Clinically meaningful improvement in disabilities of arm, shoulder, and hand (DASH) following cervical spine surgery

被引：6

作者：

Javeed, Saad ^{[1
]}

Greenberg, Jacob K. ^{[1
]}

Plog, Benjamin ^{[1
]}

Zhang, Justin K. ^{[1
]}

Yahanda, Alexander T. ^{[1
]}

Dibble, Christopher F. ^{[1
]}

Khalifeh, Jawad M. ^{[2
]}

Ruiz-Cardozo, Miguel ^{[1
]}

Lavadi, Raj S. ^{[1
]}

Molina, Camilo A. ^{[1
]}

Santiago, Paul ^{[1
]}

Agarwal, Nitin ^{[1
]}

Pennicooke, Brenton H. ^{[1
]}

Ray, Wilson Z. ^{[1
,3
]}

机构：

[1] Washington Univ, Dept Neurol Surg, St Louis, MO USA

[2] Johns Hopkins Univ, Dept Neurol Surg, Baltimore, MD USA

[3] Washington Univ, Dept Neurol Surg, 660 S Euclid Ave,Campus Box 8057, St Louis, MO 63110 USA

来源：

SPINE JOURNAL | 2023年 / 23卷 / 06期

关键词：

Cervical spine; Minimum clinically important difference; Patient-reported outcomes; Physical function; Sub-stantial clinical benefit; Upper-extremity impairment; SPONDYLOTIC MYELOPATHY; IMPORTANT DIFFERENCE; SURGICAL DECOMPRESSION; OUTCOME MEASURES; MODEL SELECTION; QUESTIONNAIRE; RESPONSIVENESS; RELIABILITY; VALIDATION; QUICKDASH;

D O I：

10.1016/j.spinee.2023.01.010

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

BACKGROUND CONTEXT: Patients with cervical spine disease suffer from upper limb disabil-ity. At present, no clinical benchmarks exist for clinically meaningful change in the upper limb function following cervical spine surgery. PURPOSE: Primary: to establish clinically meaningful metrics; the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) of upper limb functional improvement in patients following cervical spine surgery. Secondary: to identify the prognostic factors of MCID and SCB of upper limb function following cervical spine surgery. STUDY DESIGN: Retrospective cohort study. PATIENT SAMPLE: Adult patients >= 18 years of age who underwent cervical spine surgery from 2012 to 2016. OUTCOME MEASURES: Patient-reported outcomes: Neck disability index (NDI) and Disabil-ities of Arm, Shoulder, and Hand (DASH). METHODS: MCID was defined as minimal improvement and SCB as substantial improvement in the DASH score at last follow-up. The anchor-based methods (ROC analyses) defined optimal MCID and SCB thresholds with area under curve (AUC) in discriminating improved vs. non-improved patients. The MCID was also calculated by distribution-based methods: half standard -deviation (0.5-SD) and standard error of the mean (SEM) method. A multivariable logistic regres-sion evaluated the impact of baseline factors in achieving the MCID and SCB in DASH following cervical spine surgery. RESULTS: Between 2012 and 2016, 1,046 patients with average age of 57</n>11.3 years, 53% males, underwent cervical spine surgery. Using the ROC analysis, the threshold for MCID was -8 points with AUC of 0.73 (95% CI: 0.67-0.79) and the SCB was -18 points with AUC of 0.88 (95% confidence interval [CI]: 0.85-0.91). The MCID was -11 points by 0.5-SD and -12 points by SEM-method. On multivariable analysis, patients with myelopathy had lower odds of achieving MCID and SCB, whereas older patients and those with >= 6 months duration of symptoms had lower odds of achieving DASH MCID and SCB respectively. CONCLUSIONS: In patients undergoing cervical spine surgery, MCID of -8 points and SCB of -18 points in DASH improvement may be considered clinically significant. These metrics may enable evaluation of minimal and substantial improvement in the upper extremity function follow-ing cervical spine surgery.(c) 2023 Elsevier Inc. All rights reserved.

引用

页码：832 / 840

页数：9