Patient-Reported Outcomes Measurement Information System Physical Function Validation for Use in Anterior Cervical Discectomy and Fusion: A 2-Year Follow-up Study

Abstract

Objective: Our study aims to evaluate the correlation of Patient-Reported Outcomes Measurement Information System physical function (PROMIS PF) with legacy patient-reported outcome measures (PROMs) among patients undergoing anterior cervical discectomy and fusion (ACDF). Methods: A prospectively maintained database was retrospectively reviewed for ACDF surgeries performed between May 2015 and September 2017. Inclusion criteria were primary elective, single-or multilevel ACDFs for degenerative spinal pathology. Patients lacking preoperative or 2-year PROMIS PF surveys were excluded. Mean scores were calculated for visual analogue scale (VAS) neck, VAS arm, Neck Disability Index (NDI), 12-Item Short Form Physical Component Score (SF-12 PCS), and PROMIS PF at preoperative and 6-week, 12-week, 6-month, 1-year, and 2-year postoperative timepoints. A t-test and Pearson correlation coefficient were utilized to evaluate score improvement and PROM relationships respectively. Results: The 50 subject cohort was 60.0% male, 50% obese (body mass index ≥ 30 kg/m 2 ) and had an average age of 50.9 years. Significant improvements were demonstrated for VAS neck and NDI at all postoperative timepoints (p < 0.001) and for SF-12 and PROMIS PF at all timepoints except 6 weeks (p ≤ 0.025). VAS arm improvement was seen up to 1 year (p ≤ 0.016). PROMIS PF demonstrated strong correlations with NDI and SF-12 PCS at all evaluated timepoints and with VAS neck at all postoperative timepoints except 6 weeks (all p < 0.01). Conclusion: PROMIS PF was strongly correlated with pain, disability, and physical function up to 2 years for patients undergoing ACDF. Our results support the long-term validity of PROMIS PF for measurement of patient-reported physical function among ACDF cohorts.

Level-specific Perioperative and Clinical Outcome Comparison: Cervical Disk Replacement Versus Anterior Cervical Diskectomy and Fusion at C5-C6 in Patients With Myeloradiculopathy

“…The adoption of more subjective, patient-centered metrics now serves as an adjunct to radiographic parameters, allowing a more encompassing assessment of patient satisfaction after spinal procedures. 30-32 Our study found that patients receiving ACDF or CDR at C5-C6 had similarly positive long-term PROMs for arm pain, neck pain, and physical function, highlighting the utility of both procedures for successful clinical outcomes. Specifically, the CDR patient cohort demonstrated improvement from preoperative baseline to the 1-year time point for all PROMs collected at all individual postoperative time points, with the exception of SF-12 PCS and PROMIS-PF at 6 weeks, and the ACDF patient cohort demonstrated improvement from preoperative baseline to the 1-year time point for all PROMs collected at all individual postoperative time points, with the exception of VAS arm at 1 year, NDI at 6 weeks and 1 year, and SF-12 PCS and PROMIS-PF at 6 weeks.…”

Does Baseline Severity of Arm Pain Influence Outcomes Following Single-Level Anterior Cervical Discectomy and Fusion?

“…ACDF remains the gold standard for operative treatment of cervical degenerative pathology causing persistent neck and/or arm pain from nerve root compression with 137,000 procedures performed between 2006 and 2013 [ 7 ]. PROM questionnaires have been increasingly used by spinal surgeons to evaluate the postoperative quality-of-care and cost-effectiveness of this procedure [ 7 ].…”

Preoperative Physical Function Association With Mental Health Improvement After Anterior Cervical Discectomy and Fusion

“…While a variety of physical function metrics exist in the spine literature, in this case, we chose to quantify physical function in terms of PROMIS PF scores due to their ease of administration and thorough validation in this population. 19 PROMIS PF specifically assesses factors such as mobility, dexterity, and ability to perform activities of daily living. 20 This relationship was further explored using linear regression to investigate the possible correlation between preoperative PROMIS score and either PROMIS or PHQ-9 postoperative scores.…”

“…Our study, however, adds to the current literature by contributing an investigation that has focused on the reverse directionality between physical function and depression, that is, how preoperative physical function affects depression. While a variety of physical function metrics exist in the spine literature, in this case, we chose to quantify physical function in terms of PROMIS PF scores due to their ease of administration and thorough validation in this population 19. PROMIS PF specifically assesses factors such as mobility, dexterity, and ability to perform activities of daily living 20.…”