Enduring improvement in Oswestry Disability Index outcomes following lumbar microscopic interlaminar decompression: An appraisal of prospectively collected patient outcomes

Khan, Muhammad Babar; Bashir, Muhammad Umair; Kumar, Rajesh; Enam, Syed Ather

doi:10.4103/0974-8237.167881

Cited by 4 publications

(1 citation statement)

References 21 publications

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“…As such, it is not directly comparable to the individual PROMs utilized in our study. In a study of 60 patients undergoing LD by Khan et al,31 they reported an overall MCID achievement rate for ODI of 83.3% at 2 years’ follow-up which is comparable to our rate of 72.4%–74.5% across subgroups.…”

Section: Discussionsupporting

confidence: 86%

Influence of Preoperative Depressive Burden on Achieving a Minimal Clinically Important Difference Following Lumbar Decompression

Lynch

D.K.

Jenkins

et al. 2022

Clinical Spine Surgery: A Spine Publication

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Study Design: This was a retrospective cohort study. Objective: This study evaluates the association of preoperative mental health with the rate of achieving minimal clinically important difference (MCID) in patient-reported outcomes following lumbar decompression (LD). Summary of Background Data: Research is scarce regarding the influence of preoperative depression on the rate of achieving MCID for mental health, physical function, and pain among LD patients. Methods: A surgical registry was retrospectively reviewed for primary LD surgeries. Patients were grouped by depressive symptom severity according to the preoperative Patient Health Questionnaire 9 score. The association of Patient Health Questionnaire 9 subgroups with demographic and surgical variables was analyzed, and differences among subgroups were assessed. Achievement rates of MCID for physical function, pain, disability, and mental health were compared among groups at each time point using previously established MCID thresholds. Results: Of the 321 subjects, 69.8% were male, and 170 subjects had minimal preoperative depressive symptoms, 86 had moderate, and 65 had severe. Patients in moderate and severe groups demonstrated a significantly greater rate of MCID achievement for disability at 6 weeks and 3 months postoperatively. The severe group demonstrated a significantly higher rate of achieving MCID for mental health at the 1-year time point. Conclusions: Patients with any range of preoperative depressive symptom severity had a similar rate of achieving MCID for pain and physical function throughout 1 year following LD. The severe depressive symptom group had a higher rate of MCID achievement with disability at 6 weeks and with mental health at 1 year. This study demonstrates that patients with any preoperative depressive symptom severity have an indistinguishable ability to attain MCID by 1 year following LD. Level of Evidence: Level III.

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Section: Discussionsupporting

confidence: 86%

Influence of Preoperative Depressive Burden on Achieving a Minimal Clinically Important Difference Following Lumbar Decompression

Lynch

D.K.

Jenkins

et al. 2022

Clinical Spine Surgery: A Spine Publication

View full text Add to dashboard Cite

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Worse Preoperative 12-Item Veterans Rand Physical Component Scores Prognosticate Inferior Outcomes Following Outpatient Lumbar Decompression

Anwar,

Roca,

Loya

et al. 2024

Clinical Spine Surgery

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Study Design: Retrospective Review. Objective: Evaluate the influence of the 12-Item veterans Rand (VR-12) physical component score (PCS) on patient-reported outcome measures (PROMs) in an outpatient lumbar decompression (LD) cohort. Summary of Background Data: The influence of baseline VR-12 PCS on postoperative clinical outcomes has not been evaluated in patients undergoing outpatient LD. Methods: Patients undergoing primary, elective, 1/2-level outpatient LD with baseline VR-12 PCS scores were retrospectively identified from a prospectively maintained single-surgeon database. Cohorts were preoperative VR-12 PCS<30 and VR-12 PCS≥30. Patient/perioperative characteristics and preoperative/postoperative 6-week/final follow-up (FF) PROMs were collected. Physical health PROMs included the VR-12 PCS, 12-Item Short Form (SF-12) PCS, patient-reported outcome measure information system-physical function (PROMIS-PF), visual analog scale (VAS)-back/leg, and Oswestry disability index (ODI). Mental health PROMs included the VR-12/SF-12 mental component score (MCS) and the patient-health questionnaire-9 (PHQ-9). Average FF was 13.8±8.9 months postoperatively. PROM improvements at 6 weeks/FF and minimal clinically important difference (MCID) achievement rates were determined. χ2 analysis and the Student’s t tests compared demographics, perioperative data, and preoperative PROMs. Multivariate linear/logistic regression compared postoperative PROMs, PROM improvements, and MCID achievement rates. Results: Six weeks postoperatively, VR-12 PCS<30 reported worse baseline PROMs (P≤0.042, all) and worse scores except VR-12/SF-12 MCS (P≤0.043, all). Compared with VR-12 PCS≥30, VR-12 PCS<30 had worse FF VR-12 PCS, SF-12 PCS/MCS, PROMIS-PF, PHQ-9, and VAS-Back (P≤0.033, all). VR-12 PCS<30 experienced greater 6-week improvements in VR-12/SF-12 PCS, PHQ-9, VAS-Back, and ODI (P≤0.039, all). VR-12 PCS<30 had greater FF improvements in VR-12/SF-12 PCS, PHQ-9, and ODI (P≤0.001, all) and greater overall MCID achievement in VR-12 PCS/MCS, SF-12 PCS, PHQ-9, and ODI (P≤0.033, all). Conclusions: VR-12 PCS<30 patients-reported worse baseline/postoperative mental/physical health scores. However, they reported greater improvements in physical function, depressive burden, back pain, and disability by 6 weeks and FF and experienced greater MCID achievement for physical functioning, mental health, and disability scores.

