Do Cervical Spine Surgery Patients Recall Their Preoperative Status? A Cohort Study of Recall Bias in Patient-reported Outcomes

Ilyas S. Aleem, Bradford L. Currier, Michael J Yaszemski, Heidi Poppendeck, Paul Huddleston, Jason Eck, John Rhee, Mohamad Bydon, Brett Freedman, Ahmad Nassr

Research output: Contribution to journalArticle

Abstract

Study Design: This is a prospective cohort study. Objective: To characterize the accuracy of patient recollection of preoperative symptoms after cervical spine surgery. Summary of Background Data: Recall bias is a well-known source of systematic error. The accuracy of patient recall after cervical spine surgery remains unknown. Methods: Consecutive patients undergoing cervical spine surgery for myelopathy or radiculopathy were enrolled. Neck and arm numeric pain scores and Neck Disability Indices were recorded preoperatively. Patients were asked to recall their preoperative status at either short (<1 y) or long-term (≥1 y) follow-up. Actual and recalled scores were compared using paired t tests and relations were quantified using the Pearson correlation coefficients. Multivariable linear regression was used to identify factors impacting recollection. Results: In total, 73 patients with a mean age of 58.2 years were included. Compared with their preoperative scores, patients showed significant improvement in neck pain [mean difference (MD)=-2.9; 95% confidence intervals (CIs), -3.5 to -2.3], arm pain (MD, -3.4; 95% CI, -4.0 to -2.8), and disability (MD, -12.4%; 95% CI, -16.9 to -7.9). Patient recollection of preoperative status was significantly more severe than actual for neck pain (MD, +1.5; 95% CI, 0.8-2.2), arm pain (MD, +2.3; 95% CI, 1.6-3.0), and disability (MD, +5.8%; 95% CI, 2.4-9.2). Moderate correlation between actual and recalled scores with regard to neck (r=0.41), arm (r=0.50) pain, and disability (r=0.67) was seen. This was maintained across age, sex, and time between date of surgery and recollection. Over 30% of patients switched their predominant symptom from neck-to-arm pain or vice versa on recall of their preoperative symptoms. Conclusions: Relying on patient recollection does not provide an accurate measure of preoperative status after cervical spine surgery. Prospective and not retrospective collection of patient-reported outcomes remain the gold standard to measure and interpret outcomes after cervical spine surgery. Recall bias has the potential to affect patient satisfaction and requires further study.

Original languageEnglish (US)
JournalClinical Spine Surgery
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Spine
Cohort Studies
Confidence Intervals
Arm
Neck Pain
Pain
Neck
Patient Reported Outcome Measures
Radiculopathy
Spinal Cord Diseases
Patient Satisfaction
Linear Models
Research Design
Outcome Assessment (Health Care)
Prospective Studies

Keywords

  • cervical decompression
  • cervical fusion
  • cervical myelopathy
  • cervical radiculopathy
  • patient recall
  • patient-reported outcomes
  • recall bias

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Do Cervical Spine Surgery Patients Recall Their Preoperative Status? A Cohort Study of Recall Bias in Patient-reported Outcomes. / Aleem, Ilyas S.; Currier, Bradford L.; Yaszemski, Michael J; Poppendeck, Heidi; Huddleston, Paul; Eck, Jason; Rhee, John; Bydon, Mohamad; Freedman, Brett; Nassr, Ahmad.

In: Clinical Spine Surgery, 01.01.2018.

