PMID- 30408081
OWN - NLM
STAT- MEDLINE
DCOM- 20190418
LR  - 20231004
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 13
IP  - 11
DP  - 2018
TI  - Prognostic function to estimate the probability of meaningful clinical 
      improvement after surgery - Results of a prospective multicenter observational 
      cohort study on patients with lumbar spinal stenosis.
PG  - e0207126
LID - 10.1371/journal.pone.0207126 [doi]
LID - e0207126
AB  - BACKGROUND: Approximately two thirds of patients with lumbar spinal stenosis 
      (LSS) who undergo surgical treatment benefit from the surgery. The objective of 
      this study was to derive a prognostic probability function (PPF) to identify 
      patients with a high probability of post-surgical improvement because there is 
      currently no method available. METHODS: In this multicenter, prospective, 
      observational study, we collected data from eight medical centers in Switzerland 
      in which patients underwent surgery for LSS. The endpoints were meaningful 
      clinically important differences (MCID) in pain and disability one year after 
      baseline. We developed a PPF named PROCESS (PostopeRative OutComE Spinal 
      Stenosis), based on a large set of prognostic indicators extracted from the 
      literature. The PPF was derived using data from a random subset of two thirds of 
      the patients and validated in the remaining third. We addressed overfitting by 
      shrinking the regression coefficients. The area under the ROC curve (AUC) and 
      calibration determined the accuracy of the PPF. RESULTS: In this study, 452 LSS 
      patients received surgery. 73% of the 300 patients in the derivation subset 
      reached an MCID in pain and 68% reached an MCID in disability. The corresponding 
      values were 70% and 63% in the validation subset, respectively. In the derivation 
      subsample, the AUC was 0.64 (95% CI 0.57 to 0.71) for of the PPF predicting MCID 
      in pain and 0.71 (0.64 to 0.77) for MCID in disability, after shrinkage. The 
      corresponding numbers were 0.62 (0.52 to 0.72) and 0.70 (0.60 to 0.79) in the 
      validation subsample, and the PPF showed good calibration. CONCLUSIONS: Surgical 
      treatment for patients with lumbar spinal stenosis is being performed with 
      increasing frequency. PROCESS is conditional on the individual pattern of 
      preoperatively available prognostic indicators, and may be helpful for clinicians 
      in counselling patients and in guiding the discussion on individual treatment 
      decision in the era of personalized medicine.
FAU - Held, Ulrike
AU  - Held U
AUID- ORCID: 0000-0003-3105-5840
AD  - Horten Centre for Patient Oriented Research and Knowledge Transfer, University of 
      Zurich, Zurich, Switzerland.
AD  - Epidemiology, Biostatistics and Prevention Institute, University of Zurich, 
      Zurich, Switzerland.
FAU - Burgstaller, Jakob M
AU  - Burgstaller JM
AD  - Horten Centre for Patient Oriented Research and Knowledge Transfer, University of 
      Zurich, Zurich, Switzerland.
FAU - Wertli, Maria M
AU  - Wertli MM
AUID- ORCID: 0000-0001-6347-0198
AD  - Horten Centre for Patient Oriented Research and Knowledge Transfer, University of 
      Zurich, Zurich, Switzerland.
AD  - Division of General Internal Medicine, Bern University Hospital, Bern University, 
      Bern, Switzerland.
FAU - Pichierri, Giuseppe
AU  - Pichierri G
AD  - Horten Centre for Patient Oriented Research and Knowledge Transfer, University of 
      Zurich, Zurich, Switzerland.
FAU - Winklhofer, Sebastian
AU  - Winklhofer S
AD  - Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland.
FAU - Brunner, Florian
AU  - Brunner F
AD  - Department of Physical Medicine and Rheumatology, Balgrist University Hospital, 
      Zurich, Switzerland.
FAU - Porchet, Francois
AU  - Porchet F
AD  - Department of Orthopedics and Neurosurgery, Spine Center, Schulthess Clinic, 
      Zurich, Switzerland.
FAU - Farshad, Mazda
AU  - Farshad M
AD  - Spine Division, Balgrist University Hospital, Zurich, Switzerland.
FAU - Steurer, Johann
AU  - Steurer J
AD  - Horten Centre for Patient Oriented Research and Knowledge Transfer, University of 
      Zurich, Zurich, Switzerland.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Observational Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20181108
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
SB  - IM
MH  - Aged
MH  - Area Under Curve
MH  - Disability Evaluation
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Lumbar Vertebrae/*surgery
MH  - Male
MH  - Middle Aged
MH  - Pain Measurement
MH  - Probability
MH  - Prognosis
MH  - Prospective Studies
MH  - ROC Curve
MH  - Spinal Stenosis/*diagnostic imaging/*surgery
PMC - PMC6224088
COIS- The authors have declared that no competing interests exist.
EDAT- 2018/11/09 06:00
MHDA- 2019/04/19 06:00
PMCR- 2018/11/08
CRDT- 2018/11/09 06:00
PHST- 2018/04/05 00:00 [received]
PHST- 2018/10/25 00:00 [accepted]
PHST- 2018/11/09 06:00 [entrez]
PHST- 2018/11/09 06:00 [pubmed]
PHST- 2019/04/19 06:00 [medline]
PHST- 2018/11/08 00:00 [pmc-release]
AID - PONE-D-18-10185 [pii]
AID - 10.1371/journal.pone.0207126 [doi]
PST - epublish
SO  - PLoS One. 2018 Nov 8;13(11):e0207126. doi: 10.1371/journal.pone.0207126. 
      eCollection 2018.