Aleem Ilyas S, Currier Bradford L, Yaszemski Michael J, Poppendeck Heidi, Huddleston Paul, Eck Jason, Rhee John, Bydon Mohamad, Freedman Brett, Nassr Ahmad
Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI.
Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN.
Clin Spine Surg. 2018 Dec;31(10):E481-E487. doi: 10.1097/BSD.0000000000000726.
This is a prospective cohort study.
To characterize the accuracy of patient recollection of preoperative symptoms after cervical spine surgery.
Recall bias is a well-known source of systematic error. The accuracy of patient recall after cervical spine surgery remains unknown.
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.
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.
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.
这是一项前瞻性队列研究。
描述颈椎手术后患者对术前症状回忆的准确性。
回忆偏倚是系统误差的一个众所周知的来源。颈椎手术后患者回忆的准确性仍然未知。
纳入因脊髓病或神经根病接受颈椎手术的连续患者。术前记录颈部和手臂的数字疼痛评分以及颈部功能障碍指数。在短期（<1年）或长期（≥1年）随访时，要求患者回忆其术前状态。使用配对t检验比较实际评分和回忆评分，并使用Pearson相关系数对两者关系进行量化。采用多变量线性回归确定影响回忆的因素。
共纳入73例平均年龄为58.2岁的患者。与术前评分相比，患者的颈部疼痛[平均差值（MD）=-2.9；95%置信区间（CI），-3.5至-2.3]、手臂疼痛（MD，-3.4；95%CI，-4.0至-2.8）和功能障碍（MD，-12.4%；95%CI，-16.9至-7.9）有显著改善。患者对术前状态的回忆在颈部疼痛（MD，+1.5；95%CI，0.8 - 2.2）、手臂疼痛（MD，+2.3；95%CI，1.6 - 3.0）和功能障碍（MD，+5.8%；95%CI，2.4 - 9.2）方面明显比实际情况更严重。在颈部（r = 0.41）、手臂（r = 0.50）疼痛和功能障碍（r = 0.67）方面，实际评分与回忆评分之间存在中等程度的相关性。这种相关性在年龄、性别以及手术日期与回忆时间之间保持一致。超过30%的患者在回忆术前症状时，其主要症状从颈部疼痛转变为手臂疼痛，反之亦然。
依靠患者回忆并不能准确衡量颈椎手术后的术前状态。前瞻性而非回顾性收集患者报告的结局仍然是衡量和解释颈椎手术后结局的金标准。回忆偏倚有可能影响患者满意度，需要进一步研究。
