Oral Posters: Innovative Technologies

Presented by: A. Patel - View Audio/Video Presentation (Members Only)

Author(s):

A. Patel(1), S.-N. Dodwad(2), S. Bhatt(3), J. Savage(4), W. Hsu(3), N. Rothrock(5)

(1) Northwestern University, Chicago, IL, United States
(2) University of Texas Health Science Center, Orthopaedic Surgery, Houston, TX, United States
(3) Northwestern University, Orthopaedic Surgery, Chicago, IL, United States
(4) Cleveland Clinic Main Campus, Center for Spine Health, Cleveland, OH, United States
(5) Northwestern University, Medical Social Sciences, Chicago, IL, United States

Abstract

Background: PROMIS is an adaptive, responsive assessment tool that measures patient-reported health status that is funded by the National Institutes of Health (NIH). Lumbar spinal stenosis is a common, debilitating condition in patients over the age of 50 that is often treated surgically. The objective of this project is to validate PROMIS measures pain behavior, pain interference, and physical function in surgically treated patients with lumbar spinal stenosis against historical outcomes including Zurich Claudication Questionnaire (ZCQ), Oswestry Disability Index (ODI), and the Short-Form 12 (SF-12).

Purpose: To accurately assess and compare results of PROMIS physical function and pain interference, pain behavior, and pain intensity assessment tools against various standardized legacy measures for patients with lumbar stenosis.

Methods: PROMIS (pain behavior, pain interference, and physical function), ODI, ZCQ, and SF-12 outcome measures were administered to 92 consecutive tertiary hospital patients treated surgically for lumbar spinal stenosis. Assessments were done at baseline (preoperatively) and postoperatively at 6 weeks and 3 months. We excluded patients presenting for a revision surgery, tumor, infection, or trauma. Each patient prospectively completed the PROMIS assessments and legacy measures custom built into the Assessment Center by using a secure login and password on a tablet.

Results: Of the 92 patients enrolled (mean age of 62.2, 58 male, 34 female), 60 patients (65%) completed assessments up to 3 months. PROMIS measures showed statistically significant improvement in outcome scores similar to ODI, ZCQ, and SF-12 at all-time points with Pearson correlation coefficients ranging from absolute values of .27-.73 at baseline and .27-.70 between 6 weeks and 3 months. Compared to their preoperative condition, at the 6 weeks' time point, 29 out of 33 (87.9%) patients reported improvement. Compared to their prior visit at 6 weeks, at 3 months postoperatively, 27 patients of 35 patients (77.1%) reported additional improvement in their preoperative condition. At baseline and throughout the assessment, Both ZCQ (0-25%) and SF-12 (0-45%) had more patients in the floor and ceiling areas compared to PROMIS (0-1%) and ODI (0). Nine percent, 8%, and 7% of patients had preoperative PROMIS pain behavior, pain interference, and physical function, respectively, within 5 points of the general population; at 3 months, 42%, 48%, and 38% of patients had PROMIS pain behavior, pain interference, and physical function, respectively, within 5 points of the general population. Concurrent medical conditions that contributed to responses were present in 30% of patients. When this subset of patients was compared to patients who did not identify concurrent medical conditions, there were no significant statistical differences in mean PROMIS, ODI, Zurich, SF-12 scores at baseline nor at 3 months postoperatively other than the baseline MCS of SF-12 at baseline (43.8 in patients with other conditions vs 49.1 in patients with no other related conditions, p=.019).

Conclusions: PROMIS is a valid and responsive measure of surgically treated patients with lumbar spinal stenosis when compared to legacy ODI, SF-12 and Zurich patient outcomes. PROMIS may be preferable to legacy instruments because of the efficacy in measuring treatment effect, ability to accurately evaluate multiple parameters, and avoidance of floor/ceiling effects.