PedsQL for prediction of postoperative patient-reported outcomes following Chiari decompression surgery

OBJECTIVEThe purpose of this study is to determine if the preoperative Pediatric Quality of Life Inventory (PedsQL) score is predictive of short- and intermediate-term PedsQL outcomes following Chiari decompression surgery. The utility of preoperative patient-reported outcomes (PROs) in predicting pain, opioid consumption, and long-term PROs has been demonstrated in adult spine surgery. To the best of the authors’ knowledge, however, there is currently no widely accepted tool to predict short-, intermediate-, or long-term outcomes after pediatric Chiari decompression surgery.METHODSA prospectively maintained database was retrospectively reviewed. Patients who had undergone first-time decompression for symptomatic Chiari malformation were identified and grouped according to their preoperative PedsQL scores: mild disability (score 80–100), moderate disability (score 60–79), and severe disability (score < 60). PedsQL scores at the 6-week, 3-month, and/or 6-month follow-ups were collected. Preoperative PedsQL subgroups were tested for an association with demographic and perioperative characteristics using one-way ANOVA or chi-square analysis. Preoperative PedsQL subgroups were tested for an association with improvements in short- and intermediate-term PedsQL scores using one-way ANOVA and a paired Wilcoxon signed-rank test controlling for statistically different demographic characteristics when appropriate.RESULTSA total of 87 patients were included in this analysis. According to their preoperative PedsQL scores, 28% of patients had mild disability, 40% had moderate disability, and 32% had severe disability. There was a significant difference in the prevalence of comorbidities (p = 0.009) and the presenting symptoms of headaches (p = 0.032) and myelopathy (p = 0.047) among the subgroups; however, in terms of other demographic or operative factors, there was no significant difference. Patients with greater preoperative disability demonstrated statistically significantly lower PedsQL scores at all postoperative time points, except in terms of the parent-reported PedsQL at 6 months after surgery (p = 0.195). Patients with severe disability demonstrated statistically significantly greater improvements (compared to preoperative scores) in PedsQL scores at all time points after surgery, except in terms of the 6-week and 6-month PROs and the 6-month parent-reported outcomes (p = 0.068, 0.483, and 0.076, respectively).CONCLUSIONSPatients with severe disability, as assessed by the PedsQL, had lower absolute PedsQL scores at all time points after surgery but greater improvement in short- and intermediate-term PROs. The authors conclude that the PedsQL is an efficient and accurate tool that can quickly assess patient disability in the preoperative period and predict both short- and intermediate-term surgical outcomes.

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PedsQL for Prediction of Postoperative Patient-Reported Outcomes following Chiari Decompression Surgery

Proceedings of IMPRS ◽

10.18060/23419 ◽

2019 ◽

Vol 2 (1) ◽

Author(s):

Shawyon Baygani, BS ◽

Kristin Zieles,BS ◽

Andrew Jea, MD, MHA

Keyword(s):

Chiari Malformation ◽

Patient Reported Outcomes ◽

Rank Test ◽

Decompression Surgery ◽

Type I ◽

Postoperative Patient ◽

Disability Score ◽

Chiari Malformation Type I ◽

Patient Reported

Background and Hypothesis: Chiari malformation type I (CM-I) is a common pediatric disorder in which the cerebellar tonsils herniate the foramen magnum with associated spinal symptoms. The purpose of this study is to determine if the preoperative Pediatric Quality of Life Inventory (PedsQL) score is predictive of intermediate-term PedsQL outcomes following Chiari decompression surgery. The utility of preoperative patient-reported outcomes (PROs) to postoperative PROs has been previously demonstrated in adult spine surgery. However, to our knowledge, there is currently no widely accepted tool to predict short-, intermediate-, or long-term outcomes after pediatric Chiari decompression surgery. Project Methods: A prospectively maintained database was retrospectively reviewed. Patients who underwent first-time decompression for symptomatic Chiari malformation were identified and grouped by their preoperative PedsQL scores: mild disability (score 80–100), moderate disability (score 60–80); and severe disability (score < 60). PedsQL outcomes were collected at 6-week, 3-month, and 6-month follow-up. Preoperative PedsQL subgroups were tested for an association with demographic, perioperative characteristics, and improvements between groups by one-way ANOVA, chi-square, or Wilcoxon signed rank test, where appropriate. Results: The postoperative patient- and parent-reported PedsQL values were significantly different between all three groups at 6-weeks, 3-months, and 6-months after surgery (p < 0.05), except at the 6-month timepoint for parent-reported outcomes (p = 0.111). Patients with higher preoperative disability demonstrated statistically significant greater improvements (compared to preoperative score) in parent-reported PedsQL at all timepoints after surgery, except at the 6-month parent-reported outcomes (p = 0.133). Conclusion: Patients with worse preoperative disability, as assessed by PedsQL, experienced lower absolute PedsQL scores at all timepoints after surgery but had greater improvement in short- and intermediate-term PROs. We conclude that PedsQL is an efficient and accurate tool that can quickly assess patient disability in the preoperative period and predict both short-term and long-term surgical outcomes.

