The Minimum Clinically Important Difference for Patient Health Questionnaire-9 in Minimally Invasive Transforaminal Interbody Fusion

Abstract

Study Design. Retrospective cohort. Objective. To investigate and establish minimum clinically important differences (MCID) for Patient Health Questionnaire-9 (PHQ-9) among patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). Summary of Background. Spine surgery is linked to postoperative improvements in anxiety, depression, and mental health. These improvements have been documented using patientreported outcome measures such as PHQ-9. Few studies evaluated the clinical significance of PHQ-9 for lumbar spine surgery. Methods. Patients who underwent single-level, primary MIS TLIF from 2015 to 2017 were retrospectively reviewed in a prospective database. Patients with incomplete preoperative and 2-year postoperative PHQ-9 surveys were excluded. Demographic and perioperative characteristics were recorded. PHQ-9, 12-Item Short Form (SF-12), and Veterans RAND 12-Item Health Survey (VR-12) Mental Component Summary (MCS) were collected at preoperative, 6-week, 12-week, 6-month, 1-year, and 2-year intervals. MCID was calculated using anchor and distribution-based methods. SF-12 served as an anchor. MCID was assessed using mean change methodology, four receiver operating characteristic curve assessments, and standard error measurement. Cutoff values were selected from receiver operating characteristic curve analysis. MCID achievement rates for all patient-reported outcome measures were calculated. Results. A total of 139 patients met inclusion criteria, with a mean age of 55 years and 39% females. The most common spinal pathology was radiculopathy (92%). MCID analysis revealed the following ranges of values: 2.0 to 4.8 (PHQ-9), 6.7 to 12.1 (SF-12 MCS), and 7.5 to 15.9 (VR-12 MCS). Final MCID thresholds were 3.0 (PHQ-9), 9.1 (SF-12 MCS), and 8.1 (VR-12 MCS). MCID achievement at 2-years for PHQ-9, SF-12 MCS, and VR-12 MCS was 89.2%, 85.6%, and 84.9% respectively. Conclusion. Our 2-year postoperative MCID analysis is the first mental health calculation from an MIS TLIF cohort. We report a 2-year MCID value for PHQ-9 of 3.0 (2.0-4.8). MCID values for mental health instruments are important for determining overall success of lumbar spine surgery.

Patients with diabetes mellitus experience poorer outcomes after arthroscopic rotator cuff repair

“…Prior studies have established an MCID of 28.8 points for the SANE score and 8.1 points for the VR-12 score, a substantial clinical benefit of 50.2 points for the SANE score and 20.7 points for the ASES score, and a patient acceptable symptomatic state of 81.9 points for the SANE score and 75.5 points for the ASES score. 12 , 16 Another study limitation was mild attrition of eligible subjects as the length of the follow-up period progressed in this study.…”

Preoperative Neck Disability Severity Limits Extent of Postoperative Improvement Following Cervical Spine Procedures

“…Assessment of significant improvements as perceived by the patient was collected through MCID achievement by comparing the improvement from preoperative to postoperative scores (Delta) with established thresholds from the literature: 2.6 (VAS neck); 20 4.1 (VAS arm); 20 17.3 (NDI); 20 8.1 (SF-12 PCS); 20 4.7 www.e-neurospine.org 379 (SF-12 MCS); 20 4.5 (PROMIS PF); 21 3.0 (PHQ-9). 22…”

Does Baseline Mental Health Influence Outcomes among Workers’ Compensation Claimants Undergoing Minimally Invasive Transforaminal Lumbar Interbody Fusion?

“…Student t -test was used to compare the mean PROMs among the mental health groups, while multiple regression analysis was used to determine the influence of SF-12 MCS grouping on PROMs after accounting for varying presenting spinal pathologies of recurrent herniated nucleus pulposus, degenerative spondylolisthesis, and isthmic spondylolisthesis between the groups. MCID achievement was determined by comparing ΔPROMs to established threshold values acquired from previously published studies that have calculated these variables: VAS back=2.1 [ 8 ]; VAS leg=2.8 [ 8 ]; ODI=14.9 [ 8 ]; SF-12 PCS=2.5 [ 9 ]; SF-12 MCS=9.1 [ 10 ]; and PROMIS-PF=4.5 [ 11 ]. Patients who achieved MCID were considered to have improved in a clinically meaningful/significant manner for that PROM.…”

“…Patient-reported outcome measures (PROMs) signify a transition from purely quantitative to qualitative markers of surgical success, empowering patients by providing their perspective a voice and contributing to the evolution of value-based care [7]. Minimal clinically important difference (MCID) is a mutually agreed upon and validated threshold employed to rate clinical efficacy among various PROMs used in spine surgery, including Oswestry Disability Index (ODI), Visual Analog Scale for back and leg pain (VAS back and VAS leg, respectively), Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), and 12-item Short Form Physical Composite Scale (SF-12 PCS) [8][9][10][11].…”