Do Lumbar Decompression and Fusion Patients Recall Their Preoperative Status? A Cohort Study of Recall Bias in Patient-Reported Outcomes

Aleem, Ilyas; Duncan, J.; Ahmed, Amin Mohamed; Zarrabian, Mohammad; Eck, Jason C.; Rhee, John M.; Clarke, Michelle J.; Currier, Bradford L.; Nassr, Ahmad

doi:10.1016/j.spinee.2016.07.306

Cited by 9 publications

(12 citation statements)

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“…These findings confirm what has been demonstrated by previous literature in which patients almost always recalled worse pain and functional loss/disability than their prospectively recorded scores. 1,7,19 For the iHOT-12 and mHHS, patients on average scored lower retrospectively (more pain/less function), likely underestimating the preoperative condition of the hip and/or overstating their improvement owing to surgery on account of a shift in their frame of reference. Similarly, on the HOOS-PS, patients averaged higher retrospective scores (more difficulty with function), again underestimating the condition of the hip preoperatively when asked to recall function.…”

Section: Discussionmentioning

confidence: 99%

Recall Bias in the Retrospective Collection of Common Patient-Reported Outcome Scores in Hip Arthroscopy

et al. 2022

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Background: The use of patient-reported outcomes (PROs) is common practice in the treatment of patients undergoing hip arthroscopy. While the prospective collection of PROs is preferred, retrospective collection involving patient recall is not uncommon and may be subject to bias. Purpose: To assess the presence of recall bias between prospectively and retrospectively collected PRO scores in hip arthroscopy. Study Design: Cohort study; Level of evidence, 2. Methods: Patients who underwent hip arthroscopy between 2015 and 2021 and provided preoperative baseline responses for the International Hip Outcome Tool–12 (iHOT-12), the Hip disability and Osteoarthritis Outcome Score–Physical Shortform (HOOS-PS), and the modified Harris Hip Score (mHHS) were eligible for recruitment. After surgery, participants were asked to complete a study-specific survey and the same preoperative PROs retrospectively. Agreements between the prospective and retrospective scores were assessed, and associations between score discrepancies and patient characteristics were identified. Results: A total of 94 patients (43.3% participation rate) completed study requirements and were included for analysis. The mean ± standard deviation duration of symptoms before surgery was 25.3 ± 32.8 months, and the mean duration to recall (from the day of surgery) for the PROs was 29.6 ± 22.2 months. The iHOT-12 (intraclass correlation coefficient [ICC], 0.409; P < .001) and HOOS-PS (ICC, 0.415; P < .001) scores had low agreement between prospectively and retrospectively collected scores. The mHHS showed moderate agreement (ICC, 0.598; P < .001). The mean scores for the iHOT-12 (41.4 ± 22.6 vs 34.6 ± 16.3; P < .01), HOOS-PS (29.7 ± 18.5 vs 40.9 ± 17.1; P < .001), and mHHS (62.7 ± 16.5 vs 54.5 ± 14.8; P < .001) were all significantly different prospectively versus retrospectively. The average changes in score for the iHOT-12, HOOS-PS, and mHHS were −6.8, 11.2, and −8.2, respectively. Duration to recall and female sex were predictors of the difference between prospectively and retrospectively collected iHOT-12 data, while no predictors were significant for the HOOS-PS or mHHS. Conclusion: The retrospective collection of PROs for hip arthroscopy procedures is subject to bias. On average, retrospective (recalled) PROs reflected worse pain/function than their prospectively recorded counterpoints; therefore, retrospective patient recall is an unreliable source of clinical data, and the prospective collection of iHOT-12, mHHS, and HOOS-PS data should be prioritized.

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Section: Discussionmentioning

confidence: 99%

Recall Bias in the Retrospective Collection of Common Patient-Reported Outcome Scores in Hip Arthroscopy

et al. 2022

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“…Further validation done in multicenter and international manner would be desirable to enhance prove of validation. Finally, patients were asked to indicate their current function as opposed to their pretrauma function with a median follow-up of 94.5 months, which may have resulted in recall bias 33. Nevertheless, the reported correlation between the EQ-5D-5L, ODI, NDI, and AO Spine PROST in the current study suggests a low probability of recall bias, especially for reliability and validity testing, since these questionnaires do not ask patients to recall their pretrauma function.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Reliability and Validity of the AO Spine PROST (Patient-Reported Outcome Spine Trauma)

