Nie James W, Hartman Timothy J, Oyetayo Omolabake O, Zheng Eileen, MacGregor Keith R, Singh Kern
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
World Neurosurg. 2023 Apr;172:e304-e311. doi: 10.1016/j.wneu.2023.01.013. Epub 2023 Jan 9.
To examine the impact of Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance (PROMIS-SD) on clinical outcomes in patients undergoing lumbar decompression.
Patients undergoing lumbar decompression with preoperative PROMIS-SD scores were retrospectively included. Patients were separated into 2 cohorts: none to slight sleep disturbance (PROMIS-SD <55) and mild to severe sleep disturbance (PROMIS-SD ≥55). Patient-reported outcome measures including PROMIS Physical Function, PROMIS Anxiety, PROMIS Pain Interference, PROMIS SD, 9-item Patient Health Questionnaire, visual analog scale back/leg, and Oswestry Disability Index were collected preoperatively and up to 1 year postoperatively.
Of 87 patients identified, 48 patients had PROMIS-SD scores ≥55. Regardless of preoperative PROMIS-SD score, patients reported significant improvement in physical function, anxiety, pain interference, depression, pain, and disability outcomes in at least 1 time point. Patients in the PROMIS-SD ≥55 cohort reported postoperative improvement in sleep disturbance. Patients in the PROMIS-SD <55 cohort reported superior preoperative patient-reported outcome measures in all domains and superior postoperative improvement in pain interference and sleep disturbance. Minimum clinically important difference attainment rates were higher in the PROMIS-SD ≥55 cohort in physical function, anxiety, pain interference, sleep disturbance, and pain.
Patients undergoing lumbar decompression demonstrated significant postoperative improvement in most clinical outcomes regardless of preoperative sleep disturbance. Patients with mild to severe sleep disturbance had higher minimum clinically important difference attainment rates for physical function, mental function, and pain. Patients undergoing lumbar decompression with greater preoperative sleep disturbance may experience more clinically noticeable improvement.
探讨患者报告结局测量信息系统（PROMIS）睡眠障碍量表（PROMIS-SD）对接受腰椎减压手术患者临床结局的影响。
回顾性纳入术前有PROMIS-SD评分的接受腰椎减压手术的患者。患者被分为2组：无至轻度睡眠障碍（PROMIS-SD<55）和中度至重度睡眠障碍（PROMIS-SD≥55）。收集患者报告的结局指标，包括术前及术后长达1年的PROMIS身体功能、PROMIS焦虑、PROMIS疼痛干扰、PROMIS睡眠障碍、9项患者健康问卷、视觉模拟量表背部/腿部评分以及Oswestry功能障碍指数。
在纳入的87例患者中，48例患者的PROMIS-SD评分≥55。无论术前PROMIS-SD评分如何，患者在至少1个时间点报告身体功能、焦虑、疼痛干扰、抑郁、疼痛及功能障碍结局均有显著改善。PROMIS-SD≥55组患者报告术后睡眠障碍有所改善。PROMIS-SD<55组患者在所有领域的术前患者报告结局指标均更优，且在疼痛干扰和睡眠障碍方面术后改善更明显。PROMIS-SD≥55组在身体功能、焦虑、疼痛干扰、睡眠障碍及疼痛方面达到最小临床重要差异的比例更高。
接受腰椎减压手术的患者，无论术前睡眠障碍情况如何，术后多数临床结局均有显著改善。中度至重度睡眠障碍患者在身体功能、心理功能及疼痛方面达到最小临床重要差异的比例更高。术前睡眠障碍更严重的接受腰椎减压手术的患者可能会有更明显的临床改善。
