Defining the minimum clinically important difference for grade I degenerative lumbar spondylolisthesis: insights from the Quality Outcomes Database.

Asher, Anthony L

Kerezoudis, Panagiotis

Mummaneni, Praveen V

Bisson, Erica F

Glassman, Steven D

Foley, Kevin T

Slotkin, Jonathan R

Potts, Eric A

Shaffrey, Mark E

Shaffrey, Christopher I

Coric, Domagoj

Knightly, John J

Park, Paul

Fu, Kai-Ming

Devin, Clinton J

Archer, Kristin R

Chotai, Silky

Chan, Andrew K

Virk, Michael S

Bydon, Mohamad

2023-07-08T13:31:48Z

2023-07-08T13:31:48Z

2018-01

2023-07-08T13:31:47Z

OBJECTIVE Patient-reported outcomes (PROs) play a pivotal role in defining the value of surgical interventions for spinal disease. The concept of minimum clinically important difference (MCID) is considered the new standard for determining the effectiveness of a given treatment and describing patient satisfaction in response to that treatment. The purpose of this study was to determine the MCID associated with surgical treatment for degenerative lumbar spondylolisthesis. METHODS The authors queried the Quality Outcomes Database registry from July 2014 through December 2015 for patients who underwent posterior lumbar surgery for grade I degenerative spondylolisthesis. Recorded PROs included scores on the Oswestry Disability Index (ODI), EQ-5D, and numeric rating scale (NRS) for leg pain (NRS-LP) and back pain (NRS-BP). Anchor-based (using the North American Spine Society satisfaction scale) and distribution-based (half a standard deviation, small Cohen's effect size, standard error of measurement, and minimum detectable change [MDC]) methods were used to calculate the MCID for each PRO. RESULTS A total of 441 patients (80 who underwent laminectomies alone and 361 who underwent fusion procedures) from 11 participating sites were included in the analysis. The changes in functional outcome scores between baseline and the 1-year postoperative evaluation were as follows: 23.5 ± 17.4 points for ODI, 0.24 ± 0.23 for EQ-5D, 4.1 ± 3.5 for NRS-LP, and 3.7 ± 3.2 for NRS-BP. The different calculation methods generated a range of MCID values for each PRO: 3.3-26.5 points for ODI, 0.04-0.3 points for EQ-5D, 0.6-4.5 points for NRS-LP, and 0.5-4.2 points for NRS-BP. The MDC approach appeared to be the most appropriate for calculating MCID because it provided a threshold greater than the measurement error and was closest to the average change difference between the satisfied and not-satisfied patients. On subgroup analysis, the MCID thresholds for laminectomy-alone patients were comparable to those for the patients who underwent arthrodesis as well as for the entire cohort. CONCLUSIONS The MCID for PROs was highly variable depending on the calculation technique. The MDC seems to be a statistically and clinically sound method for defining the appropriate MCID value for patients with grade I degenerative lumbar spondylolisthesis. Based on this method, the MCID values are 14.3 points for ODI, 0.2 points for EQ-5D, 1.7 points for NRS-LP, and 1.6 points for NRS-BP.

2017.10.FOCUS17554

1092-0684

1092-0684

https://hdl.handle.net/10161/28352

eng

Journal of Neurosurgery Publishing Group (JNSPG)

Neurosurgical focus

10.3171/2017.10.focus17554

Lumbosacral Region

Lumbar Vertebrae

Humans

Spondylolisthesis

Back Pain

Pain Measurement

Treatment Outcome

Adult

Aged

Middle Aged

Patient Satisfaction

Female

Male

Defining the minimum clinically important difference for grade I degenerative lumbar spondylolisthesis: insights from the Quality Outcomes Database.

Journal article

Shaffrey, Christopher I|0000-0001-9760-8386

E2

1

Duke

School of Medicine

Clinical Science Departments

Orthopaedic Surgery

Neurosurgery

Published

44