Makanji Heeren, Solomito Matthew J
Research Department, Hartford HealthCare Bone and Joint Institute, Hartford, CT, United States of America.
Orthopaedic Associates of Hartford, Hartford, CT, United States of America.
N Am Spine Soc J. 2024 Nov 9;20:100571. doi: 10.1016/j.xnsj.2024.100571. eCollection 2024 Dec.
Prospective, longitudinal collection of patients reported outcomes (PRO) has become an essential metric in orthopedics. Despite the utility of PROs, data collection presents a significant challenge to the healthcare system. There is a need to better understand if serial data collection over a 1 to 2 year postoperative period is truly warranted. The purpose of this study was to determine if continued PRO collection after 3 months postop is needed in patients that underwent lumbar fusion.
This retrospective study utilized 239 patients that underwent an elective single level lumbar fusion between April 1, 2020 and February 1, 2023. Changes in the Oswestry Disability Index (ODI) scores over a 1 year period were assessed for all patients. Patients were placed into 1 of 3 study groups, those that improved by 10 points, those that worsened by 10 points, and those that did not change (score change less than 10 points in either direction). Movement between study groups, the minimal clinical important difference (MCID), and patient satisfaction were analyzed for each patient.
Improvement between preoperative and the 3 month postoperative evaluations was noted for most patients. There was limited change in scores after 3 months. Patients in the improved group continued to improve through 1 year postoperative. Patients in the worsened group continued to decline by 1 year postoperative. Patients in the no change group demonstrated the highest potential to change groups.
Patients with substantial improvement or worsening at 3 months have a low likelihood of substantial clinical change thereafter. This subset of patients may not need further evaluation with PROs, but those in the worsened group may benefit from other interventions to potentially alter their course.
前瞻性、纵向收集患者报告结局（PRO）已成为骨科的一项重要指标。尽管PRO有其用途，但数据收集对医疗系统构成了重大挑战。有必要更好地了解在术后1至2年进行连续数据收集是否真的有必要。本研究的目的是确定接受腰椎融合术的患者术后3个月后是否需要继续收集PRO。
这项回顾性研究纳入了239例在2020年4月1日至2023年2月1日期间接受择期单节段腰椎融合术的患者。评估了所有患者在1年期间奥斯威斯利功能障碍指数（ODI）评分的变化。患者被分为3个研究组之一，即评分改善10分的患者、评分恶化10分的患者以及评分未变化（任何方向的评分变化小于10分）的患者。分析了每位患者在研究组之间的变动、最小临床重要差异（MCID）以及患者满意度。
大多数患者在术前和术后3个月的评估之间有改善。3个月后评分变化有限。改善组的患者在术后1年持续改善。恶化组的患者在术后1年持续下降。无变化组的患者显示出最大的组间变动可能性。
术后3个月有显著改善或恶化的患者此后发生显著临床变化的可能性较低。这部分患者可能不需要通过PRO进行进一步评估，但恶化组的患者可能会从其他干预措施中受益，以潜在地改变他们的病程。
