Arpey Nicholas C, Staub Jacob R, Alvandi Bejan A, Gerlach Erik B, Barrett Joshua E, Peabody Michael T, Morgan Allison M, Divi Srikanth N, Hsu Wellington K, Patel Alpesh A
Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
Clin Spine Surg. 2025 Apr 17. doi: 10.1097/BSD.0000000000001807.
Prospective study (level II evidence).
The objective of this study was to assess recall accuracy and bias through PROMIS-PF (physical function) and PI (pain interference) scores in patients undergoing cervical or lumbar spine surgery.
Patient-reported outcomes (PROs) have improved quantitative data availability; however, the interpretation of results may remain susceptible to confounding factors including recall accuracy. No studies to date have reported the accuracy of patient recall using PROMIS outcomes in spine patients.
Patients who underwent elective lumbar or cervical spine surgery were identified at a single tertiary, academic institution. PROMIS-PF and PI CAT (computer adaptive tests) were administered preoperatively. After a minimum 2-year follow-up, patients were administered these questionnaires and asked to answer with their recalled preoperative status. Recall accuracy was assessed by comparing recalled and actual baseline PROMIS scores. Regression analyses were conducted to evaluate the agreement between actual and recalled scores. Multivariate logistic regression was performed to determine potential demographic and temporal sources of bias.
Lumbar surgery patients recalled significantly worse preoperative function (Δ -1.5, 95% CI (-2.8 to -0.3), P<0.05) and severe pain [Δ 2.1, 95% CI (0.5-3.6), P<0.01] than reported before surgery. Patients in the cervical cohort, in contrast, were more accurate in recall for both domains [PF Δ 1.8, 95% (CI -1.4 to 5.0), P>0.05 and PI Δ 0.0, 95% CI (-3.0 to 3.0), P>0.05]. The correlation between recalled and actual scores was moderate in both cohorts. Demographic and temporal variables did not significantly influence recall accuracy. Lumbar cohort patients who met PI MCID were more likely to accurately recall baseline pain scores.
Recall inaccuracy is present in patients who undergo spine surgery; however, patients on average recall significantly worse preoperative status as measured by PROMIS PF and PI scores. Accurate recollection of preoperative status may influence patient perception of care.
前瞻性研究（二级证据）。
本研究的目的是通过PROMIS-身体功能量表（PF）和疼痛干扰量表（PI）评分，评估接受颈椎或腰椎手术患者的回忆准确性和偏差。
患者报告结局（PROs）提高了定量数据的可获得性；然而，结果的解释可能仍易受包括回忆准确性在内的混杂因素影响。迄今为止，尚无研究报告脊柱疾病患者使用PROMIS结局进行患者回忆的准确性。
在一家单一的三级学术机构中识别接受择期腰椎或颈椎手术的患者。术前进行PROMIS-PF和PI计算机自适应测试（CAT）。在至少2年的随访后，向患者发放这些问卷，并要求他们根据回忆的术前状态进行回答。通过比较回忆的和实际的基线PROMIS评分来评估回忆准确性。进行回归分析以评估实际评分与回忆评分之间的一致性。进行多因素逻辑回归以确定潜在的人口统计学和时间偏差来源。
腰椎手术患者回忆的术前功能显著差于手术前报告的情况（差值-1.5，95%可信区间[-2.8至-0.3]，P<0.05），且严重疼痛程度更高[差值2.1，95%可信区间（0.5-3.6），P<0.01]。相比之下，颈椎队列中的患者在两个领域的回忆更准确[PF差值1.8，95%（可信区间-1.4至5.0），P>0.05；PI差值0.0，95%可信区间（-3.0至3.0），P>0.05]。两个队列中回忆评分与实际评分之间的相关性均为中等。人口统计学和时间变量并未显著影响回忆准确性。达到PI最小临床重要差异的腰椎队列患者更有可能准确回忆基线疼痛评分。
脊柱手术患者存在回忆不准确的情况；然而，平均而言，患者回忆的术前状态按PROMIS PF和PI评分衡量显著差于实际情况。准确回忆术前状态可能会影响患者对医疗护理的认知。