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Explanatory multivariate modeling for disability, pain, and claims in patients with spine pain via a physical therapy direct access model of care

Green

Pastore

Leah

et al. 2019

BMR

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BACKGROUND: Direct access physical therapy (DAPT) may result in improved patient outcomes and reduced healthcare costs. Prognostic factors associated with spine-related outcomes and insurance claims with DAPT are needed. OBJECTIVE: To identify factors that predict variations in outcomes for spine pain and insurance claims using DAPT. METHODS: Individuals (N = 250) with spine pain were analyzed. Outcomes were classified into High, Low, or Did Not Meet minimal clinically important difference (MCID) scores. Claims were categorized into low, medium, or high tertiles. Prognostic variables were identified from patient information. RESULTS: Females were more likely to meet High MCID (odds ratio [OR] 2.84 (95% CI = 1.32, 6.11) and Low MCID (OR 2.86, 95% CI = 1.34, 6.10). Higher initial ODI/NDI scores were associated with High MCID (OR 1.04, 95% CI = 1.07, 1.22) and Low MCID (OR 0.91, 95% CI = 0.77, 1.07). Odds of a high claim were lowered by the absence of imaging (OR 0.04, 95% CI = 0.02, 0.09) and an active versus passive treatment (OR 0.38, 95% CI = 0.18, 0.80). CONCLUSION: Females and higher initial disability predicted favorable outcomes. The novel introduction of claims into the prognostic modeling supports that active interventions and avoiding imaging may reduce claims. Neck pain (NP) and low back pain (LBP) are two of 2 the most common musculoskeletal conditions, with a 3 global point prevalence of 4.9% [1] and 9.4% [2], re-4 * . spectively. In the United States (US), 15% of all indi-5 viduals report experiencing NP and 29% report LBP 6 within the previous three months [3]. Whereas a ma-7 jority of persons with NP and LBP may have favorable 8 outcomes with or without treatment, a notable percent-9 age of the population will go on to develop chronic or 10 recurring pain and disability. Over a third of individu-11 als who develop NP will develop persistent symptoms 12 that last longer than six months [4]. Similarly, 24% 13 File: bmr-1-bmr171074.tex; BOKCTP/ljl p. 2 2 C. Green et al. / Explanatory multivariate modeling for disability, pain, and claims in patients LBP will continue to have recurring episodes through-15 out their lifetime [5,6]. 16 Numerous studies have examined prognostic fac-17 tors related to NP and LBP and predicting disability 18 based on these factors. There is strong evidence that 19 older age, a longer duration of symptoms, a history of 20 neck problems, and co-existing musculoskeletal disor-21 ders are poor prognostic factors for non-specific NP [7] 22 and high baseline disability, heightened psychologi-23 cal stress, older age, radicular symptoms, litigation, 24 and physically demanding work are prognostic for 25 LBP [8]. Interestingly, prognostic factors across stud-26 ies seem largely dependent on how outcomes were de-27 fined within the studies [9,10]. There is substantial 28 variability amongst predictive models using different 29 MCIDs on the Oswestry Disability Index (ODI) in the 30 LBP population [10]. For NP, studies of prognostic fac-31 tors have lacked predictors for outcome from a...

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Enduring improvement in Oswestry Disability Index outcomes following lumbar microscopic interlaminar decompression: An appraisal of prospectively collected patient outcomes

Cited by 4 publications

References 21 publications

Influence of Preoperative Depressive Burden on Achieving a Minimal Clinically Important Difference Following Lumbar Decompression

Influence of Preoperative Depressive Burden on Achieving a Minimal Clinically Important Difference Following Lumbar Decompression

Worse Preoperative 12-Item Veterans Rand Physical Component Scores Prognosticate Inferior Outcomes Following Outpatient Lumbar Decompression

Explanatory multivariate modeling for disability, pain, and claims in patients with spine pain via a physical therapy direct access model of care

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