Inadequacy of 3-month oswestry disability index outcome for assessing individual longer-term patient experience after lumbar spine surgery

Anthony L. Asher, Silky Chotai, Clinton J. Devin, Theodore Speroff, Frank E. Harrell, Hui Nian, Robert S. Dittus, Praveen V. Mummaneni, John J. Knightly, Steven D. Glassman, Mohamad Bydon, Kristin R. Archer, Kevin T. Foley, Matthew J. McGirt

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

OBJECTIVE: Prospective longitudinal outcomes registries are at the center of evidence-driven health care reform. Obtaining real-world outcomes data at 12 months can be costly and challenging. In the present study, the authors analyzed whether 3-month outcome measurements sufficiently represent 12-month outcomes for patients with degenerative lumbar disease undergoing surgery. METHODS: Data from 3073 patients undergoing elective spine surgery for degenerative lumbar disease were entered into a prospective multicenter registry (N2QOD). Baseline, 3-month, and 12-month follow-up Oswestry Disability Index (ODI) scores were recorded. The absolute differences between actual 12- and 3-month ODI scores was evaluated. Additionally, the authors analyzed the absolute difference between actual 12-month ODI scores and a model-predicted 12-month ODI score (the model used patients' baseline characteristics and actual 3-month scores). The minimal clinically important difference (MCID) for ODI of 12.8 points and the substantial clinical benefit (SCB) for ODI of 18.8 points were used based on the previously published values. The concordance rate of achieving MCID and SCB for ODI at 3- and 12-months was computed. RESULTS: The 3-month ODI scores differed from 12-month scores by an absolute difference of 11.9 ± 10.8, and predictive modeling estimations of 12-month ODI scores differed from actual 12-month scores by a mean (± SD) of 10.7 ± 9.0 points (p = 0.001). Sixty-four percent of patients (n = 1982) achieved an MCID for ODI at 3 months in comparison with 67% of patients (n = 2088) by 12 months; 51% (n = 1731) and 61% (n = 1860) of patients achieved SCB for ODI at 3 months and 12 months, respectively. Almost 20% of patients had ODI scores that varied at least 20 points (the point span of an ODI functional category) between actual 3- and 12-month values. In the aggregate analysis of achieving MCID, 77% of patients were concordant and 23% were discordant in achieving or not achieving MCID at 3 and 12 months. The discordance rates of achieving or not achieving MCID for ODI were in the range of 19% to 27% for all diagnoses and treatments (decompression with and without fusion). The positive and negative predictive value of 3-months ODI to predict 12-month ODI was 86% and 60% for MCID and 82% and 67% for SCB. CONCLUSIONS: Based on their findings, the authors conclude the following: 1) Predictive methods for functional outcome based on early patient experience (i.e., baseline and/or 3-month data) should be used to help evaluate the effectiveness of procedures in patient populations, rather than serving as a proxy for long-term individual patient experience. 2) Prospective longitudinal registries need to span at least 12 months to determine the effectiveness of spine care at the individual patient and practitioner level.

Original languageEnglish (US)
Pages (from-to)170-180
Number of pages11
JournalJournal of Neurosurgery: Spine
Volume25
Issue number2
DOIs
StatePublished - Aug 1 2016

Fingerprint

Spine
Registries
Health Care Reform
Proxy
Decompression
Minimal Clinically Important Difference

Keywords

  • Long-term
  • Lumbar
  • NQOD
  • ODI
  • Oswestry disability index
  • Patient-reported outcomes
  • Registry
  • Surgery

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Inadequacy of 3-month oswestry disability index outcome for assessing individual longer-term patient experience after lumbar spine surgery. / Asher, Anthony L.; Chotai, Silky; Devin, Clinton J.; Speroff, Theodore; Harrell, Frank E.; Nian, Hui; Dittus, Robert S.; Mummaneni, Praveen V.; Knightly, John J.; Glassman, Steven D.; Bydon, Mohamad; Archer, Kristin R.; Foley, Kevin T.; McGirt, Matthew J.

