The Influence of Preoperative Deformity Severity in Postoperative Patient Reported Outcomes in Adult Acquired Flatfoot

Category: Ankle; Hindfoot; Other Introduction/Purpose: Adult acquired flatfoot deformity (AAFD) is a complex deformity. Previous work has demonstrated correlation between postoperative foot alignment and patient-reported outcomes. While this work has provided essential targets for surgeons performing flatfoot reconstruction, there is an absence of data that would enable surgeons to predict which patients are likely to have greater or less improvement after surgery based on their preoperative deformity. Conventional radiographs alone may not provide enough detail to isolate individual elements of the deformity. Weightbearing CT (WBCT) allows for far more precise analysis in this regard. We hypothesized that there would be a set of parameters defining preoperative alignment on WBCT that would predict which patients are at risk for a lower magnitude of postoperative improvement in patient-reported outcomes (PROs). Methods: In this retrospective IRB-approved study, patients that underwent surgical flatfoot reconstruction after having a preoperative standing WBCT were identified. Preoperative WBCT images were evaluated by two independent/blinded observers. Multiple parameters related to preoperative alignment and AAFD severity were measured in the sagittal, coronal and transverse planes. Parameters measured included talus-first metatarsal angle; distances between the floor and the navicular, medial cuneiform and cuboid; subtalar joint horizontal angle; superior talar - inferior talar angle; subtalar joint subluxation; talonavicular uncoverage angle; hindfoot moment arm (HMA); and foot and ankle offset (FAO). Prospectively collected data regarding preoperative and postoperative PROs was evaluated. Six PROs components were assessed: physical function; pain interference, pain intensity, global mental health, global physical health and depression. Multivariate regression analysis and a partition prediction model were used to assess the correlation between preoperative alignment and improvement in PROs. P-values of less than 0.05 were considered significant. Results: A total of 51 patients with a preoperative WBCT and postoperative PROs scores were identified and included. Demographic data is shown in Table 1. Multivariate regression analysis demonstrated that preoperative alignment significantly correlated with improvement in three out six components of PROs: pain interference, pain intensity and global mental health. The strongest predictor of improvement in PROMIS physical function t-score was medial cuneiform to floor distance, for pain interference t-score: cuboid to floor distance, for pain intensity: subtalar joint subluxation, for depression t-score: superior talar - inferior talar angle, and for global physical and mental health t-scores: sagittal talus-first metatarsal angle. Conclusion: Our analysis yielded readily identifiable cutoffs for WBCT measurements, where values above or below were correlated with significant differences in the magnitude of PRO score change. Interestingly, measures of sagittal plane collapse and hindfoot valgus were the most predictive of score changes. This data provides useful information for surgeons counseling patients prior to flatfoot reconstruction. Future work using this data to develop prediction models for postoperative outcomes would be valuable, as would studies using WBCT to evaluate the relationship between postoperative corrected alignment and PROs. Complete results are shown in the attached Table.

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Implementation of Patient-Reported Outcomes Measurement Information System (PROMIS) Data Collection in a Private Orthopedic Surgery Practice

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000013 ◽

2017 ◽

Vol 2 (2) ◽

pp. 2473011416S0001

Author(s):

Andrew Haskell ◽

Todd Kim

Keyword(s):

