PMID- 33337676
OWN - NLM
STAT- MEDLINE
DCOM- 20210630
LR  - 20210630
IS  - 1528-1159 (Electronic)
IS  - 0362-2436 (Linking)
VI  - 46
IP  - 11
DP  - 2021 Jun 1
TI  - Clinically Meaningful Improvement Following Cervical Spine Surgery: 30% Reduction 
      Versus Absolute Point-change MCID Values.
PG  - 717-725
LID - 10.1097/BRS.0000000000003887 [doi]
AB  - STUDY DESIGN: Retrospective analysis of prospectively collected registry data. 
      OBJECTIVE: The aim of this study was to compare the performance of 30% reduction 
      to established absolute point-change values for measures of disability and pain 
      in patients undergoing elective cervical spine surgery. SUMMARY OF BACKGROUND 
      DATA: Recent studies recommend using a proportional change from baseline instead 
      of an absolute point-change value to define minimum clinically important 
      difference (MCID). METHODS: Analyses included 13,179 patients who underwent 
      cervical spine surgery for degenerative disease between April 2013 and February 
      2018. Participants completed a baseline and 12-month follow-up assessment that 
      included questionnaires to assess disability (Neck Disability Index [NDI]), neck 
      and arm pain (Numeric Rating Scale [NRS-NP/AP], and satisfaction [NASS scale]). 
      Participants were classified as met or not met 30% reduction from baseline in 
      each of the respective measures. The 30% reduction in scores at 12 months was 
      compared to a wide range of established absolute point-change MCID values using 
      receiver-operating characteristic curves, area under the receiver-operating 
      characteristic curve (AUROC), and logistic regression analyses. These analyses 
      were conducted for the entire patient cohort, as well as for subgroups based on 
      baseline severity and surgical approach. RESULTS: Thirty percent reduction in NDI 
      and NRS-NP/AP scores predicted satisfaction with more accuracy than absolute 
      point-change values for the total population and ACDF and posterior fusion 
      procedures (P < 0.05). The largest AUROC differences, in favor of 30% reduction, 
      were found for the lowest disability (ODI 0-20%: 16.8%) and bed-bound disability 
      (ODI 81%-100%: 16.6%) categories. For pain, there was a 1.9% to 11% and 1.6% to 
      9.6% AUROC difference for no/mild neck and arm pain (NRS 0-4), respectively, in 
      favor of a 30% reduction threshold. CONCLUSION: A 30% reduction from baseline is 
      a valid method for determining MCID in disability and pain for patients 
      undergoing cervical spine surgery.Level of Evidence: 3.
CI  - Copyright (c) 2021 Wolters Kluwer Health, Inc. All rights reserved.
FAU - Khan, Inamullah
AU  - Khan I
AD  - Department of Orthopaedic Surgery, Center for Musculoskeletal Research, 
      Vanderbilt University Medical Center, Nashville, TN.
FAU - Pennings, Jacquelyn S
AU  - Pennings JS
AD  - Department of Orthopaedic Surgery, Center for Musculoskeletal Research, 
      Vanderbilt University Medical Center, Nashville, TN.
FAU - Devin, Clinton J
AU  - Devin CJ
AD  - Department of Orthopaedic Surgery, Center for Musculoskeletal Research, 
      Vanderbilt University Medical Center, Nashville, TN.
AD  - Steamboat Orthopaedic and Spine Institute, Steamboat Springs, CO.
FAU - Asher, Anthony M
AU  - Asher AM
AD  - Department of Orthopaedic Surgery, Center for Musculoskeletal Research, 
      Vanderbilt University Medical Center, Nashville, TN.
FAU - Oleisky, Emily R
AU  - Oleisky ER
AD  - Department of Orthopaedic Surgery, Center for Musculoskeletal Research, 
      Vanderbilt University Medical Center, Nashville, TN.
FAU - Bydon, Mohamad
AU  - Bydon M
AD  - Department of Neurologic Surgery, Mayo Clinic, Rochester, MN.
FAU - Asher, Anthony L
AU  - Asher AL
AD  - Carolina Neurosurgery and Spine Associates, Charlotte, NC.
FAU - Archer, Kristin R
AU  - Archer KR
AD  - Department of Orthopaedic Surgery, Center for Musculoskeletal Research, 
      Vanderbilt University Medical Center, Nashville, TN.
AD  - Department of Physical Medicine & Rehabilitation, Osher Center for Integrative 
      Medicine, Vanderbilt University Medical Center, Nashville, TN.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Spine (Phila Pa 1976)
JT  - Spine
JID - 7610646
SB  - IM
MH  - Cervical Vertebrae/*surgery
MH  - Humans
MH  - *Minimal Clinically Important Difference
MH  - Spinal Diseases/surgery
MH  - Treatment Outcome
EDAT- 2020/12/19 06:00
MHDA- 2021/07/01 06:00
CRDT- 2020/12/18 15:18
PHST- 2020/12/19 06:00 [pubmed]
PHST- 2021/07/01 06:00 [medline]
PHST- 2020/12/18 15:18 [entrez]
AID - 00007632-202106010-00007 [pii]
AID - 10.1097/BRS.0000000000003887 [doi]
PST - ppublish
SO  - Spine (Phila Pa 1976). 2021 Jun 1;46(11):717-725. doi: 
      10.1097/BRS.0000000000003887.