In: Journal of Neurosurgery: Spine, Vol. 25, No. 2, 01.08.2016, p. 170-180.

Research output: Contribution to journalArticle

Asher, AL, Chotai, S, Devin, CJ, Speroff, T, Harrell, FE, Nian, H, Dittus, RS, Mummaneni, PV, Knightly, JJ, Glassman, SD, Bydon, M, Archer, KR, Foley, KT & McGirt, MJ 2016, 'Inadequacy of 3-month oswestry disability index outcome for assessing individual longer-term patient experience after lumbar spine surgery', Journal of Neurosurgery: Spine, vol. 25, no. 2, pp. 170-180. https://doi.org/10.3171/2015.11.SPINE15872
Asher, Anthony L. ; Chotai, Silky ; Devin, Clinton J. ; Speroff, Theodore ; Harrell, Frank E. ; Nian, Hui ; Dittus, Robert S. ; Mummaneni, Praveen V. ; Knightly, John J. ; Glassman, Steven D. ; Bydon, Mohamad ; Archer, Kristin R. ; Foley, Kevin T. ; McGirt, Matthew J. / Inadequacy of 3-month oswestry disability index outcome for assessing individual longer-term patient experience after lumbar spine surgery. In: Journal of Neurosurgery: Spine. 2016 ; Vol. 25, No. 2. pp. 170-180.
@article{650a6c1a7b6d4cc18d9dab231bad7f3e,
title = "Inadequacy of 3-month oswestry disability index outcome for assessing individual longer-term patient experience after lumbar spine surgery",
abstract = "OBJECTIVE: Prospective longitudinal outcomes registries are at the center of evidence-driven health care reform. Obtaining real-world outcomes data at 12 months can be costly and challenging. In the present study, the authors analyzed whether 3-month outcome measurements sufficiently represent 12-month outcomes for patients with degenerative lumbar disease undergoing surgery. METHODS: Data from 3073 patients undergoing elective spine surgery for degenerative lumbar disease were entered into a prospective multicenter registry (N2QOD). Baseline, 3-month, and 12-month follow-up Oswestry Disability Index (ODI) scores were recorded. The absolute differences between actual 12- and 3-month ODI scores was evaluated. Additionally, the authors analyzed the absolute difference between actual 12-month ODI scores and a model-predicted 12-month ODI score (the model used patients' baseline characteristics and actual 3-month scores). The minimal clinically important difference (MCID) for ODI of 12.8 points and the substantial clinical benefit (SCB) for ODI of 18.8 points were used based on the previously published values. The concordance rate of achieving MCID and SCB for ODI at 3- and 12-months was computed. RESULTS: The 3-month ODI scores differed from 12-month scores by an absolute difference of 11.9 ± 10.8, and predictive modeling estimations of 12-month ODI scores differed from actual 12-month scores by a mean (± SD) of 10.7 ± 9.0 points (p = 0.001). Sixty-four percent of patients (n = 1982) achieved an MCID for ODI at 3 months in comparison with 67{\%} of patients (n = 2088) by 12 months; 51{\%} (n = 1731) and 61{\%} (n = 1860) of patients achieved SCB for ODI at 3 months and 12 months, respectively. Almost 20{\%} of patients had ODI scores that varied at least 20 points (the point span of an ODI functional category) between actual 3- and 12-month values. In the aggregate analysis of achieving MCID, 77{\%} of patients were concordant and 23{\%} were discordant in achieving or not achieving MCID at 3 and 12 months. The discordance rates of achieving or not achieving MCID for ODI were in the range of 19{\%} to 27{\%} for all diagnoses and treatments (decompression with and without fusion). The positive and negative predictive value of 3-months ODI to predict 12-month ODI was 86{\%} and 60{\%} for MCID and 82{\%} and 67{\%} for SCB. CONCLUSIONS: Based on their findings, the authors conclude the following: 1) Predictive methods for functional outcome based on early patient experience (i.e., baseline and/or 3-month data) should be used to help evaluate the effectiveness of procedures in patient populations, rather than serving as a proxy for long-term individual patient experience. 2) Prospective longitudinal registries need to span at least 12 months to determine the effectiveness of spine care at the individual patient and practitioner level.",
keywords = "Long-term, Lumbar, NQOD, ODI, Oswestry disability index, Patient-reported outcomes, Registry, Surgery",
author = "Asher, {Anthony L.} and Silky Chotai and Devin, {Clinton J.} and Theodore Speroff and Harrell, {Frank E.} and Hui Nian and Dittus, {Robert S.} and Mummaneni, {Praveen V.} and Knightly, {John J.} and Glassman, {Steven D.} and Mohamad Bydon and Archer, {Kristin R.} and Foley, {Kevin T.} and McGirt, {Matthew J.}",
year = "2016",
month = "8",
day = "1",
doi = "10.3171/2015.11.SPINE15872",
language = "English (US)",
volume = "25",
pages = "170--180",
journal = "Journal of Neurosurgery: Spine",
issn = "1547-5654",
publisher = "American Association of Neurological Surgeons",
number = "2",

