correlation between odi and promis in minimally invasive ... · purpose historiclly, odi has been...

Correlation between ODI and PROMIS in

Minimally Invasive Lumbar Decompression

SurgeryAvani Vaishnav, MBBS,1Steven McAnany, MD,1,2 Catherine Himo Gang, MPH,1

Kern Singh, MD,3 Brittany Haws, MD,3 Benjamin Khechen, BA,3 Sheeraz Qureshi, MD, MBA1,2

1, Hospital for Special Surgery, New York, NY

2, Weill Cornell Medical College, New York, NY

3, Midwest Orthopedics at Rush, Chicago, IL

Disclosures Avani Vaishnav: This individual reported nothing to disclose

Steven McAnany, MD: This individual reported nothing to disclose

Catherine Himo Gang: This individual reported nothing to disclose

Kern Singh, MD: AAOS: Board or committee member, Avaz Surgical, LLC: Stock or stock Options, Cervical Spine Research Society:

Board or committee member, DePuy, A Johnson & Johnson Company: Paid consultant, ISASS: Board or committee member, Jaypee

Publishing: Publishing royalties, financial or material support, Pioneer: IP royalties, Scoliosis Research Society: Board or committee

member, SLACK Incorporated: Publishing royalties, financial or material support, SMISS: Board or committee member, Spine Surgery

Today: Editorial or governing board, Stryker: IP royalties, Stryker, Zimmer: Paid consultant, Thieme: Publishing royalties, financial or

material support, Vertebral Columns - ISASS: Editorial or governing board, Vital 5, LLC: Stock or stock Options, Wolters Kluwer Health -

Lippincott Williams & Wilkins: Editorial or governing board; Publishing royalties, financial or material support, Zimmer: IP royalties

Brittany Haws, MD: This individual reported nothing to disclose

Benjamin Khechen, BA: This individual reported nothing to disclose

Sheeraz Qureshi, MD: Consulting Fees from Zimmer-Biomet, Stryker Spine, Globus Medical, Inc.; Shareholder Interest in Avaz

Surgical, Vital 5; and Royalties from RTI, Zimmer-Biomet, Stryker Spine.

Correlation between ODI and PROMIS in Minimally Invasive Lumbar Decompression Surgery2

Introduction With the increase in emphasis on value-based and patient-centric

care, Patient Reported Outcomes Measures (PROMs) are becoming

increasingly important.

These measures are linked to patient satisfaction and are increasingly

being used to evaluate healthcare expenditure, assess cost-

effectiveness of interventions and determine compensation.


Thus, it is evident that PROMs are important to

various stakeholders, including patients,

physicians, payers and healthcare institutions.

A number of PROMs, including ODI, NDI, VAS for

pain, Short Forms, EQ-5D and RMDQ, have been

used in patients with spinal disorders to better

understand patients’ perspectives and

expectations in terms of disease-specific

disability, pain and health-related quality of life.

Purpose Historiclly, ODI has been the most commonly used

PROM to evaluate lumbar spinal disorders.

Patient-Reported Outcomes Measurement Information

System (PROMIS) is a relatively new outcome

measure that is increasingly being implemented.

Thus, it is important to assess the true value and

utility of this new outcome measure in common

lumbar spine conditions such as lumbar spinal

stenosis requiring decompression surgery.

The purpose of this study is to evaluate the

correlation between ODI and PROMIS Physical

Function (PROMIS-PF) in patients undergoing

minimally invasive lumbar decompression.


