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  • The Discrepancy between Clinical Measures and Self-Reported Ratings of Health Status after Surgery for Degenerative Cervical Myelopathy: An Introduction to Response Shift

    Final Number:

    Lindsay Tetreault Bsc; Mary Zhu; Rachel Howard; Michael G. Fehlings MD PhD FRCS(C) FACS; Jefferson R. Wilson MD , PhD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Section on Disorders of the Spine and Peripheral Nerves Spine Summit 2018

    Introduction: Despite objective clinical improvements following surgery for DCM, experience dictates that a proportion of patients remain dissatisfied with their outcome.

    Methods: 401 patients were enrolled at 16 global sites. Functional impairment and self-reported rating of health status were recorded baseline and 1-year postoperative. Concordance was defined as achieving a clinically meaningful improvement (MCID) on the mJOA and reporting general health as somewhat better or much better, whereas discordance was defined as achieving a MCID and reporting general health as the same, somewhat worse or much worse. Logistic regression analysis was used to determine important differences between patients with discrepancies between their clinical measures and self-reported ratings and those without.

    Results: Based on patient self-reports, 55 patients were somewhat or much worse than 1-year ago, 82 patients were the same and 264 patients were somewhat or much better. Thirty-one percent of patients who reported being somewhat or much worse achieved a MCID on the mJOA. In addition, 56% of patients who indicated their health status was the same as one year ago exhibited clinically meaningful improvements in functional impairment. Univariate analyses indicated that a patient is more likely to be dissatisfied with their outcomes if he/she exhibited less improvement in mJOA upper extremity scores (p=0.071), was older (p=0.0073), was a smoker (p=0.082) and achieved lower total mJOA scores at 1-year (p=0.087). Following multivariate analysis, the most important factors were age and improvement in mJOA upper extremity scores.

    Conclusions: A response shift in functional outcomes was detected in surgical DCM patients. Older patients, as well as those with smaller improvements in postoperative upper extremity scores, tend to report worsened or unchanged general health status, despite experiencing improvements in overall function.

    Patient Care: Evaluates reasons for dissatisfaction

    Learning Objectives: To investigate the presence of response shift in functional outcomes in DCM patients treated surgically


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