What level of symptoms are patients with adult spinal deformity prepared to live with? A cross-sectional analysis of the 12-month follow-up data from 1043 patients
A. F. Mannion, M. Loibl, J. Bago, A. Vila-Casademunt, S. Richner-Wunderlin, T. F. Fekete, D. Haschtmann, D. Jeszenszky, F. Pellisé, A. Alanay, I. Obeid, F. S. Pérez-Grueso, F. S. Kleinstück
June 2020, Volume 29, Issue 6, pp 1340 - 1352 Original Article Read Full Article 10.1007/s00586-020-06365-z
First Online: 18 March 2020
Introduction
Previous studies suggest that a meaningful and easily understood measure of treatment outcome may be the proportion of patients who are in a “patient acceptable symptom state” (PASS). We sought to quantify the score equivalent to PASS for different outcome instruments, in patients with adult spinal deformity (ASD).
Methods
We analysed the following 12-month questionnaire data from the European Spine Study Group (ESSG): Oswestry Disability Index (ODI; 0–100); Numeric Rating Scales (NRS; 0–10) for back/leg pain; Scoliosis Research Society (SRS) questionnaire; and an item “if you had to spend the rest of your life with the symptoms you have now, how would you feel about it?” (5-point scale, dichotomised with top 2 responses “somewhat satisfied/very satisfied” being considered PASS+, everything else PASS−). Receiver operating characteristics (ROC) analyses indicated the cut-off scores equivalent to PASS+.
Results
Out of 1043 patients (599 operative, 444 non-operative; 51 ± 19 years; 84% women), 42% reported being PASS+ at 12 months’ follow-up. The ROC areas under the curve were 0.71–0.84 (highest for SRS subscore), suggesting the questionnaire scores discriminated well between PASS+ and PASS−. The scores corresponding to PASS+ were > 3.5 for the SRS subscore (> 3.3–3.8 for SRS subdomains); ≤ 18 for ODI; and ≤ 3 for NRS pain. There were slight differences in cut-offs for subgroups of age, treatment type, aetiology, baseline symptoms, and sex.
Conclusion
Most interventions for ASD improve patients’ complaints but do not totally eliminate them. Reporting the percentage achieving a score equivalent to an “acceptable state” may represent a more stringent and discerning target for denoting treatment success in ASD.
Graphic abstract
These slides can be retrieved under Electronic Supplementary Material.[graphic not available: see fulltext]
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