1 year, after surgery. Furthermore, postoperative patient satisfaction 1 year after surgery was also surveyed. Results: A total of 163 patients were assessed: 60 in group S and 103 in group L. No differences in baseline characteristics and clinical outcomes were found. The ODI and VAS significantly improved from the baseline to each follow-up period (all p < 0.01). Group S had significantly lower ODI scores at 3 months (p = 0.019) and 6 months (p = 0.022). In addition, group S had significantly lower VAS scores for leg pain at 3 months (p = 0.027). In a comparison between both groups, only the patients with cauda equina symptoms showed that ODI and leg pain VAS scores at 3 months after surgery were significantly lower in group S (19.9 ± 9.1 vs. 14.1 ± 12.5; p = 0.037, 7.4 ± 13.9 vs. 14.7 ± 23.1; p = 0.032, respectively). However, the clinical outcomes were not significantly different between both groups 1 year after surgery. Patient satisfaction was also not significantly different between both groups. Conclusions: Patients with a shorter DOS tended to have a significantly slower recovery; however, clinical outcomes 1 year after surgery were good, regardless of the DOS.
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Affiliation(s)
- Yoshiaki Hiranaka
- Department of Orthopaedic Surgery, Anshin Hospital, Kobe 650-0047, Japan
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 654-0142, Japan
| | - Shingo Miyazaki
- Department of Orthopaedic Surgery, Anshin Hospital, Kobe 650-0047, Japan
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 654-0142, Japan
- Correspondence: (S.M.); (T.Y.); Tel.: +81-78-382-5985 (S.M.)
| | - Takashi Yurube
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 654-0142, Japan
- Correspondence: (S.M.); (T.Y.); Tel.: +81-78-382-5985 (S.M.)
| | - Kohei Kuroshima
- Department of Orthopaedic Surgery, Anshin Hospital, Kobe 650-0047, Japan
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 654-0142, Japan
| | - Masao Ryu
- Department of Orthopaedic Surgery, Anshin Hospital, Kobe 650-0047, Japan
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 654-0142, Japan
| | - Shinichi Inoue
- Department of Orthopaedic Surgery, Anshin Hospital, Kobe 650-0047, Japan
| | - Kenichiro Kakutani
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 654-0142, Japan
| | - Ko Tadokoro
- Department of Orthopaedic Surgery, Anshin Hospital, Kobe 650-0047, Japan
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Terai H, Tamai K, Kaneda K, Omine T, Katsuda H, Shimada N, Kobayashi Y, Nakamura H. Postoperative Physical Therapy Program Focused on Low Back Pain Can Improve Treatment Satisfaction after Minimally Invasive Lumbar Decompression. J Clin Med 2022; 11:jcm11195566. [PMID: 36233429 PMCID: PMC9571260 DOI: 10.3390/jcm11195566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/16/2022] [Accepted: 09/20/2022] [Indexed: 11/28/2022] Open
Abstract
Patient satisfaction is crucial in pay-for-performance initiatives. To achieve further improvement in satisfaction, modifiable factors should be identified according to the surgery type. Using a prospective cohort, we compared the overall treatment satisfaction after microendoscopic lumbar decompression between patients treated postoperatively with a conventional physical therapy (PT) program (control; n = 100) and those treated with a PT program focused on low back pain (LBP) improvement (test; n = 100). Both programs included 40 min outpatient sessions, once per week for 3 months postoperatively. Adequate compliance was achieved in 92 and 84 patients in the control and test cohorts, respectively. There were no significant differences in background factors; however, the patient-reported pain score at 3 months postoperatively was significantly better, and treatment satisfaction was significantly higher in the test than in the control cohort (−0.02 ± 0.02 vs. −0.03 ± 0.03, p = 0.029; 70.2% vs. 55.4%, p = 0.045, respectively). In the multivariate logistic regression analysis, patients treated with the LBP program tended to be more satisfied than those treated with the conventional program, independent of age, sex, and diagnosis (adjusted odds ratio = 2.34, p = 0.012). Postoperative management with the LBP program could reduce pain more effectively and aid spine surgeons in achieving higher overall satisfaction after minimally invasive lumbar decompression, without additional pharmacological therapy.
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Affiliation(s)
- Hidetomi Terai
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Koji Tamai
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
- Correspondence: ; Tel.: +81-6-6645-3851
| | - Kunikazu Kaneda
- Department of Orthopaedic Surgery, Shimada Hospital, Osaka 583-0875, Japan
| | - Toshimitsu Omine
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Osaka 583-8555, Japan
- Division of Physical Therapy, Department of Rehabilitation Sciences, Faculty of Allied Health Sciences, Kansai University of Welfare Sciences, Osaka 582-0026, Japan
| | - Hiroshi Katsuda
- Department of Orthopaedic Surgery, Shimada Hospital, Osaka 583-0875, Japan
| | - Nagakazu Shimada
- Department of Orthopaedic Surgery, Shimada Hospital, Osaka 583-0875, Japan
| | - Yuto Kobayashi
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
- Department of Orthopaedic Surgery, Shimada Hospital, Osaka 583-0875, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
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Haruna J, Minamoto N, Shiromaru M, Taguchi Y, Makino N, Kanda N, Uchida H. Emergency Nursing-Care Patient Satisfaction Scale (Enpss): Development and Validation of a Patient Satisfaction Scale with Emergency Room Nursing. Healthcare (Basel) 2022; 10:healthcare10030518. [PMID: 35326996 PMCID: PMC8954055 DOI: 10.3390/healthcare10030518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/09/2022] [Accepted: 03/11/2022] [Indexed: 01/25/2023] Open
Abstract
This study aimed to develop and validate an emergency nursing-care patient satisfaction scale to measure patient satisfaction with emergency room (ER) nursing. Patient satisfaction scales for ER nursing have been validated without considering the perspectives of the healthcare system or cultural background of the country. Moreover, although nursing care is changing with COVID-19, no scale has been specifically designed to assess patient satisfaction with ER nursing. The study population included patients who visited five ERs in Japan (March to December 2021) (n = 135). The rating scales were provided to patients who visited the ER and gave consent, and the patients were asked to reply. In the process of validating the scale, exploratory and confirmatory factor analyses of the construct and criterion validity were conducted. The confirmatory factor analysis results showed a factorial structure consisting of four factors. The domain and summary scores demonstrated good-to-excellent internal reliability (Cronbach’s range = 0.81–0.89). This patient satisfaction scale was designed and validated from the perspective of the Japanese healthcare system and cultural backgrounds. This scale may be useful for developing assessments and interventions to improve patient satisfaction with ER nursing.
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Affiliation(s)
- Junpei Haruna
- Department of Intensive Care Medicine, School of Medicine, Sapporo Medical University, Sapporo 060-8543, Japan
- Correspondence:
| | - Naomi Minamoto
- Department of Nursing, Sapporo City General Hospital, Sapporo 060-8604, Japan;
| | - Mizue Shiromaru
- Department of Nursing, School of Health Sciences, Sapporo Medical University, Sapporo 060-8556, Japan; (M.S.); (Y.T.)
| | - Yukiko Taguchi
- Department of Nursing, School of Health Sciences, Sapporo Medical University, Sapporo 060-8556, Japan; (M.S.); (Y.T.)
| | - Natsuko Makino
- Department of Nursing, Sapporo Medical University Hospital, Sapporo 060-8543, Japan; (N.M.); (H.U.)
| | - Naoki Kanda
- Department of Nursing & Social Services, Health Sciences University of Hokkaido, Tobetsu 061-0293, Japan;
| | - Hiromi Uchida
- Department of Nursing, Sapporo Medical University Hospital, Sapporo 060-8543, Japan; (N.M.); (H.U.)
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Tamai K, Suzuki A, Toyoda H, Terai H, Hoshino M, Takahashi S, Hori Y, Yabu A, Nakamura H. Improvements in Mental Well-Being and its Predictive Factors in Patients who Underwent Cervical versus Lumbar Decompression Surgery. Spine Surg Relat Res 2022; 6:10-16. [PMID: 35224241 PMCID: PMC8842360 DOI: 10.22603/ssrr.2021-0060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/06/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Mental well-being is essential for patient satisfaction. Therefore, a better understanding of the changes in the mental well-being of patients following spinal surgery can be useful to surgeons. We compared the 2-year postoperative change in the mental well-being of patients who underwent cervical and lumbar decompression surgery. Additionally, the predictive factors for improvement in mental well-being associated with both methods were evaluated. Methods The patients who underwent spinal decompression surgery and were followed >2 years postoperatively were enrolled (lumbar cohort: n=111, cervical cohort: n=121). The 36-item Short-Form Health Survey (SF-36) mental component summary (MCS) was set as the mental well-being parameter, and the minimal clinically important difference (MCID) was defined as 4.0. After adjusting the cervical and lumbar cohorts using propensity scores, the improvements in the MCS were compared between the groups using a mixed-effect model. To identify predictors for improvements, the correlation between the MCS changes and preoperative clinical scores was evaluated. Subsequently, multivariate linear regression was applied, which included variables with p<0.10 in the former analysis as explanatory variables, and the change of MCS as the objective variable. Results There were no significant differences in the MCS improvement between the adjusted cervical and lumbar cohorts; 47% and 49%, respectively, had MCS improvement score >MCIDs. However, predictors for the improvement were different between the two cohorts: SF-36 Social functioning in cervical surgery and lower back pain and SF-36 Role physical in lumbar surgery. Conclusions Although there was no significant difference in the improvement in the mental well-being between patients who underwent either cervical or lumbar decompression surgery, less than half of the patients in both groups achieved a meaningful improvement. Preoperative back pain and personal activity were independent predictors in the lumbar cohort, while social functioning was the only predictor in the cervical cohort. Level of evidence: III
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Affiliation(s)
- Koji Tamai
- Department of Orthopedics, Osaka City University Graduate School of Medicine
| | - Akinobu Suzuki
- Department of Orthopedics, Osaka City University Graduate School of Medicine
| | - Hiromitsu Toyoda
- Department of Orthopedics, Osaka City University Graduate School of Medicine
| | - Hidetomi Terai
- Department of Orthopedics, Osaka City University Graduate School of Medicine
| | - Masatoshi Hoshino
- Department of Orthopedics, Osaka City University Graduate School of Medicine
| | - Shinji Takahashi
- Department of Orthopedics, Osaka City University Graduate School of Medicine
| | - Yusuke Hori
- Department of Orthopedics, Osaka City University Graduate School of Medicine
| | - Akito Yabu
- Department of Orthopedics, Osaka City University Graduate School of Medicine
| | - Hiroaki Nakamura
- Department of Orthopedics, Osaka City University Graduate School of Medicine
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Tucci C, Araujo AOD, Marcon RM, Cristante AF, Barros Filho TEPD. COMPARISON BETWEEN START BACK SCREENING TOOL AND DRAM FOR DETECTION OF PSYCHOSOCIAL FACTORS IN LOW BACK PAIN. COLUNA/COLUMNA 2021. [DOI: 10.1590/s1808-185120212004239030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To correlate the results of the STarT Back Screening Tool and DRAM questionnaires, applied simultaneously, in a population with low back pain. Methods: Comparative cross-sectional study with 84 participants with low back pain assessed by both STarT Back Screening Tool (SBST) and DRAM questionnaires. The degree of correlation between the two questionnaires was analyzed through the evaluation of individualized data and using the Spearman correlation coefficient. Results: According to the DRAM, 19% of the patients were classified as “normal”, 32.1% as “at risk” and 48.8% as “distressed”. According to SBST, 59.5% of patients were classified as “low risk”, 31% as “medium risk” and 9.5% as “high risk”. Applying the Spearman's coefficient to evaluate the degree of correlation between the two questionnaires, a value of 0.4 was obtained. This shows that there is a positive, but weak, correlation (p <0.001) between the two questionnaires. Conclusion: There is a positive correlation between the two questionnaires, but the DRAM showed a greater tendency to classify patients with some degree of psychological distress when compared to the SBST. Both questionnaires are effective in identifying these factors, but the data suggest that the DRAM may be more effective as a screening tool in patients with low back pain, in view of the higher number of patients identified. Level of evidence III; Diagnostic test study.
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Affiliation(s)
- Carlos Tucci
- Hospital das Clínicas of the School of Medicine of Universidade de São Paulo, Brazil; Instituto Vita, Brazil; Pontifícia Universidade Católica de Campinas, Brazil
| | - Alex Oliveira de Araujo
- Hospital das Clínicas of the School of Medicine of Universidade de São Paulo, Brazil; Hospital Sarah Kubitschek, Brazil
| | - Raphael Martus Marcon
- Hospital das Clínicas of the School of Medicine of Universidade de São Paulo, Brazil
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Rahman R, Zhang B, Andrade NS, Ibaseta A, Kebaish KM, Riley LH, Cohen DB, Jain A, Lee SH, Sciubba DM, Skolasky RL, Neuman BJ. Mental Health Associated With Postoperative Satisfaction in Lumbar Degenerative Surgery Patients. Clin Spine Surg 2021; 34:E588-E593. [PMID: 33298800 PMCID: PMC8184861 DOI: 10.1097/bsd.0000000000001106] [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: 07/13/2020] [Accepted: 11/07/2020] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Retrospective review of prospectively collected data. OBJECTIVE To assess the association between preoperative and postoperative mental health status with postoperative satisfaction in lumbar degenerative surgery patients. SUMMARY OF BACKGROUND DATA Poor preoperative mental health has been shown to negatively affect postoperative satisfaction among spine surgery patients, but there is limited evidence on the impact of postoperative mental health on satisfaction. MATERIALS AND METHODS Adult patients undergoing surgery for lumbar degenerative conditions at a single institution were included. Mental health was assessed preoperatively and 12 months postoperatively using Patient-Reported Outcomes Measurement Information System Depression and Anxiety scores. Satisfaction was assessed 12 months postoperatively using North American Spine Society Patient Satisfaction Index. The authors evaluated associations between mental health and satisfaction with univariate and multivariable logistic regression to adjust for confounders. Preoperative depression/anxiety level was corrected for postoperative depression/anxiety level, and vice versa. Statistical significance was assessed at α=0.05. RESULTS A total of 183 patients (47% male individuals; avg. age, 62 y) were included. Depression was present in 27% preoperatively and 29% postoperatively, and anxiety in 50% preoperatively and 31% postoperatively. Ninteen percent reported postoperative dissatisfaction using the North American Spine Society Patient Satisfaction Index. Univariate analysis identified race, family income, relationship status, current smoking status, change in pain interference, and change in physical function as potential confounders. In adjusted analysis, odds of dissatisfaction were increased in those with mild postoperative depression (adjusted odds ratio=6.1; 95% confidence interval, 1.2-32; P=0.03) and moderate or severe postoperative depression (adjusted odds ratio=7.5; 95% confidence interval, 1.3-52; P=0.03). Preoperative and postoperative anxiety and preoperative depression were not associated with postoperative satisfaction. CONCLUSIONS Following lumbar degenerative surgery, patients with postoperative depression, irrespective of preoperative depression status, have significantly higher odds of dissatisfaction. These results emphasize the importance of postoperative screening and treatment of depression in spine patients with dissatisfaction. LEVEL OF EVIDENCE Level III-nonrandomized cohort study.
