Key result
Preoperative PROMIS Physical Function and Pain Interference scores strongly predicted the achievement of postoperative MCID in lumbar spine surgery patients (AUC 0.85 and 0.82, respectively).
Why the study?
The study was conducted to examine whether preoperative PROMIS scores can predict the postoperative achievement of a minimum clinically important difference following lumbar spine surgery.
Do preoperative PROMIS scores predict postoperative achievement of MCID in lumbar spine surgery patients?
Observational (n=138)
No
Do preoperative PROMIS scores predict postoperative achievement of MCID in lumbar spine surgery patients?
Effect estimate: AUC 0.85 (PF) and 0.82 (PI)
Preoperative PROMIS scores can predict which patients are most likely to achieve clinically meaningful improvement after lumbar spine surgery.
Preoperative PROMIS PF/PI scores may predict MCID after lumbar surgery; hypothesis-generating from Level 5 evidence and needs prospective validation.
STUDY DESIGN: Retrospective case series. OBJECTIVE: Our objective was to examine the ability of preoperative Patient-reported Outcomes Measurement Information System (PROMIS) scores to predict postoperative achievement of a minimum clinically important difference (MCID) in outcome scores following lumbar spine surgery. SUMMARY OF BACKGROUND DATA: PROMIS is a computer adaptive testing system that has been validated in spine surgery patients. PROMIS allows for more efficient and personalized data collection compared to legacy assessment tools. METHODS: A total of 138 patients who underwent lumbar spine surgery at a single institution completed PROMIS Physical Function (PF) and Pain Interference (PI) scores preoperatively and at 3, 12, and 24 months postoperatively. Univariate and multivariate analyses of PROMIS scores and clinical factors were performed. Receiver-operating characteristic curves were calculated to determine the ability of preoperative scores to predict postoperative achievement of an MCID of 8. PF and PI t score MCID achievement threshold values with 90% specificity were calculated. RESULTS: Preoperative PROMIS PF and PI scores were significantly correlated to achievement of postoperative MCID after multivariate analysis. Patients with worse preoperative scores were more likely to achieve MCID. Preoperative PF and PI scores showed strong predictive value in determining ability to achieve postoperative MCID with respective area under the curve of 0.85 and 0.82. A preoperative PF threshold T-score of 31.6 had a 64% chance of achieving postoperative MCID, while a preoperative PI threshold t score of 67.8 had an 86% chance of achieving postoperative MCID. CONCLUSION: Preoperative PROMIS PF and PI scores predicted improvement in postoperative PROMIS scores in lumbar spine surgery patients as worse preoperative scores correlated to improved PROMIS scores postoperatively. The calculated threshold t scores showed the ability to predict improvement in postoperative PROMIS scores. Preoperative PROMIS data may be useful in surgical decision-making and improved patient education regarding postoperative outcomes.Level of Evidence: 4.
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Snavely et al. (2021) conducted an observational in Lumbar spine surgery (n=138). Preoperative PROMIS Physical Function (PF) and Pain Interference (PI) scores was evaluated on Postoperative achievement of a minimum clinically important difference (MCID) of 8 (AUC 0.85 (PF) and 0.82 (PI)). Preoperative PROMIS Physical Function and Pain Interference scores strongly predicted the achievement of postoperative MCID in lumbar spine surgery patients (AUC 0.85 and 0.82, respectively).
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