95. PROMIS scores alone are not a reliable measure of patient outcomes after surgery for lumbar stenosis

Abstract

BACKGROUND CONTEXT As the health care industry shifts to a value-based care model, patient-reported outcome instruments such as the NIH-supported Patient-Reported Outcomes Measurement Information System (PROMIS), which evaluates patients’ global well-being, are increasingly used to gauge the cost-effectiveness of care. The Swiss Spinal Stenosis Questionnaire (SSSQ) is considered the gold standard validated disease-specific outcome measure for the treatment of lumbar spinal stenosis and has been found to be internally consistent, reproducible and responsive to clinical change. As PROMIS is further integrated into clinical care, its benefit must be evaluated relative to traditional PRO instruments such as the SSSQ. PURPOSE This study aims to establish the strength of relationship between three commonly used PROMIS measures and the SSSQ. STUDY DESIGN/SETTING Not applicable. PATIENT SAMPLE See methods section. OUTCOME MEASURES See methods section. METHODS Eighty-two patients with spinal stenosis at a single academic medical center were enrolled. They filled out one SSSQ during their enrollment visit. Patients completed the PROMIS Adult Depression (AD), Physical Function (PF), and Pain Interference (PI) instruments at each visit. For patients who had undergone lumbar decompressive surgery, PROMIS scores from the first two postop visits were averaged. Regression analysis was performed to evaluate the pain and physical function domains of the SSSQ against their respective PROMIS counterparts (PI and PF), treatment satisfaction component of the SSSQ against postop PROMIS scores, and combined pretreatment SSSQ against PROMIS AD. RESULTS PROMIS PF correlates moderately well with the SSSQ physical function domain (R2 0.14, p=0.0008) while PROMIS PI correlates poorly with the SSSQ pain domain (R2 0.03, p= 0.13). PROMIS AD correlates relatively poorly to the pretreatment SSSQ (R2 0.07, p= 0.02). In patients who have undergone surgery, postoperative PROMIS scores in all three domains correlate reasonably well with the treatment satisfaction component of the SSSQ [PROMIS AD (R2 0.13, p=0.01), PROMIS PI (R2 0.25, p= 0.003), PROMIS PF (R2 0.18, p= 0.003)]. CONCLUSIONS While postoperative PROMIS scores reflect patient outcomes after surgery for spinal stenosis reasonably well, preoperative PROMIS scores do not adequately capture the disease-specific impact of spinal stenosis on patients’ overall wellbeing. Therefore, PROMIS scores should not be used in isolation to assess outcomes in patients with spinal stenosis. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.