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Affiliation(s)
- Rafa Rahman
- Departments of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bo Zhang
- Departments of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nicholas S. Andrade
- Departments of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alvaro Ibaseta
- Departments of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Khaled M. Kebaish
- Departments of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lee H. Riley
- Departments of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David B. Cohen
- Departments of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Amit Jain
- Departments of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sang H. Lee
- Departments of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel M. Sciubba
- Departments of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Richard L. Skolasky
- Departments of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brian J. Neuman
- Departments of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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The Impact of Nurse Navigator-Led Preoperative Education on Hospital Outcomes Following Posterolateral Lumbar Fusion Surgery. Orthop Nurs 2021; 40:281-289. [PMID: 34583373 DOI: 10.1097/nor.0000000000000787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Beyond the spine-specific pathology, patient factors such as associated medical and psychosocial conditions, understanding of the treatment process, and the degree of patient activation-defined as the ability of the individual to utilize the available information and actively engage in making their healthcare decisions-can influence outcomes after posterolateral lumbar fusion (PLF) surgery. A retrospective observational cohort study of 177 patients undergoing PLF at a single institution was conducted. Patient demographics, medical and psychosocial risk factors, and outcomes were compared between patients who attended a nurse navigator-led group preoperative education course and those who did not. Patients attending the course were younger, more likely to undergo one-level fusion, less likely to undergo 5- or more-level fusion, and had less comorbidity burden as measured by the hierarchical condition categories score. No differences in psychosocial risk factors were observed between groups. Course attendees had a significantly shorter length of stay (2.12 vs. 2.60 days, p = .042) and decreased average hospital cost (U.S. $10,149 vs. U.S. $14,792, p < .001) than those who did not attend; no differences in other outcomes were observed. After controlling for differences in risk factors, patients enrolled in a preoperative education course demonstrated a statistically significant reduction in hospital cost (β=-4,143, p < .001). Preoperative education prior to PLF surgery may reduce hospital cost, possibly through increased patient activation. Given the relatively high prevalence of psychosocial risk factors in this and similar patient populations, optimizing patient activation and engagement is important to achieve high value care. Based on our findings, nurse navigator-led preoperative education appears to be valuable in this patient population and should be included in enhanced recovery protocols.
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Spine Surgery HCAHPS Patient Satisfaction Survey Results Inversely Correlate with Survey Response Time. Spine (Phila Pa 1976) 2021; 46:1264-1270. [PMID: 34435990 DOI: 10.1097/brs.0000000000003974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective review. OBJECTIVE The aim of this study was to understand the potential correlation of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey response time on reported satisfaction following spine surgery hospitalization. SUMMARY OF BACKGROUND DATA With increasing emphasis on patient satisfaction metrics, such as HCAHPS, hospital reputations, and reimbursements are being affected by the results of such surveys. HCAHPS is a 32-question survey about patient experience in the hospital and after discharge. METHODS HCAHPS surveys were routinely sent to all patients admitted after spine surgery at an academic medical center between January 2013 and August 2017. Survey data, survey return time, patient demographics, and 30-day postoperative outcomes were gathered for all spine surgery patients who returned the survey. Multivariate regression analysis controlling for age, sex, BMI, functional status, American Society of Anesthesiologists class, education, and race was used to determine whether there were differences in rates of "Top Box" response between different time ranges of survey return. RESULTS In total, 1495 consecutive spinal surgery patients who returned their HCAHPS survey were identified. Of these, 31.51% returned their surveys within 21 days, 48.09% returned them between 22 to 42 days, 13.58% returned them between 43 to 64 days, and 6.82% returned them ≥65 days after distribution. Multivariate regression demonstrated no statistical differences in reported satisfaction between surveys returned between days 0 to 21 and days 22 to 42. However, there were significantly lower scores reported by surveys returned on days 43 to 64 and 65 plus days. CONCLUSION Centers for Medicare and Medicaid Services only considers HCAHPS surveys returned within the first 42 days. It appears that the survey responses are similar over this time period. Beyond this time, lower scores are reported. Further attention to this less satisfied, later HCAHPS survey returning group seems warranted.Level of Evidence: 2.
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Lynch TS, Oak SR, Cossell C, Strnad G, Zajichek A, Goodwin R, Jones MH, Spindler KP, Rosneck J. Effect of Baseline Mental Health on 1-Year Outcomes After Hip Arthroscopy: A Prospective Cohort Study. Orthop J Sports Med 2021; 9:23259671211025526. [PMID: 34485585 PMCID: PMC8414618 DOI: 10.1177/23259671211025526] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/28/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Patient factors, including mental health, sex, and smoking, have been found
to be more predictive of preoperative hip pain and function than
intra-articular findings during hip arthroscopy for femoroacetabular
impingement (FAI); however, little is known about how these factors may
influence patients’ postoperative outcomes. Hypothesis: We hypothesized that lower patient-reported mental health scores would be
significant risk factors for worse patient-reported outcomes (PROs) 1 year
after arthroscopic hip surgery for FAI and that baseline intra-articular
pathology would fail to demonstrate an association with outcomes 1 year
after FAI surgery. Study Design: Cohort study; Level of evidence, 2. Methods: A prospective cohort of patients undergoing hip arthroscopy for FAI were
electronically enrolled. Baseline and 1-year follow-up PROs were collected,
including Hip disability and Osteoarthritis Outcome Score for pain
(HOOS-Pain), HOOS–Physical Function Short Form (HOOS-PS), and Veterans RAND
12-Item Health Survey–Mental Component Score (VR-12 MCS). Intra-articular
operative findings and treatment were documented at the time of surgery.
Proportional odds logistic regression models were built for 1-year outcomes
(HOOS-Pain, HOOS-PS, and VR-12 MCS). Risk factors included patient
characteristics and intraoperative anatomic and pathologic findings. Results: Overall, 494 patients underwent hip arthroscopy for FAI, and 385 (78%) were
evaluated at 1 year with at least 1 PRO. The median patient age was 33
years, mean body mass index was 25.5 kg/m2, and 72% were female.
Multivariable analysis demonstrated that better baseline HOOS-Pain, HOOS-PS,
and VR-12 MCS were significantly associated with improvement in the 1-year
scores for each PRO. Higher VR-12 MCS was significantly associated with
better 1-year HOOS-Pain and HOOS-PS, while current and former smokers had
worse 1-year outcomes than those who never smoked. In ranking each
variable’s relative importance, baseline HOOS-Pain and HOOS-PS and baseline
VR-12 MCS were identified as the strongest predictors of 1-year HOOS-Pain
and HOOS-PS in our multivariable model. Conclusion: During hip arthroscopy for FAI, patient factors, including baseline hip pain
and function, mental health, and smoking, were independently associated with
1-year PROs of hip pain and function, while intra-articular pathology such
as the presence of labral tear and its treatment, tear size, tear location,
and anchors placed were not independently associated.
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Affiliation(s)
- T Sean Lynch
- Columbia University Irving Medical Center, New York, New York, USA
| | - Sameer R Oak
- Cleveland Clinic Sports Medicine, Cleveland, Ohio, USA
| | | | | | - Alexander Zajichek
- Cleveland Clinic Department of Quantitative Health Sciences, Cleveland, Ohio, USA
| | - Ryan Goodwin
- Cleveland Clinic Sports Medicine, Cleveland, Ohio, USA
| | | | | | - James Rosneck
- Cleveland Clinic Sports Medicine, Cleveland, Ohio, USA
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Glennie RA, Canizares M, Perruccio AV, Abraham E, Nicholls F, Nataraj A, Phan P, Attabib N, Johnson MG, Richardson E, McIntosh G, Ahn H, Fisher CG, Manson N, Thomas K, Rampersaud YR. The impact of pathoanatomical diagnosis on elective spine surgery patient expectations: a Canadian Spine Outcomes and Research Network study. J Neurosurg Spine 2021; 35:34-41. [PMID: 34020418 DOI: 10.3171/2020.11.spine201490] [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: 08/27/2020] [Accepted: 11/19/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Patients undergoing spine surgery generally have high expectations for improvement postoperatively. Little is known about how these expectations are affected by the diagnosis. The purpose of this study was to examine whether preoperative expectations differ based on diagnostic pathoanatomical patterns in elective spine surgery patients. METHODS Patients with common degenerative cervical/lumbar pathology (lumbar/cervical stenosis, lumbar spondylolisthesis, and cervical/lumbar disc herniation) who had given their consent for surgery were analyzed using the Canadian Spine Outcomes and Research Network (CSORN). Patients reported the changes they expected to experience postoperatively in relation to 7 separate items using a modified version of the North American Spine Society spine questionnaire. Patients were also asked about the most important item that would make them consider the surgery a success. Sociodemographic, lifestyle, and clinical variables were also collected. RESULTS There were 3868 eligible patients identified within the network for analysis. Patients with lumbar disc herniation had higher expectations for relief of leg pain compared with stenosis and lumbar degenerative spondylolisthesis cohorts within the univariate analysis. Cervical stenosis (myelopathy) patients were more likely to rank general physical capacity as their most important expectation from spine surgery. The multinomial regression analysis showed that cervical myelopathy patients have lower expectations for relief of arm or neck pain from surgery (OR 0.54, 0.34-0.88; p < 0.05). Patient factors, including age, symptoms (pain, disability, depression), work status, and lifestyle factors, were significantly associated with expectation, whereas the diagnoses were not. CONCLUSIONS Patients with degenerative spinal conditions consenting for spine surgery have high expectations for improvement in all realms of their daily lives. With the exception of patients with cervical myelopathy, patient symptoms rather than diagnoses had a more substantial impact on the dimensions in which patients expected to improve or their most important expected change. Determination of patient expectation should be individualized and not biased by pathoanatomical diagnosis.
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Affiliation(s)
- R Andrew Glennie
- 1Department of Surgery, Division of Orthopedics, Dalhousie University, Halifax, Nova Scotia
| | - Mayilee Canizares
- 2The Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Ontario
| | - Anthony V Perruccio
- 2The Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Ontario
| | - Edward Abraham
- 3Department of Surgery, Dalhousie University
- 11Canada East Spine Centre; and
| | - Fred Nicholls
- 4Department of Surgery, University of Calgary, Alberta
| | - Andrew Nataraj
- 5Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alberta
| | | | - Najmedden Attabib
- 3Department of Surgery, Dalhousie University
- 12Department of Neurosurgery, Saint John Regional Hospital, Saint John, New Brunswick
| | - Michael G Johnson
- 7Section of Orthopaedic Surgery, University of Manitoba, Winnipeg, Manitoba
| | - Eden Richardson
- 8Canadian Spine Outcomes and Research Network
- 11Canada East Spine Centre; and
| | | | - Henry Ahn
- 9Department of Surgery, University of Toronto, Toronto, Ontario; and
| | - Charles G Fisher
- 10Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopaedic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Neil Manson
- 3Department of Surgery, Dalhousie University
- 11Canada East Spine Centre; and
| | | | - Y Raja Rampersaud
- 1Department of Surgery, Division of Orthopedics, Dalhousie University, Halifax, Nova Scotia
- 9Department of Surgery, University of Toronto, Toronto, Ontario; and
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Tran TT, Kortlever JTP, Teunis T, Ring D, Vagner GA, Reichel LM. Attitudes Toward Aging Among Patients With Upper Extremity Illness. Hand (N Y) 2021; 16:354-361. [PMID: 31378085 PMCID: PMC8120584 DOI: 10.1177/1558944719866872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: An adaptive attitude toward aging might limit symptom intensity and magnitude of limitations. This study sought factors associated with attitudes toward aging (measured with the Brief Aging Perceptions Questionnaire [B-APQ]) and studied the relationship of having an age-related disease to magnitude of limitations, pain intensity, patient satisfaction, and patient comfort with completing a questionnaire about attitudes toward aging. We also looked for a subset of questions from B-APQ that maintained the construct validity and internal consistency of B-APQ, without unacceptable flooring or ceiling effects. Methods: A total of 161 upper extremity patients completed the following questionnaires: B-APQ, Patient Health Questionnaire-Short Form, Pain Self-efficacy-Short Form, Pain Catastrophizing Scale-Short Form, Patient-Reported Outcomes Measurement Information System Physical Function-Upper Extremity, pain intensity, satisfaction with the surgeon, and comfort with completing the B-APQ. We created multivariable linear regression models to test for associations. Results: Factors independently associated with less positive perceptions about aging included white race, retired work status, having nonspecific comorbidities, and more catastrophic thinking. Variation in the magnitude of limitations and pain intensity was accounted for by effectiveness of coping strategies rather than attitudes toward aging in particular. A 4-question version of the B-APQ has acceptable performance. Conclusion: Adaptive attitudes toward aging are associated with psychological and social determinants of health. We present a 4-item short form of B-APQ that could be used as a brief measure to assess attitudes toward aging. Interventions to improve adaptiveness to nociception (eg, cognitive behavioral therapy to limit catastrophic thinking) might help with adaptation to age-related changes.
