Friday, September 28, 2018 4:05 PM–5:05 PM abstracts: new concepts: cervical spine: 241. Improvements in pain and physical function after cervical spine surgery predict betterment in other areas of health and wellness

Abstract

BACKGROUND CONTEXT The primary goal of surgery for cervical degenerative disease is to reduce pain and improve physical function. However, patients often experience problems in other areas of health and wellness. In setting expectations for outcomes of cervical spine surgery, it would be beneficial to understand how improvements in pain and physical function may influence these other health domains. PROMIS is a multidimensional assessment that measures spine patients’ pain, physical function, fatigue, anxiety, depression, sleep disturbance, and social participation with a population mean of 50 (SD 10). PURPOSE To investigate whether pain and physical limitation with surgery for cervical degenerative disease will result in improvements in other domains of health and wellness. STUDY DESIGN/SETTING Longitudinal study. PATIENT SAMPLE A total of 561 visits of 220 unique patients. OUTCOME MEASURES PROMIS domain change scores (preoperative vs. postoperative). METHODS Patients undergoing surgery for degenerative cervical disease completed PROMIS surveys preoperatively and 6 weeks and 3, 6 and 12 months postoperatively. Between December 2014 and January 2018, PROMIS data was collected for 561 visits of 220 unique patients. Repeated measures logistic regression was used to calculate the odds of a meaningful improvement (MCID) in PROMIS domains given a 5-point improvement in either pain or physical function. RESULTS A 5-point decrease in pain was associated with 76% increased odds of MCID in fatigue (95% CI 1.18, 2.62 p=.006), 57% increased odds for anxiety (CI 1.02, 2.42, p=.039), 76% increased odds for sleep disturbance (CI 1.33–2.33, p CONCLUSIONS Decreases in pain yield meaningful improvements in fatigue, anxiety, sleep disturbance, and social participation. Additionally, gains in physical function result in meaningful improvements in social role participation. Although patients present for cervical spine surgery primarily due to pain and limitations in physical function, our results suggest that improvement in these domains will lead to improvements in other areas of health and wellness.