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PROMIS Physical Function for prediction of postoperative pain, narcotics consumption, and patient-reported outcomes following minimally invasive transforaminal lumbar interbody fusion

Journal of Neurosurgery Spine ◽

10.3171/2018.9.spine18863 ◽

2019 ◽

Vol 30 (4) ◽

pp. 476-482 ◽

Cited By ~ 5

Author(s):

Dil V. Patel ◽

Mundeep S. Bawa ◽

Brittany E. Haws ◽

Benjamin Khechen ◽

Andrew M. Block ◽

...

Keyword(s):

Postoperative Pain ◽

Patient Reported Outcomes ◽

Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Leg Pain ◽

Disability Score ◽

Pain Scores ◽

Patient Reported ◽

Mild Disability

OBJECTIVEThis study aimed to determine if the preoperative Patient-Reported Outcomes Measurement Information System, Physical Function (PROMIS PF) score is predictive of immediate postoperative patient pain and narcotics consumption or long-term patient-reported outcomes (PROs) following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).METHODSA prospectively maintained database was retrospectively reviewed. Patients who underwent primary, single-level MIS TLIF for degenerative pathology were identified and grouped by their preoperative PROMIS PF scores: mild disability (score 40–50), moderate disability (score 30–39.9), and severe disability (score 20–29.9). Postoperative pain was quantified using the visual analog scale (VAS), and narcotics consumption was quantified using Oral Morphine Equivalents. PROMIS PF, Oswestry Disability Index (ODI), 12-Item Short-Form Health Survey, Physical Component Summary (SF-12 PCS), and VAS back and leg pain were collected preoperatively and at 6-week, 3-month, 6-month, and 12-month follow-up. Preoperative PROMIS PF subgroups were tested for an association with demographic and perioperative characteristics using 1-way ANOVA or chi-square analysis. Preoperative PROMIS PF subgroups were tested for an association with immediate postoperative pain and narcotics consumption in addition to improvements in PROMIS PF, ODI, SF-12 PCS, and VAS back and leg pain by using linear regression controlling for statistically different demographic characteristics.RESULTSA total of 130 patients were included in this analysis. Patients were grouped by their preoperative PROMIS PF scores: 15.4% had mild disability, 63.8% had moderate disability, and 20.8% had severe disability. There were no significant differences among the subgroups in terms of age, sex, smoking status, and comorbidity burden. Patients with greater disability were more likely to be obese and to have workers’ compensation insurance. There were no differences among subgroups in regard to operative levels, operative time, estimated blood loss, and hospital length of stay. Patients with greater disability reported higher VAS pain scores and narcotics consumption for postoperative day 0 and postoperative day 1. Patients with greater preoperative disability demonstrated lower PROMIS PF, ODI, SF-12 PCS, and worse VAS pain scores at each postoperative time point.CONCLUSIONSPatients with worse preoperative disability, as assessed by PROMIS PF, experienced increased pain and narcotics consumption, along with less improvement in long-term PROs. The authors conclude that PROMIS PF is an efficient and accurate instrument that can quickly assess patient disability in the preoperative period and predict both short-term and long-term surgical outcomes.

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Equivalent 10-Year Outcomes After Implantation of Autologous Bone Marrow–Derived Mesenchymal Stem Cells Versus Autologous Chondrocyte Implantation for Chondral Defects of the Knee

The American Journal of Sports Medicine ◽

10.1177/0363546519867933 ◽

2019 ◽

Vol 47 (12) ◽

pp. 2881-2887 ◽

Cited By ~ 13

Author(s):

Alex Quok An Teo ◽

Keng Lin Wong ◽

Liang Shen ◽

Jia Ying Lim ◽

Wei Seong Toh ◽

...