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Affiliation(s)
| | | | - Teun Teunis
- University Medical Center Utrecht, The Netherlands
| | - David Ring
- The University of Texas at Austin, USA,David Ring, Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, 1701 Trinity Street, Austin, TX 78712, USA.
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Too A, Gatien C, Cormier S. Treatment satisfaction mediates the association between perceived physician empathy and psychological distress in a community sample of individuals with chronic pain. PATIENT EDUCATION AND COUNSELING 2021; 104:1213-1221. [PMID: 33059949 DOI: 10.1016/j.pec.2020.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/30/2020] [Accepted: 09/05/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE While the benefits of patient-centered care have been consistently demonstrated in the health literature, there exists a dearth of pathway research within health outcome research, especially within the chronic pain context. This study examined the relationship between perceived physician empathy and patient psychological distress and its underlying mechanism. METHODS A community sample of 259 adults with chronic pain completed online questionnaires measuring patient-perceived physician empathy, treatment satisfaction, depressive and anxiety symptoms. Analyses were conducted using correlational and mediation analyses. RESULTS Results revealed perceived empathy to be positively and strongly correlated with treatment satisfaction (r = .72, p < .001). A significant negative correlation was also demonstrated between perceived empathy and depressive symptoms (r = -.13, p < .05), but not between perceived empathy and anxious symptoms (r = .03, p = .65). Results revealed significant mediation models between perceived empathy and patient depressive symptoms (indirect effect: B = -.19, SE =.06, 95 % CI [-.31, -.09]) and anxious symptoms (indirect effect: B = -.24, SE = .06, 95 % CI [-.35, -.14]), via treatment satisfaction as mediator and including covariates. CONCLUSION Chronic pain patients who perceive greater levels of physician empathy experience fewer depressive and anxious symptoms, as mediated by treatment satisfaction. PRACTICE IMPLICATIONS Clinical training and practice should promote empathetic components of health communication within chronic pain treatment.
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Affiliation(s)
- Andrea Too
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais Gatineau, Québec, Canada.
| | - Catherine Gatien
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais Gatineau, Québec, Canada.
| | - Stéphanie Cormier
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais Gatineau, Québec, Canada.
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16
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Lynch CP, Cha EDK, Jenkins NW, Parrish JM, Mohan S, Jadczak CN, Geoghegan CE, Singh K. The Minimum Clinically Important Difference for Patient Health Questionnaire-9 in Minimally Invasive Transforaminal Interbody Fusion. Spine (Phila Pa 1976) 2021; 46:603-609. [PMID: 33290370 DOI: 10.1097/brs.0000000000003853] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE To investigate and establish minimum clinically important differences (MCID) for Patient Health Questionnaire-9 (PHQ-9) among patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). SUMMARY OF BACKGROUND Spine surgery is linked to postoperative improvements in anxiety, depression, and mental health. These improvements have been documented using patient-reported outcome measures such as PHQ-9. Few studies evaluated the clinical significance of PHQ-9 for lumbar spine surgery. METHODS Patients who underwent single-level, primary MIS TLIF from 2015 to 2017 were retrospectively reviewed in a prospective database. Patients with incomplete preoperative and 2-year postoperative PHQ-9 surveys were excluded. Demographic and perioperative characteristics were recorded. PHQ-9, 12-Item Short Form (SF-12), and Veterans RAND 12-Item Health Survey (VR-12) Mental Component Summary (MCS) were collected at preoperative, 6-week, 12-week, 6-month, 1-year, and 2-year intervals. MCID was calculated using anchor and distribution-based methods. SF-12 served as an anchor. MCID was assessed using mean change methodology, four receiver operating characteristic curve assessments, and standard error measurement. Cutoff values were selected from receiver operating characteristic curve analysis. MCID achievement rates for all patient-reported outcome measures were calculated. RESULTS A total of 139 patients met inclusion criteria, with a mean age of 55 years and 39% females. The most common spinal pathology was radiculopathy (92%). MCID analysis revealed the following ranges of values: 2.0 to 4.8 (PHQ-9), 6.7 to 12.1 (SF-12 MCS), and 7.5 to 15.9 (VR-12 MCS). Final MCID thresholds were 3.0 (PHQ-9), 9.1 (SF-12 MCS), and 8.1 (VR-12 MCS). MCID achievement at 2-years for PHQ-9, SF-12 MCS, and VR-12 MCS was 89.2%, 85.6%, and 84.9% respectively. CONCLUSION Our 2-year postoperative MCID analysis is the first mental health calculation from an MIS TLIF cohort. We report a 2-year MCID value for PHQ-9 of 3.0 (2.0-4.8). MCID values for mental health instruments are important for determining overall success of lumbar spine surgery.Level of Evidence: 3.
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Affiliation(s)
- Conor P Lynch
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
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Goh GS, Liow MHL, Yue WM, Tan SB, Chen JLT. Are Patient-Reported Outcomes of Minimally Invasive Transforaminal Lumbar Interbody Fusion Influenced by Preoperative Mental Health? Global Spine J 2021; 11:500-508. [PMID: 32875869 PMCID: PMC8119908 DOI: 10.1177/2192568220912712] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
STUDY DESIGN This was a retrospective review of prospectively collected data. OBJECTIVES Few studies have described the relationship between mental health and patient-reported outcome measures (PROMs) after minimally invasive spine surgery. Prior studies on open surgery included small cohorts with short follow-ups. METHODS Patients undergoing primary minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for degenerative pathology were retrospectively reviewed and stratified by Short Form (SF-36) Mental Component Summary (MCS): low MCS (<50, n = 436) versus high MCS (≥50, n = 363). PROMs assessed were back pain, leg pain, North American Spine Society Neurogenic Symptoms, Oswestry Disability Index, SF-36 Physical Component Summary, and MCS. Satisfaction, expectation fulfilment, and return to work (RTW) rates also were recorded at 1 month, 3 months, 6 months, and 2 years. RESULTS Preoperative MCS was 39.4 ± 8.6 and 58.5 ± 5.4 in the low and high MCS groups, respectively (P < .001). The low MCS group had significantly poorer preoperative PROMs and longer lengths of stay. Despite this, both groups achieved comparable PROMs from 3 months onward. The mean MCS was no longer significantly different by 3 months (P = .353). The low MCS group had poorer satisfaction (P = .022) and expectation fulfilment (P = .020) at final follow-up. RTW rates were initially lower in the low MCS group up to 3 months (P = .034), but the rates converged from 6 months onward. CONCLUSIONS Despite poorer PROMs preoperatively, patients with poor baseline mental health still achieved comparable results from 3 months up to 2 years after MIS-TLIF. Preoperative optimization of mental health should still be pursued to improve satisfaction and prevent delayed RTW after surgery.
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Affiliation(s)
- Graham S. Goh
- Singapore General Hospital, Singapore,Graham S. Goh, Department of Orthopaedic
Surgery, Singapore General Hospital, Singapore 557891, Singapore.
| | | | - Wai-Mun Yue
- Mount Elizabeth Medical Centre, General Hospital, Singapore
| | - Seang-Beng Tan
- Mount Elizabeth Medical Centre, General Hospital, Singapore
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Núñez-Pereira S, Serra-Burriel M, Vila-Casademunt A, Hayashi K, Haddad S, Pizones J, Kleinstück F, Obeid I, Alanay A, Pellisé F. The dynamics of satisfaction in surgical and non-surgical adult spinal deformity patients. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:1235-1246. [PMID: 33754196 DOI: 10.1007/s00586-021-06816-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 03/07/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE For adult spinal deformity (ASD) patients receiving operative (op) and non-operative (non-op) treatment, the relationship between HRQoL measures, complications and self-reported satisfaction remains unclear. The objective of this analysis is to study nonlinear association dynamics between ASD patient satisfaction, HRQoL, and complications over a two-year follow-up period. METHODS From a prospective multicenter international adult spinal deformity database, all patients with 2-year follow-up data on satisfaction (21st question of SRS-22r) were identified and included. A total of 12 LOESS (local polynomial fit) regressions were performed between patient satisfaction (SRS22 item 21) and HRQoL measures (ODI, SF36PCS and SRS22 subtotal) interacting with surgery at baseline, 6 months and 1 and 2 years of follow-up. RESULTS A total of 856 patients (527 op and 329 non-op) were included. At baseline, satisfaction was lower for patients scheduled for surgery even when HRQL was similar to those elected for conservative treatment. The nonlinear correlations showed that for similar PROMs, op patients reached higher satisfaction levels during follow-up, especially at six months. In fact, at six months operated patients with a deterioration of their initial PROMs had some improvement in their satisfaction, which could not be further observed at the end of follow-up. CONCLUSIONS Satisfaction does not correlate well with other PROMs, and it might be subject to other external factors not directly related to treatment. Even if patient satisfaction is important in evaluating well-being and patient's experience with medical care, it should not be considered as an isolated proxy to measure quality of treatment.
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Affiliation(s)
- Susana Núñez-Pereira
- Vall D'Hebron Institute of Research (VHIR), Barcelona, Spain. .,Orthopaedics and Traumatology Department, Hospital Universitario Donostia, Paseo del Dr. Begiristain 109, 20014, San Sebastián, Spain.
| | | | | | - Kazunori Hayashi
- Department of Orthopedic Surgery, Osaka City Juso Hospital, Osaka, Japan
| | - Sleiman Haddad
- Spine Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | | | | | - Ahmet Alanay
- Acibadem University School of Medicine, Istambul, Turkey
| | - Ferran Pellisé
- Spine Unit, Vall d'Hebron University Hospital, Barcelona, Spain
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Van de Velde SK, Cola K, Bompadre V, Steinman SE. Seasonal Variation in Parental Satisfaction With Pediatric Orthopaedics. J Pediatr Orthop 2021; 41:e296-e300. [PMID: 33417390 DOI: 10.1097/bpo.0000000000001747] [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] [Indexed: 02/07/2023]
Abstract
BACKGROUND The degree of parental satisfaction with health care is determined by the family's characteristics and expectations. Many aspects of human physiology and behavior have seasonal rhythms. The purpose of the present study was to determine whether parental satisfaction scores vary across the year in a pediatric orthopaedic outpatient population. METHODS We retrospectively reviewed a total of 22,951 parental satisfaction scores related to outpatient pediatric orthopaedic encounters between October 2015 and April 2019. Parental satisfaction was measured using the provider subdomain of the shortened version of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). Families were stratified according to various pediatric orthopaedic subspecialty services. RESULTS The satisfaction scores of all pediatric orthopaedic encounters combined did not vary significantly across the year (P=0.8745). When the families were stratified into groups by pediatric orthopaedic subspecialty clinic, variation in seasons was not associated with statistically significant variation in satisfaction scores for the elective surgery, sports medicine, trauma/fracture care, and hand/upper extremity services. However, satisfaction with the spine service was significantly lower in the winter compared with the summer and fall (73.9±3.8 vs. 83.5±5.3 and 82.6±3.6, respectively; P=0.0147). CONCLUSIONS The provision of pediatric spine care in a region with 4 distinct seasons received lower parental satisfaction scores during the winter than during the summer and fall. This seasonal variation is an additional source of bias in the measurement of satisfaction with health care. LEVEL OF EVIDENCE Level II-retrospective study.
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Affiliation(s)
| | - Kristin Cola
- Pediatric Orthopedics of Southwest Florida, Fort Myers, FL
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Effect of Multimodal Drugs Infiltration on Postoperative Pain in Split Laminectomy of Lumbar Spine: A Randomized Controlled Trial. Spine (Phila Pa 1976) 2020; 45:1687-1695. [PMID: 32890299 DOI: 10.1097/brs.0000000000003679] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A randomized, double-blinded controlled trial. OBJECTIVE This study tested the effect of single-dose wound infiltration with multiple drugs for pain management after lumbar spine surgery. SUMMARY OF BACKGROUND DATA Patients undergoing spine surgery often experience severe pain especially in early postoperative period. We hypothesized that intraoperative wound infiltration with multiple drugs would improve outcomes in lumbar spine surgery. METHODS Fifty-two patients who underwent one to two levels of spinous process splitting laminectomy of lumbar spine, were randomized into two groups. Infiltration group received intraoperative wound infiltration of local anesthetics, morphine sulfate, epinephrine, and nonsteroidal anti-inflammatory drugs at the end of surgery, and received patient-controlled analgesia (PCA) postoperatively. The control group received only PCA postoperatively. The primary outcome measures were amount of morphine consumption and visual analogue scale (VAS) for pain. The secondary outcome measures were Oswestry Disability Index (ODI), Roland-Morris Low Back Pain and Disability Questionnaire (RMDQ), patient satisfaction, length of hospital stay, and side effects. RESULTS A total of 49 patients (23 patients for local infiltration group, and 26 patients for control group) were analyzed. There were statistically significant [P < 0.001, the effect size -5.0, 95% CI (-6.1, -3.9)] less morphine consumptions in the local infiltration group than the control group during the first 12 hours, 12 to 24 hours, and 24 to 48 hours after surgery. The VAS of postoperative pain reported by patients at rest and during motion was significantly lower in the local infiltration group than the control group at all assessment times (P < 0.001). The effect size of VAS of postoperative pain at rest and during motion were -2.0, 95% CI (-2.5, -1.4) and -2.0, 95% CI (-2.6, -1.4) respectively. ODI and RMDQ at 2 week and 3 month follow-ups in both groups had significant improvement from baseline (P < 0.001). No significant differences were found between groups (P = 0.262 for ODI and P = 0.296 for RMDQ). There were no significant differences of patient satisfaction, length of stay, and side effects between both groups (P = 0.256, P = 0.262, P = 0.145 respectively). CONCLUSION Intraoperative wound infiltration with multimodal drugs reduced postoperative morphine consumption, decreased pain score with no increased side effects. LEVEL OF EVIDENCE 1.
