Turcotte Justin J, Baxter Samantha, Pipkin Karen, Patton Chad M
Department of Orthopedics, Luminis Health Anne Arundel Medical Center, Annapolis, MD.
Spine (Phila Pa 1976). 2023 May 15;48(10):720-727. doi: 10.1097/BRS.0000000000004611. Epub 2023 Feb 27.
Retrospective, observational.
To evaluate the influence of baseline health status on the physical and mental health (MH) outcomes of spine patients.
Spine conditions can have a significant burden on both the physical and MH of patients. To date, few studies have evaluated the outcomes of both dimensions of health, particularly in nonoperative populations.
At their first visit to a multidisciplinary spine clinic, 2668 nonoperative patients completed the Patient-reported Outcomes Measurement Information System-Global Health (PROMIS-GH) instrument and a questionnaire evaluating symptoms and goals of care. Patients were stratified by their baseline percentile score of the MH and physical health (PH) components of the PROMIS-GH. Four groups of patients were compared based on the presence or absence of bottom quartile PH or MH scores. The primary end point was the achievement of a minimal clinically important difference (MCID) on the MH or PH components at follow-up. Multivariate regression assessed the predictors of MCID achievement.
After controlling for demographics, symptoms, and goals, each 1-point increase in baseline PROMIS-GH mental score reduced the odds of achieving MH MCID by 9.0% ( P <0.001). Conversely, each 1-point increase in baseline GH-physical score increased the odds of achieving MCID by 4.5% ( P =0.005). Each 1-point increase in baseline GH-physical score reduced the odds of achieving PH MCID by 12.5% ( P <0.001), whereas each 1-point increase in baseline GH-mental score increased the odds of achieving MCID by 5.0% ( P <0.001).
Spine patients presenting with the lowest levels of physical or MH were most likely to experience clinically significant improvement in those domains. However, lower levels of physical or mental health made it less likely that patients would experience significant improvement in the alternative domain. Physicians should evaluate and address the complex spine population holistically to maximize improvement in both physical and mental health status.
回顾性观察研究。
评估基线健康状况对脊柱疾病患者身心健康结局的影响。
脊柱疾病会给患者的身体和心理健康带来重大负担。迄今为止，很少有研究评估健康两个维度的结局，尤其是在非手术人群中。
2668名非手术患者在首次就诊于多学科脊柱诊所时，完成了患者报告结局测量信息系统-总体健康（PROMIS-GH）工具以及一份评估症状和护理目标的问卷。患者根据PROMIS-GH心理健康（MH）和身体健康（PH）成分的基线百分位数得分进行分层。根据PH或MH得分是否处于四分位下限，比较四组患者。主要终点是随访时在MH或PH成分上达到最小临床重要差异（MCID）。多变量回归评估MCID达成的预测因素。
在控制了人口统计学、症状和目标因素后，基线PROMIS-GH心理得分每增加1分，达到MH MCID的几率降低9.0%（P<0.001）。相反，基线GH-身体得分每增加1分，达到MCID的几率增加4.5%（P=0.005）。基线GH-身体得分每增加1分，达到PH MCID的几率降低12.5%（P<0.001），而基线GH-心理得分每增加1分，达到MCID的几率增加5.0%（P<0.001）。
身体或心理健康水平最低的脊柱疾病患者在这些领域最有可能经历临床上的显著改善。然而，较低的身体或心理健康水平使患者在另一领域经历显著改善的可能性降低。医生应全面评估和处理复杂的脊柱疾病人群，以最大程度地改善身心健康状况。
