Rundell Sean D, Resnik Linda, Heagerty Patrick J, Kumar Amit, Jarvik Jeffrey G
Department of Rehabilitation Medicine, University of Washington, Seattle, WA.
Comparative Effectiveness, Cost, and Outcomes Research Center; University of Washington, Seattle, WA.
J Orthop Sports Phys Ther. 2019 Jul 23:1-18. doi: 10.2519/jospt.2019.8764.
Secondary analysis of prospective cohort study.
Common comorbidity indices were developed to predict mortality and may not be optimal for functional outcomes.
Determine how well the Functional Comorbidity Index (FCI) predicts outcomes in older adults with back pain versus the Quan/Charlson and Elixhauser comorbidity indices.
We included 5155 adults ≥65 years with new primary care visits for back pain. Comorbidity was measured using diagnosis codes 12 months prior to the new visit. Outcomes of functional limitation (Roland Morris Disability Questionnaire [RMDQ]), health-related quality-of-life (EQ5D), and total health care use (sum of Relative Value Units [RVUs]) were measured 12 months the new visit. We compared multivariable models containing preselected prognostic factors.
Spearman's Correlation Coefficients among the indices were ≥0.70. Multivariable models for RMDQ had similar R2 and mean squared error (MSE) of prediction when using the FCI (R=0.190; MSE= 6.19), Quan/Charlson (R=0.184; MSE=6.20), or Elixhauser (R=0.189; MSE=6.19). Multivariable models for EQ5D showed small differences in R and MSE when using the FCI (R=0.157; MSE= 0.163), Quan/Charlson (R=0.148; MSE=0.164), or Elixhauser (R=0.154; MSE=0.163). Multivariable models for health care use had similar Akaike's information criterion (AICs) when using the FCI (AIC=10.04), Quan/Charlson (AIC=10.04), or Elixhauser (AIC=10.01).
All indices performed similarly in predicting outcomes. There does not seem to be an advantage to using one index over another for older adults with back pain. There is still a need to develop better function-based risk adjustment models that improve prediction of functional outcomes versus standard comorbidity indices.
Level 2 Prognostic Evidence. .
前瞻性队列研究的二次分析。
常见的合并症指数用于预测死亡率，可能并非功能结局的最佳指标。
确定功能合并症指数（FCI）与全/查尔森合并症指数及埃利克斯豪泽合并症指数相比，在老年背痛患者中预测结局的效果如何。
我们纳入了5155名年龄≥65岁的因新发背痛进行初级保健就诊的成年人。使用新就诊前12个月的诊断编码测量合并症情况。在新就诊12个月后测量功能受限（罗兰·莫里斯残疾问卷[RMDQ]）、健康相关生活质量（EQ5D）以及总医疗保健使用情况（相对价值单位[RVU]总和）等结局指标。我们比较了包含预先选定的预后因素的多变量模型。
各指数之间的斯皮尔曼相关系数≥0.70。当使用FCI（R = 0.190；均方误差[MSE] = 6.19）、全/查尔森指数（R = 0.184；MSE = 6.20）或埃利克斯豪泽指数（R = 0.189；MSE = 6.19）时，RMDQ的多变量模型在预测的R² 和平均平方误差方面相似。当使用FCI（R = 0.157；MSE = 0.163）、全/查尔森指数（R = 0.148；MSE = 0.164）或埃利克斯豪泽指数（R = 0.154；MSE = 0.163）时，EQ5D的多变量模型在R和MSE方面显示出微小差异。当使用FCI（赤池信息准则[AIC] = 10.04）、全/查尔森指数（AIC = 10.04）或埃利克斯豪泽指数（AIC = 10.01）时，医疗保健使用情况的多变量模型的AIC相似。
所有指数在预测结局方面表现相似。对于老年背痛患者，使用一种指数而非另一种指数似乎并无优势。仍需开发更好的基于功能的风险调整模型，以改善与标准合并症指数相比的功能结局预测。
2级预后证据。
