Development of a Preoperative Predictive Model for Reaching the Oswestry Disability Index Minimal Clinically Important Difference for Adult Spinal Deformity Patients

International Spine Study Group

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Study Design: Retrospective review of prospective multicenter adult spinal deformity (ASD) database. Objective: To create a model based on baseline demographic, radiographic, health-related quality of life (HRQOL), and surgical factors that can predict patients meeting the Oswestry Disability Index (ODI) minimal clinically important difference (MCID) at the two-year postoperative follow-up. Summary of Background Data: Surgical correction of ASD can result in significant improvement in disability as measured by ODI, with the goal of reaching at least one MCID. However, a predictive model for reaching MCID following ASD correction does not exist. Methods: ASD patients ≥18 years and baseline ODI ≥ 30 were included. Initial training of the model comprised forty-three variables including demographic data, comorbidities, modifiable surgical variables, baseline HRQOL, and coronal/sagittal radiographic parameters. Patients were grouped by whether or not they reached at least one ODI MCID at two-year follow-up. Decision trees were constructed using the C5.0 algorithm with five different bootstrapped models. Internal validation was accomplished via a 70:30 data split for training and testing each model, respectively. Final predictions from the models were chosen by voting with random selection for tied votes. Overall accuracy, and the area under a receiver operating characteristic curve (AUC) were calculated. Results: 198 patients were included (MCID: 109, No-MCID: 89). Overall model accuracy was 86.0%, with an AUC of 0.94. The top 11 predictors of reaching MCID were gender, Scoliosis Research Society (SRS) activity subscore, back pain, sagittal vertical axis (SVA), pelvic incidence–lumbar lordosis mismatch (PI-LL), primary version revision, T1 spinopelvic inclination angle (T1SPI), American Society of Anesthesiologists (ASA) grade, T1 pelvic angle (T1PA), SRS pain, SRS total. Conclusions: A successful model was built predicting ODI MCID. Most important predictors were not modifiable surgical parameters, indicating that baseline clinical and radiographic status is a critical factor for reaching ODI MCID. Level of Evidence: Level II.

Original languageEnglish (US)
JournalSpine Deformity
DOIs
StateAccepted/In press - Jan 1 2018

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Scoliosis
Area Under Curve
Research
Quality of Life
Demography
Minimal Clinically Important Difference
Lordosis
Decision Trees
Politics
Back Pain
ROC Curve
Comorbidity
Retrospective Studies
Databases
Pain

Keywords

  • Adult spinal deformity
  • Minimum clinically important difference
  • Oswestry Disability Index
  • Predictive modeling
  • Scoliosis

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

@article{8b75929d70f64a55bcc1aa8c2727345e,
title = "Development of a Preoperative Predictive Model for Reaching the Oswestry Disability Index Minimal Clinically Important Difference for Adult Spinal Deformity Patients",
abstract = "Study Design: Retrospective review of prospective multicenter adult spinal deformity (ASD) database. Objective: To create a model based on baseline demographic, radiographic, health-related quality of life (HRQOL), and surgical factors that can predict patients meeting the Oswestry Disability Index (ODI) minimal clinically important difference (MCID) at the two-year postoperative follow-up. Summary of Background Data: Surgical correction of ASD can result in significant improvement in disability as measured by ODI, with the goal of reaching at least one MCID. However, a predictive model for reaching MCID following ASD correction does not exist. Methods: ASD patients ≥18 years and baseline ODI ≥ 30 were included. Initial training of the model comprised forty-three variables including demographic data, comorbidities, modifiable surgical variables, baseline HRQOL, and coronal/sagittal radiographic parameters. Patients were grouped by whether or not they reached at least one ODI MCID at two-year follow-up. Decision trees were constructed using the C5.0 algorithm with five different bootstrapped models. Internal validation was accomplished via a 70:30 data split for training and testing each model, respectively. Final predictions from the models were chosen by voting with random selection for tied votes. Overall accuracy, and the area under a receiver operating characteristic curve (AUC) were calculated. Results: 198 patients were included (MCID: 109, No-MCID: 89). Overall model accuracy was 86.0{\%}, with an AUC of 0.94. The top 11 predictors of reaching MCID were gender, Scoliosis Research Society (SRS) activity subscore, back pain, sagittal vertical axis (SVA), pelvic incidence–lumbar lordosis mismatch (PI-LL), primary version revision, T1 spinopelvic inclination angle (T1SPI), American Society of Anesthesiologists (ASA) grade, T1 pelvic angle (T1PA), SRS pain, SRS total. Conclusions: A successful model was built predicting ODI MCID. Most important predictors were not modifiable surgical parameters, indicating that baseline clinical and radiographic status is a critical factor for reaching ODI MCID. Level of Evidence: Level II.",
keywords = "Adult spinal deformity, Minimum clinically important difference, Oswestry Disability Index, Predictive modeling, Scoliosis",
author = "{International Spine Study Group} and Scheer, {Justin K.} and Osorio, {Joseph A.} and Smith, {Justin S.} and Frank Schwab and Hart, {Robert A.} and Richard Hostin and Virginie Lafage and Amit Jain and Burton, {Douglas C.} and Shay Bess and Tamir Ailon and Protopsaltis, {Themistocles S.} and Klineberg, {Eric Otto} and Shaffrey, {Christopher I.} and Ames, {Christopher P.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.jspd.2018.02.010",
language = "English (US)",
journal = "Spine Deformity",
issn = "2212-134X",
publisher = "Elsevier BV",

}

TY - JOUR

T1 - Development of a Preoperative Predictive Model for Reaching the Oswestry Disability Index Minimal Clinically Important Difference for Adult Spinal Deformity Patients

AU - International Spine Study Group

AU - Scheer, Justin K.

