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P117. The use of patient-reported outcomes measurement information system (PROMIS) in spine surgery: a systematic review
S212
Proceedings of the 34th Annual Meeting of the North American Spine Society / The Spine Journal 19 (2019) S195−S231
BACKGROUND CONTEXT: Anterior cervical plating in anterior cervical discectomy and fusion (ACDF) procedures are associated with improved outcomes compared to stand-alone cages. However, concerns exist regarding increased rates of postoperative dysphagia following an ACDF. PURPOSE: To quantify the effect of anterior plating on SWAL-QOL scores and radiographic swelling assessments following a primary, singlelevel ACDF. STUDY DESIGN/SETTING: Retrospective cohort. PATIENT SAMPLE: A total of 68 patients who underwent a primary, single-level ACDF from 2014-2017. OUTCOME MEASURES: SWAL-QOL scores, radiographic swelling. METHODS: Patients were retrospectively reviewed and grouped by those receiving a stand-alone cage (cage) or cage with anterior plating (plate). SWAL-QOL scores were recorded preoperatively and 6-week and 12-week postoperatively. Lateral radiographs were used to create a swelling index with a ratio of the prevertebral swelling distance to the anteriorposterior diameter of each involved vertebral body. A tracheal air index was created using the same methodology. Statistical analysis was performed using chi-square analysis and independent t-tests for categorical and continuous variables. RESULTS: A total of 68 primary, single-level ACDF patients were included. Forty-one (60.3%) received a stand-alone cage and 27 (39.7%) received a cage with anterior plating. No differences in demographics, comorbidities, operative time, estimated blood loss, or length of hospital stay were identified between cage and plate cohorts. Additionally, no differences were observed in postoperative SWAL-QOL scores. Swelling index was greater for the plate cohort at 6-weeks but was similar between groups at 12-weeks. The air index was similar at all time points. CONCLUSIONS: The results demonstrate that patients undergoing a primary, single-level ACDF with or without anterior plating experience similar operative times and lengths of stay. Patients that receive a cage with anterior plating did not experience significant increases in dysphagia as measured by the SWAL-QOL questionnaire compared to patients that received a stand-alone cage. Furthermore, radiographic assessments of swelling are comparable between cohorts. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.541 P117. The use of patient-reported outcomes measurement information system (PROMIS) in spine surgery: a systematic review Kelsey Young, BA1, Catherine Himo Gang, MPH1, Avani S. Vaishnav, MBBS1, Bridget Jivanelli, MS, BA2, Michael E. Steinhaus, MD1, Francis C. Lovecchio, MD1, Sheeraz A. Qureshi, MD, MBA2, Steven J. McAnany, MD3, Han Jo Kim, MD1, Sravisht Iyer, MD4; 1 Hospital for Special Surgery, New York, NY, US; 2 New York, NY, US; 3 Hospital for Special Surgery, Stamford, CT, US; 4 Rush University Medical Center, Chicago, IL, US BACKGROUND CONTEXT: PROMIS was developed to provide a time-saving, easy to administer patient outcome questionnaire that was adaptable to a variety of medical and surgical subspecialties. Numerous authors have examined the effectiveness of PROMIS in various areas of spine surgery. PURPOSE: To assess the correlation of PROMIS with legacy patientreported outcome measures in spine surgery STUDY DESIGN/SETTING: Systematic review. OUTCOME MEASURES: Correlation coefficient (r) of PROMIS PF, Pin, PIf, PB with legacy outcomes. METHODS: A systematic search of the Pubmed, EMBASE, and Cochrane databases using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines was performed yielding 254 unique studies reporting on “PROMIS” in “spine.” Each study was independently reviewed. Fifty-four studies were selected for review, and 16 studies were selected for inclusion.