Pain Intensity ◽

Orthopedic Surgery ◽

Patient Reported Outcomes ◽

Global Mental Health ◽

Pain Interference ◽

Measurement Information ◽

Outcomes Measurement ◽

Item Banks ◽

Patient Reported ◽

Measurement Information System

Category: Other Introduction/Purpose: The use of computerized adaptive testing (CAT) allows measurement of patient reported outcomes (PROs) through the fewest number of questions while achieving a higher precision, diminished floor and ceiling effects, and minimal administration burden compared with traditional methods. The National Institute of Health (NIH) created the Patient-Reported Outcomes Measurement Information System (PROMIS), a series of validated item banks that measure key clinical domains. Each item bank has as few as 4 questions or up to 12 questions depending on the subject’s answers. This study describes a method of administering the PROMIS CAT in a high volume Orthopedic Surgery practice, reports the administration burden and rate of patient capture, compares this population to previously reported national standards, and compares preoperative to postoperative pain item banks. Methods: The PROMIS CAT was intended to be collected prospectively for all patients as part of a standard intake. Patients used a tablet-based program that accesses the NIH PROMIS server generating a CAT in English or Spanish. Clinical domains include physical function, pain intensity, pain interference, global physical health, and global mental health. Scores for each domain and the time required were recorded in the patient’s electronic medical record (EMR) as part of their clinic visit, preserving confidentiality of the data and preventing the need for a separate database. De-identified data was retrospectively extracted from the EMR of every patient from March to December 2015. Results for each domain were compared to validated national norms using single variable t-test. Linear regression was used to assess the effect of age on outcome variables. Paired t-test was used to compare preoperative and postoperative pain intensity and pain interference when these scores were available. Results: 1688 PROMIS CATs were administered during 5345 visits (32%), reaching 70% as logistical issues were resolved. Patient age was 53±16. Completing the CAT required 157±164 seconds, with older patients taking 10.5 more seconds per decade (p < 0.05). The PROMIS item banks are normalized to mean 50±10 for the US population. Our results were: pain intensity 47.8±8.6*, pain interference 57.9±8.8*, physical function 40.1±9.0*, global physical health 43.3±9.6*, and global mental health 48.4±8.9 (*p < 0.05). Age has a small effect on all domains (p < 0.05). Approximately 20 patients are required to demonstrate a 15% change for a two-tailed, paired study with α=0.05 and 80% power. 109 patients had pre and postoperative PROMIS data. Pain intensity improved from 51.8±7.8 to 44.6±8.6 (p < 0.001) and pain interference improved from 60.1±8.8 to 55.5±9.0 (p < 0.001). Conclusion: Using tablets to access PROMIS CATs and entering the data in the patient’s chart for later retrieval is an effective technique to collect PROs in a busy Orthopedic Surgery practice with limited resources and no research coordinator. The process adds 2.5 minutes to a patient’s intake and does not require a complicated database or expensive equipment or licensing. Adequate number of tablets and “buy in” from staff are needed for acceptable completion rates. Demonstrating improvement in PROs after surgery holds promise for comparative studies of surgical indications and techniques and highlights the value these interventions add to patient care.

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Patient-Reported Outcomes Demonstrate The Value Of Non-Operative And Operative Orthopedic Treatments And Predict The Odds Of Improvement With Surgery

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000047 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0000

Author(s):

Andrew Haskell ◽

Todd S. Kim

Keyword(s):

Pain Intensity ◽

Patient Reported Outcomes ◽

Pain Interference ◽

Surgical Patients ◽

Final Visit ◽

Adaptive Tests ◽

Item Banks ◽

Patient Reported ◽

Computer Adaptive Tests ◽

Better Than

Category: Outcomes Measurement Introduction/Purpose: The importance of patient reported outcomes (PROs) has become increasingly recognized as an important tool to measure our clinical value. The National Institute of Health (NIH) created the Patient-Reported Outcomes Measurement Information System (PROMIS), a series of validated item banks, to help clinicians and researches measure key clinical domains. The PROMIS computer adaptive tests (CAT) may be administered with minimal resources or administrative burden. This study describes the results of administering computer adaptive tests (CAT) to every patient in a high volume Orthopedic Surgery practice. We test the hypotheses that both non-operative treatment and operative treatments improve PRO scores. Furthermore, we test the hypothesis that preoperative scores in these domains may be used to predict chances of improvement after surgery. Methods: The PROMIS CAT was administered prospectively for all patients as part of standard clinic intake and recorded in the patient’s electronic medical record (EMR) at each clinic visit. The PROMIS item banks are normalized to mean 50±10 for the US population. De-identified data was retrospectively extracted from the EMR including PROMIS scores, demographic information, as well as surgery specific information. As of this submission, 1688 PROMIS CATs from March 2015 to September 2016 have been analyzed. Data for initial and final clinic visits, as well as for the final preoperative visit for patients who had surgery, are compared using Wilcoxon Matched Pairs Test for paired samples and Mann-Whitney U Test for unpaired samples. Linear regression is used to assess the association of initial values to change in value after treatment. The effect of stratified initial clinic domain value on odds of improving with surgery is assessed using Analysis of Variance. Results: Non-surgical and surgical patients present with similar pain intensity (49.6±7.9 vs. 49.4±7.8). Surgical patients do not improve prior to surgery, but both improve by their final visit (45.7±7.5, 43.7±8.8, p<0.05). Non-surgical and surgical patients present with similar pain interference (60.0±8.4 vs. 60.3±8.9). Surgical patients do not improve prior to surgery, but both improve by their final visit (56.9±8.8, 54.3±9.4, p<0.05). For surgical patients, change in pain intensity and pain interference correlate with initial values (R2 0.32 and 0.27, p<0.05). The percentage whose pain intensity improves after surgery when initial value is over one SD worse than mean is 96%, within one SD worse than mean is 81%, within one SD better than mean is 56%, and over one SD better than mean is 40% (p<0.05). Conclusion: Both non-operative and operative orthopedic treatments improve patient reported pain intensity and pain interference. For patients that have surgery, patients that present with more severe symptoms tend to improve more with surgery. Furthermore, the odds of improving after surgery can be calculated based on preoperative PRO scores. This may allow surgeons to counsel patients about the potential benefits of surgery with personalized precision that is currently unavailable. Measuring PROs using PROMIS CATs demonstrates the value of both non-operative and operative Orthopedic Surgery care for our patients. Preoperative PRO scores may predict the odds of successful surgical intervention.

