J Orthop Sports Phys Ther. 2020 Mar;50(3):143-148. doi: 10.2519/jospt.2020.8764.
To determine how well the functional comorbidity index (FCI) predicts outcomes in older adults with back pain compared to Quan's modification of the Charlson comorbidity index (Quan-Charlson comorbidity index) and the Elixhauser comorbidity index.
Secondary analysis of a prospective cohort study.
We included 5155 adults 65 years of age or older 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), health-related quality of life (European Quality of Life-5 Dimensions [EQ-5D]), and total health care use (sum of relative value units) were measured 12 months after the new visit. We compared multivariable models containing preselected prognostic factors.
Spearman correlation coefficients among the indices were 0.70 or greater. Multivariable models for the Roland-Morris Disability Questionnaire had similar and root-mean-square error (RMSE) of prediction when using the FCI ( = 0.190; RMSE, 6.19), Quan-Charlson comorbidity index ( = 0.185; RMSE, 6.20), or Elixhauser comorbidity index ( = 0.189; RMSE, 6.19). Multivariable models for the EQ-5D score showed small differences in and RMSE when using the FCI ( = 0.157; RMSE, 0.163), Quan-Charlson comorbidity index ( = 0.148; RMSE, 0.164), or Elixhauser comorbidity index ( = 0.154; RMSE, 0.163). Multivariable models for health care use had similar Akaike information criterion (AIC) values when using the FCI (AIC = 10.04), Quan-Charlson comorbidity index (AIC = 10.04), or Elixhauser comorbidity index (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. .
与 Quan 对 Charlson 共病指数（Quan-Charlson 共病指数）和 Elixhauser 共病指数的修改版相比，确定功能共病指数（FCI）在预测老年背痛患者结局方面的效果如何。
前瞻性队列研究的二次分析。
我们纳入了 5155 名年龄在 65 岁及以上、因新发背痛首次到基层医疗机构就诊的成年人。在新就诊前 12 个月内，使用诊断代码来测量共病情况。在新就诊后 12 个月，使用 Roland-Morris 残疾问卷（测量功能受限）、欧洲五维健康量表（EQ-5D）（测量健康相关生活质量）和总医疗保健使用量（相对价值单位总和）来测量结局。我们比较了包含预筛选预后因素的多变量模型。
各指数之间的斯皮尔曼相关系数均在 0.70 或以上。在 Roland-Morris 残疾问卷的多变量模型中，使用 FCI（ = 0.190；均方根误差（RMSE），6.19）、Quan-Charlson 共病指数（ = 0.185；RMSE，6.20）或 Elixhauser 共病指数（ = 0.189；RMSE，6.19）时，其预测值和 RMSE 的差异相似。在 EQ-5D 评分的多变量模型中，使用 FCI（ = 0.157；RMSE，0.163）、Quan-Charlson 共病指数（ = 0.148；RMSE，0.164）或 Elixhauser 共病指数（ = 0.154；RMSE，0.163）时，预测值和 RMSE 的差异较小。在医疗保健使用的多变量模型中，使用 FCI（AIC = 10.04）、Quan-Charlson 共病指数（AIC = 10.04）或 Elixhauser 共病指数（AIC = 10.01）时，Akaike 信息准则（AIC）值相似。
所有指数在预测结局方面的表现均相似。对于背痛的老年患者，使用一种指数而不是另一种指数似乎并没有优势。仍然需要开发更好的基于功能的风险调整模型，以改善对功能结局的预测，而不是使用标准共病指数。