Keyword(s):

Patient Reported Outcomes ◽

Tumor Formation ◽

Chondral Defects ◽

Sf 36 ◽

Significant Difference ◽

Patient Reported ◽

Chondrocyte Implantation ◽

Autologous Chondrocyte

Background: The use of bone marrow–derived mesenchymal stem cells (BMSCs) in cartilage repair procedures circumvents some of the limitations of autologous chondrocyte implantation (ACI), but long-term outcomes for this newer procedure are lacking. The authors previously reported comparable outcomes for the 2 procedures at 2-year follow-up. Purpose/Hypothesis: The purpose was to compare the long-term clinical outcomes of ACI versus BMSCs. It was hypothesized that there would be no significant difference between the groups in terms of patient-reported outcome scores and safety outcomes at 10-year follow-up. Study Design: Cohort study; Level of evidence, 2. Methods: Seventy-two patients who underwent either ACI or BMSC implantation—matched in terms of age and lesion site— were followed up to a median of at least 10 years. Patients were assessed with the 36-item Short Form Health Survey (SF-36), the International Knee Documentation Committee knee evaluation form, the Lysholm Knee Score, and the Tegner Activity Scale. In addition, information was obtained regarding any additional surgical procedures as well as safety data, with particular attention to infection and tumor formation. Results: There was an improvement in all patient-reported outcomes scores apart from the Mental Component Summary of the SF-36 after cartilage repair surgery. There was no significant difference in any of the patient-reported outcomes between cohorts at any time point. Six and 5 patients in the ACI and BMSC groups, respectively, underwent subsequent surgical procedures, including 1 total knee replacement in the BMSC group. None of the patients in either group developed any deep infection or tumor within the follow-up period. Conclusion: BMSC implantation used for the treatment of chondral defects of the knee appears to result in equivalent clinical outcomes to first-generation ACI at up to 10 years, with no apparent increased tumor formation risk.

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Pain Management Telementoring, Long-term Opioid Prescribing, and Patient-Reported Outcomes

Pain Medicine ◽

10.1093/pm/pnz338 ◽

2019 ◽

Vol 21 (2) ◽

pp. 266-273 ◽

Cited By ~ 1

Author(s):

Diane Flynn ◽

Ardith Z Doorenbos ◽

Alana Steffen ◽

Honor McQuinn ◽

Dale J Langford

Keyword(s):

Pain Management ◽

Patient Reported Outcomes ◽

Medical Center ◽

Intervention Group ◽

Control Group ◽

Significant Difference ◽

Patient Reported ◽

Intent To Treat ◽

The Relationship

Abstract Objective Benefits of primary care provider (PCP) participation in pain management telementoring have been reported; however, no studies have examined within-patient changes in dose or discontinuation of long-term opioid therapy (LOT). The objectives of this nonrandomized study were to evaluate the relationship between telementoring participation and 1) LOT dose reduction and 2) LOT discontinuation and to 3) explore the relationship between LOT dose changes and patient-reported outcomes. Methods PCPs were recruited from a US Army medical center. Intervention group PCPs (N = 12) attended telementoring sessions; control group providers (N = 13) did not. Morphine equivalent daily doses (MEDD) for patients of study providers (N = 396) were extracted from the study site’s opioid database. The intervention group was subdivided based on number of sessions attended (i.e., active and low participation). Intent-to-treat and as-treated analyses were conducted using generalized estimating equations. Separate analyses evaluated the association between within-patient changes in MEDD and pain impact, depression, and anxiety (N = 40). Results Intent-to-treat analysis revealed no significant difference in MEDD reduction; however, a higher proportion of patients of intervention PCPs discontinued LOT (25% ± 3.6%) compared with control PCPs (16% ± 3.6%, P < 0.05). As-treated analyses revealed differences in MEDD reduction between active (13.2 ± 3.0) and low-participating (2.6 ± 3.0) PCPs (P < 0.01). Further, a higher proportion of patients of actively participating PCPs discontinued LOT (29% ± 4.9%) compared with control PCPs (16% ± 3.6%, P = 0.01). We found no evidence that decreased MEDD was associated with poorer self-reported outcomes within patients. Conclusions Pain management telementoring supports PCPs’ efforts to reduce reliance on LOT for chronic pain management and highlights the need for actively engaged PCP pain champions.