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The PROMIS Global Health Questionnaire Correlates With the QuickDASH in Patients With Upper Extremity Illness

Hand ◽

10.1177/1558944717691127 ◽

2017 ◽

Vol 13 (1) ◽

pp. 118-121 ◽

Cited By ~ 7

Author(s):

Nicky Stoop ◽

Mariano E. Menendez ◽

Jos J. Mellema ◽

David Ring

Keyword(s):

Mental Health ◽

Global Health ◽

Upper Extremity ◽

Patient Reported Outcomes ◽

Global Mental Health ◽

Pearson Correlation ◽

Measurement Information ◽

Consistent Finding ◽

Patient Reported ◽

Mental Health Subscale

Background: The objective of this study is to evaluate the construct validity of the Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health instrument by establishing its correlation to the Quick-Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire in patients with upper extremity illness. Methods: A cohort of 112 patients completed a sociodemographic survey and the PROMIS Global Health and QuickDASH questionnaires. Pearson correlation coefficients were used to evaluate the association of the QuickDASH with the PROMIS Global Health items and subscales. Results: Six of the 10 PROMIS Global Health items were associated with the QuickDASH. The PROMIS Global Physical Health subscale showed moderate correlation with QuickDASH and the Mental Health subscale. There was no significant relationship between the PROMIS Global Mental Health subscale and QuickDASH. Conclusions: The consistent finding that general patient-reported outcomes correlate moderately with regional patient-reported outcomes suggests that a small number of relatively nonspecific patient-reported outcome measures might be used to assess a variety of illnesses. In our opinion, the blending of physical and mental health questions in the PROMIS Global Health makes this instrument less useful for research or patient care.

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Can Patient Reported Outcomes Guide Therapy Needs in Foot and Ankle Patients?

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00250 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0025

Author(s):

Jeff Houck ◽

Jillian Santer ◽

Judith Baumhauer

Keyword(s):

