Turcotte Justin J, Brennan Jane C, Johnson Andrea H, Patton Chad M
Luminis Health Anne Arundel Medical Center, Annapolis, MD, USA
Luminis Health Anne Arundel Medical Center, Annapolis, MD, USA.
Int J Spine Surg. 2025 May 12;19(2):207-215. doi: 10.14444/8755.
Previous studies have identified patient and surgical factors associated with patient-reported outcomes measurement information system (PROMIS)-physical function (PF) minimal clinically important difference (MCID) rates after lumbar fusion, but investigation into the timing of MCID achievement remains limited. This study aimed to assess whether time to MCID achievement differed across patients presenting with mild, moderate, or severe disability as measured using the PROMIS-PF instrument.
A retrospective review of 144 patients undergoing 1- to 3-level lumbar fusion from 2020 to 2023 was performed. All patients completed PROMIS-PF surveys at baseline and 1 year postoperatively. Patients were classified as mild (PROMIS-PF > 40), moderate (30-40), or severe (<30) disability based on baseline PROMIS-PF T-scores. MCID achievement rates and time to MCID were compared across groups using univariate and multivariate analyses. Multivariate Cox proportional hazard models were used to assess the relationship between baseline disability and MCID achievement rates over time.
Twenty (13.9%) patients presented with mild disability, 92 (63.9%) with moderate disability, and 32 (22.2%) with severe disability. The overall rate of 1-year postoperative MCID achievement was 59%. After adjusting for American Society of Anesthesiologists scores and Charlson Comorbidity Index, severe baseline disability was associated with increased odds of early MCID achievement (<90 days; OR = 2.95, = 0.015) and shorter days to MCID achievement. In the adjusted Cox models, patients with severe baseline disability demonstrated increased MCID achievement at any time over the 1-year postoperative period when compared with the mild disability (HR = 3.52, = 0.005) and moderate disability (HR = 1.85, = 0.020) groups.
Patients presenting with severe disability were more likely to achieve clinically significant improvements in function across time points during the 1-year postoperative period. Furthermore, these patients demonstrated higher rates of early MCID achievement and less time to MCID than those with moderate or mild baseline disability. Utilization of PROMIS-PF may assist with preoperative patient selection and expectation setting.
In the clinical setting, establishing realistic recovery expectations is a critical aspect of the surgeon-patient relationship. The data presented in the current study may be used in preoperative consultations to provide patients with a depiction of their potential improvement in physical function over time based on their baseline level of function. Postoperatively, the data may serve as a benchmark for assessing an individual's recovery trajectory compared to historically similar patients.
既往研究已确定了与腰椎融合术后患者报告结局测量信息系统（PROMIS）-身体功能（PF）最小临床重要差异（MCID）发生率相关的患者和手术因素，但对达到MCID的时间的研究仍然有限。本研究旨在评估使用PROMIS-PF工具测量时，不同程度残疾（轻度、中度或重度）的患者达到MCID的时间是否存在差异。
对2020年至2023年接受1至3节段腰椎融合术的144例患者进行回顾性研究。所有患者在基线和术后1年完成PROMIS-PF调查。根据基线PROMIS-PF T评分，患者被分为轻度（PROMIS-PF＞40）、中度（30-40）或重度（＜30）残疾。使用单因素和多因素分析比较各组的MCID达成率和达到MCID的时间。多因素Cox比例风险模型用于评估基线残疾与随时间推移的MCID达成率之间的关系。
20例（13.9%）患者为轻度残疾，92例（63.9%）为中度残疾，32例（22.2%）为重度残疾。术后1年达到MCID的总体发生率为59%。在调整了美国麻醉医师协会评分和Charlson合并症指数后，严重的基线残疾与早期达到MCID（＜90天；OR = 2.95，P = 0.015）的几率增加和达到MCID的天数缩短相关。在调整后的Cox模型中，与轻度残疾组（HR = 3.52，P = 0.005）和中度残疾组（HR = 1.85，P = 0.020）相比，严重基线残疾的患者在术后1年的任何时间达到MCID的情况均有所增加。
重度残疾患者在术后1年的各个时间点功能更有可能实现具有临床意义的改善。此外，与基线残疾为中度或轻度的患者相比，这些患者早期达到MCID的发生率更高，达到MCID的时间更短。使用PROMIS-PF可能有助于术前患者选择和预期设定。
在临床环境中，建立现实的恢复预期是医患关系的一个关键方面。本研究中呈现的数据可用于术前咨询，根据患者的基线功能水平，向其描述其身体功能随时间的潜在改善情况。术后，这些数据可作为与历史上相似患者相比评估个体恢复轨迹的基准。
