PMID- 37642774 OWN - NLM STAT- MEDLINE DCOM- 20231030 LR - 20240415 IS - 1432-0932 (Electronic) IS - 0940-6719 (Linking) VI - 32 IP - 10 DP - 2023 Oct TI - Values derived from patient reported outcomes in spine surgery: a systematic review of the minimal clinically important difference, substantial clinical benefit, and patient acceptable symptom state. PG - 3333-3351 LID - 10.1007/s00586-023-07896-x [doi] AB - PURPOSE: While patient reported outcome measures (PROMs) define value in spine surgery, several values such as minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptom state (PASS) help guide the interpretation of PROMs and identify thresholds of clinical significance. Significant variation exists in reported values and their calculation, so the primary objective of this study was to systematically review the spine surgery literature for metrics of clinical significance derived from PROMs. METHODS: We conducted a query of PubMed/MEDLINE and Scopus databases from inception to January 1, 2023, for studies that derived quantitative metrics (e.g., SCB, MCID, PASS) from PROMs in the setting of spine surgery with minimum 1-year follow-up. Details regarding the specific PROMs were collected including which PROM was measured, whether anchor- or distribution-based methods were utilized, the specific calculations, and the recommended value for a given PROM based on all evaluated calculations. RESULTS: Thirty-seven studies of 21,780 patients were included. The most commonly evaluated PROM-derived value was the MCID (n = 28), followed by PASS (n = 6) and SCB (n = 4). Twenty-one studies only utilized anchor-based calculations, 15 utilized both anchor-based and distribution-based methods, and one only utilized distribution-based calculations. The most commonly evaluated legacy PROMs were the Oswestry Disability Index (ODI) (N = 11, MCID range 4-20) and visual analog scale back pain (N = 5, MCID range 0.5-4.6). All 10 studies that derived SCB or PASS utilized the receiver operating characteristic methods. Among the six studies deriving a PASS value, four only evaluated ODI, identifying PASS ranging from 5 to 22. CONCLUSION: While calculated measures of clinical significance such as MCID, PASS, and SCB exist, significant heterogeneity exists in the current literature. Current shortcomings include a wide variability of reported value thresholds across the literature, and limited applicability to more heterogenous patient populations than the targeted cohorts included in published investigations. Continued investigations that apply these methods to heterogenous, large-scale populations can help increase generalizability and validity of these measures. LEVEL OF EVIDENCE: III. CI - (c) 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature. FAU - Issa, Tariq Z AU - Issa TZ AUID- ORCID: 0000-0002-0978-5225 AD - Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 125 S 9th St, Suite 1000, Philadelphia, PA, 19107, USA. tariq.issa@rothmanortho.com. FAU - Lee, Yunsoo AU - Lee Y AD - Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 125 S 9th St, Suite 1000, Philadelphia, PA, 19107, USA. FAU - Henry, Tyler W AU - Henry TW AD - Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 125 S 9th St, Suite 1000, Philadelphia, PA, 19107, USA. FAU - Trenchfield, Delano AU - Trenchfield D AD - Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 125 S 9th St, Suite 1000, Philadelphia, PA, 19107, USA. FAU - Schroeder, Gregory D AU - Schroeder GD AD - Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 125 S 9th St, Suite 1000, Philadelphia, PA, 19107, USA. FAU - Vaccaro, Alexander R AU - Vaccaro AR AD - Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 125 S 9th St, Suite 1000, Philadelphia, PA, 19107, USA. FAU - Kepler, Christopher K AU - Kepler CK AD - Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 125 S 9th St, Suite 1000, Philadelphia, PA, 19107, USA. LA - eng PT - Journal Article PT - Systematic Review DEP - 20230829 PL - Germany TA - Eur Spine J JT - European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society JID - 9301980 SB - IM MH - Humans MH - *Back Pain/diagnosis/surgery MH - *Minimal Clinically Important Difference MH - Patient Reported Outcome Measures MH - Treatment Outcome MH - Spine/surgery OTO - NOTNLM OT - Minimal clinically important difference OT - Patient acceptable symptom state OT - Patient-reported outcomes OT - Spine surgery OT - Systematic review EDAT- 2023/08/29 12:43 MHDA- 2023/10/30 06:46 CRDT- 2023/08/29 11:11 PHST- 2023/04/04 00:00 [received] PHST- 2023/08/08 00:00 [accepted] PHST- 2023/08/05 00:00 [revised] PHST- 2023/10/30 06:46 [medline] PHST- 2023/08/29 12:43 [pubmed] PHST- 2023/08/29 11:11 [entrez] AID - 10.1007/s00586-023-07896-x [pii] AID - 10.1007/s00586-023-07896-x [doi] PST - ppublish SO - Eur Spine J. 2023 Oct;32(10):3333-3351. doi: 10.1007/s00586-023-07896-x. Epub 2023 Aug 29.