Measuring clinically relevant improvement after lumbar spine surgery: is it time for something new?

Asher, Anthony M.; Oleisky, Emily R.; Pennings, Jacquelyn S.; Khan, Inamullah; Sivaganesan, Ahilan; Devin, C.; Bydon, Mohamad; Asher, Anthony L.; Archer, Kristin R.

doi:10.1016/j.spinee.2020.01.010

Cited by 52 publications

(46 citation statements)

References 54 publications

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“…These data are consistent with the works by Crawford et al, Asher et al, and Glassman et al that established these criteria for clinical improvement thresholds. 12,21,22 In comparison, a significantly higher proportion of patients in the LTJR cohort in our study were found to achieve MSS (58%), SCB (77%), and MCID (90%) at 1-year. In the multivariate regression analysis, LTJR was shown to provide 3.3 times greater odds of achieving MSS (95% CI=1.6 to 6.5, p=0.003), 2.4 times greater odds of achieving SCB (95% CI=1.1 to 5.2, p=0.028), and 4.1 greater odds of achieving MCID (95% CI=1.5 to 11.5, p=0.013), compared to fusion.…”

Section: Discussioncontrasting

confidence: 47%

“…Each of these three metrics have been previously reported as means to assess the relative clinical success in treating lumbar disease. 21,20 Multivariable logistic regression analyses were used to predict the odds of having each of these optimal outcomes for each cohort while adjusting for preoperative ODI, age, blood loss, and revision status.…”

Section: Discussionmentioning

confidence: 99%

“…The MSS was defined as an ODI score less than 20% and a NRS back and leg pain less than 2, as described by Crawford, et al 12 MCID was defined as a 30% overall reduction in ODI score compared to preoperative scores; which has been shown to outperform MCID point-change MCID thresholds in patients undergoing lumbar spine surgery. 21 SCB was also utilized as reported by Glassman et al as an 18 percentage-point reduction in the overall ODI score. 22 We separately analyzed the patient-report outcomes using each of these three metrics in order to evaluate the LTJR vs. TLIF using multiple criteria for clinical success.…”

Section: Clinical Outcome Measuresmentioning

confidence: 99%

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A novel lumbar total joint replacement may be an improvement over fusion for degenerative lumbar conditions: a comparative analysis of patient-reported outcomes at one year

et al. 2021

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Section: Discussioncontrasting

confidence: 47%

Section: Discussionmentioning

confidence: 99%

Section: Clinical Outcome Measuresmentioning

confidence: 99%

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A novel lumbar total joint replacement may be an improvement over fusion for degenerative lumbar conditions: a comparative analysis of patient-reported outcomes at one year

et al. 2021

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“…The ODI has good test-retest reliability, validity and internal consistency in chronic back pain and spine surgery populations [44,45]. The minimal clinically important difference (MCID) for the ODI is a 30% reduction [46].…”

Section: Physical Functionmentioning

confidence: 99%

Early postoperative physical activity and function: a descriptive case series study of 53 patients after lumbar spine surgery