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Long-Term Efficacy, Visual Performance and Patient Reported Outcomes with a Trifocal Intraocular Lens: A Six-Year Follow-up

Journal of Clinical Medicine ◽

10.3390/jcm10092009 ◽

2021 ◽

Vol 10 (9) ◽

pp. 2009

Author(s):

Joaquín Fernández ◽

Manuel Rodríguez-Vallejo ◽

Javier Martinez ◽

Noemi Burguera ◽

David P. Piñero

Keyword(s):

Intraocular Lens ◽

Patient Reported Outcomes ◽

Phone Call ◽

Distortion Analysis ◽

Patient Reported ◽

Visual Function Questionnaire ◽

Secondary Objective ◽

Defocus Curve ◽

The Mean

(1) Background: To evaluate the efficacy at 6 years postoperative after the implantation of a trifocal intraocular lens (IOL) AT Lisa Tri 839MP. The secondary objective was to evaluate the contrast sensitivity defocus curve (CSDC), light distortion analysis (LDA), and patient reported outcomes (PROs). (2) Methods: Sixty-two subjects participated in phone call interviews to collect data regarding a visual function questionnaire (VF-14), a patient reported spectacle independence questionnaire (PRSIQ), and questions related to satisfaction and decision to be implanted with the same IOL. Thirty-seven of these subjects were consecutively invited to a study visit for measurement of their visual acuity (VA), CSDC, and LDA. (3) Results: The mean monocular distance corrected VA was −0.05, 0.08, and 0.05 logMAR at far and distances of 67 cm and 40 cm, respectively. These VAs were significantly superior to those reported in previous literature (p < 0.05). The total area under the CSDC was 2.29 logCS/m−1 and the light distortion index 18.82%. The mean VF-14 score was 94.73, with 19.4% of subjects requiring spectacles occasionally for near distances, and 88.9% considering the decision of being operated again; (4) Conclusions: Long-term AT LISA Tri 839MP IOL efficacy results were equal or better than those reported 12 months postoperatively in previous studies. The spectacle independence and satisfaction rates were comparable to those reported in short-term studies.

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Clinical and Immunological Efficacy of Mangosteen and Propolis Extracted Complex in Patients with Gingivitis: A Multi-Centered Randomized Controlled Clinical Trial

Nutrients ◽

10.3390/nu13082604 ◽

2021 ◽

Vol 13 (8) ◽

pp. 2604

Author(s):

Jin-Young Park ◽

Kyung-A Ko ◽

Ji-Yeong Lee ◽

Jae-Woon Oh ◽

Hyun-Chang Lim ◽

...

Keyword(s):

Patient Reported Outcomes ◽

Daily Intake ◽

Test Group ◽

Control Group ◽

Controlled Clinical Trial ◽

Control Groups ◽

Immunological Parameters ◽

Significant Difference ◽

Patient Reported ◽

And Control

Background: Mangosteen and propolis extracts (MAEC) have been potential therapeutic agents known to exhibit powerful antioxidant and anti-inflammatory properties. The aim of the current study was to evaluate the clinical and immunological efficacy of MAEC as well as safety and patient-reported outcomes (PROMs) on gingivitis and incipient periodontitis. Methods: This study was performed on 104 patients diagnosed with gingivitis or incipient periodontitis. At baseline, the participants were randomly allocated to either the test group, with daily intake of a single capsule containing 194 mg of MAEC for eight weeks, or control group, with placebo. Clinical periodontal evaluation and immunological parameters from saliva and gingival sulcular fluid were assessed at baseline, four, and eight weeks. Individual PROMs were assessed by OHIP-14 questionnaires. Results: There was a significant difference of modified gingival index at four and eight weeks between the test and control groups. In the test group, crevicular interleukin (IL)-6 was reduced, and the salivary matrix metalloproteinase (MMP)-9 was increased after eight weeks. PROMs were improved up to four weeks compared to placebo. Conclusion: Oral administration of MAEC would have a potential to reduce gingival inflammation clinically and immunologically in the patients with gingivitis and incipient periodontitis.

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No Difference in Outcomes Following Osteochondral Allograft with Fresh Precut Cores Compared to Hemi-Condylar Allografts

Cartilage ◽

10.1177/19476035211021911 ◽

2021 ◽

pp. 194760352110219

Author(s):

Danielle H. Markus ◽

Anna M. Blaeser ◽

Eoghan T. Hurley ◽

Brian J. Mannino ◽

Kirk A. Campbell ◽

...