Methods Study Design: Retrospective review of prospectively collected data

Population: Patients undergoing minimally invasive lumbar decompression for degenerative

conditions of the spine

Outcome: Correlation between ODI and PROMIS pre-operatively and at 6-weeks, 3-months, 6-

months and 1-year post-operatively

Statistics:

Pearson product-moment correlation at each time-point

Further sub-group analysis by number of levels


Results: Mean ODI and PROMIS-PF Scores

Title of Presentation Here6

ODI PROMIS

All Lumbar Decompressions

Pre-operatively 44.02 + 17.71 35.41 + 6.18

6 weeks 26.20 + 18.12 41.45 + 7.45

3 months 23.81 + 19.63 43.63 + 9.58

6 months 26.32 + 20.11 42.92 + 9.49

1 year 21.88 + 20.80 46.05 + 10.07

1 Level Lumbar Decompression

Pre-operatively 45.17 + 17.58 35.62 + 6.12

6 weeks 26.01 + 18.42 41.93 + 7.61

3 months 23.43 + 20.23 44.14 + 9.96

6 months 24.32 + 19.96 44.38 + 9.37

1 year 21.35 + 21.92 46.89 + 10.04


Pre-operatively 42.94 + 17.88 34.77 + 6.50

6 weeks 27.18 + 18.27 40.87 + 7.11

3 months 24.59 + 20.32 43.14 + 8.89

6 months 30.65 + 21.04 39.16 + 9.16

1 year 24.18 + 19.11 45.32 + 10.13


Pre-operatively 29.02 + 14.11 35.40 + 6.19

6 weeks 24.58 + 13.73 36.41 + 4.46

3 months 21.27 + 10.16 39.35 + 7.05

6 months 28.93 + 17.16 42.95 + 9.68

1 year 21.11 + 12.69 34.77 + 4.72

Results: Correlation between ODI and PROMIS-PF

7

Number of

observations (n)

Pearson Correlation

Co-efficient (r)

Strength of

Correlation

p - value

All Lumbar Decompressions

Pre-operatively 243 -0.59 Moderate <0.0001

6 weeks 150 -0.70 Strong <0.0001

3 months 95 -0.80 Very Strong <0.0001

6 months 78 -0.75 Strong <0.0001

1 year 50 -0.83 Very Strong <0.0001


Pre-operatively 180 -0.59 Moderate <0.0001

6 weeks 108 -0.68 Strong <0.0001


6 months 53 -0.74 Strong <0.0001

1 year 38 -0.87 Very Strong <0.0001


Pre-operatively 52 -0.63 Strong <0.0001

6 weeks 35 -0.80 Very Strong <0.0001



1 year 10 -0.69 Strong 0.028


Pre-operatively 10 -0.62 Strong 0.059

6 weeks 7 -0.15 Very Weak 0.744

3 months 6 -0.38 Weak 0.454

6 months 5 -0.48 Moderate 0.411

1 year 2 -1.00 Very Strong

Results: Correlation between ODI and PROMIS-PF


Limitations Retrospective review of prospectively collected data, thus selection bias cannot be completely

eliminated. Patients who answered their PROMs questionnaires may not necessarily be

representative of all patients undergoing this surgical procedure.

Loss to follow-up: All patients did not have complete follow-up till 1-year, which could be a potential

source of bias.

Radiographic outcomes were not analyzed and their correlation with patient-reported outcomes

was not assessed.

Patients included in the study were limited to those with degenerative conditions of the lumbar spine

who underwent minimally invasive spine surgery, and hence these findings may not be applicable

to other populations.

Limited sample size

Unable to further stratify by type of surgical procedure.

The number of 3-level cases was quite small & may not have been adequately powered to detect change


Conclusion While ODI has been used in spine patients for several years, PROMIS

is a new outcome measure that is increasingly being implemented.

PROMIS has been shown to decrease patient burden and be more

efficient, flexible and precise than other PROMs.

The results of our study show a statistically significant moderate to

very strong, negative correlation between ODI and PROMIS-PF for

all patients, except those undergoing 3 level lumbar decompression.

Thus, PROMIS-PF is a good surrogate for ODI.

Larger studies are warranted to evaluate the utility and value of this

outcome measure, and methods to interpret its clinical significance

need to be established.

Further research on the use of PROMIS to track outcomes will

contribute to guiding patient-centered care and thus enhance the

value of spine care.Correlation between ODI and PROMIS in Minimally Invasive Lumbar Decompression Surgery10

Thank you!

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