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Patient-Reported Outcome Instruments in Spine Surgery

Guzman, Javier Z., MD; Cutler, Holt S., BSE; Connolly, James, BA; Skovrlj, Branko, MD; Mroz, Thomas E., MD; Riew, K. Daniel, MD; Cho, Samuel K., MD

doi: 10.1097/BRS.0000000000001211

Study Design. A critical review of the current literature.

Objective. The purpose of this study was to determine frequency, trends, and methods of utilization of spine-related PROIs over the last 10 years.

Summary of Background Data. . Patient-reported outcome instruments (PROIs) have become the gold standard to assess the efficacy of various medical and surgical treatments. Currently, however, there is an expansive range of PROIs without a clear consensus or guideline addressing which PROIs should be used for a particular diagnosis or surgical intervention.

Methods. A PubMed search was conducted from 2004 to 2013 of 5 orthopedic journals (The Journal of Bone and Joint Surgery, The Bone and Joint Journal, The Spine Journal, The European Spine Journal, and Spine) that publish spine articles, chosen on the basis of readership and impact factor. Journal abstracts were inspected for spine surgery and inclusion of at least 1 PROI. All articles containing PROIs and investigating a surgical intervention with a level of evidence (LOE) 1 to 4 were included for analysis. Article title, LOE, journal, and chosen PROI were recorded for selected articles.

Results. Out of 19,736 articles published in our selected time frame, 1,079 utilized PROIs. Most studies were LOE 4 (32.7%). Nearly half (48.9%) of all articles addressed degenerative thoracolumbar conditions. In total, there were 206 unique PROIs in the studies chosen for inclusion. The top 6 instruments utilized were the (1) visual analog scale, (2) Oswestry disability index, (3) Short Form-36, (4) Japanese Orthopaedic Association Outcome Questionnaire, (5) Neck Disability Index, and (6) Scoliosis Research Society-22.

Conclusion. The breadth of PROIs in spine surgery is extensive. Although there are preferred patient-reported outcome measures, a consensus or guideline addressing which instruments should be used for a particular diagnosis or procedure may be warranted.

Level of Evidence: 4

*Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY

Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH

Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO.

Address correspondence and reprint requests to Samuel K. Cho, MD, Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, Box 1188, New York, NY 10029; E-mail:

Received 13 July, 2015

Revised 23 August, 2015

Accepted 31 August, 2015

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership, consultancy, expert testimony, grants, payment for lectures, royalties, stocks, travel/accommodations/meeting expenses.

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