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Predictors of Outcomes After Single-level Anterior Cervical Discectomy and Fusion for Cervical Spondylotic Myelopathy: A Multivariate Analysis. Clin Spine Surg 2020; 33:E525-E532. [PMID: 32349058 DOI: 10.1097/bsd.0000000000000997] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
STUDY DESIGN This was a retrospective study that was carried out using prospectively collected registry data. OBJECTIVE The objective of this study was to identify preoperative predictors of outcomes after anterior cervical discectomy and fusion (ACDF) for cervical spondylotic myelopathy. SUMMARY OF BACKGROUND DATA Proper patient selection is paramount to achieving good surgical results. Identifying predictors of outcomes may aid surgical decision-making and facilitate counseling of patients to manage expectations. METHODS Prospectively collected registry data of 104 patients who underwent single-level ACDF for cervical spondylotic myelopathy were reviewed. Outcomes assessed at 2 years were the presence of residual neck pain/arm pain (AP), and attainment of a minimal clinically important difference (MCID) for Neck Disability Index (NDI), Japanese Orthopaedic Association (JOA) score, and Physical Component Score (PCS) of SF-36, as well as patient satisfaction, fulfilment of expectations, willingness to undergo same surgery again, return to work (RTW), and return to function (RTF). Receiver operating characteristic curves and multivariate stepwise logistical regression were performed to identify independent predictors of each outcome using 22 covariates including demographics, comorbidities, and preoperative disease state. RESULTS Lower preoperative NDI was predictive of the absence of residual neck pain/AP at 2 years. Higher preoperative JOA score was predictive of MCID attainment for PCS, satisfaction, expectation fulfilment, willingness to undergo the same surgery for same condition, and RTF. Poorer preoperative scores of NDI, JOA, and PCS were predictors of attaining MCID of the respective scores. Older patients were less likely to attain MCID for JOA. Higher preoperative AP was a risk factor for unsuccessful RTW. CONCLUSIONS In general, the preoperative JOA score was the best predictor of outcomes after ACDF. A preoperative JOA cutoff value of 9.25-10.25 predicted satisfaction, expectation fulfilment, willingness to undergo same surgery, and RTF with at least 70% sensitivity and 50% specificity. These findings may aid surgeons in identifying patients at risk of a poor outcome and guide preoperative counseling to establish realistic expectations of the surgical outcome. LEVEL OF EVIDENCE Level III-Non-randomized controlled cohort/follow-up study.
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Lehrich BM, Goshtasbi K, Brown NJ, Shahrestani S, Lien BV, Ransom SC, Tafreshi AR, Ransom RC, Chan AY, Diaz-Aguilar LD, Sahyouni R, Pham MH, Osorio JA, Oh MY. Predictors of Patient Satisfaction in Spine Surgery: A Systematic Review. World Neurosurg 2020; 146:e1160-e1170. [PMID: 33253954 DOI: 10.1016/j.wneu.2020.11.125] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/20/2020] [Accepted: 11/21/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Recently, there has been increased interest in patient satisfaction measures such as Press Ganey and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. In this systematic review, the spine surgery literature is analyzed to evaluate factors predictive of patient satisfaction as measured by these surveys. METHODS A thorough literature search was performed in PubMed/MEDLINE, Google Scholar, and Cochrane databases. All English-language articles from database inception to July 2020 were screened for study inclusion according to PRISMA guidelines. RESULTS Twenty-four of the 1899 published studies were included for qualitative analysis. There has been a statistically significant increase in the number of publications across years (P = 0.04). Overall, the studies evaluated the relationship between patient satisfaction and patient demographics (71%), preoperative and intraoperative clinical factors (21%), and postoperative factors (33%). Top positive predictors of patient satisfaction were patient and nursing/medical staff relationship (n = 4; 17%), physician-patient relationship (n = 4; 17%), managerial oversight of received care (n = 3; 13%), same sex/ethnicity between patient and physician (n = 2; 8%), and older age (n = 2; 8%). Top negative predictors of patient satisfaction were high Charlson Comorbidity Index/high disability/worse overall health functioning (n = 7; 29%), increased length of hospital stay (n = 4; 17%), high rating for pain/complications/readmissions (n = 4; 17%), and psychosocial factors (n = 3; 13%). CONCLUSIONS There is heterogeneity in terms of different factors, both clinical and nonclinically related, that affect patient satisfaction ratings. More research is warranted to investigate the role of hospital consumer surveys in the spine surgical patient population.
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Affiliation(s)
- Brandon M Lehrich
- Medical Scientist Training Program, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, Pennsylvania, USA.
| | - Khodayar Goshtasbi
- School of Medicine, University of California, Irvine, Irvine, California, USA
| | - Nolan J Brown
- Department of Neurosurgery, University of California, Irvine, Irvine, California, USA
| | - Shane Shahrestani
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA; Department of Medical Engineering, California Institute of Technology, Pasadena, California, USA
| | - Brian V Lien
- Department of Neurosurgery, University of California, Irvine, Irvine, California, USA
| | - Seth C Ransom
- School of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Ali R Tafreshi
- Department of Neurological Surgery, Geisinger Health System, Danville, Pennsylvania, USA
| | - Ryan C Ransom
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Alvin Y Chan
- Department of Neurosurgery, University of California, Irvine, Irvine, California, USA
| | - Luis D Diaz-Aguilar
- Department of Neurological Surgery, University of California, San Diego, La Jolla, California, USA
| | - Ronald Sahyouni
- Department of Neurological Surgery, University of California, San Diego, La Jolla, California, USA
| | - Martin H Pham
- Department of Neurological Surgery, University of California, San Diego, La Jolla, California, USA
| | - Joseph A Osorio
- Department of Neurological Surgery, University of California, San Diego, La Jolla, California, USA
| | - Michael Y Oh
- Department of Neurosurgery, University of California, Irvine, Irvine, California, USA
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Jackson KL, Rumley J, Griffith M, Agochukwu U, DeVine J. Correlating Psychological Comorbidities and Outcomes After Spine Surgery. Global Spine J 2020; 10:929-939. [PMID: 32905726 PMCID: PMC7485071 DOI: 10.1177/2192568219886595] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
STUDY DESIGN Literature review. OBJECTIVE The aim of this literature review is to examine the effects of psychological disorders on postoperative complications, surgical outcomes, and long-term narcotic use. We also hope to detail the value of preoperative identification and treatment of these pathologies. METHODS A series of systematic reviews of the relevant literature examining the effects of psychological disorders and spine surgery was conducted using PubMed and Cochrane databases. RESULTS Combined, the database queries yielded 2275 articles for consideration. After applying screening criteria, 96 articles were selected for inclusion. Patients with underlying psychological disease have higher rates of delirium, readmission, longer hospital stays, and higher rates of nonroutine discharge following spine surgery. They also have higher rates of chronic postoperative narcotic use and may experience worse surgical outcomes. Because of these defined issues, researchers have developed multiple screening tools to help identify patients with psychological disorders preoperatively for potential treatment. Treatment of these disorders prior to surgery may significantly improve surgical outcomes. CONCLUSION Patients with psychological disorders represent a unique population with respect to their higher rates of spinal pain complaints, postoperative complications, and worsened functional outcomes. However, proper identification and treatment of these conditions prior to surgery may significantly improve many outcome measures in this population. Future investigations in this field should attempt to develop and validate current strategies to identify and treat individuals with psychological disorders before surgery to further improve outcomes.
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Affiliation(s)
- Keith L. Jackson
- Dwight David Eisenhower Army Medical Center, Fort Gordon, GA, USA
| | | | - Matthew Griffith
- Dwight David Eisenhower Army Medical Center, Fort Gordon, GA, USA
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Nixon DC, Zhang C, Weinberg MW, Presson AP, Nickisch F. Relationship of Press Ganey Satisfaction and PROMIS Function and Pain in Foot and Ankle Patients. Foot Ankle Int 2020; 41:1206-1211. [PMID: 32660263 DOI: 10.1177/1071100720937013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patient satisfaction has garnered interest as a tool to measure health care quality. However, orthopedic studies in total joint arthroplasty, spine, and hand patients have offered conflicting relationships between Press Ganey (PG) satisfaction metrics and patient-reported outcome (PRO) measures. No prior study has assessed the relationship between PG and PROs in foot and ankle patients. Whether satisfaction and outcomes instruments, though, measure similar or differing aspects of the patient experience is unclear. Here, we tested if there was an association between Patient-Reported Outcomes Measurement Information System (PROMIS) outcomes and PG satisfaction scores. METHODS PG and PROMIS outcomes data for new patient visits to an orthopedic foot and ankle clinic between 2015 and 2017 were retrospectively analyzed. Patients that completed PG satisfaction surveys were included for study. All patients who completed PG surveys and completed one or both PROMIS physical function (PF) or pain interference (PI) metrics administered by computerized adaptive testing were included. Negative binomial regressions were used to compare PRO scores to PG overall satisfaction and PG satisfaction with care provider, adjusting for patient characteristics. Results were reported as dissatisfaction score ratios, which represented the amount of PG dissatisfaction associated with a 10-point increase in PROMIS PF or PI. Of the 3984 new patient visits, only 441 completed the PG survey (11.3% response rate). RESULTS Ceiling effects were seen with PG data: 64% of patients reported perfect satisfaction with care provider and 27% had perfect overall satisfaction. Higher function on the PROMIS PF was weakly associated with increased overall satisfaction (ratio = 0.82, 95% CI: 0.68-0.99, P = .039) and increased satisfaction with care provider (ratio = 0.60, 95% CI: 0.40-0.92, P = .019). However, pain (PROMIS PI) was not associated with overall satisfaction or with satisfaction with care provider. CONCLUSIONS Based on our data here, patient satisfaction was weakly related to patient-reported function but not pain interference among this subset of new patients presenting to a foot and ankle clinic. Given our essentially negative findings, further study is needed to determine which aspects of the PG satisfaction and PROMIS scores track similarly. Further, our findings add to the growing literature showcasing limitations of the PG tool, including low response rates and notable ceiling effects. If satisfaction metrics and patient-reported outcomes capture differing aspects of the patient experience, we need to better understand how that influences the measurement of health care quality and value. LEVEL OF EVIDENCE Level III, comparative study.
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Affiliation(s)
- Devon C Nixon
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Chong Zhang
- Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, UT, USA
| | - Maxwell W Weinberg
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Angela P Presson
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA.,Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, UT, USA
| | - Florian Nickisch
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
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25
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Ogura Y, Kobayashi Y, Shinozaki Y, Kitagawa T, Yonezawa Y, Takahashi Y, Yoshida K, Yasuda A, Ogawa J. Factors Influencing Patient Satisfaction After Decompression Surgery Without Fusion for Lumbar Spinal Stenosis. Global Spine J 2020; 10:627-632. [PMID: 32677560 PMCID: PMC7359692 DOI: 10.1177/2192568219868205] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES Decompression without fusion is a standard surgical treatment for lumbar spinal stenosis (LSS) with reasonable surgical outcomes. Nevertheless, some studies have reported low patient satisfaction (PS) following decompression surgery. The cause of the discrepancy between reasonable clinical outcomes and PS is unknown; moreover, the factors associated with PS are expected to be complex, and little is known about them. This study aimed to identify satisfaction rate and to clarify the factors related to PS following decompression surgery in LSS patients. METHODS We retrospectively reviewed 126 patients who underwent lumbar decompression with a minimum follow-up of 1 year. Patients were divided into 2 groups based on the PS question. The Japanese Orthopaedic Association (JOA) scores, and the Numeric Rating Scale (NRS) scores of low back pain (LBP), leg pain, and leg numbness were compared between the 2 groups preoperatively and at the latest visit. To identify the prognostic factors for dissatisfaction, multiple logistic regression analysis was performed. RESULTS Overall satisfaction rate was 75%. The JOA recovery rate, NRS improvement, and Short Form-8 (SF-8) were significantly higher in the satisfied group. Postoperative NRS scores of LBP, leg pain, and leg numbness were significantly lower in the satisfied group. Multivariate logistic regression analysis showed that smoking and scoliosis were significant risk factors for dissatisfaction. CONCLUSIONS Overall satisfaction rate was 75% in patients with LSS undergoing decompression surgery. This study found that smoking status and scoliosis were associated with patient dissatisfaction following decompression in LSS patients.
