Lower Extremity Motor Deficits Are Underappreciated in Patient-Reported Outcome Measures: Added Value of Objective Outcome Measures
Objective The patient-reported outcome measure (PROM)-based evaluation in lumbar degenerative disc disease (DDD) is today’s gold standard but has limitations. We studied the impact of lower extremity motor deficits (LEMDs) on PROMs and a new objective outcome measure. Methods We evaluated patients w...
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| Format: | Article |
| Language: | English |
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Korean Spinal Neurosurgery Society
2020-03-01
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| Series: | Neurospine |
| Subjects: | |
| Online Access: | http://www.e-neurospine.org/upload/pdf/ns-1938368-184.pdf |
| _version_ | 1827364795464024064 |
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| author | Martin Nikolaus Stienen Nicolai Maldaner Marketa Sosnova Holger Joswig Marco Vincenzo Corniola Luca Regli Gerhard Hildebrandt Karl Schaller Oliver Pascal Gautschi |
| author_facet | Martin Nikolaus Stienen Nicolai Maldaner Marketa Sosnova Holger Joswig Marco Vincenzo Corniola Luca Regli Gerhard Hildebrandt Karl Schaller Oliver Pascal Gautschi |
| author_sort | Martin Nikolaus Stienen |
| collection | DOAJ |
| description | Objective The patient-reported outcome measure (PROM)-based evaluation in lumbar degenerative disc disease (DDD) is today’s gold standard but has limitations. We studied the impact of lower extremity motor deficits (LEMDs) on PROMs and a new objective outcome measure. Methods We evaluated patients with lumbar DDD from a prospective 2-center database. LEMDs were graded according to the British Medical Research Council (BMRC; 5 [normal] –0 [no movement]). The PROM-based evaluation included pain (visual analogue scale), disability (Oswestry Disability Index [ODI] & Roland-Morris Disability Index [RMDI]), and health-related quality of life (HRQoL; Short-Form 12 physical component summary/mental component summary & EuroQol-5D index). Objective functional impairment (OFI) was determined as age- and sex-adjusted Timed-Up and Go (TUG) test value. Results One hundred five of 375 patients (28.0%) had a LEMD. Patients with LEMD had slightly higher disability (ODI: 52.8 vs. 48.2, p = 0.025; RMDI: 12.6 vs. 11.3, p = 0.034) but similar pain and HRQoL scores. OFI T-scores were significantly higher in patients with LEMD (144.2 vs. 124.3, p = 0.006). When comparing patients with high- (BMRC 0–2) vs. low-grade LEMD (BMRC 3–4), no difference was evident for the PROM-based evaluation (all p > 0.05) but patients with high-grade LEMD had markedly higher OFI T-scores (280.9 vs. 136.0, p = 0.001). Patients with LEMD had longer TUG test times and OFI T-scores than matched controls without LEMDs. Conclusion Our data suggest that PROMs fail to sufficiently account for LEMD-associated disability, which is common and oftentimes bothersome to patients. The objective functional evaluation with the TUG test appears to be more sensitive to LEMD-associated disability. An objective functional evaluation of patients with LEMD appears reasonable. |
| first_indexed | 2024-03-08T08:17:25Z |
| format | Article |
| id | doaj.art-81cacf36b5814d59af05d06e5a68d251 |
| institution | Directory Open Access Journal |
| issn | 2586-6583 2586-6591 |
| language | English |
| last_indexed | 2024-03-08T08:17:25Z |
| publishDate | 2020-03-01 |
| publisher | Korean Spinal Neurosurgery Society |
| record_format | Article |
| series | Neurospine |
