161 Association Between Preoperative Narcotic Use With Surgical Outcomes, Patient Reported Pain Scores and Ambulatory Status After Complex Spinal Fusion (≥5 Levels) for Adult Deformity Correction

OBJECTIVEMedical comorbidities, particularly preoperatively diagnosed anxiety, depression, and obesity, may influence how patients perceive and measure clinical benefit after a surgical intervention. The current study was performed to define and compare the minimum clinically important difference (MCID) thresholds in patients with and without preoperative diagnoses of anxiety or depression and obesity who underwent spinal fusion for grade 1 degenerative spondylolisthesis.METHODSThe Quality Outcomes Database (QOD) was queried for patients who underwent lumbar fusion for grade 1 degenerative spondylolisthesis during the period from January 2014 to August 2017. Collected patient-reported outcomes (PROs) included the Oswestry Disability Index (ODI), health status (EQ-5D), and numeric rating scale (NRS) scores for back pain (NRS-BP) and leg pain (NRS-LP). Both anchor-based and distribution-based methods for MCID calculation were employed.RESULTSOf 462 patients included in the prospective registry who underwent a decompression and fusion procedure, 356 patients (77.1%) had complete baseline and 12-month PRO data and were included in the study. The MCID values for ODI scores did not significantly differ in patients with and those without a preoperative diagnosis of obesity (20.58 and 20.69, respectively). In addition, the MCID values for ODI scores did not differ in patients with and without a preoperative diagnosis of anxiety or depression (24.72 and 22.56, respectively). Similarly, the threshold MCID values for NRS-BP, NRS-LP, and EQ-5D scores were not statistically different between all groups. Based on both anchor-based and distribution-based methods for determination of MCID thresholds, there were no statistically significant differences between all cohorts.CONCLUSIONSMCID thresholds were similar for ODI, EQ-5D, NRS-BP, and NRS-LP in patients with and without preoperative diagnoses of anxiety or depression and obesity undergoing spinal fusion for grade 1 degenerative spondylolisthesis. Preoperative clinical and shared decision-making may be improved by understanding that preoperative medical comorbidities may not affect the way patients experience and assess important clinical changes postoperatively.

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Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 2: Assessment of functional outcome following lumbar fusion

Journal of Neurosurgery Spine ◽

10.3171/2014.4.spine14258 ◽

2014 ◽

Vol 21 (1) ◽

pp. 7-13 ◽

Cited By ~ 15

Author(s):

Zoher Ghogawala ◽

Daniel K. Resnick ◽

William C. Watters ◽

Praveen V. Mummaneni ◽

Andrew T. Dailey ◽

...

Keyword(s):

Lumbar Spine ◽

Functional Outcome ◽

Spinal Fusion ◽

Lumbar Fusion ◽

Minimum Clinically Important Difference ◽

Degenerative Disease ◽

Psychological State ◽

Lumbar Spinal Fusion ◽

Patient Reported ◽

Lumbar Spinal

Assessment of functional patient-reported outcome following lumbar spinal fusion continues to be essential for comparing the effectiveness of different treatments for patients presenting with degenerative disease of the lumbar spine. When assessing functional outcome in patients being treated with lumbar spinal fusion, a reliable, valid, and responsive outcomes instrument such as the Oswestry Disability Index should be used. The SF-36 and the SF-12 have emerged as dominant measures of general health-related quality of life. Research has established the minimum clinically important difference for major functional outcomes measures, and this should be considered when assessing clinical outcome. The results of recent studies suggest that a patient's pretreatment psychological state is a major independent variable that affects the ability to detect change in functional outcome.

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Targeted housestaff intervention reduces opioid use without worsening patient-reported pain scores and improves outcomes among patients with IBD: the “IBD pain ladder”

International Journal of Colorectal Disease ◽

10.1007/s00384-021-03852-7 ◽

2021 ◽

Author(s):

Pavlos Kaimakliotis ◽

Ajit Ramadugu ◽

Jennifer Kang ◽

Timothy McGorisk ◽

Anne Polick ◽

...

Keyword(s):

Opioid Use ◽

Pain Scores ◽

Patient Reported

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Are the Roland Morris Disability Questionnaire and Oswestry Disability Index interchangeable in patients after lumbar spinal fusion?

Journal of Back and Musculoskeletal Rehabilitation ◽

10.3233/bmr-200206 ◽

2021 ◽

pp. 1-7

Author(s):

R.F.M.R. Kersten ◽

J. Fikkers ◽

N. Wolterbeek ◽

F.C. Öner ◽

S.M. van Gaalen

Keyword(s):

Back Pain ◽

Spinal Fusion ◽

Outcome Measures ◽

Oswestry Disability Index ◽

Roland Morris Disability Questionnaire ◽

Leg Pain ◽

Lumbar Spinal Fusion ◽

Patient Reported ◽

Disability Questionnaire ◽

Lumbar Spinal

BACKGROUND: Low back pain is a common health problem for which there are several treatment options. For optimizing clinical decision making, evaluation of treatments and research purposes it is important that health care professionals are able to evaluate the functional status of patients. Patient reported outcome measures (PROMs) are widely accepted and recommended. The Roland Morris Disability Questionnaire (RMDQ) and the Oswestry Disability Index (ODI) are the two mainly used condition-specific patient reported outcomes. Concerns regarding the content and structural validity and also the different scoring systems of these outcome measures makes comparison of treatment results difficult. OBJECTIVE: Aim of this study was to determine if the RMDQ and ODI could be used exchangeable by assessing the correlation and comparing different measurement properties between the questionnaires. METHODS: Clinical data from patients who participated in a multicenter RCT with 2 year follow-up after lumbar spinal fusion were used. Outcome measures were the RMDQ, ODI, Short Form 36 – Health Survey (SF-36), leg pain and back pain measured on a 0–100 mm visual analogue scale (VAS). Cronbach’s alpha coefficients, Spearman correlation coefficients, multiple regression analysis and Bland-Altman plots were calculated. RESULTS: three hundred and seventy-six completed questionnaires filled out by 87 patients were used. The ODI and RMDQ had both a good level of internal consistency. There was a very strong correlation between the RMDQ and the ODI (r= 0.87; p< 0.001), and between the VAS and both the ODI and RMDQ. However, the Bland-Altman plot indicated bad agreement between the ODI and RMDQ. CONCLUSIONS: The RMDQ and ODI cannot be used interchangeably, nor is there a possibility of converting the score from one questionnaire to the other. However, leg pain and back pain seemed to be predictors for both the ODI and the RMDQ.

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