The quality of spine surgery from the patient’s perspective. Part 1: The Core Outcome Measures Index in clinical practice

Abstract

The Core Outcome Measures Index (COMI) is a short, multidimensional outcome instrument, with excellent psychometric properties, that has been recommended for use in monitoring the outcome of spinal surgery from the patient's perspective. This study examined the feasibility of implementation of COMI and its performance in clinical practice within a large Spine Centre. Beginning in March 2004, all patients undergoing spine surgery in our Spine Centre (1,000-1,200 patients/year) were asked to complete the COMI before and 3, 12 and 24 months after surgery. The COMI has one question each on back (neck) pain intensity, leg/buttock (arm/shoulder) pain intensity, function, symptom-specific well being, general quality of life, work disability and social disability, scored as a 0-10 index. At follow-up, patients also rated the global effectiveness of surgery, and their satisfaction with their treatment in the hospital, on a five-point Likert scale. After some fine-tuning of the method of administration, completion rates for the pre-op COMI improved from 78% in the first year of operation to 92% in subsequent years (non-response was mainly due to emergencies or language or age issues). Effective completion rates at 3, 12 and 24-month follow-up were 94, 92 and 88%, respectively. The 12-month global outcomes (from N = 3,056 patients) were operation helped a lot, 1,417 (46.4%); helped, 860 (28.1%); helped only little, 454 (14.9%); did not help, 272 (8.9%); made things worse, 53 (1.7%). The mean reductions in COMI score for each of these categories were 5.4 (SD2.5); 3.1 (SD2.2); 1.3 (SD1.7); 0.5 (SD2.2) and -0.7 (SD2.2), respectively, yielding respective standardised response mean values ("effect sizes") for each outcome category of 2.2, 1.4, 0.8, 0.2 and 0.3, respectively. The questionnaire was feasible to implement on a prospective basis in routine practice, and was as responsive as many longer spine outcome questionnaires. The shortness of the COMI and its multidimensional nature make it an attractive option to comprehensively assess all patients within a given Spine Centre and hence avoid selection bias in reporting outcomes.

Cross-cultural adaptation and validation of the Polish version of the Core Outcome Measures Index for low back pain

“…It has been described in details by Mannion et al [11]. In short, the overall COMI score is computed by adding the highest score of the adjusted leg/back pain subset to the sum of remaining subscales and divided by 5, so it ranges from 0 (best health status) to 10 (worst health status).…”

“…The psychometric properties of COMI have been assessed by several independent research groups [6][7][8][9][10], proving it to be a valid and highly responsive instrument. It has been adapted and validated for the use in German [8,11], Spanish [7], French [12], Italian [1], Brazilian-Portuguese [13] and Norwegian [14] versions. Analogous version of COMI for patients with neck pain and related disorders was developed, adapted and validated for use in German [15] and English [9] versions.…”

A comparison of outcomes of cervical disc arthroplasty and fusion in everyday clinical practice: surgical and methodological aspects

“…Chi-square contingency analyses were used to analyse the association between surgical group and categorical variables. The global outcome was dichotomised into ''good'' (=operation helped or helped a lot) and ''poor'' (=operation only helped a little, did not help, made things worse) for the purposes of some of the subsequent analyses [33]. Multivariable linear regression analysis (with simultaneous entry of relevant variables) was used to predict the change in COMI score at FU.…”

Validity of a single-item measure to assess leg or back pain as the predominant symptom in patients with degenerative disorders of the lumbar spine

“…Indeed, in a further study by the same research group, the answers given in response to all three ''best-performing'' items (percent, NRS and treatment items) were together found to allow effective triaging of surgical candidates [2]. Although three questions is not a great deal, our current philosophy for obtaining good patient-compliance with outcome measurement in our hospital is to keep our questionnaires as short and succinct as possible [11]. Hence, we use just one question for directly assessing the predominant problem-''which problem troubles you the most'', which is not dissimilar to Wai et al's [1] treatment question ''which problem would you preferentially direct treatment at''.…”

“…Before surgery, patients were requested to complete the multidimensional Core Outcome Measures Index (COMI) questionnaire [10,11]. The questionnaire was sent to the patient at home, along with the information about their forthcoming hospital stay, and they were asked to complete it and hand it in during admission.…”