Better Quality of Life, Better Spine Surgery Outcome

A new prospective longitudinal cohort study from the Sunnybrook Health Sciences Centre in Toronto, the DeltaQuest Foundation in Concord, Massachusetts and Tufts University School of Medicine in Boston, has found that how people perceive their quality of life affects their spine surgery outcomes and may well represent “the next frontier” in outcomes assessment.

The new study, “Patient factors that matter in predicting spine surgery outcomes: a machine learning approach,” appears in the May 21, 2021 edition of the Journal of Neurosurgery.

Co-author Joel Finkelstein, M.D., M.Sc., the Feldberg Chair in Spinal Research at the University of Toronto, explained how he and his team decided to conduct this study to OTW, “Clinicians measure the outcomes of their treatment by the standardized PROMs or Patient Reported Outcome Measures. These are classified into generic and disease specific scoring systems. The nature of the evaluation is from the patient’s perspective, which is the important outcome.”

“It has been my experience (as well as others) that the observed and expected outcome, self-reported patient and objective measures, do not always align. This can affect patient satisfaction.”

Happy Patients Do Better

“The use of the PROMs assumes invariance in how a patient perceives their health-related quality of life. If there is a change in what constitutes a person’s quality of life, then they would use the outcome measure differently or answer it differently. This is not because of a change in the physical health status for which the treatment was directed, but because of how a patient appraises their quality of life.”

“This is cognitive appraisal. Measuring cognitive appraisal in our opinion is the next frontier in how we assess outcomes and predict outcomes by understanding what is going on in the brain.”

The researchers enrolled 122 adults who had spinal decompression and/or fusion surgery for degenerative spinal conditions. They measured patient expectations for pain relief, their ability to do household and exercise/recreational activities without pain, preventing future disability, and sleeping comfort.

“Appraisal items addressed 22 cognitive processes related to quality of life,” wrote the authors. “LASSO (least absolute shrinkage and selection operator) and bootstrapping tested predictors hierarchically to determine effective predictive subsets at approximately 10 months post-surgery, based on data either at baseline (model 1) or at approximately 3 months (model 2).”

“For model 1, analysis revealed better outcomes with patients expecting to be able to exercise or do recreational activities, focusing on recent events, and not focusing on how others see them. For model 2, better outcomes were predicted by expecting symptom relief, focusing on the positive and on one’s spinal condition.”

“Nearly 40% of the variance in spine outcomes was accounted for by cognitive factors, after adjusting for clinical and demographic factors,” stated Dr. Finkelstein to OTW.

“If we can identify cognitive factors which lead to poorer outcome prior to treatment, then addressing these may help with maximizing the benefits of surgery. If we identify changes in cognitive appraisal during the trajectory of recovery, we may be able to account for observed vs expected mismatches in outcome.”