Buijs

Gendt

Sadiqi

et al. 2022

Spine

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Cross-sectional validation study.Objective. The aim was to validate the AO Spine Patient-Reported Outcome Spine Trauma (PROST) at a minimum of 12 months posttrauma and to evaluate patient characteristics, types of spine fractures, and treatment strategies as determinants of AO Spine PROST scores. Summary of Background Data. The reliability and validity of the AO Spine PROST as a measure of health-related quality of life for more than 12 months after onset of spine trauma is unclear. Materials and Methods. Patients with a traumatic spine injury were recruited from a level-1 trauma center. They were asked to complete the AO Spine PROST, EuroQoL 5D-5L (EQ-5D-5L), and either Oswestry disability index (ODI) or neck disability index (NDI) for concurrent validity. Internal consistency was assessed by calculating the Cronbach α and item-total correlation coefficients. Test-retest reliability was evaluated using intraclass correlation coefficients. Spearman correlation tests were performed for the AO Spine PROST in correlation with the EQ-5D-5L, and either ODI or NDI. Determinants for AO Spine PROST score were analyzed using multivariate regression models. Results. A total of 175 patients participated in the cross-sectional arm and 49 in the test-retest arm of the study. Median duration of follow-up was 94.5 months. No floor or ceiling effects were seen. Internal consistency was excellent (α = 0.98, item-total correlation coefficient. 0.73-0.91) as well as test-retest reliability (intraclass correlation coefficient = 0.81). Satisfactory correlations were seen for the EQ-5D-5L (0.76; P < 0.001), ODI (0.69; P < 0.001), and NDI (0.68; P < 0.001) with the AO Spine PROST. Multivariate linear regression models showed that having ≥ 1 comorbidities, duration of return to work within the range of 7 to 43 months and no return to work were significant independent determinants for a worse AO Spine PROST score. Conclusions. Very good long-term reliability and validity results were found for the AO Spine PROST.

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“…They noted that patients who were satisfied postoperatively recalled significantly worse preoperative scores than what they had actually reported before surgery, suggesting that relying on patient recall of preoperative status may result in overestimation of surgical efficacy. Furthermore, Aleem et al [21] reported that recollection of neck pain, arm pain, and disability was generally more severe than the actual preoperative scores and observed that over 30% of patients shifted in regard to which symptom they stated was most predominant when asked at the postoperative timepoint to recall their preoperative condition.…”

Section: Discussionmentioning

confidence: 99%

Do Patient Expectations Represent a More Important Clinical Difference? A Study of Surgical Outcomes in the Cervical Spine

Lynch

Jacob

et al. 2022

J Minim Invasive Spine Surg Tech

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Objective: This study aims to compare the impact of achieving an MCID or meeting preoperative expectations on patient satisfaction following cervical spine procedures.Methods: A surgical database was retrospectively reviewed for cervical spine surgery patients from 2016 to 2020. Inclusion criteria were primary or revision, single- or multilevel cervical disc arthroplasty or anterior cervical discectomy and fusions (ACDF). Visual analogue scale (VAS) neck and arm pain was assessed preoperatively and postoperatively (6-week, 12-weeks, 6-months, 1-year). Preoperative patient expectation and postoperative satisfaction were recorded. MCID achievement was determined using previously established values. Expectations met and MCID achievement were compared as possible predictors of satisfaction.Results: One hundred and six cervical spine patients were included. Both meeting expectations and achieving MCID were significant predictors of satisfaction for arm pain at 6-weeks and 12-weeks (all p≤0.007). Achieving MCID significantly predicted satisfaction for neck pain at all timepoints (all p≤0.007) and meeting expectations predicted satisfaction for neck pain at 6-weeks, 12-weeks, and 1-year (all p≤0.003). Comparison of coefficients revealed no significant difference in effect size between meeting expectations and achievement of MCID as predictors of patient satisfaction (all p>0.050).Conclusion: MCID achievement and meeting expectations were significant predictors of satisfaction for neck pain and short-term arm pain. Both measures may be similarly useful for interpretation of patient outcomes and the optimal choice of metric may depend on practice-specific factors.

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Do Lumbar Decompression and Fusion Patients Recall Their Preoperative Status? A Cohort Study of Recall Bias in Patient-Reported Outcomes

Cited by 9 publications

References 0 publications

Recall Bias in the Retrospective Collection of Common Patient-Reported Outcome Scores in Hip Arthroscopy

Recall Bias in the Retrospective Collection of Common Patient-Reported Outcome Scores in Hip Arthroscopy

Long-Term Reliability and Validity of the AO Spine PROST (Patient-Reported Outcome Spine Trauma)

Do Patient Expectations Represent a More Important Clinical Difference? A Study of Surgical Outcomes in the Cervical Spine

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