| spelling | doaj.art-81cacf36b5814d59af05d06e5a68d2512024-02-02T07:08:31ZengKorean Spinal Neurosurgery SocietyNeurospine2586-65832586-65912020-03-0117127028010.14245/ns.1938368.184954Lower Extremity Motor Deficits Are Underappreciated in Patient-Reported Outcome Measures: Added Value of Objective Outcome MeasuresMartin Nikolaus Stienen0Nicolai Maldaner1Marketa Sosnova2Holger Joswig3Marco Vincenzo Corniola4Luca Regli5Gerhard Hildebrandt6Karl Schaller7Oliver Pascal Gautschi8 Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland Department of Neurosurgery, Ernst von Bergmann Hospital, Potsdam, Germany Division of Neurosurgery, Department of Clinical Neuroscience, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland Division of Neurosurgery, Department of Clinical Neuroscience, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland Neuro- and Spine Center, Hirslanden Clinic St. Anna, Lucerne, SwitzerlandObjective The patient-reported outcome measure (PROM)-based evaluation in lumbar degenerative disc disease (DDD) is today’s gold standard but has limitations. We studied the impact of lower extremity motor deficits (LEMDs) on PROMs and a new objective outcome measure. Methods We evaluated patients with lumbar DDD from a prospective 2-center database. LEMDs were graded according to the British Medical Research Council (BMRC; 5 [normal] –0 [no movement]). The PROM-based evaluation included pain (visual analogue scale), disability (Oswestry Disability Index [ODI] & Roland-Morris Disability Index [RMDI]), and health-related quality of life (HRQoL; Short-Form 12 physical component summary/mental component summary & EuroQol-5D index). Objective functional impairment (OFI) was determined as age- and sex-adjusted Timed-Up and Go (TUG) test value. Results One hundred five of 375 patients (28.0%) had a LEMD. Patients with LEMD had slightly higher disability (ODI: 52.8 vs. 48.2, p = 0.025; RMDI: 12.6 vs. 11.3, p = 0.034) but similar pain and HRQoL scores. OFI T-scores were significantly higher in patients with LEMD (144.2 vs. 124.3, p = 0.006). When comparing patients with high- (BMRC 0–2) vs. low-grade LEMD (BMRC 3–4), no difference was evident for the PROM-based evaluation (all p > 0.05) but patients with high-grade LEMD had markedly higher OFI T-scores (280.9 vs. 136.0, p = 0.001). Patients with LEMD had longer TUG test times and OFI T-scores than matched controls without LEMDs. Conclusion Our data suggest that PROMs fail to sufficiently account for LEMD-associated disability, which is common and oftentimes bothersome to patients. The objective functional evaluation with the TUG test appears to be more sensitive to LEMD-associated disability. An objective functional evaluation of patients with LEMD appears reasonable.http://www.e-neurospine.org/upload/pdf/ns-1938368-184.pdfobjective functional impairmentlumbar degenerative disc diseasemotor deficitparesisdisabilitypatient-reported outcome measure |
| spellingShingle | Martin Nikolaus Stienen Nicolai Maldaner Marketa Sosnova Holger Joswig Marco Vincenzo Corniola Luca Regli Gerhard Hildebrandt Karl Schaller Oliver Pascal Gautschi Lower Extremity Motor Deficits Are Underappreciated in Patient-Reported Outcome Measures: Added Value of Objective Outcome Measures Neurospine objective functional impairment lumbar degenerative disc disease motor deficit paresis disability patient-reported outcome measure |
| title | Lower Extremity Motor Deficits Are Underappreciated in Patient-Reported Outcome Measures: Added Value of Objective Outcome Measures |
| title_full | Lower Extremity Motor Deficits Are Underappreciated in Patient-Reported Outcome Measures: Added Value of Objective Outcome Measures |
| title_fullStr | Lower Extremity Motor Deficits Are Underappreciated in Patient-Reported Outcome Measures: Added Value of Objective Outcome Measures |
| title_full_unstemmed | Lower Extremity Motor Deficits Are Underappreciated in Patient-Reported Outcome Measures: Added Value of Objective Outcome Measures |
| title_short | Lower Extremity Motor Deficits Are Underappreciated in Patient-Reported Outcome Measures: Added Value of Objective Outcome Measures |
| title_sort | lower extremity motor deficits are underappreciated in patient reported outcome measures added value of objective outcome measures |
| topic | objective functional impairment lumbar degenerative disc disease motor deficit paresis disability patient-reported outcome measure |
| url | http://www.e-neurospine.org/upload/pdf/ns-1938368-184.pdf |
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