Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, PA.
The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth.
Clin Spine Surg. 2020 Mar;33(2):82-88. doi: 10.1097/BSD.0000000000000887.
A retrospective cohort study.
The objective of this study was to determine if patient satisfaction is predicted by improvement in health-related quality of life (HRQOL) metrics.
Patient satisfaction is becoming an increasingly common proxy for treatment quality; however, the correlation between patient satisfaction and HRQOL outcome metrics following a lumbar disk herniation is unclear.
Patients enrolled in the Spine Patient Outcomes Research Trial (SPORT) study were prospectively enrolled at 13 institutions. A retrospective subgroup analysis of prospectively collected data from the SPORT trial was performed. Receiver operating characteristic curves were used to determine if improvement in HRQOL metrics could accurately identify patient satisfaction. HRQOL metrics included: Short Form-36 (SF-36), Oswestry Disability Index (ODI), Sciatica Bothersomeness Index, Back Pain Bothersomeness Scale, and Leg Pain Bothersomeness Scale.
A total of 709 patients who underwent surgery and 319 patients treated without surgery were included. In the surgical cohort, receiver operating characteristic curve analysis demonstrated that SF-36 Physical Component Summary improvement had moderate accuracy [area under the curve (AUC)=0.77 (95% confidence interval, CI: 0.73-0.82)] at predicting satisfaction at 3 months, and it had excellent accuracy at predicting satisfaction at 2 years [AUC=0.81 (95% CI: 0.77-0.85)] and 4 years [AUC=0.81 (95% CI: 0.76-0.85)]. Absolute Physical Component Summary score had excellent accuracy at 3 months [AUC=0.83 (95% CI: 0.79-0.87)], 2 years [AUC=0.87 (95% CI: 0.84-0.9)] and 4 years [AUC=0.84 (95% CI: 0.8-0.89)]. Similarly improvement in the ODI had moderate accuracy of predicting satisfaction at 3 months [AUC=0.77 (95% CI: 0.72-0.81)], 2 years [AUC=0.78 (95% CI: 0.74-0.82)] and 4 years [AUC=0.78 (95% CI: 0.73-0.83)], and the absolute ODI score had excellent accuracy at 3 months [AUC=0.85 (95% CI: 0.82-0.89)], 2 years [AUC=0.89 (95% CI: 0.86-0.92)], and 4 years [AUC=0.88 (95% CI: 0.85-0.92)].
HRQOL metrics can accurately predict patient satisfaction with symptoms at 3 months, 2 years, and 4 years after surgical intervention for a lumbar disk herniation. Absolute outcome scores were somewhat more predictive than change scores.
回顾性队列研究。
本研究旨在确定患者满意度是否可以通过健康相关生活质量（HRQOL）指标的改善来预测。
患者满意度正日益成为治疗质量的常用替代指标；然而，腰椎间盘突出症患者满意度与 HRQOL 结果指标之间的相关性尚不清楚。
参与 Spine Patient Outcomes Research Trial（SPORT）研究的患者在 13 家机构前瞻性入组。对 SPORT 试验中前瞻性收集的数据进行了回顾性亚组分析。受试者工作特征曲线用于确定 HRQOL 指标的改善是否可以准确识别患者满意度。HRQOL 指标包括：36 项简短健康调查量表（SF-36）、Oswestry 残疾指数（ODI）、坐骨神经痛烦扰指数、腰背疼痛烦扰量表和腿部疼痛烦扰量表。
共纳入 709 例接受手术治疗的患者和 319 例未接受手术治疗的患者。在手术组中，受试者工作特征曲线分析表明，SF-36 生理成分综合评分改善具有中等准确性[曲线下面积（AUC）=0.77（95%置信区间，CI：0.73-0.82）]，可在 3 个月时预测满意度，在 2 年[AUC=0.81（95%CI：0.77-0.85）]和 4 年[AUC=0.81（95%CI：0.76-0.85）]时预测满意度具有良好的准确性。绝对生理成分综合评分在 3 个月时具有很好的准确性[AUC=0.83（95%CI：0.79-0.87）]、2 年[AUC=0.87（95%CI：0.84-0.9）]和 4 年[AUC=0.84（95%CI：0.8-0.89）]。同样，ODI 的改善在 3 个月时预测满意度具有中等准确性[AUC=0.77（95%CI：0.72-0.81）]、2 年[AUC=0.78（95%CI：0.74-0.82）]和 4 年[AUC=0.78（95%CI：0.73-0.83）]，绝对 ODI 评分在 3 个月时具有很好的准确性[AUC=0.85（95%CI：0.82-0.89）]、2 年[AUC=0.89（95%CI：0.86-0.92）]和 4 年[AUC=0.88（95%CI：0.85-0.92）]。
HRQOL 指标可准确预测腰椎间盘突出症患者术后 3 个月、2 年和 4 年的症状满意度。绝对结局评分比变化评分更具预测性。