AU - Osorio, Joseph A.

AU - Smith, Justin S.

AU - Schwab, Frank

AU - Hart, Robert A.

AU - Hostin, Richard

AU - Lafage, Virginie

AU - Jain, Amit

AU - Burton, Douglas C.

AU - Bess, Shay

AU - Ailon, Tamir

AU - Protopsaltis, Themistocles S.

AU - Klineberg, Eric Otto

AU - Shaffrey, Christopher I.

AU - Ames, Christopher P.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Study Design: Retrospective review of prospective multicenter adult spinal deformity (ASD) database. Objective: To create a model based on baseline demographic, radiographic, health-related quality of life (HRQOL), and surgical factors that can predict patients meeting the Oswestry Disability Index (ODI) minimal clinically important difference (MCID) at the two-year postoperative follow-up. Summary of Background Data: Surgical correction of ASD can result in significant improvement in disability as measured by ODI, with the goal of reaching at least one MCID. However, a predictive model for reaching MCID following ASD correction does not exist. Methods: ASD patients ≥18 years and baseline ODI ≥ 30 were included. Initial training of the model comprised forty-three variables including demographic data, comorbidities, modifiable surgical variables, baseline HRQOL, and coronal/sagittal radiographic parameters. Patients were grouped by whether or not they reached at least one ODI MCID at two-year follow-up. Decision trees were constructed using the C5.0 algorithm with five different bootstrapped models. Internal validation was accomplished via a 70:30 data split for training and testing each model, respectively. Final predictions from the models were chosen by voting with random selection for tied votes. Overall accuracy, and the area under a receiver operating characteristic curve (AUC) were calculated. Results: 198 patients were included (MCID: 109, No-MCID: 89). Overall model accuracy was 86.0%, with an AUC of 0.94. The top 11 predictors of reaching MCID were gender, Scoliosis Research Society (SRS) activity subscore, back pain, sagittal vertical axis (SVA), pelvic incidence–lumbar lordosis mismatch (PI-LL), primary version revision, T1 spinopelvic inclination angle (T1SPI), American Society of Anesthesiologists (ASA) grade, T1 pelvic angle (T1PA), SRS pain, SRS total. Conclusions: A successful model was built predicting ODI MCID. Most important predictors were not modifiable surgical parameters, indicating that baseline clinical and radiographic status is a critical factor for reaching ODI MCID. Level of Evidence: Level II.

AB - Study Design: Retrospective review of prospective multicenter adult spinal deformity (ASD) database. Objective: To create a model based on baseline demographic, radiographic, health-related quality of life (HRQOL), and surgical factors that can predict patients meeting the Oswestry Disability Index (ODI) minimal clinically important difference (MCID) at the two-year postoperative follow-up. Summary of Background Data: Surgical correction of ASD can result in significant improvement in disability as measured by ODI, with the goal of reaching at least one MCID. However, a predictive model for reaching MCID following ASD correction does not exist. Methods: ASD patients ≥18 years and baseline ODI ≥ 30 were included. Initial training of the model comprised forty-three variables including demographic data, comorbidities, modifiable surgical variables, baseline HRQOL, and coronal/sagittal radiographic parameters. Patients were grouped by whether or not they reached at least one ODI MCID at two-year follow-up. Decision trees were constructed using the C5.0 algorithm with five different bootstrapped models. Internal validation was accomplished via a 70:30 data split for training and testing each model, respectively. Final predictions from the models were chosen by voting with random selection for tied votes. Overall accuracy, and the area under a receiver operating characteristic curve (AUC) were calculated. Results: 198 patients were included (MCID: 109, No-MCID: 89). Overall model accuracy was 86.0%, with an AUC of 0.94. The top 11 predictors of reaching MCID were gender, Scoliosis Research Society (SRS) activity subscore, back pain, sagittal vertical axis (SVA), pelvic incidence–lumbar lordosis mismatch (PI-LL), primary version revision, T1 spinopelvic inclination angle (T1SPI), American Society of Anesthesiologists (ASA) grade, T1 pelvic angle (T1PA), SRS pain, SRS total. Conclusions: A successful model was built predicting ODI MCID. Most important predictors were not modifiable surgical parameters, indicating that baseline clinical and radiographic status is a critical factor for reaching ODI MCID. Level of Evidence: Level II.

KW - Adult spinal deformity

KW - Minimum clinically important difference

KW - Oswestry Disability Index

KW - Predictive modeling

KW - Scoliosis

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U2 - 10.1016/j.jspd.2018.02.010

DO - 10.1016/j.jspd.2018.02.010

M3 - Article

C2 - 30122396

AN - SCOPUS:85045214176

JO - Spine Deformity

JF - Spine Deformity

SN - 2212-134X

ER -