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Preoperative Patient Reported Outcomes Measurement Information System Scores Assist in Predicting Early Postoperative Success in Lumbar Discectomy

Rubery, Paul T., MD; Houck, Jeff, PT, PhD; Mesfin, Addisu, MD; Molinari, Robert, MD; Papuga, Mark O., PhD∗,‡

doi: 10.1097/BRS.0000000000002823

Study Design. Retrospective review of prospective data.

Objective. Determine whether patient reported outcome (PRO) data collected prior to lumbar discectomy predicts achievement of a minimal important difference (MID) after surgery. Compare ability of PRO and clinical information to predict achievement of MID in short term follow-up after discectomy.

Summary of Background Data. We investigated the ability of patient reported outcomes measurement information system (PROMIS) and clinical factors at the preoperative time point to determine patients achieving MID after surgery.

Methods. PROMIS physical function (PF), pain interference (PI), and depression (D) scores were assessed at evaluation and follow-up for consecutive visits between February, 2015 and September, 2017. Patients with preoperative scores within 30 days prior to surgery and with scores 40 days or more after surgery who completed all PROMIS domains were included yielding 78 patients. MIDs were calculated using a distribution-based method. A multivariate logistic regression model was created, and the ability to predict achieving MID for each of the PROMIS domains was assessed. Cut-off values and prognostic probabilities were determined for this model and models combining preoperative PROMIS with clinical data.

Results. Preoperative PROMIS scores modestly predict reaching MID after discectomy (areas under the curve [AUC] of 0.62, 0.68, and 0.76 for PF, PI, and D, respectively). Preoperative cut-off scores show patients who have PF and PI scores more than 2 standard deviations, and D more than 1.5 standard deviations worse-off than population mean are likely to achieve MID. The combination of PROMIS with clinical data was the most powerful predictor of reaching MID with AUCs of 0.87, 0.84, and 0.83 for PF, PI, and D.

Conclusion. PROMIS scores before discectomy modestly predict improvement after surgery. Preoperative PROMIS combined with clinical factors was more predictive of achieving MID than either clinical factors or PROMIS alone.

Level of Evidence: 3

Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, New York

Department of Physical Therapy, George Fox University, Newberg, Oregon

New York Chiropractic College, Seneca Falls, New York.

Address correspondence and reprint requests to Paul T. Rubery, MD, 601 Elmwood Ave, Box 665, Rochester, NY 14642; E-mail:

Received 11 April, 2018

Revised 14 July, 2018

Accepted 17 July, 2018

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: grants.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.