PMID- 24010900
OWN - NLM
STAT- MEDLINE
DCOM- 20140108
LR  - 20191210
IS  - 1547-5646 (Electronic)
IS  - 1547-5646 (Linking)
VI  - 19
IP  - 5
DP  - 2013 Nov
TI  - Clinically important deterioration in patients undergoing lumbar spine surgery: a 
      choice of evaluation methods using the Oswestry Disability Index, 36-Item Short 
      Form Health Survey, and pain scales: clinical article.
PG  - 564-8
LID - 10.3171/2013.8.SPINE12804 [doi]
AB  - OBJECT: Health-related quality of life (HRQOL) measures have become the mainstay 
      for outcome appraisal in spine surgery. Clinically meaningful interpretation of 
      HRQOL improvement has centered on the minimum clinically important difference 
      (MCID). The purpose of this study was to calculate clinically important 
      deterioration (CIDET) thresholds and determine a CIDET value for each HRQOL 
      measure for patients undergoing lumbar fusion. METHODS: Seven hundred twenty-two 
      patients (248 males, 127 smokers, mean age 60.8 years) were identified with 
      complete preoperative and 1-year postoperative HRQOLs including the Oswestry 
      Disability Index (ODI), 36-Item Short Form Health Survey (SF-36), and numeric 
      rating scales (0-10) for back and leg pain following primary, instrumented, 
      posterior lumbar fusion. Anchor-based and distribution-based methods were used to 
      calculate CIDET for each HRQOL. Anchor-based methods included change score, 
      change difference, and receiver operating characteristic curve analysis. The 
      Health Transition Item, an independent item of the SF-36, was used as the 
      external anchor. Patients who responded "somewhat worse" and "much worse" were 
      combined and compared with patients responding "about the same." 
      Distribution-based methods were minimum detectable change and effect size. 
      RESULTS: Diagnoses included spondylolisthesis (n = 332), scoliosis (n = 54), 
      instability (n = 37), disc pathology (n = 146), and stenosis (n = 153). There was 
      a statistically significant change (p < 0.0001) for each HRQOL measure from 
      preoperatively to 1-year postoperatively. Only 107 patients (15%) reported being 
      "somewhat worse" (n = 81) or "much worse" (n = 26). Calculation methods yielded a 
      range of CIDET values for ODI (0.17-9.06), SF-36 physical component summary 
      (-0.32 to 4.43), back pain (0.02-1.50), and leg pain (0.02-1.50). CONCLUSIONS: A 
      threshold for clinical deterioration was difficult to identify. This may be due 
      to the small number of patients reporting being worse after surgery and the 
      variability across methods to determine CIDET thresholds. Overall, it appears 
      that patients may interpret the absence of change as deterioration.
FAU - Gum, Jeffrey L
AU  - Gum JL
AD  - Department of Orthopaedic Surgery, University of Louisville School of Medicine;
FAU - Glassman, Steven D
AU  - Glassman SD
FAU - Carreon, Leah Y
AU  - Carreon LY
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20130906
PL  - United States
TA  - J Neurosurg Spine
JT  - Journal of neurosurgery. Spine
JID - 101223545
SB  - IM
MH  - Aged
MH  - Disability Evaluation
MH  - Female
MH  - Health Surveys/instrumentation/methods
MH  - Humans
MH  - Lumbosacral Region/surgery
MH  - Male
MH  - Middle Aged
MH  - Outcome Assessment, Health Care/*methods
MH  - Pain Measurement/instrumentation/methods
MH  - Prospective Studies
MH  - Quality of Life/*psychology
MH  - Retrospective Studies
MH  - Severity of Illness Index
MH  - Spinal Diseases/*surgery
MH  - Spinal Fusion/*standards
MH  - Surveys and Questionnaires
MH  - *Treatment Outcome
EDAT- 2013/09/10 06:00
MHDA- 2014/01/09 06:00
CRDT- 2013/09/10 06:00
PHST- 2013/09/10 06:00 [entrez]
PHST- 2013/09/10 06:00 [pubmed]
PHST- 2014/01/09 06:00 [medline]
AID - 10.3171/2013.8.SPINE12804 [doi]
PST - ppublish
SO  - J Neurosurg Spine. 2013 Nov;19(5):564-8. doi: 10.3171/2013.8.SPINE12804. Epub 
      2013 Sep 6.