Solomito Matthew J, Makanji Heeren
Orthopedic Research Department, 31 Seymour St. Hartford HealthCare Bone and Joint Institute, Hartford, CT, 06106 United States.
Spine Surgery, Orthopedic Associates of Hartford, 31 Seymour St. Hartford, Hartford, CT, 06106, United States.
N Am Spine Soc J. 2025 Aug 5;23:100780. doi: 10.1016/j.xnsj.2025.100780. eCollection 2025 Sep.
The reliance on patient reported outcomes (PROs) has substantially increased not only to augment current metrics of clinical success, but to capture the patient's perspective on the benefit of their treatment. As more PROs become utilized, the time and cost of longitudinal data collection and survey fatigue must be tempered with the benefit of the data collected. Therefore, this study sought to assess the responsiveness of the Neck Disability Index (NDI) compared to the PROMIS-10 Global Health Survey physical function T-score (PFT) and mental health T-score (MHT).
A total of 264 patients that had undergone a single or two level anterior cervical discectomy and fusion (ACDF) between June 2021 and January 2024 were included. All patients completed their preoperative, 3-, and 12-month postoperative PRO assessments. A responsiveness analysis was performed and included: floor and ceiling effects, correlations among the PRO scores, and effect size indices (ESI) calculations.
There were no floor or ceiling effects for the NDI and only 5.8% of the study cohort reached the floor or ceiling for the PROMIS-10 scores. The PROMIS T-scores showed weak to moderate correlations to the NDI, with the PFT having stronger correlations than the mental health T-score (MHT). The ESI demonstrated that the NDI was the most responsive tool with a maximum ESI of 0.98.
The PROMIS-10 is a responsive and valid tool that provides insight into both the general physical function and mental health of a patient; however, it does not display the same discretionary ability to detect small changes in neck function that the NDI demonstrated. Therefore, the PROMIS-10 may be useful to provide preoperative assessment for patients undergoing ACDF but longitudinal evaluation to assess the outcomes of this surgery may be best left to the NDI.
对患者报告结局（PROs）的依赖显著增加，这不仅是为了补充当前临床成功的指标，也是为了了解患者对其治疗益处的看法。随着越来越多的PROs被采用，纵向数据收集的时间和成本以及调查疲劳必须与所收集数据的益处相权衡。因此，本研究旨在评估颈部功能障碍指数（NDI）与患者报告结果测量信息系统-10（PROMIS-10）全球健康调查身体功能T评分（PFT）和心理健康T评分（MHT）相比的反应性。
纳入2021年6月至2024年1月期间接受单节段或双节段颈椎前路椎间盘切除融合术（ACDF）的264例患者。所有患者均完成术前、术后3个月和12个月的PRO评估。进行了反应性分析，包括：地板效应和天花板效应、PRO评分之间的相关性以及效应量指数（ESI）计算。
NDI没有地板效应或天花板效应，只有5.8%的研究队列在PROMIS-10评分中达到地板效应或天花板效应。PROMIS T评分与NDI呈弱至中度相关，其中PFT的相关性强于心理健康T评分（MHT）。ESI表明，NDI是反应性最强的工具，最大ESI为0.98。
PROMIS-10是一种反应性良好且有效的工具，可以深入了解患者的一般身体功能和心理健康；然而，它在检测颈部功能微小变化方面没有显示出与NDI相同的鉴别能力。因此，PROMIS-10可能有助于为接受ACDF的患者提供术前评估，但评估该手术结局的纵向评估可能最好留给NDI。