}

TY - JOUR

T1 - Inadequacy of 3-month oswestry disability index outcome for assessing individual longer-term patient experience after lumbar spine surgery

AU - Asher, Anthony L.

AU - Chotai, Silky

AU - Devin, Clinton J.

AU - Speroff, Theodore

AU - Harrell, Frank E.

AU - Nian, Hui

AU - Dittus, Robert S.

AU - Mummaneni, Praveen V.

AU - Knightly, John J.

AU - Glassman, Steven D.

AU - Bydon, Mohamad

AU - Archer, Kristin R.

AU - Foley, Kevin T.

AU - McGirt, Matthew J.

PY - 2016/8/1

Y1 - 2016/8/1

N2 - OBJECTIVE: Prospective longitudinal outcomes registries are at the center of evidence-driven health care reform. Obtaining real-world outcomes data at 12 months can be costly and challenging. In the present study, the authors analyzed whether 3-month outcome measurements sufficiently represent 12-month outcomes for patients with degenerative lumbar disease undergoing surgery. METHODS: Data from 3073 patients undergoing elective spine surgery for degenerative lumbar disease were entered into a prospective multicenter registry (N2QOD). Baseline, 3-month, and 12-month follow-up Oswestry Disability Index (ODI) scores were recorded. The absolute differences between actual 12- and 3-month ODI scores was evaluated. Additionally, the authors analyzed the absolute difference between actual 12-month ODI scores and a model-predicted 12-month ODI score (the model used patients' baseline characteristics and actual 3-month scores). The minimal clinically important difference (MCID) for ODI of 12.8 points and the substantial clinical benefit (SCB) for ODI of 18.8 points were used based on the previously published values. The concordance rate of achieving MCID and SCB for ODI at 3- and 12-months was computed. RESULTS: The 3-month ODI scores differed from 12-month scores by an absolute difference of 11.9 ± 10.8, and predictive modeling estimations of 12-month ODI scores differed from actual 12-month scores by a mean (± SD) of 10.7 ± 9.0 points (p = 0.001). Sixty-four percent of patients (n = 1982) achieved an MCID for ODI at 3 months in comparison with 67% of patients (n = 2088) by 12 months; 51% (n = 1731) and 61% (n = 1860) of patients achieved SCB for ODI at 3 months and 12 months, respectively. Almost 20% of patients had ODI scores that varied at least 20 points (the point span of an ODI functional category) between actual 3- and 12-month values. In the aggregate analysis of achieving MCID, 77% of patients were concordant and 23% were discordant in achieving or not achieving MCID at 3 and 12 months. The discordance rates of achieving or not achieving MCID for ODI were in the range of 19% to 27% for all diagnoses and treatments (decompression with and without fusion). The positive and negative predictive value of 3-months ODI to predict 12-month ODI was 86% and 60% for MCID and 82% and 67% for SCB. CONCLUSIONS: Based on their findings, the authors conclude the following: 1) Predictive methods for functional outcome based on early patient experience (i.e., baseline and/or 3-month data) should be used to help evaluate the effectiveness of procedures in patient populations, rather than serving as a proxy for long-term individual patient experience. 2) Prospective longitudinal registries need to span at least 12 months to determine the effectiveness of spine care at the individual patient and practitioner level.