Physical Function ◽

Patient Reported Outcomes ◽

Predictive Ability ◽

Pain Interference ◽

Measurement Information ◽

Foot And Ankle ◽

Data Set ◽

T Score ◽

Patient Reported ◽

Health Domains

Category: Other Introduction/Purpose: The patient acceptable symptom state (PASS) is a validated question establishing if patients activity and symptoms are at a satisfactory low level for pain and function. Surprisingly, ~20% of foot and ankle patients at their initial visit present for care with an acceptable symptom state (i.e. PASS yes). These patients are important to identify to prevent over treatment and avoid excessive cost. It is also unclear what health domains (Pain Interference (PI), Physical Function (PF), or Depression (Dep)) influence a patients judgement of their PASS state (i.e. why they are seeking treatment). The purpose of this analysis is to document the prevalance of PASS state and determine the health domains that discriminate PASS patients and predict PASS state at the initiation of rehabilitation. Methods: Patient reported outcomes measurement information system (PROMIS) computer adaptive test (CAT) scales PF, pain PIand Dep and PASS ratings starting in summer 2017 were routinely collected for patient care. Of 746 unique patients in this data set, 114 patients had ICD-10 codes that were specific to the foot and ankle. Average age was 51years (±18) and 54.4% were female. Patients were seen an average of 19.8(±15.9) days from their referral and were billed as low (51.7%), moderate (44.7%) and high complexity (2.7%) evaluations per current procedural code (CPT) visits. ANOVA models were used to evaluate differences in PROMIS scales by PASS state (Yes/No). The area under receiver operator curve (AUC) was used to determine the predictive ability of each PROMIS scale to determine a PASS state. Thresholds for near 95% specificity were also calculated for a PASS Yes state for each PROMIS scale. Results: The prevalance of PASS Yes patients was 13.2% (15/114). Pass Yes patients were significantly better by an average of 7.2 to 8.0 points across all PROMIS health domains compared to PASS No patients (Table 1). ROC analysis suggested that Dep (AUC=0.73(0.07) p=0.005) was the highest predictor of PASS status followed by PI (AUC=0.70(0.08) p=0.012) and PF (AUC=0.69(0.07) p=0.18). The threshold PROMIS t-score values for determining PASS Yes with nearest 95% specificity were PF = 51.9, PI = 50.6, and Dep = 34. Conclusion: Surprising, yet consistent with previous data, 13.2% of patients at their initial physical therapy consultation rated themselves at an acceptable level of activity and symptoms. Health domains of physical function, pain interference, and depression were better in these patients and showed moderate ability (AUC~0.7) to identify these patients. The PROMIS thresholds suggest patients are identified by pain and physical function equal to the average of the US population (PROMIS T-Score ~50) and extremely low depression scores (34). Clinically it is important to recognize these patients and purposefully provide treatments that reinforce their self efficacy and prevent unnecessary costly treatments.

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A Less Invasive Approach to Periacetabular Osteotomy Improves Patient Reported Outcomes without Compromising Orientation

The Journal of Hip Surgery ◽

10.1055/s-0037-1603804 ◽

2017 ◽

Vol 01 (02) ◽

pp. 093-098

Author(s):

Christopher Pelt ◽

Nathaniel Wingert ◽

Jill Erickson ◽

Mike Anderson ◽

Christopher Peters

Keyword(s):

Mental Health ◽

Physical Function ◽

Patient Reported Outcomes ◽

Global Mental Health ◽

Periacetabular Osteotomy ◽

Consecutive Series ◽

Invasive Approach ◽

Less Invasive ◽

Acetabular Fragment ◽

Patient Reported

AbstractA less-invasive modification of the approach to periacetabular osteotomy (PAO) has recently been popularized by sparing the rectus femoris origin (RS-PAO). The RS-PAO approach with its lack of intra-articular inspection and associated treatment is novel, and there are few published results on the outcomes following this technique. We report on a consecutive series of RS-PAO cases, including patient reported outcomes (PROs), acetabular fragment reorientation, and complications. We reviewed a consecutive series of 103 patients (103 procedures) who underwent RS-PAO from June 2012 to January 2016 with a mean 2-year follow-up. We collected PROs, radiographic, and clinical outcomes. PROs consisted of PROMIS (Patient Reported Outcomes Measurement Information System) measures covering the domains of physical function, mental health, and a numeric pain score (NPS). Physical function and mental health were reported as standardized T-scores. Appropriate bivariate statistics were used for the analyses. Physical function improved from a preoperative mean of 39.9 (95% confidence interval [CI], 38.0–42.0) to a postoperative value of 50.0 T-score units (95% CI, 47.01–52.7; dav = 1.2). The PROMIS global mental-health T-scores improved from a preoperative median of 45.8 (interquartile range [IQR], 41.1–50.8) to a postoperative value of 53.3 (IQR, 50.8–59.0; p < 0.001, correlation coefficient [r] = 0.77). Pain decreased from a median preoperative value of 6 (IQR, 3–8) to a postoperative value of 2 (IQR, 1–3; p < 0.001, r = 0.71). The postoperative acetabular index (AI) was within the correction goal in 75% of the cases (77/103) and lateral center-edge angle (LCEA) was within goal in 87% (90/103) of the cases. Complications included intraoperative ischial fracture (n = 1), nonunion of the superior ramus (n = 1), ischiofemoral impingement (n = 1), delayed union (n = 1), and wound dehiscence (n = 2). There have been no reoperations for intra-articular pathology. The data demonstrated that using the RS-PAO technique without concomitant intra-articular work allows for appropriate acetabular positioning as well as significant improvement in physical function, mental health, and pain with an acceptable short-term complication profile and low rate of reoperation.