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Affiliation(s)
- Yoji Ogura
- Japanese Red Cross Shizuoka Hospital, Shizuoka, Shizuoka, Japan,Yoji Ogura, Department of Orthopaedic Surgery, Japanese Red Cross Shizuoka Hospital, 8-2 Ohtemachi, Aoi-ku, Shizuoka 420-0853, Japan.
| | | | | | | | | | | | - Kodai Yoshida
- Japanese Red Cross Shizuoka Hospital, Shizuoka, Shizuoka, Japan
| | - Akimasa Yasuda
- Japanese Red Cross Shizuoka Hospital, Shizuoka, Shizuoka, Japan
| | - Jun Ogawa
- Japanese Red Cross Shizuoka Hospital, Shizuoka, Shizuoka, Japan
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Kuroda Y, Saito M, Çınar EN, Norrish A, Khanduja V. Patient-related risk factors associated with less favourable outcomes following hip arthroscopy. Bone Joint J 2020; 102-B:822-831. [PMID: 32600150 DOI: 10.1302/0301-620x.102b7.bjj-2020-0031.r1] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS This paper aims to review the evidence for patient-related factors associated with less favourable outcomes following hip arthroscopy. METHODS Literature reporting on preoperative patient-related risk factors and outcomes following hip arthroscopy were systematically identified from a computer-assisted literature search of Pubmed (Medline), Embase, and Cochrane Library using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and a scoping review. RESULTS Assessment of these texts yielded 101 final articles involving 90,315 hips for qualitative analysis. The most frequently reported risk factor related to a less favourable outcome after hip arthroscopy was older age and preoperative osteoarthritis of the hip. This was followed by female sex and patients who have low preoperative clinical scores, severe hip dysplasia, altered hip morphology (excess acetabular retroversion or excess femoral anteversion or retroversion), or a large cam deformity. Patients receiving workers' compensation or with rheumatoid arthritis were also more likely to have a less favourable outcome after hip arthroscopy. There is evidence that obesity, smoking, drinking alcohol, and a history of mental illness may be associated with marginally less favourable outcomes after hip arthroscopy. Athletes (except for ice hockey players) enjoy a more rapid recovery after hip arthroscopy than non-athletes. Finally, patients who have a favourable response to local anaesthetic are more likely to have a favourable outcome after hip arthroscopy. CONCLUSION Certain patient-related risk factors are associated with less favourable outcomes following hip arthroscopy. Understanding these risk factors will allow the appropriate surgical indications for hip arthroscopy to be further refined and help patients to comprehend their individual risk profile. Cite this article: Bone Joint J 2020;102-B(7):822-831.
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Affiliation(s)
- Yuichi Kuroda
- Young Adult Hip Service, Department of Trauma and Orthopaedic Surgery, Addenbrooke's - Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Mobius Hip and Knee Clinic, Cambridge Nuffield Hospital, Cambridge, UK
| | - Masayoshi Saito
- Young Adult Hip Service, Department of Trauma and Orthopaedic Surgery, Addenbrooke's - Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Mobius Hip and Knee Clinic, Cambridge Nuffield Hospital, Cambridge, UK
| | - Ece Nur Çınar
- Young Adult Hip Service, Department of Trauma and Orthopaedic Surgery, Addenbrooke's - Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Mobius Hip and Knee Clinic, Cambridge Nuffield Hospital, Cambridge, UK
| | - Alan Norrish
- Department of Academic Orthopaedics, Trauma and Sports Medicine, Queens Medical Centre, University of Nottingham, Nottingham, UK
| | - Vikas Khanduja
- Young Adult Hip Service, Department of Trauma and Orthopaedic Surgery, Addenbrooke's - Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Mobius Hip and Knee Clinic, Cambridge Nuffield Hospital, Cambridge, UK
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Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The aim of this study was to investigate changes in mental well-being after surgery for cervical spondylotic myelopathy (CSM) and identify factors associated with improvement. SUMMARY OF BACKGROUND DATA Posterior cervical surgery with laminoplasty significantly improves myelopathy and physical function in patients with CSM. However, its impact on mental well-being is unclear. METHODS Patients who underwent laminoplasty for CSM and had >2 years of follow-up were reviewed (n = 111). The mental component summary (MCS) score was used as a measure of mental well-being. The trend in MCS score change was evaluated using the Jonckheere-Terpstra trend test. Preoperative clinical scores were compared between patients with improvements greater and less than the minimal clinically important difference (MCID). Significant variables were included in a multinomial logistic regression analysis and further validated in a receiver-operating characteristic (ROC) curve analysis. Additionally, the results were confirmed in a long-term observation cohort of patients followed up for >5 years (n = 46). RESULTS The improvement in the average MCS score (5.6) was greater than the MCID (4.0). The trend of improvement was sustained for 2 years (P = 0.002), but not for 5 years (P = 0.130). In terms of individual cases, 56 patients (50.5%) achieved MCS score improvement greater than the MCID. These patients showed significantly lower preoperative MCS scores than those without meaningful improvement (P < 0.001). The preoperative "social functioning (SF)" score was independently associated with MCS score improvement (P = 0.001). ROC curve analysis validated the ability of preoperative SF to predict MCS score improvement at 2 and 5 years postoperatively (area under the curve: 0.744, 0.893, respectively). CONCLUSION Half of the patients achieved meaningful improvement in mental well-being. A lower preoperative SF score was independently associated with improvement. These results may help identify patients who could experience an improvement in mental well-being after surgery and develop novel approaches to achieve further improvement. LEVEL OF EVIDENCE 3.
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Tucci C, Jacob A, de Amorim TB, Araújo AOD, Cristante AF. Translation, Cross-cultural Adaptation and Reliability of Brazilian portuguese version of the DRAM Questionnaire for Psychometric Evaluation in Low Back Pain. Rev Bras Ortop 2020; 55:54-61. [PMID: 32123446 PMCID: PMC7048564 DOI: 10.1055/s-0039-1700812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 11/27/2018] [Indexed: 02/06/2023] Open
Abstract
Objective
Based on studies regarding pain physiology and its relation to emotional distress conditions, psychological evaluation became essential to determine the most favorable patient profiles to distinct therapeutic approaches. The Distress Risk Assessment Method (DRAM) has been developed as a screening instrument for patients with lumbar pain, classifying them in subgroups as normal, at risk, distressed somatic and distressed depressive, based on the two components of DRAM scores (Modified Somatic Perception Questionnaire [MSPQ] and Zung questionnaires). The objective of the present study is to translate and culturally adapt the DRAM to the Brazilian Portuguese language, and to determine the reliability of the final version.
Methods
As proposed by the International Quality of Life Assessment (IQOLA) method, a Brazilian Portuguese version of the DRAM has been applied to a sample of 85 individuals from 3 participant centers.
Results
The results confirmed the reliability and reproducibility of the DRAM in its Brazilian Portuguese final version: Cronbach alpha of 0.815 (MSPQ) and 0.794 (Zung) and intraclass correlation coefficient (ICC) of 0.688 (MSPQ) and 0.659 (Zung).
Conclusion
The presented DRAM version in Brazilian Portuguese is reliable and is available to clinical practice use.
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Affiliation(s)
- Carlos Tucci
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Alberto Jacob
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Thiago Bonato de Amorim
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Alex Oliveira de Araújo
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Alexandre Fogaça Cristante
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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Zuckerman SL, Devin CJ. Outcomes and value in elective cervical spine surgery: an introductory and practical narrative review. JOURNAL OF SPINE SURGERY 2020; 6:89-105. [PMID: 32309649 DOI: 10.21037/jss.2020.01.11] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
How we determine a successful clinical outcome and the value of a spine intervention are two major questions surrounding clinical spine research. Patient-reported outcomes (PROs), both LEGACY and Patient-Reported Outcomes Measurement Information System (PROMIS) measures, are becoming ubiquitous throughout the literature. Spine surgeons need a facile understanding of the financial landscape of their environment to influence change. In the current introductory, narrative review on outcomes and value in cervical spine surgery, we aim to: (I) define relevant outcome and cost terminology, (II) review recent cervical spine surgery literature, divided by specific pathology with a focus on LEGACY and PROMIS measures, and (III) discuss value and cost as they pertain to postoperative return to work and ambulatory surgery centers surgeries.
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Affiliation(s)
- Scott L Zuckerman
- Vanderbilt Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA.,Steamboat Orthopaedic and Spine Institute, Steamboat Springs, CO, USA
| | - Clinton J Devin
- Vanderbilt Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA.,Steamboat Orthopaedic and Spine Institute, Steamboat Springs, CO, USA
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Tisano BK, Nakonezny PA, Gross BS, Martinez JR, Wells JE. Depression and Non-modifiable Patient Factors Associated with Patient Satisfaction in an Academic Orthopaedic Outpatient Clinic: Is it More Than a Provider Issue? Clin Orthop Relat Res 2019; 477:2653-2661. [PMID: 31764330 PMCID: PMC6907291 DOI: 10.1097/corr.0000000000000927] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 08/01/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patient satisfaction surveys play an increasingly important role in United States healthcare policy and serve as a marker of provided physician services. In attempts to improve the patient's clinical experience, focus is often placed on components of the healthcare system such as provider interaction and other experiential factors. Patient factors are often written off as "non-modifiable"; however, by identifying and understanding these risk factors for dissatisfaction, another area for improvement and intervention becomes available. QUESTIONS/PURPOSES (1) Do patients in the orthopaedic clinic with a preexisting diagnosis of depression report lower satisfaction scores than those without a preexisting diagnosis of depression? (2) What other non-modifiable patient factors influence patient-reported satisfaction? METHODS We reviewed Press Ganey Survey scores, which assess patient experiential satisfaction with a single clinical encounter, from 3044 clinic visits (2527 patients) in adult reconstructive, sports, and general orthopaedic clinics at a single academic medical center between November 2010 and May 2017, during which time approximately 19,000 encounters occurred. Multiple patient factors including patient age, gender, race, health insurance status, number of previous clinic visits with their physician, BMI, and a diagnosis of depression were recorded. Patient satisfaction was operationalized as a binary outcome as satisfied or less satisfied, and a multiple logistic regression analysis was used to estimate the odds of being satisfied. RESULTS After adjusting for all other covariates in the model, we found that patients with a diagnosis of depression were less likely to be satisfied than patients without this diagnosis (odds ratio 0.749 [95% confidence interval, 0.600-0.940]; p = 0.01). Medicare-insured patients were more likely to be satisfied than non-Medicare patients (OR 1.257 [95% CI, 1.020-1.549]; p = 0.03), patients in the sports medicine clinic were more likely to be satisfied than those seen in the general orthopaedic clinic (OR 1.397 [95% CI, 1.096-1.775]; p = 0.007), and established patients were more likely to be satisfied than new patients (OR 0.763 [95% CI, 0.646-0.902]; p = 0.002). CONCLUSIONS Given the association of depression with lower satisfaction with a single visit at the orthopaedic clinic, providers should screen for depression and address the issue during the outpatient encounter. The impact of such comprehensive care or subsequent treatment of depression on improving patient-reported satisfaction offers areas of future study. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Breann K Tisano
- B. K. Tisano, B. S. Gross, J. R. Martinez, J. E. Wells, Department of Orthopaedic Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA P. A. Nakonezny, Department of Population and Data Sciences, Division of Biostatistics, University of Texas Southwestern Medical School, Dallas, TX, USA
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Stone AV, Beck EC, Malloy P, Chahla J, Nwachukwu BU, Neal WH, Nho SJ. Preoperative Predictors of Achieving Clinically Significant Athletic Functional Status After Hip Arthroscopy for Femoroacetabular Impingement at Minimum 2-Year Follow-Up. Arthroscopy 2019; 35:3049-3056.e1. [PMID: 31395395 DOI: 10.1016/j.arthro.2019.05.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 05/09/2019] [Accepted: 05/10/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To identify predictors of achieving clinically significant sport function in athletic patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS). METHODS Data were analyzed for all patients who treated for FAIS between 2012 to 2016 and reported being athletes, including recreational and competitive athletes. All patients had a minimum of 2-year follow-up with patient-reported athletic function in the form of the Hip Outcome Score-Sport Specific (HOS-SS), visual analog score-pain, and patient satisfaction. Achieving clinically significant sports function was defined as either reaching the minimally clinical important difference (MCID) or the patient acceptable symptomatic state (PASS) for HOS-SS at 2-year follow-up. An exploratory factor analysis was used to determine specific domains for the predictor variables and to reduce the redundancy in these variables. A logistic regression analysis was used to identify significant predictors of achieving clinically significant sports function [corrected]. RESULTS Of 780 qualifying patients, 626 completed the 2-year minimum follow-up (80%), with a mean age and body mass index of 31.6 ± 11.9 years and 24.6 ± 8.6, respectively. A total of 500 patients (86.5%) achieved high functional status, with 77.9% achieving MCID HOS-SS and 68.7% achieving PASS HOS-SS. Logistic regression analysis identified increased the α angle (odds ratio [OR] 0.976; P = .027), preoperative pain duration (OR 0.729; P = .011), and body mass index (BMI) (OR 0.919; P = .018), as well as the presence of femoral chondral defects (OR 0.769; P = .013), as negative predictors for achieving MCID. Negative predictors for achieving PASS HOS-SS included the presence of a preoperative limp (OR 0.384; P = .013), anxiety or depression (OR 0.561; P = .041), and increased BMI (OR 0.945; P = .018) and preoperative pain duration (OR 0.987; P < .001). CONCLUSIONS Several predictors of achieving clinically significant sport function performance exist, including a history of anxiety or depression, BMI, preoperative α angle, limp, femoral chondral damage, *and preoperative symptom duration. Our results suggest there are both modifiable and nonmodifiable preoperative factors that have the potential to predict achieving high athletic function after hip arthroscopy for FAIS. LEVEL OF EVIDENCE IV, Case Series.
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Affiliation(s)
- Austin V Stone
- Department of Orthopaedic Surgery, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Edward C Beck
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Philip Malloy
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Benedict U Nwachukwu
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - William H Neal
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Shane J Nho
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A..
