PMID- 36708927
OWN - NLM
STAT- MEDLINE
DCOM- 20230519
LR  - 20230604
IS  - 1878-1632 (Electronic)
IS  - 1529-9430 (Linking)
VI  - 23
IP  - 6
DP  - 2023 Jun
TI  - Clinically meaningful improvement in disabilities of arm, shoulder, and hand 
      (DASH) following cervical spine surgery.
PG  - 832-840
LID - S1529-9430(23)00022-0 [pii]
LID - 10.1016/j.spinee.2023.01.010 [doi]
AB  - BACKGROUND CONTEXT: Patients with cervical spine disease suffer from upper limb 
      disability. At present, no clinical benchmarks exist for clinically meaningful 
      change in the upper limb function following cervical spine surgery. PURPOSE: 
      Primary: to establish clinically meaningful metrics; the minimal clinically 
      important difference (MCID) and substantial clinical benefit (SCB) of upper limb 
      functional improvement in patients following cervical spine surgery. Secondary: 
      to identify the prognostic factors of MCID and SCB of upper limb function 
      following cervical spine surgery. STUDY DESIGN: Retrospective cohort study. 
      PATIENT SAMPLE: Adult patients >/=18 years of age who underwent cervical spine 
      surgery from 2012 to 2016. OUTCOME MEASURES: Patient-reported outcomes: Neck 
      disability index (NDI) and Disabilities of Arm, Shoulder, and Hand (DASH). 
      METHODS: MCID was defined as minimal improvement and SCB as substantial 
      improvement in the DASH score at last follow-up. The anchor-based methods (ROC 
      analyses) defined optimal MCID and SCB thresholds with area under curve (AUC) in 
      discriminating improved vs. non-improved patients. The MCID was also calculated 
      by distribution-based methods: half standard-deviation (0.5-SD) and standard 
      error of the mean (SEM) method. A multivariable logistic regression evaluated the 
      impact of baseline factors in achieving the MCID and SCB in DASH following 
      cervical spine surgery. RESULTS: Between 2012 and 2016, 1,046 patients with 
      average age of 57+/-11.3 years, 53% males, underwent cervical spine surgery. Using 
      the ROC analysis, the threshold for MCID was -8 points with AUC of 0.73 (95% CI: 
      0.67-0.79) and the SCB was -18 points with AUC of 0.88 (95% confidence interval 
      [CI]: 0.85-0.91). The MCID was -11 points by 0.5-SD and -12 points by SEM-method. 
      On multivariable analysis, patients with myelopathy had lower odds of achieving 
      MCID and SCB, whereas older patients and those with >/=6 months duration of 
      symptoms had lower odds of achieving DASH MCID and SCB respectively. CONCLUSIONS: 
      In patients undergoing cervical spine surgery, MCID of -8 points and SCB of -18 
      points in DASH improvement may be considered clinically significant. These 
      metrics may enable evaluation of minimal and substantial improvement in the upper 
      extremity function following cervical spine surgery.
CI  - Copyright (c) 2023 Elsevier Inc. All rights reserved.
FAU - Javeed, Saad
AU  - Javeed S
AD  - Department of Neurological Surgery, Washington University, St. Louis, MO, USA.
FAU - Greenberg, Jacob K
AU  - Greenberg JK
AD  - Department of Neurological Surgery, Washington University, St. Louis, MO, USA.
FAU - Plog, Benjamin
AU  - Plog B
AD  - Department of Neurological Surgery, Washington University, St. Louis, MO, USA.
FAU - Zhang, Justin K
AU  - Zhang JK
AD  - Department of Neurological Surgery, Washington University, St. Louis, MO, USA.
FAU - Yahanda, Alexander T
AU  - Yahanda AT
AD  - Department of Neurological Surgery, Washington University, St. Louis, MO, USA.
FAU - Dibble, Christopher F
AU  - Dibble CF
AD  - Department of Neurological Surgery, Washington University, St. Louis, MO, USA.
FAU - Khalifeh, Jawad M
AU  - Khalifeh JM
AD  - Department of Neurological Surgery, Johns Hopkins University, Baltimore, MD, USA.
FAU - Ruiz-Cardozo, Miguel
AU  - Ruiz-Cardozo M
AD  - Department of Neurological Surgery, Washington University, St. Louis, MO, USA.
FAU - Lavadi, Raj S
AU  - Lavadi RS
AD  - Department of Neurological Surgery, Washington University, St. Louis, MO, USA.
FAU - Molina, Camilo A
AU  - Molina CA
AD  - Department of Neurological Surgery, Washington University, St. Louis, MO, USA.
FAU - Santiago, Paul
AU  - Santiago P
AD  - Department of Neurological Surgery, Washington University, St. Louis, MO, USA.
FAU - Agarwal, Nitin
AU  - Agarwal N
AD  - Department of Neurological Surgery, Washington University, St. Louis, MO, USA.
FAU - Pennicooke, Brenton H
AU  - Pennicooke BH
AD  - Department of Neurological Surgery, Washington University, St. Louis, MO, USA.
FAU - Ray, Wilson Z
AU  - Ray WZ
AD  - Department of Neurological Surgery, Washington University, St. Louis, MO, USA. 
      Electronic address: rayz@wustl.edu.
LA  - eng
PT  - Journal Article
DEP - 20230126
PL  - United States
TA  - Spine J
JT  - The spine journal : official journal of the North American Spine Society
JID - 101130732
SB  - IM
MH  - Adult
MH  - Male
MH  - Humans
MH  - Middle Aged
MH  - Aged
MH  - Female
MH  - *Shoulder/surgery
MH  - *Arm
MH  - Retrospective Studies
MH  - Treatment Outcome
MH  - Upper Extremity
MH  - Cervical Vertebrae/surgery
OTO - NOTNLM
OT  - Cervical spine
OT  - Minimum clinically important difference
OT  - Patient-reported outcomes
OT  - Physical function
OT  - Substantial clinical benefit
OT  - Upper-extremity impairment
EDAT- 2023/01/29 06:00
MHDA- 2023/05/19 06:42
CRDT- 2023/01/28 19:26
PHST- 2022/09/25 00:00 [received]
PHST- 2022/12/24 00:00 [revised]
PHST- 2023/01/18 00:00 [accepted]
PHST- 2023/05/19 06:42 [medline]
PHST- 2023/01/29 06:00 [pubmed]
PHST- 2023/01/28 19:26 [entrez]
AID - S1529-9430(23)00022-0 [pii]
AID - 10.1016/j.spinee.2023.01.010 [doi]
PST - ppublish
SO  - Spine J. 2023 Jun;23(6):832-840. doi: 10.1016/j.spinee.2023.01.010. Epub 2023 Jan 
      26.