- Email: [email protected]
Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters
The Spine Journal 18 (2018) S142 S225
S167
PATIENT SAMPLE: A total of 250 orthopedic spine surgeons were randomly selected from the North American Spine Society directory utilizing a random number generator. OUTCOME MEASURES: Surgeon profiles on three physician rating websites, www.HealthGrades.com, www.Vitals.com, and www.RateMDs. com, were analyzed to gather qualitative and quantitative data on patients’ perceptions of the surgeons. METHODS: Independent variables from the websites were analyzed in relation to overall physician or patient satisfaction rating using independent-samples t-tests and linear regression analysis. Comments were coded by subject into three categories: professional competence, bedside manner, and practice characteristics. RESULTS: A total of 250 surgeons were evaluated, and 92% (n=230) of these doctors had at least one rating among the three websites. The surgeons with a higher average rating had significantly better trust (p<.01), scheduling (p<.01), staff (p<.01), helpfulness (p<.01), and punctuality (p<.01) scores but significantly less experience (p<.05). A linear regression model for the average rating of each surgeon (r-squared value=0.754) yielded only three significant variables: trustworthiness (p<.01), experience match (p<.05), and the average number of negative comments on surgeon professional competence (p<.05). Trustworthiness (beta=0.749) was the strongest predictor variable of physician rating, followed by number of negative professional competence comments (beta=−0.132) and experience match (beta=−0.112). CONCLUSIONS: This investigation assessed spine surgeon online patient ratings and categorized factors which patients associate with quality care. Trustworthiness was the most significant predictor of positive ratings, while ease of scheduling, quality of staff, helpfulness, and punctuality were also associated with higher patient ratings. Understanding what patients value may help optimize care of spine surgery patients.
and the weighting of the connections (strength of the effect) between these factors. Factors from each model were tabulated and categorized into eight domains: (1) nociceptive detection and processing, (2) behavioral or lifestyle (3) tissue injury or pathology, (4) contextual, (5) psychological (6) social or work, (7) biomechanical, and (8) individual factors. To determine the importance of each factor expressed in the FCM, centrality was computed as: Centrality = |a|*(# of connections in)+|b|*(# of connections out), where a and b are the weighting or strength of the connections. Based on this definition, centrality of a factor increases by the number of connections to and from the specific factor in the FCM, as well as by the weighting of these connections. Centrality of each domain (sum of centrality for each factor within the designated domain) was expressed as a percentage of the eight domains and grouped by discipline. RESULTS: A total of 263 factors were generated from the 28 FCM. Psychological factors was the most prominent domain accounting for 33% of the centrality across all six participant groups, and was the most “central” domain for four groups (chiropractic, physical medicine and rehabilitation, physical or exercise therapy, and psychology). Tissue injury or pathology accounted for 14.7% of the centrality across all groups and was the most “central” for the remaining two groups (basic science and spinal surgery). CONCLUSIONS: Psychological factors were considered to be the most central or important to understanding LBP across disciplines, yet many of these professions do not specialize in the psychology of LBP. Although the selection of individuals and the relatively small sample size representing each discipline may bias the results, such findings support the notion that multidisciplinary interventions (which includes consideration of psychological factors) to treating patients with LBP is sensible.
FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
https://doi.org/10.1016/j.spinee.2018.06.595
https://doi.org/10.1016/j.spinee.2018.06.594
P58. Identifying discharge destination in patients undergoing vertebral ORIF: analysis of 1,055 cases Thomas Kroshus, BA1, Khushdeep S. Vig1, William A. Ranson, MD2, Oscar A. Carrillo, BS2, Samuel J. White, BA1, Deepak Kaji, BA1, Ray Tang, BA1, Ivan B. Ye, BA1, John Di Capua, MHS, BS2, Jun Kim, MD3; 1 New York, NY, USA; 2 Icahn School of Medicine at Mount Sinai, New York, NY, USA; 3 Mount Sinai Medical Center, New York, NY, USA