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Does Patient Experience After a Total Knee Arthroplasty Predict Readmission? J Arthroplasty 2019; 34:2573-2579. [PMID: 31176560 DOI: 10.1016/j.arth.2019.04.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 04/06/2019] [Accepted: 04/22/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND To our knowledge, the relationship between patient Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores and patient outcomes in total knee arthroplasty (TKA) has not yet been analyzed. Therefore, the purpose of this study is to determine whether readmissions within the 30 or 90 days postoperative window after TKA were predicted by patient satisfaction scores, as measured by the HCAHPS survey. METHODS We analyzed HCAHPS survey scores from all patients who underwent primary or revision TKA at our institution between January 1, 2016 and September 1, 2016. Demographic readmission information, preoperative baseline health status measures, validated patient-reported pain and joint function measures, and HCAHPS survey scores were collected. To determine whether 30-day or 90-day readmissions were independently associated with HCAHPS scores, statistical analyses were conducted using chi-squared and Student's t-tests for categorical and continuous variables. Multivariable regression analysis adjusted for patient-level risk factors. RESULTS Patients readmitted within 30 days were significantly less likely to choose the highest rating on survey questions in several dimensions of patient satisfaction when compared to patients who were not readmitted. These dimensions included physician communication (P = .045), discharge information (P = .016), and transition of care (P = .044). Similarly, patients who were readmitted within 90 days were less likely to choose the highest rating in survey questions that pertained to physician communication (P = .046), medication information (P = .040), and quietness of the hospital environment (P = .048). CONCLUSION Our results show that readmission is predicted by lower patient satisfaction scores in several dimensions of patient care including physician communication, hospital environment, medication information, discharge information, and transition of care.
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Sheikh MM, Qayyum R, Panda M. Relationship of Physicians' Rapport with Patients' Satisfaction and Psychological Well-being During Hospitalization. Cureus 2019; 11:e4991. [PMID: 31497422 PMCID: PMC6707819 DOI: 10.7759/cureus.4991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Objective The purpose of this study was to assess the association between the psychological well-being and satisfaction of patients with physicians during their hospitalization. Methods This cross-sectional study was conducted at a local hospital using the following surveys: Brief Inventory of Thriving (BIT), tool to assess inpatient satisfaction with care from hospitalists (TAISCH) survey, and Erlanger Internal Patient satisfaction survey addressing demographic questions and questions on physicians' quality of care and etiquette. Mixed linear regression models were created to examine the effect of psychological well-being on patient satisfaction. Models were adjusted for age, race, and gender, and all analyses were performed in R 3.1.1 using the 'lme4' package with statistical significance set at p<0.05. Results A total of 360 patients were enrolled in this analysis and the mean age of the cohort was 54.5 years. In the unadjusted analysis, each unit increase in BIT score was associated with a 0.3% (95% CI:0.19-0.4, p<0.001) increase in mean satisfaction score using the five-domain questionnaire and a 0.25% (95%CI:0.16-0.34, p<0.01) increase in mean satisfaction score using the TAISCH questionnaire. Multivariable models, after adjusting confounding variables, also showed the direct and statistically significant relationship between patients' level of psychological well-being and patient satisfaction. Each unit increase in BIT score was associated with a 0.31% (95% CI:0.20-0.43, p<0.001) and 0.26% (95% CI:0.17-0.36, p<0.001) increase in mean satisfaction scores across the five-domain questionnaire and TAISCH questionnaire. Conclusions There is a positive correlation between the level of patients' psychological well-being and satisfaction with his/her physician with a statistical significance. With patient-specific strategies, we can further improve patient rapport with their physicians, resulting in positive patient outcomes.
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Affiliation(s)
| | - Rehan Qayyum
- Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, USA
| | - Mukta Panda
- Internal Medicine, University of Tennessee College of Medicine, Health and Science Center, Chattanooga, USA
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Poor Baseline Mental Health Does Not Influence Improvement in Patient-reported Outcomes, Satisfaction, and Return to Work Two Years After Single-level Anterior Cervical Discectomy and Fusion. Spine (Phila Pa 1976) 2019; 44:839-847. [PMID: 30540718 DOI: 10.1097/brs.0000000000002960] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study using prospectively collected registry data. OBJECTIVE The authors examine the influence of preoperative mental health on outcomes after anterior cervical discectomy and fusion (ACDF) and determine the impact of ACDF on postoperative mental health. SUMMARY OF BACKGROUND DATA While studies have reported a negative correlation between preoperative mental health and outcomes following lumbar spine surgery, the influence on outcomes following cervical spine surgery remains relatively understudied. METHODS Prospectively collected registry data of 104 patients who underwent single-level ACDF for cervical spondylotic myelopathy were reviewed. Patients were dichotomized into top and bottom halves based on preoperative SF-36 MCS (Mental Component Summary) using a cutoff of 48. Outcomes assessed were visual analogue scale for neck pain, arm pain, AAOS Neck Pain and Disability, Neurogenic Symptoms, Neck Disability Index, Short-Form 36, Japanese Orthopaedic Association myelopathy score, return to work, return to function, satisfaction and expectation fulfilment up to 2 years postoperatively. RESULTS The preoperative MCS was 37.5 ± 8.1 and 57.4 ± 6.3 in the Low and High MCS groups respectively (P < 0.001). The Low MCS group had poorer preoperative scores (P < 0.05). There was no significant difference in length of stay or comorbidities (P > 0.05). The High MCS group had less neck pain (P = 0.002) and showed a trend towards lower Neck Disability Index (P = 0.062) at 2 years. The Low MCS group demonstrated greater improvement in Japanese Orthopaedic Association (P = 0.007) and similar improvement in other scores (P > 0.05). There was no significant difference in proportion that achieved minimal clinically important difference for each score (P > 0.05). Both groups had similar rates of return to work, return to function, expectation fulfilment, and satisfaction (P > 0.05). Lower preoperative MCS was predictive of greater improvement in MCS (r = -0.477, P < 0.001). CONCLUSION Despite relatively greater pain and disability at 2 years, patients with poor baseline mental health experienced similar improvement in clinical outcomes, return to work, and satisfaction rates. LEVEL OF EVIDENCE 3.
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Abstract
Background: Rating the patient experience is an increasingly important component of value-based health care. Generation of lower ratings on validated functional assessments by patients with Workers’ Compensation is well known; however, the relationship between Workers’ Compensation status and patient satisfaction is poorly described in orthopaedic patient populations. Methods: All orthopaedic outpatient patient satisfaction surveys (Press Ganey) generated over an 18-month period at a U.S. academic tertiary care center were included in this study. Data with regard to the primary payer, demographic characteristics, orthopaedic subspecialty, and planned surgical interventions with the provider for whom the survey was completed were analyzed in conjunction with patient satisfaction data. Results: During the study period, 3,720 consecutive patient satisfaction surveys were generated, and 244 surveys were generated by 215 patients with Workers’ Compensation. Satisfied patients with Workers’ Compensation were more likely to be male (p = 0.0007), to have higher mental health self-assessments (p = 0.004), and to be scheduled for surgical intervention (p = 0.03). Scheduling a surgical procedure was independently associated with improved patient satisfaction, whereas Workers’ Compensation status was independently associated with dissatisfaction when adjusting for sex, language, race, and marital status. Across all patient satisfaction domains, patients with Workers’ Compensation gave significantly lower scores (p < 0.05) compared with all other patients. Patients with Workers’ Compensation were more likely to rate their overall health as lower compared with other patients (p < 0.0001). Patients with Workers’ Compensation were more likely to give lower ratings to providers on a 1-to-10 scale (p < 0.0001) and were less likely to recommend the practice to others (p < 0.0001). Conclusions: Workers’ Compensation status is a non-modifiable independent predictor of dissatisfaction with health care compared with other primary payer groups. Further research is warranted to understand the factors influencing patient satisfaction ratings.
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Affiliation(s)
- Jocelyn Compton
- Department of Orthopedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Natalie Glass
- Department of Orthopedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Timothy Fowler
- Department of Orthopedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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Oleisky ER, Pennings JS, Hills J, Sivaganesan A, Khan I, Call R, Devin CJ, Archer KR. Comparing different chronic preoperative opioid use definitions on outcomes after spine surgery. Spine J 2019; 19:984-994. [PMID: 30611889 DOI: 10.1016/j.spinee.2018.12.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 12/11/2018] [Accepted: 12/27/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT No consensus exists for defining chronic preoperative opioid use. Most spine studies rely solely on opioid duration to stratify patients into preoperative risk categories. PURPOSE The purpose of this study is to compare established opioid definitions that contain both duration and dosage to opioid models that rely solely on duration, including the CDC Guideline for Prescribing Opioids for Chronic Pain, in patients undergoing spine surgery. STUDY DESIGN This was a retrospective cohort study that used opioid data from the Tennessee Controlled Substance Monitoring Database and prospective clinical data from a single-center academic spine registry. PATIENT SAMPLE The study cohort consisted of 2,373 patients who underwent elective spine surgery for degenerative conditions between January 2011 and February 2017 and who completed a follow-up assessment at 12 months after surgery. OUTCOME MEASURES Postoperative opioid use and patient-reported satisfaction (NASS Satisfaction Scale), disability (Oswestry/Neck Disability Index), and pain (Numeric Rating Scale) at 12 month follow-up. METHODS Six different chronic preoperative opioid use variables were created based on the number of times a prescription was filled and/or daily morphine milligram equivalent for the one year before surgery. These variables defined chronic opioid use as 1) most days for > 3 months (CDC), 2) continuous use for ≥ 6 months (Schoenfeld), 3) >4,500 mg for at least 9 months (Svendsen wide), 4) >9,000 mg for 12 months (Svendsen intermediary), 5) >18,000 mg for 12 months (Svendsen strict), 6) low-dose chronic (1-36 mg for >91 days), medium-dose chronic (36-120 mg for >91 days), and high-dose chronic (>120 mg for >91 days) (Edlund). Multivariable regression models yielding C-index and R2 values were used to compare chronic preoperative opioid use definitions by postoperative outcomes, adjusting for type of surgery. RESULTS Chronic preoperative opioid use was reported in 470 to 725 (19.8% to 30.6%) patients, depending on definition. The Edlund definition, accounting for duration and dosage, had the highest predictive ability for postoperative opioid use (77.5%), followed by Schoenfeld (75.7%), CDC (72.6%), and Svendsen (59.9% to 72.5%) definitions. A combined Edlund and Schoenfeld duration and dosage definition in post-hoc analysis, that included 3 and 6 month duration cut-offs, performed the best overall with a C-index of 78.4%. Both Edlund and Schoenfeld definitions explained similar amounts of variance in satisfaction, disability, and pain (4.2% to 8.5%). Svendsen and CDC definitions demonstrated poorer performance for patient-reported outcomes (1.4% to 7.2%). CONCLUSIONS The Edlund definition is recommended for identifying patients at highest risk for postoperative opioid use. When opioid dosage is unavailable, the Schoenfeld definition is a reasonable choice with similar predictive ability. For patient-reported outcomes, either the Edlund or Schoenfeld definition is recommended. Future work should consider combing dosage and duration, with 3 and 6 month cutoffs, into chronic opioid use definitions.
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Affiliation(s)
- Emily R Oleisky
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jacquelyn S Pennings
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jeffrey Hills
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ahilan Sivaganesan
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Inamullah Khan
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Richard Call
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Clinton J Devin
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Steamboat Orthopaedic and Spine Institute, Steamboat Springs, CO, USA
| | - Kristin R Archer
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA.
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Klein JS, Davis DE, Wells ZS, Kane LT, Sholder D, Namdari S, Abboud JA. The Distress and Risk Assessment Method predicts postoperative narcotic use in patients undergoing rotator cuff repair. J Shoulder Elbow Surg 2019; 28:S146-S153. [PMID: 31196509 DOI: 10.1016/j.jse.2019.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/17/2019] [Accepted: 04/18/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Distress and Risk Assessment Method (DRAM) predicts poor outcomes in spine, hip, and knee surgery. Unlike other areas of orthopedic surgery, DRAM scores are not predictive of lower postoperative patient-reported outcomes after arthroscopic rotator cuff repair (RCR). PURPOSE As concerns for opioid dependence and abuse grow, the purpose of this study was to analyze the correlation between preoperative DRAM scores, modified Zung scores, and postoperative narcotic use in patients who underwent arthroscopic RCR. MATERIALS AND METHODS This prospective cohort study identified and enrolled patients >18 years of age with full-thickness rotator cuff tears at a single institution. Patients with prior shoulder surgery, greater than 1-tendon RCR, and preoperative narcotic use were excluded. One-hundred and fifty patients were enrolled, with 114 (76%) completing all preoperative and postoperative questionnaires. Preoperative DRAM scores were collected from every patient. Postoperative narcotic use was evaluated via survey and converted to total morphine equivalents. RESULTS Increased preoperative DRAM scores predicted higher postoperative morphine equivalent units (P = .002, r = 0.29). When dividing patients into those <17 or ≥17 on the modified Zung score, 44 of 114 (39%) met criteria for "at risk or depressed." This group showed a statistically significant trend toward higher postoperative morphine equivalent unit intake (P = .004). CONCLUSION Baseline psychological distress (DRAM) can predict narcotic requirements after RCR and serve as a powerful tool to identify patients at risk for increased narcotics requirements postoperatively. In our cohort, 39% of patients showed evidence of baseline depression, which highlights a potential role of the modified Zung score to identify patients in need of preoperative psychological counseling.