RESULTS: The pooled sample size yielded a total of 4,344 patients. In the cervical population, PROMIS physical function (PF), pain intensity (PIn), pain interference (PIf) and pain behavior (PB) all strongly correlated with the NDI (average jrj=0.64-0.76). PROMIS PF also strongly correlated with the mJOA (average jrj=0.66). Among patients with lumbar pathology and adult spinal deformities, the PF, PIn, PIf, PB, and social roles satisfaction (SR) all strongly correlated with the ODI (jrj=0.66-0.76). PF, PI, and anxiety (AX) also strongly correlated with the SRS-22/SRS-30. When comparing PROMIS to legacy measures of global health, PROMIS PF was strongly correlated with the SF-12 (jrj=0.67), while PROMIS AX and depression (D) correlated with the GAD and PHQ-8 measures. On average, all individual PROMIS domains required less time to complete (49.6-56 seconds) compared to ODI (176 seconds), NDI (190.3 seconds), SF-12 (214 seconds), and SF-36 PF (99 seconds). Responsiveness of PROMIS PF (ES=0.85, SRM=0.88), PIf (ES=1.14, SRM=0.92), and PB (ES=0.895) was comparable to ODI (ES=1.02, SRM=1.06), NDI (ES=0.75, SRM=0.96) and SF-12 (ES=0.675) CONCLUSIONS: PROMIS PF, PIn, PIf and PB demonstrated strong correlations with NDI, mJOA, ODI, SRS, and SF-12 measures in various spine patient populations. Decreased time to completion and comparable responsiveness of PROMIS suggests that it may be used to assess patientreported outcomes in spinal surgery patients. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.542
P118. Which NDI domains best predict change in physical function in patients undergoing cervical spine surgery? Michael E. Steinhaus, MD1, Sravisht Iyer, MD2, Francis C. Lovecchio, MD1, Dan Stein, BS1, Thomas Ross, RN, MS3, Jingyan Yang, PhD1, Virginie Lafage, PhD1, Todd J. Albert, MD1, Han Jo Kim, MD1; 1 Hospital for Special Surgery, New York, NY, US; 2 Rush University Medical Center, Chicago, IL, US; 3 New York, NY, US BACKGROUND CONTEXT: Physical function is a critical aspect of patient-reported outcomes and is measured by multiple instruments. While the Neck Disability Index (NDI) is a popular and widely validated outcome measure in cervical spine disease, to what extent its individual domains predict changes in physical function remains unknown. PURPOSE: To examine the impact of individual NDI domains on changes in physical function in patients undergoing cervical spine surgery. STUDY DESIGN/SETTING: Prospective cohort study. PATIENT SAMPLE: Adult patients undergoing cervical spine surgery, excluding those undergoing surgery for instability due to trauma. OUTCOME MEASURES: Absolute change in outcome measures (PROMIS PF, SF-36 PCS, NDI) from pre- to postoperatively, correlation of NDI individual domains with PROMIS PF and SF-36 PCS (preoperatively, postoperatively, and change from pre- to postoperatively). METHODS: Patients undergoing cervical spine surgery between 20162018 were prospectively enrolled. Patients completed questionnaires (NDI, SF-36 PCS, and PROMIS PF) preoperatively and at 6 months postoperatively. Patient demographics, including age, body mass index (BMI), Charlson Comorbidity Index (CCI) and underlying diagnoses were collected. Comparisons between NDI scores preoperatively versus postoperatively were conducted using Student paired t-test. Correlations of NDI individual items and PROMIS/SF-36 were assessed using Pearson correlation. A stepwise linear regression analysis was performed to identify NDI items that are independently predictive of PROMIS PF and SF-36 PCS. RESULTS: A total of 137 patients were included in the study, with mean age 56.9 years (range, 24.4-84.9). Each of the NDI domains as well as PROMIS PF and SF-36 PCS demonstrated significant improvement following cervical spine surgery (p<0.001). Changes in all NDI domains demonstrated significant negative correlation with changes in PROMIS PF, with recreation (R=-0.537, p<0.001), work (R=-0.514, p<0.001), and pain intensity (R=-0.488, p<0.001) having the greatest negative
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.