P57. NASS Think Tank workshop reveals psychological factors are central to understanding chronic low back pain John M. Popovich Jr., PhD, DPT, ATC1, Payam Aminpor, PhD2, Jacek Cholewicki, PhD3, Paul Hodges, PhD4, Steven Gray, PhD2; 1 MSU Center for Orthopedic Research, Lansing, MI, USA; 2 East Lansing, MI, USA; 3 Michigan State University, East Lansing, MI, USA; 4 The University of Queensland, Brisbane, QLD, Australia BACKGROUND CONTEXT: Low back pain (LBP) is a bio-psychosocial condition and LBP patients are treated by various health professionals with different training and presumed beliefs. Considering that theoretical foundations and emphases vary among health disciplines, it is possible that these professionals (eg, researchers and clinicians from different disciplines) possess different “mental models” of what and how various factors relate to LBP. A novel way to investigate individual thinking about particular processes is through the development and analysis of fuzzy-logic cognitive maps (FCM). FCMs are particularly useful for modeling interactions between variables in complex systems, such as LBP. This study aimed to use this approach to describe similarities and differences by which different health professionals think about LBP. METHODS: Participants from different disciplines (n=28), who have contributed significantly to the understanding of LBP (eg, publications, contributions to societies, etc.), were selectively recruited for this study and represented the following disciplines: (1) basic science (n=6), (2) chiropractic (n=4), (3) spine surgery (n=2), (4) physical medicine & rehabilitation (n=2), (5) physical or exercise therapy (n=12), and (6) psychology (n=2). Each participant underwent a structured one-on-one interview to construct an FCM that represented the individual's understanding (mental model) of how factors related to LBP using Mental Modeler software (www.mentalmodeler.org). This process involved nomination of factors contributing to patients’ outcomes (ie, pain, disability, and quality of life)
FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
BACKGROUND CONTEXT: Literature isolating the risk factors correlated with postoperative discharge destination after open reduction internal fixation (ORIF) procedures for vertebral fractures or dislocations is scarce. Delineating these risk factors is crucial to risk stratification and outcome improvement in high-risk populations. The purpose of this study was to identify risk factors associated with discharge to a nonhome facility in patients undergoing ORIF in order to isolate predictive factors that may be used to plan patient discharge. METHODS: This was a retrospective analysis of prospectively collected data from ACS-NSQIP database from 2010 to 2014. Patients undergoing ORIF of vertebral fractures and/or dislocations were identified and different independent risk factors were analyzed for their correlation with discharge to a nonhome facility. Nonhome destinations include skilled and nonskilled care facilities, nursing homes, assisted living, and rehabilitation center. Vertebral ORIF procedures occurring in the cervical spine were compared to thoracic and lumbar procedures with respect to nonhome discharge destination. Univariate analysis was used to assess patient baseline characteristics, comorbidities, and perioperative outcomes. Multivariable stepwise logistic regression models were employed, adjusting for patient demographic, and patient comorbidities, to identify the clinical risk factors associated with nonhome discharge. RESULTS: A total of 1,055 vertebral ORIF cases were identified, and 387 (36.68%) of these patients were discharged to a nonhome facility. In comparison to cervical vertebral ORIF procedures, thoracic and lumbar procedures did not show a statistically significant propensity for nonhome discharge but both did show different statistical trends: thoracic procedures
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.
S167
PATIENT SAMPLE: A total of 250 orthopedic spine surgeons were randomly selected from the North American Spine Society directory utilizing a random number generator. OUTCOME MEASURES: Surgeon profiles on three physician rating websites, www.HealthGrades.com, www.Vitals.com, and www.RateMDs. com, were analyzed to gather qualitative and quantitative data on patients’ perceptions of the surgeons. METHODS: Independent variables from the websites were analyzed in relation to overall physician or patient satisfaction rating using independent-samples t-tests and linear regression analysis. Comments were coded by subject into three categories: professional competence, bedside manner, and practice characteristics. RESULTS: A total of 250 surgeons were evaluated, and 92% (n=230) of these doctors had at least one rating among the three websites. The surgeons with a higher average rating had significantly better trust (p<.01), scheduling (p<.01), staff (p<.01), helpfulness (p<.01), and punctuality (p<.01) scores but significantly less experience (p<.05). A linear regression model for the average rating of each surgeon (r-squared value=0.754) yielded only three significant variables: trustworthiness (p<.01), experience match (p<.05), and the average number of negative comments on surgeon professional competence (p<.05). Trustworthiness (beta=0.749) was the strongest predictor variable of physician rating, followed by number of negative professional competence comments (beta=−0.132) and experience match (beta=−0.112). CONCLUSIONS: This investigation assessed spine surgeon online patient ratings and categorized factors which patients associate with quality care. Trustworthiness was the most significant predictor of positive ratings, while ease of scheduling, quality of staff, helpfulness, and punctuality were also associated with higher patient ratings. Understanding what patients value may help optimize care of spine surgery patients.