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Changes in patient-reported outcomes in light chain amyloidosis in the first year after diagnosis and relationship to NT-proBNP change

Blood Cancer Journal ◽

10.1038/s41408-021-00412-8 ◽

2021 ◽

Vol 11 (2) ◽

Author(s):

Anita D’Souza ◽

Ruta Brazauskas ◽

Angela Dispenzieri ◽

Julie Panepinto ◽

Kathryn E. Flynn

Keyword(s):

Mental Health ◽

Physical Function ◽

Light Chain ◽

Patient Reported Outcomes ◽

Social Roles ◽

Global Mental Health ◽

First Year ◽

Al Amyloidosis ◽

Patient Reported ◽

Anxiety Depression

AbstractWe conducted a prospective cohort study in newly diagnosed systemic light chain (AL) amyloidosis patients (N = 59) to study patient-reported outcomes (PROs) through the first year. The median age was 68 years with 42% female, 8% Black, and 78% lambda subtype. Organ involvement was cardiac in 66%, renal in 58%, with 25% having 3 or greater organs involved. Between baseline and 3 months, all PROMIS®-29 domain scores worsened by 0.4–4.1 points except anxiety which improved by 2.1 points. By 1 year, scores improved compared to the greatest decline at 3 months, most statistically significant for global physical health, physical function, and fatigue. On stage-adjusted survival analysis, in addition to baseline global physical and mental health, domains measuring physical function, fatigue, anxiety, depression, and social roles were associated with 1-year survival. At 1 year, PROMIS measures were associated with NT-proBNP changes and hematologic response. Among patients with an NT-proBNP response, the improvement was seen in physical function, social roles, global mental health, and anxiety. Among patients with an NT-proBNP progression, worsening was seen with anxiety, depression, sleep, and global mental health. Measuring and tracking PROs in patients with AL amyloidosis is important and these important outcomes can be used as correlative endpoints in clinical care/research.

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Cancer rehabilitation outpatient consultation: Patient characteristics, symptom burden and quality of life.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.5_suppl.136 ◽

2017 ◽

Vol 35 (5_suppl) ◽

pp. 136-136

Author(s):

Carolina Gutierrez

Keyword(s):

Mental Health ◽

Standard Deviation ◽

Cancer Survivors ◽

Patient Reported Outcomes ◽

Cancer Rehabilitation ◽

Population Mean ◽

T Score ◽

Patient Reported ◽

The Us

136 Background: Cancer rehabilitation focuses on the functional and psychological needs of cancer survivors. Patient-reported outcomes have been increasingly used as part of the standard of care during clinical encounters. We review characteristics that patients present to their outpatient cancer rehabilitation consultation at a large academic hospital. Methods: Patients presenting for their first outpatient cancer rehabilitation consultation completed a paper copy of the PROMIS-10 (Patient Reported Outcomes Measurement Information System) instrument immediately prior to meeting with the physician. It includes 10 items evaluating quality of life, social life, functional activity, mental health, pain, and fatigue. A caregiver or health care provider could provide assistance in completing the form. Patient-reported outcomes were analyzed as part of an IRB-approved protocol. Data were analyzed using descriptive statistics and the “PROMIS Scoring Global Short Form v1.0 and v1.1” (12/16/2010). T-Score distributions are standardized such that a 50 represents the average (mean) for the US general population, and the standard deviation around that mean is 10 points. Results: Twenty-seven patients presented for consultation (63% women, 37% men) from 3/2014 through 6/2015 with an average age of 54.5 (44-76 range). Disease types included 52% brain tumors, 33% breast, 5% prostate, and 1% of each of the following: melanoma, myelofibrosis, and multiple myeloma. For our population, the physical health subscale score was 11.51 with a T-Score 38.6, standard error 4.1, a T-Score more than one standard deviation below the population mean. The mental health subscale was 11.92 with a T-Score 43.5, standard error 3.6, representing less than one standard deviation below the mean. The global health score was 28.55, which fell 2 standard deviations below the population mean. Conclusions: Compared to the US population mean, cancer survivors presenting for a cancer rehabilitation consultation had lower physical health than mental health. Our findings suggest the importance of screening cancer survivors for physical impairments and providing interventions focused on functional recovery.

