Determination of minimally clinically important differences for JOABPEQ measure after discectomy in patients with lumbar disc herniation

Azimi, Parisa; Yazdanian, Taravat; Benzel, Edward C.

doi:10.21037/jss.2018.03.11

Cited by 20 publications

(17 citation statements)

References 22 publications

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“…In the hands of a well-trained and experienced endoscopic spine surgeon, this outpatient procedure is associated with an overall lower burden to patients, and excellent long-term durability of favorable outcomes, especially since the procedure can be performed under local anesthesia and eliminate the use of general anesthesia. 29 The authors of this study stipulated that the MCIDs for VAS and ODI as a result of the outpatient transforaminal endoscopic decompression may be different from those published [36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52] for open translaminar decompression as the perception of its clinical benefit well known to patients is driven by the stark differences between the two procedures: a clean small stab versus an open incision with risk of infection, in most cases an outpatient procedure at an ambulatory surgery center) under local anesthesia versus an inpatient surgery at a hospital, minimal bleeding and incisional discomfort versus wound pain with potential for blood loss, and, last but not least, faster recovery and social reintegration versus longer narcotic dependence, delayed return to work, and higher direct and indirect cost. With the advent of the internet and social media this easy-tounderstand context of improved standards of care with the endoscopic over traditional translaminar surgery is becoming common knowledge among patients and one wonders how patient perception and, hence, the respective MCID threshold values are impacted by these trends.…”

Section: Introductionmentioning

confidence: 99%

Minimal Clinically Important Difference in Patient-Reported Outcome Measures with the Transforaminal Endoscopic Decompression for Lateral Recess and Foraminal Stenosis

Lewandrowski

Carvalho

et al. 2020

Int J Spine Surg

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Background: Patient-reported outcome measures (PROMs) have become widely used to better measure patients' judgment of treatment benefits from surgical spine care. The concept of determining the minimal clinically important differences (MCIDs) of PROMs is aimed at assessing the benefits of lumbar spine care that are meaningful to the patient. The goal of this study was to validate the utility of MCIDs of the visual analog score (VAS) and Oswestry Disability Index (ODI) in patients with sciatica-type low back and leg pain due to lateral recess and foraminal stenosis who were treated with directly visualized transforaminal outpatient endoscopic decompression. Methods: The retrospective study population consisted of 406 patients on whom PROMs were obtained preoperatively, and again postoperatively at final follow-up. Employing an anchor-based approach with a patient satisfaction index based on the modified Macnab criteria, a receiver operating characteristics (ROC) and area under the curve (AUC) analysis was performed using IBM SPSS 25.0 to define the optimal MCID in VAS and ODI with the transforaminal endoscopy using the top-left-corner criteria and the Youden index. Improvements in walking endurance were recorded as an additional parameter of patient functioning and correlated with PROMs to test for statistical significance. Results: The patients' average age was 41.08 years, ranging from 30 to 84 years. The mean follow-up was 33.59 months, ranging from 24 to 85 months, with a standard deviation of 12.79. The MCIDs for VAS and ODI were 2.5 to 3.5 and 15 to 16.5, respectively. Patients were dichotomized as improved (377/406; 92.9%) if they reported excellent (224/406; 55.2%), good (112/406; 27.6%), and fair (41/406; 10.1%) Macnab outcomes. Patients were dichotomized as failed if they reported poor (29/406; 7.1%) Macnab outcomes. Preoperatively, only 32.5% (132/406) of patients had unlimited walking endurance compared to 77.6% (315/406) of patients postoperatively. The ROC and AUC analysis showed better accuracy with the single-integer VAS score (0.926) than with the 10-item ODI score (0.751). Conclusions: Transforaminal outpatient endoscopic decompression for symptomatic foraminal and lateral recess stenosis is an effective surgical treatment to alleviate sciatica-type and back symptoms in 92.9% of patients. Of the PROMs analyzed, the VAS provided a more meaningful and accurate reflection of patients' interpretation of outcome with the transforaminal endoscopic spinal decompression procedure than ODI. Understanding which patient expectations drive these MCIDs may aid in replacing open surgeries for sciatica-type low back and leg pain currently preferred by traditional spine surgeons with a personalized early-staged transforaminal endoscopic hybrid decompressive/ablative procedures favored by the authors. These may prove more cost effective by focusing on significant pain generators validated with a diagnostic interventional workup instead of employing image-based indication criteria for surgery.

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Section: Introductionmentioning

confidence: 99%

Minimal Clinically Important Difference in Patient-Reported Outcome Measures with the Transforaminal Endoscopic Decompression for Lateral Recess and Foraminal Stenosis

Lewandrowski

Carvalho

et al. 2020

Int J Spine Surg

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“…The majority of the articles that fit our inclusion criteria described c-index analyses-concordance statistics used to assess the correlation of a binary outcome variable's goodness of fit included in a logistic regression model 7 -for the predictive models. Two papers (by Azimi et al 8 and Spratt et al 29 ) reported AUC or classification percentages in their validation analyses. Reported c-index values ranged from 0.47 to 0.79.…”