Research output: Contribution to journalArticle

Aleem, Ilyas S. ; Currier, Bradford L. ; Yaszemski, Michael J ; Poppendeck, Heidi ; Huddleston, Paul ; Eck, Jason ; Rhee, John ; Bydon, Mohamad ; Freedman, Brett ; Nassr, Ahmad. / Do Cervical Spine Surgery Patients Recall Their Preoperative Status? A Cohort Study of Recall Bias in Patient-reported Outcomes. In: Clinical Spine Surgery. 2018.
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abstract = "Study Design: This is a prospective cohort study. Objective: To characterize the accuracy of patient recollection of preoperative symptoms after cervical spine surgery. Summary of Background Data: Recall bias is a well-known source of systematic error. The accuracy of patient recall after cervical spine surgery remains unknown. Methods: Consecutive patients undergoing cervical spine surgery for myelopathy or radiculopathy were enrolled. Neck and arm numeric pain scores and Neck Disability Indices were recorded preoperatively. Patients were asked to recall their preoperative status at either short (<1 y) or long-term (≥1 y) follow-up. Actual and recalled scores were compared using paired t tests and relations were quantified using the Pearson correlation coefficients. Multivariable linear regression was used to identify factors impacting recollection. Results: In total, 73 patients with a mean age of 58.2 years were included. Compared with their preoperative scores, patients showed significant improvement in neck pain [mean difference (MD)=-2.9; 95{\%} confidence intervals (CIs), -3.5 to -2.3], arm pain (MD, -3.4; 95{\%} CI, -4.0 to -2.8), and disability (MD, -12.4{\%}; 95{\%} CI, -16.9 to -7.9). Patient recollection of preoperative status was significantly more severe than actual for neck pain (MD, +1.5; 95{\%} CI, 0.8-2.2), arm pain (MD, +2.3; 95{\%} CI, 1.6-3.0), and disability (MD, +5.8{\%}; 95{\%} CI, 2.4-9.2). Moderate correlation between actual and recalled scores with regard to neck (r=0.41), arm (r=0.50) pain, and disability (r=0.67) was seen. This was maintained across age, sex, and time between date of surgery and recollection. Over 30{\%} of patients switched their predominant symptom from neck-to-arm pain or vice versa on recall of their preoperative symptoms. Conclusions: Relying on patient recollection does not provide an accurate measure of preoperative status after cervical spine surgery. Prospective and not retrospective collection of patient-reported outcomes remain the gold standard to measure and interpret outcomes after cervical spine surgery. Recall bias has the potential to affect patient satisfaction and requires further study.",
keywords = "cervical decompression, cervical fusion, cervical myelopathy, cervical radiculopathy, patient recall, patient-reported outcomes, recall bias",
author = "Aleem, {Ilyas S.} and Currier, {Bradford L.} and Yaszemski, {Michael J} and Heidi Poppendeck and Paul Huddleston and Jason Eck and John Rhee and Mohamad Bydon and Brett Freedman and Ahmad Nassr",
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AU - Currier, Bradford L.

AU - Yaszemski, Michael J

AU - Poppendeck, Heidi

AU - Huddleston, Paul

AU - Eck, Jason

AU - Rhee, John

AU - Bydon, Mohamad

AU - Freedman, Brett

AU - Nassr, Ahmad

PY - 2018/1/1

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N2 - Study Design: This is a prospective cohort study. Objective: To characterize the accuracy of patient recollection of preoperative symptoms after cervical spine surgery. Summary of Background Data: Recall bias is a well-known source of systematic error. The accuracy of patient recall after cervical spine surgery remains unknown. Methods: Consecutive patients undergoing cervical spine surgery for myelopathy or radiculopathy were enrolled. Neck and arm numeric pain scores and Neck Disability Indices were recorded preoperatively. Patients were asked to recall their preoperative status at either short (<1 y) or long-term (≥1 y) follow-up. Actual and recalled scores were compared using paired t tests and relations were quantified using the Pearson correlation coefficients. Multivariable linear regression was used to identify factors impacting recollection. Results: In total, 73 patients with a mean age of 58.2 years were included. Compared with their preoperative scores, patients showed significant improvement in neck pain [mean difference (MD)=-2.9; 95% confidence intervals (CIs), -3.5 to -2.3], arm pain (MD, -3.4; 95% CI, -4.0 to -2.8), and disability (MD, -12.4%; 95% CI, -16.9 to -7.9). Patient recollection of preoperative status was significantly more severe than actual for neck pain (MD, +1.5; 95% CI, 0.8-2.2), arm pain (MD, +2.3; 95% CI, 1.6-3.0), and disability (MD, +5.8%; 95% CI, 2.4-9.2). Moderate correlation between actual and recalled scores with regard to neck (r=0.41), arm (r=0.50) pain, and disability (r=0.67) was seen. This was maintained across age, sex, and time between date of surgery and recollection. Over 30% of patients switched their predominant symptom from neck-to-arm pain or vice versa on recall of their preoperative symptoms. Conclusions: Relying on patient recollection does not provide an accurate measure of preoperative status after cervical spine surgery. Prospective and not retrospective collection of patient-reported outcomes remain the gold standard to measure and interpret outcomes after cervical spine surgery. Recall bias has the potential to affect patient satisfaction and requires further study.

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KW - cervical decompression

KW - cervical fusion

KW - cervical myelopathy

KW - cervical radiculopathy

KW - patient recall

KW - patient-reported outcomes

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