Can early patient-reported outcomes be used to identify patients at risk for poor 1-year health outcomes after lumbar laminectomy with arthrodesis?

Research output: Contribution to journalArticle

Abstract

Study Design. Prospective cohort. Objective. Determine A) between-patient variability in patient-reported outcomes (PROs) at four postoperative time points; B) within-patient correlation of 1-year PROs with PROs at three earlier time points; and C) ability of early PROs to predict 1-year PROs after lumbar laminectomy with arthrodesis. Summary of Background Data. It is unclear whether early PROs can help identify patients at risk for poor health outcomes. Methods. Between 2015 and 2016, we assessed pre- A nd postoperative back pain, leg pain, disability, physical health, and mental health in 146 patients. We examined PRO variability between patients and correlations within patients during the first postoperative year. For early (≤3-mo) and 1-year PROs, we examined concordance between experiencing a minimal important difference (MID) early and at 1 year and odds of experiencing a 1-year MID given early absence of a MID. Results. Postoperatively, we found increasing between-patient variability of PROs. For individual patients, we found moderate to strong between-assessment correlations (intraclass correlations) between repeated PROs (back pain, 0.47; leg pain, 0.51; disability, 0.47; physical health, 0.63; mental health, 0.53). Early MIDs were experienced for back pain (57%), leg pain (52%), physical health (38%), disability (34%), and mental health (16%). Concordance was moderate for leg pain (0.48), mental health (0.46), disability (0.38), back pain (0.36), and physical health (0.25). In patients without an early MID, odds of experiencing a MID at 1 year were low for physical health (odds ratio [OR] = 0.33), back pain (OR = 0.30), leg pain (OR = 0.14), and disability (OR = 0.11) but not mental health (OR = 0.50). Conclusion. Although postoperative recovery is variable, early PROs can identify patients at risk for poor 1-year outcomes and may help tailor care during the first year after lumbar laminectomy with arthrodesis.

Original languageEnglish (US)
Pages (from-to)1067-1073
Number of pages7
JournalSpine
Volume43
Issue number15
DOIs
StatePublished - Aug 1 2018

Fingerprint

Laminectomy
Arthrodesis
Health
Back Pain
Leg
Mental Health
Odds Ratio
Pain
Patient Reported Outcome Measures
Aptitude
Postoperative Pain

Keywords

  • arthrodesis
  • brief pain inventory
  • disability
  • lumbar laminectomy
  • lumbar spine
  • Oswestry Disability Index
  • pain
  • patient counseling
  • patient-reported outcomes
  • Short-Form 12-Item Health Survey
  • version 2

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

@article{52dcda3d86b649c698f4685b5196435e,
title = "Can early patient-reported outcomes be used to identify patients at risk for poor 1-year health outcomes after lumbar laminectomy with arthrodesis?",
abstract = "Study Design. Prospective cohort. Objective. Determine A) between-patient variability in patient-reported outcomes (PROs) at four postoperative time points; B) within-patient correlation of 1-year PROs with PROs at three earlier time points; and C) ability of early PROs to predict 1-year PROs after lumbar laminectomy with arthrodesis. Summary of Background Data. It is unclear whether early PROs can help identify patients at risk for poor health outcomes. Methods. Between 2015 and 2016, we assessed pre- A nd postoperative back pain, leg pain, disability, physical health, and mental health in 146 patients. We examined PRO variability between patients and correlations within patients during the first postoperative year. For early (≤3-mo) and 1-year PROs, we examined concordance between experiencing a minimal important difference (MID) early and at 1 year and odds of experiencing a 1-year MID given early absence of a MID. Results. Postoperatively, we found increasing between-patient variability of PROs. For individual patients, we found moderate to strong between-assessment correlations (intraclass correlations) between repeated PROs (back pain, 0.47; leg pain, 0.51; disability, 0.47; physical health, 0.63; mental health, 0.53). Early MIDs were experienced for back pain (57{\%}), leg pain (52{\%}), physical health (38{\%}), disability (34{\%}), and mental health (16{\%}). Concordance was moderate for leg pain (0.48), mental health (0.46), disability (0.38), back pain (0.36), and physical health (0.25). In patients without an early MID, odds of experiencing a MID at 1 year were low for physical health (odds ratio [OR] = 0.33), back pain (OR = 0.30), leg pain (OR = 0.14), and disability (OR = 0.11) but not mental health (OR = 0.50). Conclusion. Although postoperative recovery is variable, early PROs can identify patients at risk for poor 1-year outcomes and may help tailor care during the first year after lumbar laminectomy with arthrodesis.",
keywords = "arthrodesis, brief pain inventory, disability, lumbar laminectomy, lumbar spine, Oswestry Disability Index, pain, patient counseling, patient-reported outcomes, Short-Form 12-Item Health Survey, version 2",
author = "Purvis, {Taylor E.} and Neuman, {Brian J} and Riley, {Lee H} and Richard Skolasky",
year = "2018",
month = "8",
day = "1",
doi = "10.1097/BRS.0000000000002522",
language = "English (US)",
volume = "43",
pages = "1067--1073",
journal = "Spine",
issn = "0362-2436",
publisher = "Lippincott Williams and Wilkins",
number = "15",

}

TY - JOUR

T1 - Can early patient-reported outcomes be used to identify patients at risk for poor 1-year health outcomes after lumbar laminectomy with arthrodesis?

