Does the severity of pain correlate with severity of functional disability? Factors influencing 'patient reported outcome measures' in spinal patients.

Abstract

Aims: To assess correlation between the Visual Analogue Scale (VAS) pain score and the Oswestry Disability Index (ODI) and which patient factors can influence patient-reported outcome measures (PROMs). This study also aims to assess the response to the sexual function question of the ODI.Methods: Retrospective analysis of 200 consecutive patients undergoing a range of different lumbar spinal procedures between July 2012 and September 2015 was performed. Subgroup analysis was also performed on the 122 patients who underwent microdiscectomy and/or decompression procedures only. Data from notes and clinical letters from the patient's first clinic appointment were collected. In addition to these outcome measures, data were also extracted regarding patients' gender, age, smoking status, alcohol use, employment and mental health status.Results: Significant correlation was found between VAS pain score and ODI (p = 0.002) and between VAS pain score and question 1 of ODI (p = 0.0001). A lower ODI score was reported at time of surgery by those in employment compared to those who are unemployed (p = 0.008). In addition to this, a lower ODI score was reported in those who are self-employed compared to those in employment (p = 0.048) in both cohorts. A significantly higher mean ODI score was shown within the subgroup analysis for current smokers (p = 0.02). None of the other patient factors that were analysed were found to affect PROMs. 65% of patients answered the sexual function question of the ODI.Conclusions: Significant correlation was demonstrated between VAS pain score and ODI. Those who are in employment are far more likely to report a lower ODI score than those who are unemployed at the time of surgery. Self-employed patients were found to have reported a significantly lower ODI score than those who are in employment. Smoking cessation should be encouraged as those who are current smokers may be more likely to report a higher ODI. As 65% of patients decided to answer the sexual function question of the ODI, this supports its further use.