Proceedings of the 34th Annual Meeting of the North American Spine Society / The Spine Journal 19 (2019) S195−S231
BACKGROUND CONTEXT: Anterior cervical plating in anterior cervical discectomy and fusion (ACDF) procedures are associated with improved outcomes compared to stand-alone cages. However, concerns exist regarding increased rates of postoperative dysphagia following an ACDF. PURPOSE: To quantify the effect of anterior plating on SWAL-QOL scores and radiographic swelling assessments following a primary, singlelevel ACDF. STUDY DESIGN/SETTING: Retrospective cohort. PATIENT SAMPLE: A total of 68 patients who underwent a primary, single-level ACDF from 2014-2017. OUTCOME MEASURES: SWAL-QOL scores, radiographic swelling. METHODS: Patients were retrospectively reviewed and grouped by those receiving a stand-alone cage (cage) or cage with anterior plating (plate). SWAL-QOL scores were recorded preoperatively and 6-week and 12-week postoperatively. Lateral radiographs were used to create a swelling index with a ratio of the prevertebral swelling distance to the anteriorposterior diameter of each involved vertebral body. A tracheal air index was created using the same methodology. Statistical analysis was performed using chi-square analysis and independent t-tests for categorical and continuous variables. RESULTS: A total of 68 primary, single-level ACDF patients were included. Forty-one (60.3%) received a stand-alone cage and 27 (39.7%) received a cage with anterior plating. No differences in demographics, comorbidities, operative time, estimated blood loss, or length of hospital stay were identified between cage and plate cohorts. Additionally, no differences were observed in postoperative SWAL-QOL scores. Swelling index was greater for the plate cohort at 6-weeks but was similar between groups at 12-weeks. The air index was similar at all time points. CONCLUSIONS: The results demonstrate that patients undergoing a primary, single-level ACDF with or without anterior plating experience similar operative times and lengths of stay. Patients that receive a cage with anterior plating did not experience significant increases in dysphagia as measured by the SWAL-QOL questionnaire compared to patients that received a stand-alone cage. Furthermore, radiographic assessments of swelling are comparable between cohorts. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.541 P117. The use of patient-reported outcomes measurement information system (PROMIS) in spine surgery: a systematic review Kelsey Young, BA1, Catherine Himo Gang, MPH1, Avani S. Vaishnav, MBBS1, Bridget Jivanelli, MS, BA2, Michael E. Steinhaus, MD1, Francis C. Lovecchio, MD1, Sheeraz A. Qureshi, MD, MBA2, Steven J. McAnany, MD3, Han Jo Kim, MD1, Sravisht Iyer, MD4; 1 Hospital for Special Surgery, New York, NY, US; 2 New York, NY, US; 3 Hospital for Special Surgery, Stamford, CT, US; 4 Rush University Medical Center, Chicago, IL, US BACKGROUND CONTEXT: PROMIS was developed to provide a time-saving, easy to administer patient outcome questionnaire that was adaptable to a variety of medical and surgical subspecialties. Numerous authors have examined the effectiveness of PROMIS in various areas of spine surgery. PURPOSE: To assess the correlation of PROMIS with legacy patientreported outcome measures in spine surgery STUDY DESIGN/SETTING: Systematic review. OUTCOME MEASURES: Correlation coefficient (r) of PROMIS PF, Pin, PIf, PB with legacy outcomes. METHODS: A systematic search of the Pubmed, EMBASE, and Cochrane databases using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines was performed yielding 254 unique studies reporting on “PROMIS” in “spine.” Each study was independently reviewed. Fifty-four studies were selected for review, and 16 studies were selected for inclusion.
