Department of Orthopedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
Spine (Phila Pa 1976). 2021 Sep 1;46(17):1139-1146. doi: 10.1097/BRS.0000000000003972.
Retrospective case series.
Our objective was to examine the ability of preoperative Patient-reported Outcomes Measurement Information System (PROMIS) scores to predict postoperative achievement of a minimum clinically important difference (MCID) in outcome scores following lumbar spine surgery.
PROMIS is a computer adaptive testing system that has been validated in spine surgery patients. PROMIS allows for more efficient and personalized data collection compared to legacy assessment tools.
A total of 138 patients who underwent lumbar spine surgery at a single institution completed PROMIS Physical Function (PF) and Pain Interference (PI) scores preoperatively and at 3, 12, and 24 months postoperatively. Univariate and multivariate analyses of PROMIS scores and clinical factors were performed. Receiver-operating characteristic curves were calculated to determine the ability of preoperative scores to predict postoperative achievement of an MCID of 8. PF and PI t score MCID achievement threshold values with 90% specificity were calculated.
Preoperative PROMIS PF and PI scores were significantly correlated to achievement of postoperative MCID after multivariate analysis. Patients with worse preoperative scores were more likely to achieve MCID. Preoperative PF and PI scores showed strong predictive value in determining ability to achieve postoperative MCID with respective area under the curve of 0.85 and 0.82. A preoperative PF threshold T-score of 31.6 had a 64% chance of achieving postoperative MCID, while a preoperative PI threshold t score of 67.8 had an 86% chance of achieving postoperative MCID.
Preoperative PROMIS PF and PI scores predicted improvement in postoperative PROMIS scores in lumbar spine surgery patients as worse preoperative scores correlated to improved PROMIS scores postoperatively. The calculated threshold t scores showed the ability to predict improvement in postoperative PROMIS scores. Preoperative PROMIS data may be useful in surgical decision-making and improved patient education regarding postoperative outcomes.Level of Evidence: 4.
回顾性病例系列研究。
本研究旨在评估术前患者报告结局测量信息系统（PROMIS）评分预测腰椎手术后结局评分达到最小临床重要差异（MCID）的能力。
PROMIS 是一种已在脊柱外科患者中得到验证的计算机自适应测试系统。与传统评估工具相比，PROMIS 允许更高效、更个性化的数据收集。
在一家单机构接受腰椎手术的 138 例患者在术前和术后 3、12 和 24 个月时完成了 PROMIS 躯体功能（PF）和疼痛干扰（PI）评分。对 PROMIS 评分和临床因素进行单变量和多变量分析。计算受试者工作特征曲线以确定术前评分预测术后达到 8 分 MCID 的能力。计算 PF 和 PI t 评分 MCID 达到阈值 90%特异性的阈值值。
多变量分析显示，术前 PROMIS PF 和 PI 评分与术后达到 MCID 显著相关。术前评分较差的患者更有可能达到 MCID。术前 PF 和 PI 评分在确定术后达到 MCID 的能力方面具有很强的预测价值，其曲线下面积分别为 0.85 和 0.82。术前 PF 阈值 T 评分 31.6 有 64%的机会达到术后 MCID，而术前 PI 阈值 t 评分 67.8 有 86%的机会达到术后 MCID。
术前 PROMIS PF 和 PI 评分预测腰椎手术患者术后 PROMIS 评分的改善，因为较差的术前评分与术后 PROMIS 评分的改善相关。计算得出的阈值 t 评分显示了预测术后 PROMIS 评分改善的能力。术前 PROMIS 数据可能有助于手术决策，并改善患者对术后结局的教育。
4 级。
