Goyal Dhruv K C, Murphy Hamadi A, Hollern Douglas A, Divi Srikanth N, Nicholson Kristen, Stawicki Christie, Kaye I David, Schroeder Gregory D, Woods Barrett I, Kurd Mark F, Rihn Jeffrey A, Anderson D Greg, Kepler Christopher K, Hilibrand Alan S, Vaccaro Alexander R, Radcliff Kristen E
Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania.
Int J Spine Surg. 2020 Feb 29;14(1):53-58. doi: 10.14444/7007. eCollection 2020 Feb.
The Neck Disability Index (NDI) is a 10-item questionnaire about symptoms relevant to cervical spine pathology, originally validated in the physical therapy literature. It is unclear if all of the items apply to spine surgery. The purpose of this study was to determine if improvements in the composite NDI score or specific NDI domains are appropriate measures for tracking changes in physical function after surgical intervention for cervical spondylotic myelopathy (CSM).
A retrospective cohort review of patients treated at a major academic medical center was undertaken. Baseline and postoperative standardized outcome measurement scores, including composite NDI, NDI subdomain, and SF-12 physical component score (PCS), were collected. Wilcoxon signed-rank test was used to determine whether patients exhibited improvement in each of the outcome measures included. Multiple linear regression was performed to determine whether change in NDI composite or subdomain scores predicted change in physical function after surgery for CSM-compared with the well-validated PCS score-controlling for factors such as age, sex, etc.
Baseline data were collected on 118 patients. All outcome measures exhibited significant improvement after surgery based on the Wilcoxon signed-rank test. On linear regression, work (β = -2.419 [-3.831, -1.006]; = .001) and recreation (β = -1.354 [-2.640, -0.068]; = .039), as well as the NDI composite score (β = -0.223 [-0.319, -0.127]; < .001), were significant predictors of change in physical function over time.
Although the NDI composite score did predict change in PCS over time, only 2 of the 10 NDI subdomains were found to be associated with change in physical function over time. Based on these results, the item bank and composite scoring of the NDI are inappropriate for evaluating quality of life in studies of surgically treated cervical spondylotic myelopathy patients.
NDI may not be a valid tool in the determination of physical function changes after surgery for CSM.
III.
颈部功能障碍指数（NDI）是一份包含10个条目的问卷，涉及与颈椎病理相关的症状，最初在物理治疗文献中得到验证。目前尚不清楚所有条目是否都适用于脊柱手术。本研究的目的是确定NDI综合评分或特定NDI领域的改善是否是跟踪脊髓型颈椎病（CSM）手术干预后身体功能变化的合适指标。
对一家大型学术医疗中心治疗的患者进行回顾性队列研究。收集基线和术后标准化结局测量分数，包括NDI综合评分、NDI子领域评分和SF-12身体成分评分（PCS）。采用Wilcoxon符号秩检验确定患者在各项纳入的结局测量指标上是否有改善。进行多元线性回归以确定NDI综合或子领域评分的变化是否能预测CSM手术后身体功能的变化，同时与经过充分验证的PCS评分进行比较，并控制年龄、性别等因素。
收集了118例患者的基线数据。根据Wilcoxon符号秩检验，所有结局测量指标在术后均有显著改善。在线性回归分析中，工作（β = -2.419 [-3.831, -1.006]；P = 0.001）、娱乐（β = -1.354 [-2.640, -0.068]；P = 0.039）以及NDI综合评分（β = -0.223 [-0.319, -0.127]；P < 0.001）是随时间身体功能变化的显著预测因素。
虽然NDI综合评分确实能预测PCS随时间的变化，但在10个NDI子领域中，只有2个与随时间身体功能的变化相关。基于这些结果，NDI的条目库和综合评分不适用于评估接受手术治疗的脊髓型颈椎病患者的生活质量。
NDI可能不是评估CSM手术后身体功能变化的有效工具。
III级。