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Affiliation(s)
- Jason S Klein
- Department of Shoulder and Elbow Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Daniel E Davis
- Department of Shoulder and Elbow Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Zach S Wells
- Department of Shoulder and Elbow Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Liam T Kane
- Department of Shoulder and Elbow Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Daniel Sholder
- Department of Shoulder and Elbow Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Surena Namdari
- Department of Shoulder and Elbow Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Joseph A Abboud
- Department of Shoulder and Elbow Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
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Chotai S, Khan I, Nian H, Archer KR, Harrell FE, Weisenthal BM, Bydon M, Asher AL, Devin CJ. Utility of Anxiety/Depression Domain of EQ-5D to Define Psychological Distress in Spine Surgery. World Neurosurg 2019; 126:e1075-e1080. [DOI: 10.1016/j.wneu.2019.02.211] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 12/11/2022]
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Bessette MC, Westermann RW, Davis A, Farrow L, Hagen MS, Miniaci A, Nickodem R, Parker R, Rosneck J, Saluan P, Spindler KP, Stearns K, Jones MH. Predictors of Pain and Function Before Knee Arthroscopy. Orthop J Sports Med 2019; 7:2325967119844265. [PMID: 31205963 PMCID: PMC6537074 DOI: 10.1177/2325967119844265] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Patient-reported outcome measures are commonly used to measure knee pain and functional impairment. When structural abnormality is identified on examination and imaging, arthroscopic partial meniscectomy and chondroplasty are commonly indicated for treatment in the setting of pain and decreased function. PURPOSE To evaluate the relationship between patient characteristics, mental health, intraoperative findings, and patient-reported outcome measures at the time of knee arthroscopy. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Between February 2015 and October 2016, patients aged 40 years and older who were undergoing routine knee arthroscopy for meniscal and cartilage abnormality, without reconstructive or restorative procedures, were prospectively enrolled in this study. Routine demographic information was collected, and the Knee injury and Osteoarthritis Outcome Score (KOOS) Pain, Quality of Life (QoL), and Physical Function Short Form (PS) subscales and the mental and physical component subscales of the Veterans RAND 12-Item Health Survey (VR-12 MCS and VR-12 PCS) were administered preoperatively on the day of surgery. Intraoperative findings were collected in a standardized format. Patient demographics, intraoperative findings, and the VR-12 MCS were used as predictor values, and a multivariate analysis was conducted to assess for relationships with the KOOS and VR-12 as dependent variables. RESULTS Of 661 eligible patients, baseline patient-reported outcomes and surgical data were used for 638 patients (97%). Lower scores on both subscales of the VR-12 were predicted by female sex, positive smoking history, fewer years of education, and higher body mass index (BMI). All KOOS subscales were negatively affected by lower VR-12 MCS scores, female sex, lower education level, and higher BMI in a statistically meaningful way. Positive smoking history was associated with worse scores on the KOOS-PS. Abnormal synovial status was associated with worse KOOS-Pain. CONCLUSION The demographic factors of sex, smoking status, BMI, and education level had an overwhelming impact on preoperative KOOS and VR-12 scores. Of interest, mental health as assessed by the VR-12 MCS was also a consistent predictor of KOOS scores. The only intraoperative finding with a significant association was abnormal synovial status and its effect on KOOS-Pain scores.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Kurt P. Spindler
- Investigation performed at Cleveland Clinic Sports Health, Cleveland, Ohio,
USA
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Stone AV, Malloy P, Beck EC, Neal WH, Waterman BR, Bush-Joseph CA, Nho SJ. Predictors of Persistent Postoperative Pain at Minimum 2 Years After Arthroscopic Treatment of Femoroacetabular Impingement. Am J Sports Med 2019; 47:552-559. [PMID: 30822125 DOI: 10.1177/0363546518817538] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hip arthroscopy for femoroacetabular impingement syndrome (FAIS) is a rapidly expanding field, and preoperative factors predictive of persistent postoperative pain are currently unknown. PURPOSE To identify predictors for persistent postoperative pain at the site of surgery after hip arthroscopy for FAIS. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Patients who underwent hip arthroscopy for FAIS and had a minimum 2-year follow-up with patient-reported outcomes (PROs) were included in this study. Patients with previous open hip surgery and diagnoses other than FAIS were excluded. Patients were grouped by visual analog scale scores for pain as limited (<30) and persistent (≥30). Patient factors and outcomes were analyzed with univariate and correlation analyses to build a logistic regression model to identify predictors of persistent postoperative pain. RESULTS The limited pain (n = 514) and persistent pain (n = 174) groups totaled 688 patients (449 females). There was a statistically significant difference in age between groups, with the persistent pain group being older than the low pain group (35.9 ± 12.2 vs 32.4 ± 12.6, respectively; P = .002). Patients with persistent postoperative pain demonstrated significantly lower preoperative PRO scores in the Hip Outcome Score-Activities of Daily Living (57.6 ± 21.2 vs 67.7 ± 16.8), Hip Outcome Score-Sport Specific (35.9 ± 23.9 vs 44.1 ± 22.7), modified Harris Hip Score (51.6 ± 16.2 vs 59.6 ± 12.9), and International Hip Outcome Tool (32.0 ± 16.8 vs 40.0 ± 17.82) but no significant differences in preoperative visual analog scale scores for pain (7.3 ± 1.8 vs 7.2 ± 1.7). Mean postoperative PRO differences between pain groups were all statistically significant. Bivariate logistic regression analysis demonstrated that history of anxiety or depression (odds ratio, 1.8; 95% CI, 1.02-3.32; P = .042), revision hip arthroscopy (odds ratio, 8.6; 95% CI, 1.79-40.88; P = .007), and a low preoperative modified Harris Hip Score (odds ratio, 0.97; 95% CI, 0.95-0.99; P = .30) were predictors of persistent postoperative pain. CONCLUSION Independent predictors for persistent postoperative pain include revision hip arthroscopy and mental health history positive for anxiety and depression. Our analysis demonstrated significant improvements in pain and functional PROs in the limited pain and persistent pain groups; however, those with persistent pain demonstrated significantly lower PRO scores.
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Affiliation(s)
- Austin V Stone
- Department of Orthopaedic Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - Philip Malloy
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Edward C Beck
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - William H Neal
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Charles A Bush-Joseph
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Shane J Nho
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Bernstein DN, Fear K, Mesfin A, Hammert WC, Mitten DJ, Rubery PT, Baumhauer JF. Patient-reported outcomes use during orthopaedic surgery clinic visits improves the patient experience. Musculoskeletal Care 2019; 17:120-125. [PMID: 30615249 DOI: 10.1002/msc.1379] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 11/18/2018] [Accepted: 11/19/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES The Patient-Reported Outcomes Measurement Information System (PROMIS) is growing in popularity as healthcare shifts towards a value-based system. However, it remains unclear if PROMIS use improves the patient experience. The aim of the present study was to determine if PROMIS use as part of routine orthopaedic clinical care is associated with improved patient experience, as measured by the Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CGCAHPS) survey. METHODS All patient visits to an orthopaedic surgery clinic at a single academic medical centre between February 2015 and September 2016 were reviewed. Accounting for known patient factors that have an impact on clinic visit satisfaction, CGCAHPS scores were compared between patients who had PROMIS used as part of their routine care and those who had not had PROMIS used as part of their routine care. A p-value of <0.05 was considered significant. RESULTS A total of 8,607 patient visits fitted our inclusion criteria. Of these, surgeons elected not to use PROMIS in 8,422 patient encounters, leaving 185 patient visits in which PROMIS was actively used. When PROMIS was used, patients were significantly more likely to feel that the provider had spent enough time with them, to recommend this provider office to another patient and to rate the provider significantly higher on a scale from 0 to 10. Although not significant, a trend was found between use of PROMIS and whether a patient felt that a provider explained health information in way that the patient understood. CONCLUSIONS PROMIS use in an orthopaedic clinic visit can have a positive impact on the patient experience, which is currently part of a number of alternative payment models.
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Affiliation(s)
- David N Bernstein
- University of Rochester School of Medicine & Dentistry, Rochester, New York, USA
| | - Kathleen Fear
- University of Rochester Medical Center, Rochester, New York, USA
| | - Addisu Mesfin
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, New York, USA
| | - Warren C Hammert
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, New York, USA
| | - David J Mitten
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, New York, USA
| | - Paul T Rubery
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, New York, USA
| | - Judith F Baumhauer
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, New York, USA
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Tyser AR, Gaffney CJ, Zhang C, Presson AP. The Association of Patient Satisfaction with Pain, Anxiety, and Self-Reported Physical Function. J Bone Joint Surg Am 2018; 100:1811-1818. [PMID: 30399075 PMCID: PMC6636800 DOI: 10.2106/jbjs.17.00372] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND A complete understanding of the variables that influence patient satisfaction has yet to be reached. The purpose of this study was to determine whether patient-reported physical function, pain, and/or anxiety are associated with patient satisfaction in a hand and upper-extremity outpatient setting. METHODS This is a cohort study of 1,160 adult patients presenting to an upper-extremity (non-shoulder) clinic from January 1, 2014, to December 31, 2016, who completed functional patient-reported outcome measures (PROMIS [Patient-Reported Outcomes Measurement Information System] Physical Function, PROMIS Upper Extremity, and abbreviated Disabilities of the Arm, Shoulder and Hand scale [QuickDASH]) and psychological patient-reported outcome measures (PROMIS Anxiety and PROMIS Pain Interference) immediately prior to their physician encounter. After the clinic visit, included patients filled out the Press Ganey Medical Practice satisfaction survey online. Logistic regression models were used to predict overall patient satisfaction and satisfaction with the care provider among all, new, and return clinic visit types from the patient-reported functional and psychological measures, controlling for age and provider. RESULTS Among all visit types, there was a significant negative association of both pain and anxiety with patient satisfaction, whereby a 10-point increase in PROMIS Pain Interference (higher self-reported pain symptomatology) was associated with a 17% decrease in the odds of overall satisfaction (odds ratio [OR], 0.83 [95% confidence interval (CI), 0.71 to 0.98]; p = 0.03), and a 10-point increase in PROMIS Anxiety (higher self-reported anxiety) was associated with a 16% decrease in the odds of satisfaction with the care provider (OR, 0.84 [95% CI, 0.72 to 0.97]; p = 0.02). A significant positive association was found between higher levels of self-reported physical function and new-patient satisfaction with their care provider (OR, 1.22 [95% CI, 1.02 to 1.47]; p = 0.03). Among return patient visits, there was a negative association with overall patient satisfaction between both pain interference (OR, 0.76 [95% CI, 0.58 to 0.98]; p = 0.04) and anxiety (OR, 0.69 [95% CI, 0.53 to 0.89]; p < 0.01). CONCLUSIONS In hand and upper-extremity (non-shoulder) clinic visits, pre-encounter levels of patient-reported physical function, anxiety, and pain were significantly associated with patient satisfaction with the care provided. As the U.S. health-care system increasingly utilizes satisfaction scores in payment models and in quality assessment, these associations may influence how such metrics are interpreted and are utilized.
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Affiliation(s)
- Andrew R. Tyser
- Department of Orthopaedics (A.R.T. and C.J.G.) and Division of Epidemiology, Department of Internal Medicine (C.Z. and A.P.P.), University of Utah, Salt Lake City, Utah
| | - Christian J. Gaffney
- Department of Orthopaedics (A.R.T. and C.J.G.) and Division of Epidemiology, Department of Internal Medicine (C.Z. and A.P.P.), University of Utah, Salt Lake City, Utah
| | - Chong Zhang
- Department of Orthopaedics (A.R.T. and C.J.G.) and Division of Epidemiology, Department of Internal Medicine (C.Z. and A.P.P.), University of Utah, Salt Lake City, Utah
| | - Angela P. Presson
- Department of Orthopaedics (A.R.T. and C.J.G.) and Division of Epidemiology, Department of Internal Medicine (C.Z. and A.P.P.), University of Utah, Salt Lake City, Utah
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Andresen AK, Paulsen RT, Busch F, Isenberg-Jørgensen A, Carreon LY, Andersen MØ. Patient-Reported Outcomes and Patient-Reported Satisfaction After Surgical Treatment for Cervical Radiculopathy. Global Spine J 2018; 8:703-708. [PMID: 30443480 PMCID: PMC6232721 DOI: 10.1177/2192568218765398] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES It is estimated that 10 000 patients seek medical care due to cervical radiculopathy every year in Denmark. Although the natural course is usually favorable, around 20% undergo surgery for cervical degenerative disease every year in Denmark. We aim to evaluate the patient-reported results and satisfaction of anterior cervical decompression and fusion over a 5-year period from a single Danish center for spine surgery. METHODS This study is a retrospective study based on prospectively collected data from 318 consecutive patients treated with anterior cervical decompression and fusion over 1 to 3 levels. Data in the DaneSpine registry was collected pre- and postoperatively, and at 1 year after surgery. The outcome measures were Neck Disability Index (NDI), European Quality of Life 5D (EQ-5D), visual analogue score (VAS), and Short Form-36 Physical Component Summary (SF-36 PCS). RESULTS Of 318 cases enrolled, 272 (85.5%) had follow-up data available at a minimum 1-year postoperatively. The mean preoperative NDI was 40.0 and improved to 22.7. Mean EQ-5D was 0.50 and improved to 0.70, and mean VAS arm was 60.4 improved to 26.4. All improvements were statistically significant. A total of 74.3% were back to work 1 year after surgery. Achieving minimal clinically important difference (MCID) in VAS neck and SF-36 PCS was strongly correlated to patient satisfaction. CONCLUSION Patients who undergo anterior cervical discectomy and fusion can expect improvement in their pain and disability, with 74.3% of patients reporting a positive change in health status after surgery.