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PROMIS Patient Reported Pain Outcomes Compared With Numerical Pain Score Before and After Ankle Surgery

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00028 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0002

Author(s):

Andrew Haskell ◽

Todd Kim

Keyword(s):

Pain Intensity ◽

Effect Size ◽

Patient Reported Outcomes ◽

Pain Interference ◽

Lateral Ankle ◽

Ankle Replacement ◽

Ankle Ligament ◽

Patient Reported ◽

Before And After ◽

Lateral Ankle Ligament

Category: Patient Reported Outcomes Introduction/Purpose: Patient reported outcomes (PRO) are important for measuring clinical changes after surgical intervention. This study compares PROMIS pain intensity, PROMIS pain interference, and a zero-to-ten numerical pain score (NPS) before and after three common ankle surgeries to test the hypothesis that pain improvement is measurable by each scale. In addition, the effects size (ES) of each scale is compared to help determine which scale may provide the most power to detect an improvement in pain. Methods: PRO scores were routinely collected during clinic visits between 2015 and 2018. Over 175 patients who had undergone total ankle replacement, subtalar fusion, or lateral ankle ligament stabilization were identified in the electronic health record using the surgical billing codes for these procedures. The most recent preoperative and postoperative PROs for these patients were compared by Mann-Whitney U, and effect size was calculated using Cohen’s d. Results: For total ankle replacement, NPS, pain intensity, and pain interference all improved (p<0.05) with ES 1.29, 0.95, and 0.63 respectively. For subtalar fusion, NPS, and pain interference improved (p<0.05) with ES 0.86 and 0.54; pain intensity (p=0.21) was unchanged with ES 0.30. For lateral ankle ligament stabilization, NPS, and pain interference improved (p<0.05) with ES 0.49 and 0.59; pain intensity (p=0.49) was unchanged with ES 0.19. Conclusion: While both NPS and PROMIS pain interference consistently demonstrated improvements after common ankle surgeries, NPS is preferable given its single question format and greater effect size in two of the three procedures studies. PROMIS pain intensity did not routinely measure changes in our surgical population questioning its utility.

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Impact of Preoperative Opioid Use on 2-Year Patient-Reported Outcomes in Knee Surgery Patients

The Journal of Knee Surgery ◽

10.1055/s-0040-1716358 ◽

2020 ◽

Author(s):

Ali Aneizi ◽

Patrick M. J. Sajak ◽

Aymen Alqazzaz ◽

Tristan Weir ◽

Cameran I. Burt ◽

...

Keyword(s):

