Response rate does not affect patient-reported outcome after lumbar discectomy

Elkan, Peter; Lagerbäck, Tobias; Möller, Hans; Gerdhem, Paul

doi:10.1007/s00586-018-5541-0

Cited by 37 publications

(36 citation statements)

References 25 publications

(35 reference statements)

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“…Furthermore, Elkan et al showed that RR did not affect PROM results after lumbar discectomy. 24 This indicates that a goal of 80% may not be necessary, but further studies are needed to determine an acceptable limit. The limit may also vary depending on the field, as previous studies have demonstrated significant differences between responders and non-responders both in demographic and in outcomes in various fields.…”

Section: Discussionmentioning

confidence: 99%

Review of response rates over time in registry-based studies using patient-reported outcome measures

et al. 2020

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ObjectivesGain an overview of expected response rates (RRs) to patient-reported outcome measures (PROMs) in clinical quality registry-based studies and long-term cohorts in order to better evaluate the validity of registries and registry-based studies. Examine the trends of RRs over time and how they vary with study type, questionnaire format, and the use of reminders.DesignLiterature review with systematic search.Data sourcesPubMed, MEDLINE, EMBASE, kvalitetsregistre.no, kvalitetsregister.se and sundhed.dk.Eligibility criteriaArticles in all areas of medical research using registry-based data or cohort design with at least two follow-up time points collecting PROMs and reporting RRs. Annual reports of registries including PROMs that report RRs for at least two time points.Primary outcome measureRRs to PROMs.ResultsA total of 10 articles, 12 registry reports and 6 registry articles were included in the review. The overall RR at baseline was 75%±22.1 but decreased over time. Cohort studies had a markedly better RR (baseline 97%±4.7) compared with registry-based data at all time points (baseline 72%±21.8). For questionnaire formats, paper had the highest RR at 86%±19.4, a mix of electronic and paper had the second highest at 71%±15.1 and the electronic-only format had a substantially lower RR at 42%±8.7. Sending one reminder (82%±16.5) or more than one reminder (76%±20.9) to non-responders resulted in a higher RR than sending no reminders (39%±6.7).ConclusionsThe large variation and downward trend of RRs to PROMs in cohort and registry-based studies are of concern and should be assessed and addressed when using registry data in both research and clinical practice.

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Section: Discussionmentioning

confidence: 99%

Review of response rates over time in registry-based studies using patient-reported outcome measures

et al. 2020

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“…The current study analyzed a larger set of explanatory variables for a larger population, which might explain the inferential disparity. Elkan et al [5] compared differences in outcome between the Swespine disc hernia population and a cohort of disc hernia patients from a single hospital. In the latter group, the response rates were considerably larger than in the Swespine register.…”

Section: Discussionmentioning

confidence: 99%

“…The validity of spine registers in the context of patient dropout has been tested before in Denmark, Norway and Sweden [3][4][5][6]. In these studies, the outcome for nonrespondents was assessed in either phone interviews or by postal questionnaires.…”

Section: Introductionmentioning

confidence: 99%

“…Despite a missing data rate on the outcome variable level of more than 40% the Swespine cohort showed similar results to the separate group, which had a follow-up rate of 98%. Thus, it was concluded that patientreported outcome data in Swespine was representative for large cohorts [5]. Endler et al studied 351 patients registered in Swespine as operated for degenerative conditions in the lumbar spine.…”

Section: Introductionmentioning

confidence: 99%

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Characteristics and predicted outcome of patients lost to follow-up after degenerative lumbar spine surgery

