Likelihood of reaching minimal clinically important difference in adult spinal deformity: A comparison of operative and nonoperative treatment

Shian Liu, Frank Schwab, Justin S. Smith, Eric Otto Klineberg, Christopher P. Ames, Gregory Mundis, Richard Hostin, Khaled Kebaish, Vedat Deviren, Munish Gupta, Oheneba Boachie-Adjei, Robert A. Hart, Shay Bess, Virginie Lafage

Research output: Contribution to journalArticle

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Abstract

Background: Few studies have examined threshold improvements in health-related quality of life (HRQOL) by measuring minimal clinically important differences (MCIDs) in treatment of adult spinal deformity. We hypothesized that patients undergoing operative treatment would be more likely to achieve MCID threshold improvement compared with those receiving nonoperative care, although a subset of nonoperative patients may still reach threshold. Methods: We analyzed a multicenter, prospective, consecutive case series of 464 patients: 225 nonoperative and 239 operative. To be included in the study, patients had to have adult spinal deformity, be older than 18 years, and have both baseline and 1-year follow-up HRQOL measures (Oswestry Disability Index [ODI], Short Form-36 [SF-36] health survey, and Scoliosis Research Society-22 [SRS-22] questionnaire). We compared the percentages of patients achieving established MCID thresholds between operative and nonoperative groups using risk ratios (RR) with a 95% confidence interval (CI). Results: Compared to nonoperative patients, surgical patients demonstrated significant mean improvement (P<0.01) and were more likely to achieve threshold MCID improvement across all HRQOL scores (ODI RR = 7.37 [CI 4.45, 12.21], SF-36 physical component score RR = 2.96 [CI 2.11, 4.15], SRS Activity RR = 3.16 [CI 2.32, 4.31]). Furthermore, operative patients were more likely to reach threshold MCID improvement in 2 or more HRQOL measures simultaneously and were less likely to deteriorate. Conclusion: Patients in both the operative and nonoperative treatment groups demonstrated improvement in at least one HRQOL measure at 1 year. However, surgical treatment was more likely to result in threshold improvement and more likely to lead to simultaneous improvement across multiple measures of ODI, SF-36, and SRS-22. Although a subset of nonoperative patients achieved threshold improvement, nonoperative patients were significantly less likely to improve in multiple HRQOL measures and more likely to sustain MCID deterioration or no change.

Original languageEnglish (US)
Pages (from-to)67-77
Number of pages11
JournalOchsner Journal
Volume14
Issue number1
StatePublished - 2014

Fingerprint

Quality of Life
Odds Ratio
Therapeutics
Confidence Intervals
Scoliosis
Minimal Clinically Important Difference
Health Surveys
Research

Keywords

  • Disability evaluation
  • Pain management
  • Quality of life
  • Spinal cord diseases
  • Surgical procedures-operative

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Likelihood of reaching minimal clinically important difference in adult spinal deformity : A comparison of operative and nonoperative treatment. / Liu, Shian; Schwab, Frank; Smith, Justin S.; Klineberg, Eric Otto; Ames, Christopher P.; Mundis, Gregory; Hostin, Richard; Kebaish, Khaled; Deviren, Vedat; Gupta, Munish; Boachie-Adjei, Oheneba; Hart, Robert A.; Bess, Shay; Lafage, Virginie.

In: Ochsner Journal, Vol. 14, No. 1, 2014, p. 67-77.

Research output: Contribution to journalArticle

Liu, S, Schwab, F, Smith, JS, Klineberg, EO, Ames, CP, Mundis, G, Hostin, R, Kebaish, K, Deviren, V, Gupta, M, Boachie-Adjei, O, Hart, RA, Bess, S & Lafage, V 2014, 'Likelihood of reaching minimal clinically important difference in adult spinal deformity: A comparison of operative and nonoperative treatment', Ochsner Journal, vol. 14, no. 1, pp. 67-77.
Liu, Shian ; Schwab, Frank ; Smith, Justin S. ; Klineberg, Eric Otto ; Ames, Christopher P. ; Mundis, Gregory ; Hostin, Richard ; Kebaish, Khaled ; Deviren, Vedat ; Gupta, Munish ; Boachie-Adjei, Oheneba ; Hart, Robert A. ; Bess, Shay ; Lafage, Virginie. / Likelihood of reaching minimal clinically important difference in adult spinal deformity : A comparison of operative and nonoperative treatment. In: Ochsner Journal. 2014 ; Vol. 14, No. 1. pp. 67-77.
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abstract = "Background: Few studies have examined threshold improvements in health-related quality of life (HRQOL) by measuring minimal clinically important differences (MCIDs) in treatment of adult spinal deformity. We hypothesized that patients undergoing operative treatment would be more likely to achieve MCID threshold improvement compared with those receiving nonoperative care, although a subset of nonoperative patients may still reach threshold. Methods: We analyzed a multicenter, prospective, consecutive case series of 464 patients: 225 nonoperative and 239 operative. To be included in the study, patients had to have adult spinal deformity, be older than 18 years, and have both baseline and 1-year follow-up HRQOL measures (Oswestry Disability Index [ODI], Short Form-36 [SF-36] health survey, and Scoliosis Research Society-22 [SRS-22] questionnaire). We compared the percentages of patients achieving established MCID thresholds between operative and nonoperative groups using risk ratios (RR) with a 95{\%} confidence interval (CI). Results: Compared to nonoperative patients, surgical patients demonstrated significant mean improvement (P<0.01) and were more likely to achieve threshold MCID improvement across all HRQOL scores (ODI RR = 7.37 [CI 4.45, 12.21], SF-36 physical component score RR = 2.96 [CI 2.11, 4.15], SRS Activity RR = 3.16 [CI 2.32, 4.31]). Furthermore, operative patients were more likely to reach threshold MCID improvement in 2 or more HRQOL measures simultaneously and were less likely to deteriorate. Conclusion: Patients in both the operative and nonoperative treatment groups demonstrated improvement in at least one HRQOL measure at 1 year. However, surgical treatment was more likely to result in threshold improvement and more likely to lead to simultaneous improvement across multiple measures of ODI, SF-36, and SRS-22. Although a subset of nonoperative patients achieved threshold improvement, nonoperative patients were significantly less likely to improve in multiple HRQOL measures and more likely to sustain MCID deterioration or no change.",
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author = "Shian Liu and Frank Schwab and Smith, {Justin S.} and Klineberg, {Eric Otto} and Ames, {Christopher P.} and Gregory Mundis and Richard Hostin and Khaled Kebaish and Vedat Deviren and Munish Gupta and Oheneba Boachie-Adjei and Hart, {Robert A.} and Shay Bess and Virginie Lafage",
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T1 - Likelihood of reaching minimal clinically important difference in adult spinal deformity

