Preoperative Patient Reported Outcomes Measurement Information System Scores Assist in Predicting Early Postoperative Success in Lumbar Discectomy.

STUDY DESIGN: Retrospective review of prospective data. OBJECTIVE: Determine whether patient reported outcome (PRO) data collected prior to lumbar discectomy predicts achievement of a minimal important difference (MID) after surgery. Compare ability of PRO and clinical information to predict achievement of MID in short term follow-up after discectomy. SUMMARY OF BACKGROUND DATA: We investigated the ability of patient reported outcomes measurement information system (PROMIS) and clinical factors at the preoperative time point to determine patients achieving MID after surgery. METHODS: PROMIS physical function (PF), pain interference (PI), and depression (D) scores were assessed at evaluation and follow-up for consecutive visits between February, 2015 and September, 2017. Patients with preoperative scores within 30 days prior to surgery and with scores 40 days or more after surgery who completed all PROMIS domains were included yielding 78 patients. MIDs were calculated using a distribution-based method. A multivariate logistic regression model was created, and the ability to predict achieving MID for each of the PROMIS domains was assessed. Cut-off values and prognostic probabilities were determined for this model and models combining preoperative PROMIS with clinical data. RESULTS: Preoperative PROMIS scores modestly predict reaching MID after discectomy (areas under the curve [AUC] of 0.62, 0.68, and 0.76 for PF, PI, and D, respectively). Preoperative cut-off scores show patients who have PF and PI scores more than 2 standard deviations, and D more than 1.5 standard deviations worse-off than population mean are likely to achieve MID. The combination of PROMIS with clinical data was the most powerful predictor of reaching MID with AUCs of 0.87, 0.84, and 0.83 for PF, PI, and D. CONCLUSION: PROMIS scores before discectomy modestly predict improvement after surgery. Preoperative PROMIS combined with clinical factors was more predictive of achieving MID than either clinical factors or PROMIS alone. LEVEL OF EVIDENCE: 3.

Correlation of PROMIS Physical Function and Pain CAT Instruments With Oswestry Disability Index and Neck Disability Index in Spine Patients.

STUDY DESIGN: A prospective and retrospective cross-sectional cohort analysis. OBJECTIVE: The aim of this study was to show that Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive testing (CAT) assessments for physical function and pain interference can be efficiently collected in a standard office visit and to evaluate these scores with scores from previously validated Oswestry Disability Index (ODI) and Neck Disability Index (NDI) providing evidence of convergent validity for use in patients with spine pathology. SUMMARY OF BACKGROUND DATA: Spinal surgery outcomes are highly variable, and substantial debate continues regarding the role and value of spine surgery. The routine collection of patient-based outcomes instruments in spine surgery patients may inform this debate. Traditionally, the inefficiency associated with collecting standard validated instruments has been a barrier to routine use in outpatient clinics. We utilized several CAT instruments available through PROMIS and correlated these with the results obtained using "gold standard" legacy outcomes measurement instruments. METHODS: All measurements were collected at a routine clinical visit. The ODI and the NDI assessments were used as "gold standard" comparisons for patient-reported outcomes. RESULTS: PROMIS CAT instruments required 4.5 ±â€Š1.8 questions and took 35 ±â€Š16 seconds to complete, compared with ODI/NDI requiring 10 questions and taking 188 ±â€Š85 seconds when administered electronically. Linear regression analysis of retrospective scores involving a primary back complaint revealed moderate to strong correlations between ODI and PROMIS physical function with r values ranging from 0.5846 to 0.8907 depending on the specific assessment and patient subsets examined. CONCLUSION: Routine collection of physical function outcome measures in clinical practice offers the ability to inform and improve patient care. We have shown that several PROMIS CAT instruments can be efficiently administered during routine clinical visits. The moderate to strong correlations found validate the utility of computer adaptive testing when compared with the gold standard "static" legacy assessments. LEVEL OF EVIDENCE: 4.

The frequency and reliability of cortical activity using a novel strategy to present pressure pain stimulus over the lumbar spine.

BACKGROUND: The blocked stimulus presentation strategy, in fMRI study designs, is an important means to study brain function related to a particular stimulus. Specifically, applying pressure stimuli perceived as painful to different anatomical regions has been used to improve our understanding of central sensitization, which is an important clinical phenomenon in chronic pain. NEW METHOD: This paper introduces a novel MR-compatible device used to apply pressure pain stimuli to the lumbar spine of 13 subjects in the supine position. We present the frequency of individuals and within-subject reliability of cortical activity in the following brain regions: the primary somatosensory cortex, insula and anterior cingulate cortex bilaterally. RESULTS: Using the novel MR-compatible device, a high frequency of individuals showed cortical activity within the a priori brain regions. There was good to excellent run-to-run reliability for peak voxel, while cluster size was less reliable. We found a higher than expected association between stimulus presentation and movement artifacts. COMPARISON WITH EXISTING METHOD(S): Unlike previous methods, the current strategy can apply pressure stimuli to subjects over the lumbar spine while they lay supine. Previous methods required subjects to lay prone. CONCLUSIONS: This strategy could be used for evaluating pressure stimuli related central sensitization associated with back pain.