PROMIS Scores Should Not be Used in Isolation to Measure Outcomes in Lumbar Stenosis Patients

Abstract

Study Design. Retrospective cross-sectional analysis.Objective. The aim of this study was to establish the strength of relationship between the Patient-reported Outcomes Measurement Information System (PROMIS) Adult Depression (AD), Physical Function (PF), and Pain Interference (PI) with the Swiss Spinal Stenosis Questionnaire (SSSQ) in assessing lumbar spinal stenosis (LSS). Summary of Background Data. In 2009, there were >35,000 surgeries for LSS, which amounted to $1.65 billion in health care cost. By 2021, there will be >2.4 million people in the United States with symptomatic LSS. There is an increasing emphasis on patient-reported outcomes (PROs) to define value in medicine. Therefore, it would be beneficial to compare PROMIS, a universal PRO, against the SSSQ, the ''criterion standard'' for assessing LSS. Methods. Eighty-two patients with LSS completing the PROMIS and SSSQ were enrolled. Per existing institutional protocol, PROMIS AD, PF, and PI were completed at every clinic visit. Linear regression analysis was then performed to evaluate how well the SSSQ and PROMIS scores correlated to each other. Results. When linear regression was performed for pretreatment values, the R 2 value for the SSSQ PF versus PROMIS PF was 0.14 (P ¼ 0.0008), whereas the R 2 value for the SSSQ symptom severity versus PROMIS PI was 0.03 (P ¼ 0.13). The R 2 value for the combined SSSQ physical function and symptom severity versus PROMIS AD was 0.07 (P ¼ 0.02). When post-treatment SSSQ satisfaction scores were correlated to postoperative PROMIS AD, PI, and PF scores, the R 2 values for a good linear fit were 0.13, 0.25, and 0.18 respectively (P values: 0.01, 0.003, and 0.003). Conclusion. Pre-treatment PROMIS scores do not adequately capture the disease-specific impact of spinal stenosis, but postoperative PROMIS scores better reflect outcomes after surgery for LSS. PROMIS scores should not be used in isolation to assess outcomes in patients with LSS.

Comparison of Psychometric Properties of Patient-Reported Outcomes Measurement Information System With Traditional Outcome Metrics in Spine Surgery

“…Similarly, in lumbar spinal stenosis patients, Patel et al demonstrated the efficiency, convergent and discriminatory validity, and responsiveness of PROMIS CATs compared with legacy measures 42 . Although the PROMIS CAT was deemed valid based on its comparison with the aforementioned legacy measures, a subsequent study 44 assessed PROMIS CAT using the Swiss Spinal Stenosis Questionnaire (SSSQ), which has been recommended by the North American Spine Society as the “criterion standard” for LSS outcomes 45 . The authors concluded that PROMIS should not be used in isolation to evaluate patients with lumbar spinal stenosis because there were poor correlations with these legacy instruments.…”

Emerging Need for PROMs to Measure the Impact of Spine Disorders on Overall Health and Well-being: Measuring Expectations as an Example for Lumbar Degenerative Spondylolisthesis

“…Specifically, analyses show a low correlation coefficient ( R value) (indicating the relationship is relatively weak) with a significant P value (indicating a high probability that the association is not due to chance) [32]. This issue is becoming increasingly relevant as comprehensive assessments, such as those measuring the impact of a given condition on overall health and well-being, are considered indicators of the quality of health care [19,33]. Such health indicators are important to patients, stakeholders, and administrators.…”