Friday, September 28, 2018 10:30 AM–12:00 PM abstracts: deformity: technical factors: 168. The implementation of HRQOL instruments in appropriateness criteria of surgery for degenerative lumbar scoliosis

Abstract

BACKGROUND CONTEXT Degenerative lumbar scoliosis (DLS) afflicts a considerable proportion of the aging population and its prevalence is increasing. Current management of DLS is characterized by a substantial variability in treatment options, reflecting the absence of a clear, evidence based commonly acknowledged approach. In order to improve clinical decision making as well as consistency and quality of care for patients with DLS, the Scoliosis Research Society assessed the appropriateness of surgery for DLS patients with specific clinical characteristics using the RAND/UCLA Appropriateness Method. In the appropriateness criteria for DLS, the patient perspective was not formally incorporated. Since patient perspective is an extremely important consideration in informed decision making, PROMs should be embedded in the appropriateness criteria for DLS to ensure a patient-centered approach. PURPOSE The purpose of this study is to evaluate whether there is an association between the appropriateness criteria for DLS and PROMs. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE For this study, medical records of all adult patients suffering from DLS who were treated at the Maastricht University Medical Centre were reviewed. OUTCOME MEASURES Medical records and radiographs were reviewed and scored according to the appropriateness criteria for DLS and various PROMs (VAS, SF-36, ODI, PCS and HADS) were collected. METHODS Two experts scored the appropriateness criteria using all available information. Analysis of variance was used to test for differences in PROMS for each of the three categories resulting from the appropriateness criteria. Subsequently, the appropriateness criteria were dichotomized into appropriate (appropriate and necessary) and inappropriate. Logistic regression was used to assess how well PROMs can discriminate between appropriate and inappropriate. Discriminative ability was subsequently determined by computing the AUC, resulting from the logistic regression analysis. RESULTS A total of 150 patients was included (mean age 67.1 years, mean Cobb angle 29.6°). The absolute inter-observer agreement between the two raters to determine the appropriateness category was 92.3% (Kappa coefficient 0.88 (p CONCLUSIONS The appropriateness criteria for lumbar degenerative scoliosis (DLS) as developed by the Scoliosis Research Society represent a significant step towards evidence based uniform treatment in spinal surgery. One important limitation of the criteria is the absence of the patient perspective (ie PROMs). By using individual patient PROMs clinicians receive standardized information on patient problems in order to identify or monitor symptoms and support shared decision-making. In this study, we retrospectively evaluated that there is a strong association between the appropriateness criteria for DLS and the patient perspective. Based on the findings of the current study, one might reason that PROMs should be incorporated in the appropriateness criteria.