Implementation of patient-reported outcome measures in appropriateness criteria of surgery for degenerative lumbar scoliosis

Abstract

BACKGROUND CONTEXTDegenerative lumbar scoliosis (DLS) is an increasingly common spinal disorder of which current management is characterized by a substantial variety in treatment advice. To improve evidence-based clinical decision-making and increase uniformity and transparency of care, the Scoliosis Research Society established appropriateness criteria for surgery for DLS. In these criteria, however, the patient perspective was not formally incorporated. Since patient perspective is an increasingly important consideration in informed decision-making, embedding patient-reported outcome measures (PROMs) in the appropriateness criteria would allow for an objective and transparent patient-centered approach. PURPOSETo evaluate the extent that patient perspective is integrated into the appropriateness criteria of surgery for DLS. STUDY DESIGNSingle center, retrospective, cohort study. PATIENT SAMPLE150 patients with symptomatic degenerative lumbar scoliosis. Outcome MeasuresThe association between appropriateness for surgery and various PROMs [Visual Analogue Scale for pain, Short Form 36 (SF-36), Pain Catastrophizing Scale (PCS), Hospital Anxiety Depression Scale (HADS), and Oswestry Disability Index (ODI)]. METHODSMedical records of all patients with symptomatic DLS were reviewed and scored according to the appropriateness criteria. To assess the association between the appropriateness criteria and the validated PROMs, analysis of variance was used to test for differences in PROMS for each of the three categories resulting from the appropriateness criteria. To assess how well PROMs can discriminate between appropriate and inappropriate, we used a logistic regression analysis. Discriminative ability was subsequently determined by computing the area under the curve (AUC), resulting from the logistic regression analysis. Spearman rank analysis was used to establish a correlation pattern between the PROMs used and the appropriateness criteria. RESULTSThere was a significant association between the appropriateness of surgery and the PROMs. The discriminative ability for appropriateness of surgery for PROMs as a group was strong (AUC of 0.83). However, when considered in isolation, the predictive power of any individual PROMs was poor. The different categories of the appropriateness criteria significantly coincided with the PROMs used. CONCLUSIONThere is a statistically significant association between the appropriateness criteria of surgery for DLS and PROMs. Implementation of PROMs into the appropriateness criteria may lead to more transparent, quantifiable and uniform clinical decision making for DLS.