et al. 2020

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Purpose The relatively large number of participants lost to follow-up (attrition) in spinal registers calls for studies that investigate the features of these individuals and their possible outcome. The aim was to explore the effect of attrition on patient-reported outcome in patients undergoing degenerative lumbar spine surgery. Three groups were studied: spinal stenosis (LSS), disc herniation (LDH) and degenerative disc disorder (DDD). Methods Patients who underwent surgery for degenerative lumbar spine conditions during 2008-2012 according to registration in the Swespine national register were eligible for the study. Non-respondents were registered in Swespine prior to surgery, but not at follow-up. Swespine data were merged with hospital data from seven Swedish regions (65% of the population), Statistics Sweden, the National Patient Register and the Social Insurance Agency. Baseline characteristics of non-respondents were described and compared to those of the respondents. Coefficients from regression analyses on PROM values for respondents were used to estimate the levels of PROM values for non-respondents, assuming the same effects of baseline characteristics for the two subgroups. Regression analyses were then conducted to identify variables associated with non-response. The results from the regression analyses were used to predict outcomes for patients with the characteristics of a non-respondent. Primary outcome variable in LSS and LDH was Global Assessment for leg pain, and in DDD, Global Assessment for back pain. Results Age, sex, educational level, smoking, living alone, being born outside the EU, previous spine surgery and unexpected events before follow-up were factors that were significantly associated with non-response. Being born inside, the EU was important in all of the studied groups (LSS: OR 0.61 p = < 0.000; LDH: OR 0.68 p = 0.001; DDD: OR 0.58 p = 0.04). For spinal stenosis patients, an unexpected event appeared particularly important (OR 3.40, p = 0.000). The predicted outcome of non-respondents was significantly worse than for respondents (LSS: 75.4% successful outcome vs. 78.7%; LDH: 53.9% vs. 58.2%; DDD: 62.7% vs. 67.5%. P-value in all groups = < 0.000). Conclusion Attrition in Swespine cannot be ignored, as non-respondents were predicted to have worse outcome. The effect of attrition bias should always be considered when contemplating outcome recorded in a quality register with patients lost to follow-up.

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“…Although primary discectomy is an effective treatment for LDH with radiculopathy, a small proportion of patients (5%-15%) experience symptomatic recurrent LDH (rLDH), 19,46,47 and 4% to 6% undergo revision surgery within 2 years. [48][49][50] Techniques for management of recurrent herniation are dependent upon the specific patient indications and the surgeon's experience, on a case-by-case basis. Regardless of the reoperation strategy, clinical evidence has shown that patients who undergo revision surgery for symptomatic rLDH have worse clinical outcomes (eg, pain and disability) compared to patients who do not reherniate following primary discectomy.…”

Section: Prevention Of Recurrent Ldhmentioning

confidence: 99%

International Society for the Advancement of Spine Surgery Policy 2019—Surgical Treatment of Lumbar Disc Herniation with Radiculopathy

et al. 2020

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Lumbar disc herniation (LDH) is a frequent cause of low back pain and radiculopathy, disability, and diminution in quality of life. While nonsurgical care remains the mainstay of initial treatment, symptoms that persist for prolonged periods of time are well treated with discectomy surgery. A large body of evidence shows that, in patients with unremitting symptoms despite a reasonable period of nonsurgical treatment, discectomy surgery is safe and efficacious. In patients with symptoms lasting greater than 6 weeks, various forms of discectomy (open, microtubular, and endoscopic) are superior to continued nonsurgical treatment. The small but significant proportion of patients with recurrent disc herniation experience less improvement overall than patients who do not experience reherniation after primary discectomy. Lumbar discectomy patients with large annular defects (!6 mm wide) are at a higher risk for recurrent herniation and revision surgery. Annular closure via a bone-anchored device has been shown to decrease the rate of recurrent disc herniation and associated reoperation in these high-risk patients. After a detailed review of the literature, current clinical evidence supports discectomy (open, microtubular, or endoscopic discectomy) as a medically necessary procedure for the treatment of LDH with radiculopathy in indicated patients. Furthermore, there is new scientific evidence that supports the use of bone-anchored annular closure in patients with large annular defects, who are at greater risk for recurrent disc herniation.

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Response rate does not affect patient-reported outcome after lumbar discectomy

Abstract: Higher response rates than seen in Swespine are not needed to achieve reasonably representative data on patient-reported outcome for large cohorts. Two-year data do not seem to add additional information. These slides can be retrieved under Electronic Supplementary Material.

Cited by 37 publications

References 25 publications

Review of response rates over time in registry-based studies using patient-reported outcome measures

Review of response rates over time in registry-based studies using patient-reported outcome measures

Characteristics and predicted outcome of patients lost to follow-up after degenerative lumbar spine surgery

International Society for the Advancement of Spine Surgery Policy 2019—Surgical Treatment of Lumbar Disc Herniation with Radiculopathy

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