General Session: Value and Outcomes in Spine Surgery - Hall F

Presented by: N. Stekas


D. Vasquez-Montes(1), J. Tishelman(1), D. Jevotovsky(1), R. Karia(1), N. Stekas(1), C. Bortz(1), C. Fischer(1), A. Buckland(1), T. Errico(1), T. Protopsaltis(1)

(1) NYU Langone Orthopedic Hospital, New York, NY, United States


Introduction: Traditional measures of disability such as the Oswestry Disability Index (ODI) and Neck Disability Index (NDI) are the gold standard for quantifying disability and quality of life in patients with back and neck pathology. The Visual Analog Scale (VAS) reliably reports pain in the back, neck, arms and legs. The Patient Reported Outcomes Measurement Information System (PROMIS) Physical Function, Pain Intensity, and Pain Interference have become increasingly popular for their computer adaptive testing (CAT) methodology. This study aims to validate the association between PROMIS and its outcome measurement predecessors for patients with back and neck pain.

Methods: A retrospective review of a PROM database was performed at a single institution in an urban center. Inclusion criteria was >18 years and a presenting complaint of neck or back pain. PROMIS CAT Pain Interference, Physical Function, and Pain Intensity t-scores were compared with the traditional PROMs ODI, NDI, and VAS Back, Leg, Neck, and Arm pain. The cohort was dichotomized based on their primary complaint (back or neck). The relationship between PROMIS instruments and traditional PROMs was assessed using Pearson Correlation coefficients. The average number of questions answered for each instrument was calculated and means were compared to test for significant difference at α = 0.05 level of significance. Instrument sensitivity was assessed by comparing the score distribution.

Results: 494 patients with back pain and 130 patients with neck pain were analyzed. In the back pain cohort, ODI showed a strong correlation with PROMIS Physical Function (R= -0.749, p< 0.001), Pain Intensity (R = 0.790, p< 0.001), Pain Interference (R=0.709, p< 0.001). Additionally, PROMIS Pain Intensity correlated to both VAS Back (R = 0.642, p< 0.001) and Leg Pain (R = 0.462, p< 0.001). On average, patients completing the PROMIS Physical Function domain answered significantly fewer questions than when they filled out the ODI (4.123 vs. 9.906, p< 0.001). When assessing for instrument sensitivity, neither survey presented a significant Ceiling & Floor effect in the Back population (ODI: 0.40% and 2.63%, PROMIS PF (Back): 0.60% and 1.41%). In the Neck Pain cohort, NDI showed a strong correlation to all PROMIS dimensions (R= -0.771, p< 0.001), Pain Intensity (R = 0.786, p< 0.001), and Pain Interference (R=0.605, p< 0.001). Additionally, PROMIS Pain Intensity correlated to VAS Neck (R = 0.642, p< 0.001), and with Arm Pain (R = 0.376, p< 0.001). For NDI and the PROMIS Physical Function domain, patients answered significantly fewer questions when using the PROMIS CAT than when filling out NDI (4.417 vs. 10, p< 0.001). There was no significant differences found in terms of Ceiling and Floor effects for patients with Neck complaints (NDI: 0.00% and 6.92%, PF (Neck): 0.00% and 5.34%).

Conclusions: PROMIS CAT dimensions correlate strongly with traditional disability and neck/back pain. For both groups, the PROMIS CAT Physical Function questionnaire required significantly fewer answers to achieve similar granularity. There were no significant differences in ceiling and floor effects for NDI or ODI when compared with PROMIS Physical Function. The PROMIS domains can detect pain and disability in the neck and back while allowing patients to fill out the questionnaires faster.