RESULTS: The pooled sample size yielded a total of 4,344 patients. In the cervical population, PROMIS physical function (PF), pain intensity (PIn), pain interference (PIf) and pain behavior (PB) all strongly correlated with the NDI (average jrj=0.64-0.76). PROMIS PF also strongly correlated with the mJOA (average jrj=0.66). Among patients with lumbar pathology and adult spinal deformities, the PF, PIn, PIf, PB, and social roles satisfaction (SR) all strongly correlated with the ODI (jrj=0.66-0.76). PF, PI, and anxiety (AX) also strongly correlated with the SRS-22/SRS-30. When comparing PROMIS to legacy measures of global health, PROMIS PF was strongly correlated with the SF-12 (jrj=0.67), while PROMIS AX and depression (D) correlated with the GAD and PHQ-8 measures. On average, all individual PROMIS domains required less time to complete (49.6-56 seconds) compared to ODI (176 seconds), NDI (190.3 seconds), SF-12 (214 seconds), and SF-36 PF (99 seconds). Responsiveness of PROMIS PF (ES=0.85, SRM=0.88), PIf (ES=1.14, SRM=0.92), and PB (ES=0.895) was comparable to ODI (ES=1.02, SRM=1.06), NDI (ES=0.75, SRM=0.96) and SF-12 (ES=0.675) CONCLUSIONS: PROMIS PF, PIn, PIf and PB demonstrated strong correlations with NDI, mJOA, ODI, SRS, and SF-12 measures in various spine patient populations. Decreased time to completion and comparable responsiveness of PROMIS suggests that it may be used to assess patientreported outcomes in spinal surgery patients. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.542
P118. Which NDI domains best predict change in physical function in patients undergoing cervical spine surgery? Michael E. Steinhaus, MD1, Sravisht Iyer, MD2, Francis C. Lovecchio, MD1, Dan Stein, BS1, Thomas Ross, RN, MS3, Jingyan Yang, PhD1, Virginie Lafage, PhD1, Todd J. Albert, MD1, Han Jo Kim, MD1; 1 Hospital for Special Surgery, New York, NY, US; 2 Rush University Medical Center, Chicago, IL, US; 3 New York, NY, US BACKGROUND CONTEXT: Physical function is a critical aspect of patient-reported outcomes and is measured by multiple instruments. While the Neck Disability Index (NDI) is a popular and widely validated outcome measure in cervical spine disease, to what extent its individual domains predict changes in physical function remains unknown. PURPOSE: To examine the impact of individual NDI domains on changes in physical function in patients undergoing cervical spine surgery. STUDY DESIGN/SETTING: Prospective cohort study. PATIENT SAMPLE: Adult patients undergoing cervical spine surgery, excluding those undergoing surgery for instability due to trauma. OUTCOME MEASURES: Absolute change in outcome measures (PROMIS PF, SF-36 PCS, NDI) from pre- to postoperatively, correlation of NDI individual domains with PROMIS PF and SF-36 PCS (preoperatively, postoperatively, and change from pre- to postoperatively). METHODS: Patients undergoing cervical spine surgery between 20162018 were prospectively enrolled. Patients completed questionnaires (NDI, SF-36 PCS, and PROMIS PF) preoperatively and at 6 months postoperatively. Patient demographics, including age, body mass index (BMI), Charlson Comorbidity Index (CCI) and underlying diagnoses were collected. Comparisons between NDI scores preoperatively versus postoperatively were conducted using Student paired t-test. Correlations of NDI individual items and PROMIS/SF-36 were assessed using Pearson correlation. A stepwise linear regression analysis was performed to identify NDI items that are independently predictive of PROMIS PF and SF-36 PCS. RESULTS: A total of 137 patients were included in the study, with mean age 56.9 years (range, 24.4-84.9). Each of the NDI domains as well as PROMIS PF and SF-36 PCS demonstrated significant improvement following cervical spine surgery (p<0.001). Changes in all NDI domains demonstrated significant negative correlation with changes in PROMIS PF, with recreation (R=-0.537, p<0.001), work (R=-0.514, p<0.001), and pain intensity (R=-0.488, p<0.001) having the greatest negative
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.