AU - Purvis, Taylor E.

AU - Neuman, Brian J

AU - Riley, Lee H

AU - Skolasky, Richard

PY - 2018/8/1

Y1 - 2018/8/1

N2 - Study Design. Prospective cohort. Objective. Determine A) between-patient variability in patient-reported outcomes (PROs) at four postoperative time points; B) within-patient correlation of 1-year PROs with PROs at three earlier time points; and C) ability of early PROs to predict 1-year PROs after lumbar laminectomy with arthrodesis. Summary of Background Data. It is unclear whether early PROs can help identify patients at risk for poor health outcomes. Methods. Between 2015 and 2016, we assessed pre- A nd postoperative back pain, leg pain, disability, physical health, and mental health in 146 patients. We examined PRO variability between patients and correlations within patients during the first postoperative year. For early (≤3-mo) and 1-year PROs, we examined concordance between experiencing a minimal important difference (MID) early and at 1 year and odds of experiencing a 1-year MID given early absence of a MID. Results. Postoperatively, we found increasing between-patient variability of PROs. For individual patients, we found moderate to strong between-assessment correlations (intraclass correlations) between repeated PROs (back pain, 0.47; leg pain, 0.51; disability, 0.47; physical health, 0.63; mental health, 0.53). Early MIDs were experienced for back pain (57%), leg pain (52%), physical health (38%), disability (34%), and mental health (16%). Concordance was moderate for leg pain (0.48), mental health (0.46), disability (0.38), back pain (0.36), and physical health (0.25). In patients without an early MID, odds of experiencing a MID at 1 year were low for physical health (odds ratio [OR] = 0.33), back pain (OR = 0.30), leg pain (OR = 0.14), and disability (OR = 0.11) but not mental health (OR = 0.50). Conclusion. Although postoperative recovery is variable, early PROs can identify patients at risk for poor 1-year outcomes and may help tailor care during the first year after lumbar laminectomy with arthrodesis.

AB - Study Design. Prospective cohort. Objective. Determine A) between-patient variability in patient-reported outcomes (PROs) at four postoperative time points; B) within-patient correlation of 1-year PROs with PROs at three earlier time points; and C) ability of early PROs to predict 1-year PROs after lumbar laminectomy with arthrodesis. Summary of Background Data. It is unclear whether early PROs can help identify patients at risk for poor health outcomes. Methods. Between 2015 and 2016, we assessed pre- A nd postoperative back pain, leg pain, disability, physical health, and mental health in 146 patients. We examined PRO variability between patients and correlations within patients during the first postoperative year. For early (≤3-mo) and 1-year PROs, we examined concordance between experiencing a minimal important difference (MID) early and at 1 year and odds of experiencing a 1-year MID given early absence of a MID. Results. Postoperatively, we found increasing between-patient variability of PROs. For individual patients, we found moderate to strong between-assessment correlations (intraclass correlations) between repeated PROs (back pain, 0.47; leg pain, 0.51; disability, 0.47; physical health, 0.63; mental health, 0.53). Early MIDs were experienced for back pain (57%), leg pain (52%), physical health (38%), disability (34%), and mental health (16%). Concordance was moderate for leg pain (0.48), mental health (0.46), disability (0.38), back pain (0.36), and physical health (0.25). In patients without an early MID, odds of experiencing a MID at 1 year were low for physical health (odds ratio [OR] = 0.33), back pain (OR = 0.30), leg pain (OR = 0.14), and disability (OR = 0.11) but not mental health (OR = 0.50). Conclusion. Although postoperative recovery is variable, early PROs can identify patients at risk for poor 1-year outcomes and may help tailor care during the first year after lumbar laminectomy with arthrodesis.

KW - arthrodesis

KW - brief pain inventory

KW - disability

KW - lumbar laminectomy

KW - lumbar spine

KW - Oswestry Disability Index

KW - pain

KW - patient counseling

KW - patient-reported outcomes

KW - Short-Form 12-Item Health Survey

KW - version 2

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U2 - 10.1097/BRS.0000000000002522

DO - 10.1097/BRS.0000000000002522

M3 - Article

VL - 43

SP - 1067

EP - 1073

JO - Spine

JF - Spine

SN - 0362-2436

IS - 15

ER -