AB - OBJECTIVE: Prospective longitudinal outcomes registries are at the center of evidence-driven health care reform. Obtaining real-world outcomes data at 12 months can be costly and challenging. In the present study, the authors analyzed whether 3-month outcome measurements sufficiently represent 12-month outcomes for patients with degenerative lumbar disease undergoing surgery. METHODS: Data from 3073 patients undergoing elective spine surgery for degenerative lumbar disease were entered into a prospective multicenter registry (N2QOD). Baseline, 3-month, and 12-month follow-up Oswestry Disability Index (ODI) scores were recorded. The absolute differences between actual 12- and 3-month ODI scores was evaluated. Additionally, the authors analyzed the absolute difference between actual 12-month ODI scores and a model-predicted 12-month ODI score (the model used patients' baseline characteristics and actual 3-month scores). The minimal clinically important difference (MCID) for ODI of 12.8 points and the substantial clinical benefit (SCB) for ODI of 18.8 points were used based on the previously published values. The concordance rate of achieving MCID and SCB for ODI at 3- and 12-months was computed. RESULTS: The 3-month ODI scores differed from 12-month scores by an absolute difference of 11.9 ± 10.8, and predictive modeling estimations of 12-month ODI scores differed from actual 12-month scores by a mean (± SD) of 10.7 ± 9.0 points (p = 0.001). Sixty-four percent of patients (n = 1982) achieved an MCID for ODI at 3 months in comparison with 67% of patients (n = 2088) by 12 months; 51% (n = 1731) and 61% (n = 1860) of patients achieved SCB for ODI at 3 months and 12 months, respectively. Almost 20% of patients had ODI scores that varied at least 20 points (the point span of an ODI functional category) between actual 3- and 12-month values. In the aggregate analysis of achieving MCID, 77% of patients were concordant and 23% were discordant in achieving or not achieving MCID at 3 and 12 months. The discordance rates of achieving or not achieving MCID for ODI were in the range of 19% to 27% for all diagnoses and treatments (decompression with and without fusion). The positive and negative predictive value of 3-months ODI to predict 12-month ODI was 86% and 60% for MCID and 82% and 67% for SCB. CONCLUSIONS: Based on their findings, the authors conclude the following: 1) Predictive methods for functional outcome based on early patient experience (i.e., baseline and/or 3-month data) should be used to help evaluate the effectiveness of procedures in patient populations, rather than serving as a proxy for long-term individual patient experience. 2) Prospective longitudinal registries need to span at least 12 months to determine the effectiveness of spine care at the individual patient and practitioner level.

KW - Long-term

KW - Lumbar

KW - NQOD

KW - ODI

KW - Oswestry disability index

KW - Patient-reported outcomes

KW - Registry

KW - Surgery

UR - http://www.scopus.com/inward/record.url?scp=84982105595&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84982105595&partnerID=8YFLogxK

U2 - 10.3171/2015.11.SPINE15872

DO - 10.3171/2015.11.SPINE15872

M3 - Article

VL - 25

SP - 170

EP - 180

JO - Journal of Neurosurgery: Spine

JF - Journal of Neurosurgery: Spine

SN - 1547-5654

IS - 2

ER -