Section: Resultsmentioning

confidence: 99%

“…The final prediction model was published and included age, Roland-Morris function score, and present pain intensity to predict persistent postsurgical pain. Azimi et al 8 created a predictive model from a sample of 133 patients who underwent lumbar disc herniation to determine minimum clinically important differences (MCIDs) in the ODI and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) after 12 months. A 13-point postoperative improvement on the ODI was defined as a success and was observed in 81.9% of cases, with a mean improvement of 19.6 scale points.…”

Section: Variability In Prediction Models and C-indices (Or Auc)mentioning

confidence: 99%

Variability in the utility of predictive models in predicting patient-reported outcomes following spine surgery for degenerative conditions: a systematic review

Dietz

Sharma

Alhourani

et al. 2018

Neurosurgical Focus

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OBJECTIVEThere is increasing emphasis on patient-reported outcomes (PROs) to quantitatively evaluate quality outcomes from degenerative spine surgery. However, accurate prediction of PROs is challenging due to heterogeneity in outcome measures, patient characteristics, treatment characteristics, and methodological characteristics. The purpose of this study was to evaluate the current landscape of independently validated predictive models for PROs in elective degenerative spinal surgery with respect to study design and model generation, training, accuracy, reliability, variance, and utility.METHODSThe authors analyzed the current predictive models in PROs by performing a search of the PubMed and Ovid databases using PRISMA guidelines and a PICOS (participants, intervention, comparison, outcomes, study design) model. They assessed the common outcomes and variables used across models as well as the study design and internal validation methods.RESULTSA total of 7 articles met the inclusion criteria, including a total of 17 validated predictive models of PROs after adult degenerative spine surgery. National registry databases were used in 4 of the studies. Validation cohorts were used in 2 studies for model verification and 5 studies used other methods, including random sample bootstrapping techniques. Reported c-index values ranged from 0.47 to 0.79. Two studies report the area under the curve (0.71–0.83) and one reports a misclassification rate (9.9%). Several positive predictors, including high baseline pain intensity and disability, demonstrated high likelihood of favorable PROs.CONCLUSIONSA limited but effective cohort of validated predictive models of spine surgical outcomes had proven good predictability for PROs. Instruments with predictive accuracy can enhance shared decision-making, improve rehabilitation, and inform best practices in the setting of heterogeneous patient characteristics and surgical factors.

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“…Usually, anchors are presented as Global Rating of Changes (GRC), a change measured by a single item, most of the time a Likert scale. The GRC is often completed by the patient himself, but sometimes by a relative or clinician(s) [25]. Patient is then assigned into several groups ranging from large negative to large positive changes in clinical or health status.…”

Section: Anchor-based Methodsmentioning

confidence: 99%

Practical issues encountered while determining Minimal Clinically Important Difference in Patient-Reported Outcomes

Woaye-Hune

Hardouin

Lehur

et al. 2020

Health Qual Life Outcomes

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Background: Using a real dataset, we highlighted several major methodological issues raised by the estimation of the Minimal Clinically Important Difference (MCID) of a Patient-Reported Outcomes instrument. We especially considered the management of missing data and the use of more than two times of measurement. While inappropriate missing data management and inappropriate use of multiple time points can lead to loss of precision and/or bias in MCID estimation, these issues are almost never dealt with and require cautious considerations in the context of MCID estimation. Methods: We used the LIGALONGO study (French Randomized Controlled Trial). We estimated MCID on the SF-36 General Health score by comparing many methods (distribution or anchor-based). Different techniques for imputation of missing data were performed (simple and multiple imputations). We also consider all measurement occasions by longitudinal modeling, and the dependence of the score difference on baseline. Results: Three hundred ninety-three patients were studied. With distribution-based methods, a great variability in MCID was observed (from 3 to 26 points for improvement). Only 0.2 SD and 1/3 SD distribution methods gave MCID values consistent with anchor-based methods (from 4 to 7 points for improvement). The choice of missing data imputation technique clearly had an impact on MCID estimates. Simple imputation by mean score seemed to lead to out-of-range estimate, but as missing not at random mechanism can be hypothesized, even multiple imputations techniques can have led to an slight underestimation of MCID. Using 3 measurement occasions for improvement led to an increase in precision but lowered estimates. Conclusion: This practical example illustrates the substantial impact of some methodological issues that are usually never dealt with for MCID estimation. Simulation studies are needed to investigate those issues. Trial registration: NCT01240772 (ClinicalTrials.gov) registered on November 15, 2010.

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Determination of minimally clinically important differences for JOABPEQ measure after discectomy in patients with lumbar disc herniation

Abstract: These findings support the value of the MCID to assess surgical success for the JOABPEQ subscales in patients with LDH. This estimate may be a useful tool in clinical practice.

Cited by 20 publications

References 22 publications

Minimal Clinically Important Difference in Patient-Reported Outcome Measures with the Transforaminal Endoscopic Decompression for Lateral Recess and Foraminal Stenosis

Minimal Clinically Important Difference in Patient-Reported Outcome Measures with the Transforaminal Endoscopic Decompression for Lateral Recess and Foraminal Stenosis

Variability in the utility of predictive models in predicting patient-reported outcomes following spine surgery for degenerative conditions: a systematic review

Practical issues encountered while determining Minimal Clinically Important Difference in Patient-Reported Outcomes

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