Keyword(s):

Patient Reported Outcomes ◽

Knee Injury ◽

Lesion Size ◽

Osteochondral Allograft ◽

Osteochondral Lesions ◽

Radiographic Outcomes ◽

Significant Difference ◽

Patient Reported ◽

The Mean

Objective The purpose of the current study is to evaluate the clinical and radiographic outcomes at early to midterm follow-up between fresh precut cores versus hemi-condylar osteochondral allograft (OCAs) in the treatment of symptomatic osteochondral lesions. Design A retrospective review of patients who underwent an OCA was performed. Patient matching between those with OCA harvested from an allograft condyle/patella or a fresh precut allograft core was performed to generate 2 comparable groups. The cartilage at the graft site was assessed with use of a modified Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scoring system and patient-reported outcomes were collected. Results Overall, 52 total patients who underwent OCA with either fresh precut OCA cores ( n = 26) and hemi-condylar OCA ( n = 26) were pair matched at a mean follow-up of 34.0 months (range 12 months to 99 months). The mean ages were 31.5 ± 10.7 for fresh precut cores and 30.9 ± 9.8 for hemi-condylar ( P = 0.673). Males accounted for 36.4% of the overall cohort, and the mean lesion size for fresh precut OCA core was 19.6 mm2 compared to 21.2 mm2 for whole condyle ( P = 0.178). There was no significant difference in patient-reported outcomes including Visual Analogue Scale, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, and Tegner ( P > 0.5 for each), or in MOCART score (69.2 vs. 68.3, P = 0.93). Conclusions This study found that there was no difference in patient-reported clinical outcomes or MOCART scores following OCA implantation using fresh precut OCA cores or size matched condylar grafts at early to midterm follow-up.

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Treatment of End-Stage Hallux Rigidus and Impact of Arthrodesis versus Arthroplasty on Patient Reported Outcomes

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000129 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0001

Author(s):

Monique Chambers ◽

MaCalus Hogan ◽

Dukens LaBaze

Keyword(s):

Patient Reported Outcomes ◽

Surgical Intervention ◽

Metatarsophalangeal Joint ◽

Hallux Rigidus ◽

First Metatarsophalangeal Joint ◽

Significant Difference ◽

Patient Reported ◽

Outcome Scores ◽

Vas Scores ◽

End Stage

Category: Bunion, Midfoot/Forefoot Introduction/Purpose: Hallux rigidus is a degenerative disease of the first metatarsophalangeal joint. Severe, end-stage hallux rigidus can become debilitating with surgical intervention becoming necessary once conservative measures and shoe modifications have failed. Joint salvage procedures include metatarsal phalangeal (MTP) arthrodesis and MTP arthroplasty. The purpose of this study was to assess for differences in patient reported outcomes in two cohorts who underwent fusion or joint reconstruction. Methods: This study was a retrospective review of prospectively collected data of 385 patients from an academic medical institution. Patients who underwent surgical intervention from July 2015 to November 2016 were identified based on CPT codes for MTP arthrodesis (28750) and arthroplasty (28293). We extracted outcome scores including SF12-M, SF12-P, FAAM, and VAS scores. Exclusion criteria included poly-trauma, revision procedures, and lack of pre and post-operative outcome scores. Mann- Whitney t-test was performed using GraphPad Prism version 7.0b for Mac to compare procedure groups, with significance define by a p-value of 0.05. Results: A total of eighteen patients met the inclusion criteria, with 6 who underwent arthroplasty and 12 arthrodesis. The average age was 63.7 amongst the cohort, with a total of 16 female and 2 males. Patients who underwent arthrodesis had better outcomes across all parameters. When comparing preoperative and postoperative scores, arthrodesis patients showed greater improvement of SF12-M (arthrodesis 9 vs arthroplasty -2, p=0.05), and SF12-P (9 vs -16, respectively p=0.05) scores. Arthroplasty patients were more likely to have a decrease in their SF-12 scores. VAS scores and FAAM scores showed no statistical difference between the two cohorts. Postoperative VAS scores were worse in 33% of arthroplasty patients despite surgical intervention, compared to 10% of arthrodesis patients. Conclusion: Our results suggests that both procedures provide a statistically significant difference in pain with several patients having a Global Rate of Change that is “very much better”. However, fusion of the metatarsophalangeal joint results in improved pain and functional outcomes for patients with severe hallux rigidus. These findings are consistent with current reports in the literature, which are mostly case series reports. Larger studies are needed to provide appropriate power and better support the findings of this study.

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