Physical Function ◽

Patient Reported Outcomes ◽

Knee Surgery ◽

The Body ◽

Pain Interference ◽

Opioid Use ◽

Opioid Prescription ◽

Social Satisfaction ◽

Patient Reported ◽

Met Expectations

AbstractThe objectives of this study are to assess perioperative opioid use in patients undergoing knee surgery and to examine the relationship between preoperative opioid use and 2-year postoperative patient-reported outcomes (PROs). We hypothesized that preoperative opioid use and, more specifically, higher quantities of preoperative opioid use would be associated with worse PROs in knee surgery patients. We studied 192 patients undergoing knee surgery at a single urban institution. Patients completed multiple PRO measures preoperatively and 2-year postoperatively, including six patient-reported outcomes measurement information system (PROMIS) domains; the International Knee Documentation Committee (IKDC) questionnaire, numeric pain scale (NPS) scores for the operative knee and the rest of the body, Marx's knee activity rating scale, Tegner's activity scale, International Physical Activity Questionnaire, as well as measures of met expectations, overall improvement, and overall satisfaction. Total morphine equivalents (TMEs) were calculated from a regional prescription monitoring program. Eighty patients (41.7%) filled an opioid prescription preoperatively, and refill TMEs were significantly higher in this subpopulation. Opioid use was associated with unemployment, government insurance, smoking, depression, history of prior surgery, higher body mass index, greater comorbidities, and lower treatment expectations. Preoperative opioid use was associated with significantly worse 2-year scores on most PROs, including PROMIS physical function, pain interference, fatigue, social satisfaction, IKDC, NPS for the knee and rest of the body, and Marx's and Tegner's scales. There was a significant dose-dependent association between greater preoperative TMEs and worse scores for PROMIS physical function, pain interference, fatigue, social satisfaction, NPS body, and Marx's and Tegner's scales. Multivariable analysis confirmed that any preoperative opioid use, but not quantity of TMEs, was an independent predictor of worse 2-year scores for function, activity, and knee pain. Preoperative opioid use and TMEs were neither independent predictors of met expectations, satisfaction, patient-perceived improvement, nor improvement on any PROs. Our findings demonstrate that preoperative opioid use is associated with clinically relevant worse patient-reported knee function and pain after knee surgery.

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Understanding quality of life and treatment history of patients with Bertolotti syndrome compared with lumbosacral radiculopathy

Journal of Neurosurgery Spine ◽

10.3171/2019.2.spine1953 ◽

2019 ◽

Vol 31 (2) ◽

pp. 222-228 ◽

Cited By ~ 1

Author(s):

Joshua L. Golubovsky ◽

Arbaz Momin ◽

Nicolas R. Thompson ◽

Michael P. Steinmetz

Keyword(s):

Quality Of Life ◽

Mental Health ◽

Propensity Score ◽

Disc Herniation ◽

Symptom Onset ◽

Patient Reported Outcomes ◽

Lumbosacral Radiculopathy ◽

Patient Reported ◽

Age And Sex

OBJECTIVEBertolotti syndrome is a rare spinal condition that causes low-back pain due to a lumbosacral transitional vertebra (LSTV), which is a pseudoarticulation between the fifth lumbar transverse process and the sacral ala. Bertolotti syndrome patients are rarely studied, particularly with regard to their quality of life. This study aimed to examine the quality of life and prior treatments in patients with Bertolotti syndrome at first presentation to the authors’ center in comparison with those with lumbosacral radiculopathy.METHODSThis study was a retrospective cohort analysis of patients with Bertolotti syndrome and lumbosacral radiculopathy due to disc herniation seen at the authors’ institution’s spine center from 2005 through 2018. Diagnoses were confirmed with provider notes and imaging. Variables collected included demographics, diagnostic history, prior treatment, patient-reported quality of life metrics, and whether or not they underwent surgery at the authors’ institution. Propensity score matching by age and sex was used to match lumbosacral radiculopathy patients to Bertolotti syndrome patients. Group comparisons were made using t-tests, Fisher’s exact test, Mann-Whitney U-tests, Cox proportional hazards models, and linear regression models where variables found to be different at the univariate level were included as covariates.RESULTSThe final cohort included 22 patients with Bertolotti syndrome who had patient-reported outcomes data available and 46 propensity score–matched patients who had confirmed radiculopathy due to disc herniation. The authors found that Bertolotti syndrome patients had significantly more prior epidural steroid injections (ESIs) and a longer time from symptom onset to their first visit. Univariate analysis showed that Bertolotti syndrome patients had significantly worse Patient-Reported Outcomes Measurement Information System (PROMIS) mental health T-scores. Adjustment for prior ESIs and time from symptom onset revealed that Bertolotti syndrome patients also had significantly worse PROMIS physical health T-scores. Time to surgery and other quality of life metrics did not differ between groups.CONCLUSIONSPatients with Bertolotti syndrome undergo significantly longer workup and more ESIs and have worse physical and mental health scores than age- and sex-matched patients with lumbosacral radiculopathy. However, both groups of patients had mild depression and clinically meaningful reduction in their quality of life according to all instruments. This study shows that Bertolotti syndrome patients have a condition that affects them potentially more significantly than those with lumbosacral radiculopathy, and increased attention should be paid to these patients to improve their workup, diagnosis, and treatment.

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