New Outcomes Test Superior to ODI and SF-36?!

A team of researchers has undertaken a study looking at spine patient reported outcomes measurement systems—(ODI) and SF-36 specifically. They then compared those well understood and validated measures against a new approach—the Patient-Reported Outcomes Measurement Information SystemPhysical Function (PROMIS PF) computer adaptive test (CAT).

The study, “Physical function computer adaptive test outcomes in diabetic lumbar spine surgical patients,” appears in the December 12, 2018 edition of The Spine Journal. 

Co-author Darrel Brodke, M.D., vice chair of the Department of Orthopaedics at the University of Utah in Salt Lake City, told OTW, “We at the University of Utah have been working for the last several years to improve patient reported outcomes measurement in spine patients, both the process of collection and the actual measures used.”

“Legacy measures, such as the ODI [Oswestry Disability Index] and the SF-36 [Short Form Health Survey], are most commonly used to understand lumbar spine surgery outcomes, but newer measures, such as the PROMIS PF, have been shown to be better. The PROMIS Group, with extensive NIH [National Institutes of Health] funding, developed an array of patient reported outcome measures using new test development techniques that enable higher precision, lower patient and provider burden, and better cross specialty understanding.”

“For spine care, the PROMIS Physical Function domain and associated CAT are particularly important for outcomes measurement, and we have focused on better understanding how the measure functions broadly in spine patients and specifically in subpopulations of patients with varying demographics and co-morbidities.”

“The better we understand the measure and how physical function itself is affected by the spinal disorder, the treatment, and the specific demographics and co-morbidities of the patient or population, the better we can assess outcomes in general and apply it to specific patients in the clinic.”

The study, which enrolled 233 nondiabetic patients and 65 diabetic patients, found that the mean physical function CAT scores of diabetics were lower than those of nondiabetics at all time-points (preoperative through 12 months postoperative). The researchers also noted that the mean ODI scores among diabetics were significantly higher than nondiabetic patients at 3 and 12 months after surgery.

As Dr. Brodke explained to OTW, “Diabetes is a disease that effects many aspects of general health and we wanted to know if patients with diabetes who undergo spine surgery have a different response than nondiabetic patients as measured by the PROMIS Physical Function measure, as well as the ODI.”

“In fact, spine patients with diabetes do not get quite as much improvement in these scores as nondiabetic patients. This may well be due to aspects of diabetes that affect function in ways other than just the spinal disorder being treated.”

“This is important to know as we focus on the actual scores and change in scores after spine surgery, so that we understand the various other aspects of patients’ health that may affect the specific outcomes scores being used to measure improvement after treatment.”

“Also, as we move to more patient-focused shared decision-making and expectation management, we want to use benchmarking data that is more specific to that patient’s condition (spine and other).”