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Affiliation(s)
- Andreas Kiilerich Andresen
- Hospital Lillebælt, Middelfart, Denmark,University of Southern Denmark, Middelfart, Denmark,Andreas Kiilerich Andresen, Kløvervænget 26a-2, 5000
Odense C, Denmark.
| | - Rune Tendal Paulsen
- Hospital Lillebælt, Middelfart, Denmark,University of Southern Denmark, Middelfart, Denmark
| | | | | | | | - Mikkel Ø. Andersen
- Hospital Lillebælt, Middelfart, Denmark,University of Southern Denmark, Middelfart, Denmark
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Kohring JM, Pelt CE, Anderson MB, Peters CL, Gililland JM. Press Ganey Outpatient Medical Practice Survey Scores Do Not Correlate With Patient-Reported Outcomes After Primary Joint Arthroplasty. J Arthroplasty 2018; 33:2417-2422. [PMID: 29691167 DOI: 10.1016/j.arth.2018.03.044] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 03/19/2018] [Accepted: 03/19/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Patient delivery of care satisfaction surveys have emerged as instruments to assess the quality of health care at both the hospital and provider levels. We evaluated the correlation between these care satisfaction surveys and patient-reported outcomes (PROs). METHODS We reviewed secondary data on 540 patients with 540 random visits who underwent primary total joint arthroplasty between January 2014 and February 2017. The Press Ganey Outpatient Medical Practice Survey was collected from outpatient clinical encounters to measure patient satisfaction with their experience and matched to PRO measures from the same encounter. The PROs evaluated included the Patient-Reported Outcomes Measurement Information System physical function computerized adaptive test, v1.2, and the Patient-Reported Outcomes Measurement Information System Global 10 health survey. In addition to the random selection, we reviewed separate cross-sections of the data including preoperative visits within 90 days of the index procedure, all postoperative visits at least 1 year from the index procedure, and the magnitude of change in PRO scores from preoperative to a minimum 1-year postoperative visit. Data were evaluated using the Spearman correlation coefficient (rs). RESULTS There was little if any correlation between the Press Ganey scores and PROs at all time points evaluated (all, rs: -0.13 to 0.14). When evaluating knee and hip arthroplasty cases separately, the data demonstrated similar results (all, rs: -0.33 to 0.18). CONCLUSION We found little, if any, correlation between a patient's satisfaction with their care experience and their own perception of physical function and global health measures at all time points evaluated. These data question the utility of these scores as surrogate measures of health care quality, especially when reimbursements become tied to these metrics.
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Affiliation(s)
- Jessica M Kohring
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | | | - Mike B Anderson
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
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The impact of mental health on patient-reported outcomes in cervical radiculopathy or myelopathy surgery. J Clin Neurosci 2018; 54:102-108. [DOI: 10.1016/j.jocn.2018.06.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 04/23/2018] [Accepted: 06/04/2018] [Indexed: 11/19/2022]
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Kohring JM, Erickson JA, Anderson MB, Gililland JM, Peters CL, Pelt CE. Treated Versus Untreated Depression in Total Joint Arthroplasty Impacts Outcomes. J Arthroplasty 2018; 33:S81-S85. [PMID: 29506925 DOI: 10.1016/j.arth.2018.01.065] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 01/24/2018] [Accepted: 01/28/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND To determine if there was a difference in the change in patient-reported physical function (PF) between nondepressed and medically treated depressed or untreated depressed total joint arthroplasty (TJA) patients. METHODS This is an Institutional Review Board exempt retrospective review of 280 TJA cases from March 2014 to May 2016. Patient-reported PF was measured as part of the routine care via the Patient Reported Outcomes Measurement Information System PF computerized adaptive test. Linear generalized estimating equation regression analyses were used. RESULTS Untreated depressed cases demonstrated much smaller gains in PF scores compared to nondepressed patients (P = .020). Additionally, although treated and untreated depressed patients had statistically similar preoperative and postoperative PF scores (P > .05), untreated depressed cases experienced a lower magnitude of change (P = .015). CONCLUSION Medically treated depressed patients may have similar PF gains as nondepressed patients. Larger prospective studies may help identify whether screening for untreated depression and subsequent treatment leads to improved outcomes.
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Affiliation(s)
- Jessica M Kohring
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT
| | - Jill A Erickson
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT
| | - Mike B Anderson
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT
| | - Jeremy M Gililland
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT
| | | | - Christopher E Pelt
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT
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The Association Between Readmission and Patient Experience in a Total Hip Arthroplasty Population. J Arthroplasty 2018; 33:1668-1674. [PMID: 29352688 DOI: 10.1016/j.arth.2017.12.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 12/01/2017] [Accepted: 12/19/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Our goal was to determine whether readmissions within 30 or 90 days following discharge are associated with Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores for total hip arthroplasty (THA) patients. METHODS HCAHPS surveys from all patients who underwent THA between January 2016 and September 2016 in our institution were analyzed. Readmissions, demographics, baseline joint pain, joint function, and Veterans RAND-12 scores were collected. Statistical analyses involved Pearson's chi-squared tests for categorical variables and Student's t-tests for continuous variables. Multivariable logistic regression models were used to determine whether 30-day or 90-day readmissions were independently associated with HCAHPS scores. RESULTS A total of 1868 patients were identified, the survey was sent to 969 patients and 578 completed the survey (59.6%). Eight patients (1.4%) were readmitted within 30 days, and 28 patients (4.8%) within 90 days. These patients were more likely to undergo revision THA (P < .001). For the 30-day readmission cohort, 4 of 8 patients (50.0%) rated the hospital a 9 or 10 out of 10 compared to 466 of 567 patients (82.2%) of the non-readmitted cohort (P = .019). Thirty-day readmissions were associated with significantly lower likelihood of rating the hospital a 9 or 10 out of 10 (odds ratio 0.18). CONCLUSIONS Our results demonstrate a significant negative association between readmission and HCAHPS scores under several dimensions of the survey including nurse communication, doctor communication, pain management, and global satisfaction with the hospital experience.
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Chan AK, Bisson EF, Bydon M, Glassman SD, Foley KT, Potts EA, Shaffrey CI, Shaffrey ME, Coric D, Knightly JJ, Park P, Fu KM, Slotkin JR, Asher AL, Virk MS, Kerezoudis P, Chotai S, DiGiorgio AM, Chan AY, Haid RW, Mummaneni PV. Women fare best following surgery for degenerative lumbar spondylolisthesis: a comparison of the most and least satisfied patients utilizing data from the Quality Outcomes Database. Neurosurg Focus 2018; 44:E3. [DOI: 10.3171/2017.10.focus17553] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe American Association of Neurological Surgeons launched the Quality Outcomes Database (QOD), a prospective longitudinal registry that includes demographic, clinical, and patient-reported outcome (PRO) data, to measure the safety and quality of neurosurgical procedures, including spinal surgery. Differing results from recent randomized controlled trials have established a need to clarify the groups that would most benefit from surgery for degenerative lumbar spondylolisthesis. In the present study, the authors compared patients who were the most and the least satisfied following surgery for degenerative lumbar spondylolisthesis.METHODSThis was a retrospective analysis of a prospective, national longitudinal registry including patients who had undergone surgery for grade 1 degenerative lumbar spondylolisthesis. The most and least satisfied patients were identified based on an answer of “1” and “4,” respectively, on the North American Spine Society (NASS) Satisfaction Questionnaire 12 months postoperatively. Baseline demographics, clinical variables, surgical parameters, and outcomes were collected. Patient-reported outcome measures, including the Numeric Rating Scale (NRS) for back pain, NRS for leg pain, Oswestry Disability Index (ODI), and EQ-5D (the EuroQol health survey), were administered at baseline and 3 and 12 months after treatment.RESULTSFour hundred seventy-seven patients underwent surgery for grade 1 degenerative lumbar spondylolisthesis in the period from July 2014 through December 2015. Two hundred fifty-five patients (53.5%) were the most satisfied and 26 (5.5%) were the least satisfied. Compared with the most satisfied patients, the least satisfied ones more often had coronary artery disease (CAD; 26.9% vs 12.2%, p = 0.04) and had higher body mass indices (32.9 ± 6.5 vs 30.0 ± 6.0 kg/m2, p = 0.02). In the multivariate analysis, female sex (OR 2.9, p = 0.02) was associated with the most satisfaction. Notably, the American Society of Anesthesiologists (ASA) class, smoking, psychiatric comorbidity, and employment status were not significantly associated with satisfaction. Although there were no significant differences at baseline, the most satisfied patients had significantly lower NRS back and leg pain and ODI scores and a greater EQ-5D score at 3 and 12 months postoperatively (p < 0.001 for all).CONCLUSIONSThis study revealed that some patient factors differ between those who report the most and those who report the least satisfaction after surgery for degenerative lumbar spondylolisthesis. Patients reporting the least satisfaction tended to have CAD or were obese. Female sex was associated with the most satisfaction when adjusting for potential covariates. These findings highlight several key factors that could aid in setting expectations for outcomes following surgery for degenerative lumbar spondylolisthesis.
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Affiliation(s)
- Andrew K. Chan
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Erica F. Bisson
- 2Department of Neurological Surgery, University of Utah, Salt Lake City, Utah
| | - Mohamad Bydon
- 3Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Kevin T. Foley
- 5Department of Neurological Surgery, University of Tennessee Health Science Center, Semmes Murphey Neurologic and Spine Institute, Memphis, Tennessee
| | - Eric A. Potts
- 6Department of Neurological Surgery, Indiana University, Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Christopher I. Shaffrey
- 7Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Mark E. Shaffrey
- 7Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Domagoj Coric
- 8Neuroscience Institute, Carolinas HealthCare System and Carolina NeuroSurgery & Spine Associates, Charlotte, North Carolina
| | | | - Paul Park
- 10Department of Neurological Surgery, University of Michigan, Ann Arbor, Michigan
| | - Kai-Ming Fu
- 11Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | | | - Anthony L. Asher
- 8Neuroscience Institute, Carolinas HealthCare System and Carolina NeuroSurgery & Spine Associates, Charlotte, North Carolina
| | - Michael S. Virk
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | | | - Silky Chotai
- 13Department of Neurological Surgery, Vanderbilt University, Nashville, Tennessee
| | - Anthony M. DiGiorgio
- 1Department of Neurological Surgery, University of California, San Francisco, California
- 14Department of Neurosurgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana; and
| | - Alvin Y. Chan
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | | | - Praveen V. Mummaneni
- 1Department of Neurological Surgery, University of California, San Francisco, California
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Riklin E, Talaei-Khoei M, Merker VL, Sheridan MR, Jordan JT, Plotkin SR, Vranceanu AM. First report of factors associated with satisfaction in patients with neurofibromatosis. Am J Med Genet A 2017; 173:671-677. [PMID: 28211981 DOI: 10.1002/ajmg.a.38079] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 11/15/2016] [Indexed: 11/06/2022]
Abstract
Patient satisfaction is an integral part of quality health care. We assessed whether health literacy and psychosocial factors are associated with patient satisfaction among adults with neurofibromatosis. Eighty adults (mean age = 44 years; 55% female, 87% white) with NF (50% NF1, 41% NF2, and 9% schwannomatosis) completed an adapted Functional, Communicative, and Critical Health Literacy Questionnaire (FCCHL), the Health Literacy Assessment, a series of Patient Reported Outcome Measures Information System (PROMIS) psychosocial tests, and demographics before the medical visit. After, participants completed two measures of satisfaction: the Medical Interview Satisfaction Scale (MISS) to assess satisfaction with the medical visit, and an adapted version of the Consumer Assessment of Healthcare Providers and Systems Health Literacy Item Set (CAHPS-HL) to assess satisfaction with communication with the provider. Although higher FCCHL health literacy (r = 0.319, P = 0.002), male gender (t = 2.045, P = 0.044) and better psychosocial functioning (r = -0.257 to 0.409, P < 0.05) were associated with higher satisfaction with the medical visit in bivariate correlations, only male gender and higher health literacy remained as significant predictors in multivariable analyses. Higher FCCHL health literacy, less pain interference, fewer pain behaviors, and higher satisfaction with social roles and social discretionary activities (r = -0.231 to 0.331, P < 0.05) were associated with higher satisfaction with the communication with the provider in bivariate analyses. Results support the use of psychosocial and health literacy measures in clinical practice. Referrals to psychosocial treatments in addition to brief interventions focused on increasing health literacy may also be beneficial. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Eric Riklin
- Department of Psychiatry, Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mojtaba Talaei-Khoei
- Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Vanessa L Merker
- Department of Neurology and Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Monica R Sheridan
- Department of Neurology and Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Justin T Jordan
- Department of Neurology and Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Scott R Plotkin
- Department of Neurology and Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ana-Maria Vranceanu
- Department of Psychiatry, Behavioral Medicine Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Patient Satisfaction is Not Associated With Self-reported Disability in a Spine Patient Population. Clin Spine Surg 2017; 30:E1165-E1168. [PMID: 27764055 DOI: 10.1097/bsd.0000000000000431] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This is a retrospective review. OBJECTIVE To evaluate the relationship between patient functional status and self-assessment of disability as measured by 3 commonly used clinical assessment instruments-the Oswestry Disability Index (ODI), the Neck Disability Index (NDI), and the EuroQol (EQ)-5D and patient satisfaction scores in a spine surgery clinic population. SUMMARY OF BACKGROUND DATA Patient satisfaction surveys, which measure the "patient experience of care" are becoming an increasingly important measure of the quality of medical care. Despite the widespread use of patient satisfaction surveys, little is known about the relationship between patient satisfaction and patient functional status or self-assessed level of disability. MATERIALS AND METHODS We retrospectively reviewed records of 231 consecutive patients presenting to a single academic spine surgery center between February 2011 and October 2013 who completed both a patient satisfaction survey as well as one or more patient-reported outcome questionnaires (NDI, ODI, and/or EQ-5D) for a single clinical encounter. Statistical analysis was performed to determine if an association exists between the overall patient satisfaction score and each patient-reported outcome score. RESULTS Spearman correlation coefficients demonstrated no correlation between any patient-reported outcome score and the patient satisfaction score [NDI=-0.113 (-0.409 to 0.207) P=0.489] [ODI=-0.008 (-0.149 to 0.133) P=0.912] [EQ-5D=0.011 (-0.119 to 0.140) P=0.872] for a single clinical encounter. CONCLUSIONS These results provide evidence against an association between patient-reported functional status or self-assessed level of disability and patient satisfaction in a spine patient population.
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