Coronado

Master

White

et al. 2020

BMC Musculoskelet Disord

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Background The purpose of this prospective case series study was to compare changes in early postoperative physical activity and physical function between 6 weeks and 3 and 6 months after lumbar spine surgery. Methods Fifty-three patients (mean [95% confidence interval; CI] age = 59.2 [56.2, 62.3] years, 64% female) who underwent spine surgery for a degenerative lumbar condition were assessed at 6 weeks and 3- and 6-months after surgery. The outcomes were objectively-measured physical activity (accelerometry) and patient-reported and objective physical function. Physical activity was assessed using mean steps/day and time spent in moderate to vigorous physical activity (MVPA) over a week. Physical function measures included Oswestry Disability Index (ODI), 12-item Short Form Health Survey (SF-12), Timed Up and Go (TUG), and 10-Meter Walk (10 MW). We compared changes over time in physical activity and function using generalized estimating equations with robust estimator and first-order autoregressive covariance structure. Proportion of patients who engaged in meaningful physical activity (e.g., walked at least 4400 and 6000 steps/day or engaged in at least 150 min/week in MVPA) and achieved clinically meaningful changes in physical function were compared at 3 and 6 months. Results After surgery, 72% of patients initiated physical therapy (mean [95%CI] sessions =8.5 [6.6, 10.4]) between 6 weeks and 3 months. Compared to 6 weeks post-surgery, no change in steps/day or time in MVPA/week was observed at 3 or 6 months. From 21 to 23% and 9 to 11% of participants walked at least 4400 and 6000 steps/day at 3 and 6 months, respectively, while none of the participants spent at least 150 min/week in MVPA at these same time points. Significant improvements were observed on ODI, SF-12, TUG and 10 MW (p < 0.05), with over 43 to 68% and 62 to 87% achieving clinically meaningful improvements on these measures at 3 and 6 months, respectively. Conclusion Limited improvement was observed in objectively-measured physical activity from 6 weeks to 6 months after spine surgery, despite moderate to large function gains. Early postoperative physical therapy interventions targeting physical activity may be needed.

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“…natural history, contextual effects) or additional intervention. We further benefit from this design as it employs a previously validated criteria to define SMT responders; improvement in self-reported ODI occurring over 2 treatment sessions [28]. Importantly, this criterion has been tied to improvements in physical measurements in responders including biomechanical, neurological and biological variables [29][30][31] that were also collected in this study and available for use in baseline predictions.…”

Section: Plos Onementioning

confidence: 99%

Predicting who responds to spinal manipulative therapy using a short-time frame methodology: Results from a 238-participant study

et al. 2020

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Background Spinal manipulative therapy (SMT) is among the nonpharmacologic interventions that has been recommended in clinical guidelines for patients with low back pain, however, some patients appear to benefit substantially more from SMT than others. Several investigations have examined potential factors to modify patients’ responses prior to SMT application. The objective of this study was to determine if the baseline prediction of SMT responders can be improved through the use of a restricted, non-pragmatic methodology, established variables of responder status, and newly developed physical measures observed to change with SMT. Materials and methods We conducted a secondary analysis of a prior study that provided two applications of standardized SMT over a period of 1 week. After initial exploratory analysis, principal component analysis and optimal scaling analysis were used to reduce multicollinearity among predictors. A multiple logistic regression model was built using a forward Wald procedure to explore those baseline variables that could predict response status at 1-week reassessment. Results Two hundred and thirty-eight participants completed the 1-week reassessment (age 40.0± 11.8 years; 59.7% female). Response to treatment was predicted by a model containing the following 8 variables: height, gender, neck or upper back pain, pain frequency in the past 6 months, the STarT Back Tool, patients’ expectations about medication and strengthening exercises, and extension status. Our model had a sensitivity of 72.2% (95% CI, 58.1–83.1), specificity of 84.2% (95% CI, 78.0–89.0), a positive likelihood ratio of 4.6 (CI, 3.2–6.7), a negative likelihood ratio of 0.3 (CI, 0.2–0.5), and area under ROC curve, 0.79. Conclusion It is possible to predict response to treatment before application of SMT in low back pain patients. Our model may benefit both patients and clinicians by reducing the time needed to re-evaluate an initial trial of care.

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Measuring clinically relevant improvement after lumbar spine surgery: is it time for something new?

Cited by 52 publications

References 54 publications

A novel lumbar total joint replacement may be an improvement over fusion for degenerative lumbar conditions: a comparative analysis of patient-reported outcomes at one year

A novel lumbar total joint replacement may be an improvement over fusion for degenerative lumbar conditions: a comparative analysis of patient-reported outcomes at one year

Early postoperative physical activity and function: a descriptive case series study of 53 patients after lumbar spine surgery

Predicting who responds to spinal manipulative therapy using a short-time frame methodology: Results from a 238-participant study

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