and the weighting of the connections (strength of the effect) between these factors. Factors from each model were tabulated and categorized into eight domains: (1) nociceptive detection and processing, (2) behavioral or lifestyle (3) tissue injury or pathology, (4) contextual, (5) psychological (6) social or work, (7) biomechanical, and (8) individual factors. To determine the importance of each factor expressed in the FCM, centrality was computed as: Centrality = |a|*(# of connections in)+|b|*(# of connections out), where a and b are the weighting or strength of the connections. Based on this definition, centrality of a factor increases by the number of connections to and from the specific factor in the FCM, as well as by the weighting of these connections. Centrality of each domain (sum of centrality for each factor within the designated domain) was expressed as a percentage of the eight domains and grouped by discipline. RESULTS: A total of 263 factors were generated from the 28 FCM. Psychological factors was the most prominent domain accounting for 33% of the centrality across all six participant groups, and was the most “central” domain for four groups (chiropractic, physical medicine and rehabilitation, physical or exercise therapy, and psychology). Tissue injury or pathology accounted for 14.7% of the centrality across all groups and was the most “central” for the remaining two groups (basic science and spinal surgery). CONCLUSIONS: Psychological factors were considered to be the most central or important to understanding LBP across disciplines, yet many of these professions do not specialize in the psychology of LBP. Although the selection of individuals and the relatively small sample size representing each discipline may bias the results, such findings support the notion that multidisciplinary interventions (which includes consideration of psychological factors) to treating patients with LBP is sensible.
FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
https://doi.org/10.1016/j.spinee.2018.06.595
https://doi.org/10.1016/j.spinee.2018.06.594
P58. Identifying discharge destination in patients undergoing vertebral ORIF: analysis of 1,055 cases Thomas Kroshus, BA1, Khushdeep S. Vig1, William A. Ranson, MD2, Oscar A. Carrillo, BS2, Samuel J. White, BA1, Deepak Kaji, BA1, Ray Tang, BA1, Ivan B. Ye, BA1, John Di Capua, MHS, BS2, Jun Kim, MD3; 1 New York, NY, USA; 2 Icahn School of Medicine at Mount Sinai, New York, NY, USA; 3 Mount Sinai Medical Center, New York, NY, USA
P57. NASS Think Tank workshop reveals psychological factors are central to understanding chronic low back pain John M. Popovich Jr., PhD, DPT, ATC1, Payam Aminpor, PhD2, Jacek Cholewicki, PhD3, Paul Hodges, PhD4, Steven Gray, PhD2; 1 MSU Center for Orthopedic Research, Lansing, MI, USA; 2 East Lansing, MI, USA; 3 Michigan State University, East Lansing, MI, USA; 4 The University of Queensland, Brisbane, QLD, Australia BACKGROUND CONTEXT: Low back pain (LBP) is a bio-psychosocial condition and LBP patients are treated by various health professionals with different training and presumed beliefs. Considering that theoretical foundations and emphases vary among health disciplines, it is possible that these professionals (eg, researchers and clinicians from different disciplines) possess different “mental models” of what and how various factors relate to LBP. A novel way to investigate individual thinking about particular processes is through the development and analysis of fuzzy-logic cognitive maps (FCM). FCMs are particularly useful for modeling interactions between variables in complex systems, such as LBP. This study aimed to use this approach to describe similarities and differences by which different health professionals think about LBP. METHODS: Participants from different disciplines (n=28), who have contributed significantly to the understanding of LBP (eg, publications, contributions to societies, etc.), were selectively recruited for this study and represented the following disciplines: (1) basic science (n=6), (2) chiropractic (n=4), (3) spine surgery (n=2), (4) physical medicine & rehabilitation (n=2), (5) physical or exercise therapy (n=12), and (6) psychology (n=2). Each participant underwent a structured one-on-one interview to construct an FCM that represented the individual's understanding (mental model) of how factors related to LBP using Mental Modeler software (www.mentalmodeler.org). This process involved nomination of factors contributing to patients’ outcomes (ie, pain, disability, and quality of life)
FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
BACKGROUND CONTEXT: Literature isolating the risk factors correlated with postoperative discharge destination after open reduction internal fixation (ORIF) procedures for vertebral fractures or dislocations is scarce. Delineating these risk factors is crucial to risk stratification and outcome improvement in high-risk populations. The purpose of this study was to identify risk factors associated with discharge to a nonhome facility in patients undergoing ORIF in order to isolate predictive factors that may be used to plan patient discharge. METHODS: This was a retrospective analysis of prospectively collected data from ACS-NSQIP database from 2010 to 2014. Patients undergoing ORIF of vertebral fractures and/or dislocations were identified and different independent risk factors were analyzed for their correlation with discharge to a nonhome facility. Nonhome destinations include skilled and nonskilled care facilities, nursing homes, assisted living, and rehabilitation center. Vertebral ORIF procedures occurring in the cervical spine were compared to thoracic and lumbar procedures with respect to nonhome discharge destination. Univariate analysis was used to assess patient baseline characteristics, comorbidities, and perioperative outcomes. Multivariable stepwise logistic regression models were employed, adjusting for patient demographic, and patient comorbidities, to identify the clinical risk factors associated with nonhome discharge. RESULTS: A total of 1,055 vertebral ORIF cases were identified, and 387 (36.68%) of these patients were discharged to a nonhome facility. In comparison to cervical vertebral ORIF procedures, thoracic and lumbar procedures did not show a statistically significant propensity for nonhome discharge but both did show different statistical trends: thoracic procedures
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.