T2 - A comparison of operative and nonoperative treatment

AU - Liu, Shian

AU - Schwab, Frank

AU - Smith, Justin S.

AU - Klineberg, Eric Otto

AU - Ames, Christopher P.

AU - Mundis, Gregory

AU - Hostin, Richard

AU - Kebaish, Khaled

AU - Deviren, Vedat

AU - Gupta, Munish

AU - Boachie-Adjei, Oheneba

AU - Hart, Robert A.

AU - Bess, Shay

AU - Lafage, Virginie

PY - 2014

Y1 - 2014

N2 - Background: Few studies have examined threshold improvements in health-related quality of life (HRQOL) by measuring minimal clinically important differences (MCIDs) in treatment of adult spinal deformity. We hypothesized that patients undergoing operative treatment would be more likely to achieve MCID threshold improvement compared with those receiving nonoperative care, although a subset of nonoperative patients may still reach threshold. Methods: We analyzed a multicenter, prospective, consecutive case series of 464 patients: 225 nonoperative and 239 operative. To be included in the study, patients had to have adult spinal deformity, be older than 18 years, and have both baseline and 1-year follow-up HRQOL measures (Oswestry Disability Index [ODI], Short Form-36 [SF-36] health survey, and Scoliosis Research Society-22 [SRS-22] questionnaire). We compared the percentages of patients achieving established MCID thresholds between operative and nonoperative groups using risk ratios (RR) with a 95% confidence interval (CI). Results: Compared to nonoperative patients, surgical patients demonstrated significant mean improvement (P<0.01) and were more likely to achieve threshold MCID improvement across all HRQOL scores (ODI RR = 7.37 [CI 4.45, 12.21], SF-36 physical component score RR = 2.96 [CI 2.11, 4.15], SRS Activity RR = 3.16 [CI 2.32, 4.31]). Furthermore, operative patients were more likely to reach threshold MCID improvement in 2 or more HRQOL measures simultaneously and were less likely to deteriorate. Conclusion: Patients in both the operative and nonoperative treatment groups demonstrated improvement in at least one HRQOL measure at 1 year. However, surgical treatment was more likely to result in threshold improvement and more likely to lead to simultaneous improvement across multiple measures of ODI, SF-36, and SRS-22. Although a subset of nonoperative patients achieved threshold improvement, nonoperative patients were significantly less likely to improve in multiple HRQOL measures and more likely to sustain MCID deterioration or no change.

AB - Background: Few studies have examined threshold improvements in health-related quality of life (HRQOL) by measuring minimal clinically important differences (MCIDs) in treatment of adult spinal deformity. We hypothesized that patients undergoing operative treatment would be more likely to achieve MCID threshold improvement compared with those receiving nonoperative care, although a subset of nonoperative patients may still reach threshold. Methods: We analyzed a multicenter, prospective, consecutive case series of 464 patients: 225 nonoperative and 239 operative. To be included in the study, patients had to have adult spinal deformity, be older than 18 years, and have both baseline and 1-year follow-up HRQOL measures (Oswestry Disability Index [ODI], Short Form-36 [SF-36] health survey, and Scoliosis Research Society-22 [SRS-22] questionnaire). We compared the percentages of patients achieving established MCID thresholds between operative and nonoperative groups using risk ratios (RR) with a 95% confidence interval (CI). Results: Compared to nonoperative patients, surgical patients demonstrated significant mean improvement (P<0.01) and were more likely to achieve threshold MCID improvement across all HRQOL scores (ODI RR = 7.37 [CI 4.45, 12.21], SF-36 physical component score RR = 2.96 [CI 2.11, 4.15], SRS Activity RR = 3.16 [CI 2.32, 4.31]). Furthermore, operative patients were more likely to reach threshold MCID improvement in 2 or more HRQOL measures simultaneously and were less likely to deteriorate. Conclusion: Patients in both the operative and nonoperative treatment groups demonstrated improvement in at least one HRQOL measure at 1 year. However, surgical treatment was more likely to result in threshold improvement and more likely to lead to simultaneous improvement across multiple measures of ODI, SF-36, and SRS-22. Although a subset of nonoperative patients achieved threshold improvement, nonoperative patients were significantly less likely to improve in multiple HRQOL measures and more likely to sustain MCID deterioration or no change.

KW - Disability evaluation

KW - Pain management

KW - Quality of life

KW - Spinal cord diseases

KW - Surgical procedures-operative

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