Impact on health related quality of life of adult spinal deformity (ASD) compared with other chronic conditions
- 1k Downloads
Medical and health policy providers should be aware of the impact of adult spinal deformity (ASD) on health-related quality of life (HRQL). The purpose of this study was to compare the relative burden of four chronic conditions with that of ASD.
The International Quality of Life Assessment project gathered data from 24,936 people and published the SF-36 scores of patients with self-reported arthritis, chronic lung disease, diabetes and congestive heart failure from 8 industrialized countries (3 continents) Alonso et al. (Qual Life Res Int J Qual Life Asp Treat Care Rehabil 13:283–298, 2004). We compared these with the SF-36 baseline data of consecutive patients with ASD enrolled in a prospective multicentre international database with the following inclusion criteria: age >18 years and scoliosis >20°, sagittal vertical axis >5 cm, pelvic tilt >25° or thoracic kyphosis >60°. Four ASD groups were considered: all ASD patients, surgical candidates (preop HRQL scores), and non-surgical candidates with and without previous surgery. Adjusted estimates of the impact of chronic disease were calculated using separate multivariate linear regression models. Individuals without chronic conditions were used as the reference group. Coefficients for each chronic condition and ASD represent the difference compared with this healthy group.
766 patients (mean age 45.8 years) met the inclusion criteria for ASD. The scores on all SF-36 domains were lower in ASD patients than in any other chronic condition. Differences between ASD and the other chronic conditions were always greater than the reported minimal clinically important differences. When compared with individuals reporting no medical conditions, SF-36 scores from the population with self-reported chronic conditions ranged from −2.5 to −14.1. Comparable scores for patients with ASD ranged from −10.9 to −45.0. Physical function, role physical and pain domains showed the worst scores. Surgical candidates with ASD displayed the worst HRQL scores (−17.4 to −45.0) and patients previously operated the best (−10.9 to −33.3); however, even the latter remained worse than any scores for the other self-reported chronic conditions.
The global burden of ASD was huge compared with other self-reported chronic conditions in the general population of eight industrialized countries. The impact of ASD on HRQL warrants the same research and health policy attention as other important chronic diseases.
KeywordsSF-36 Adult spinal deformity Impact on HRQL IQOLA project Chronic diseases
Conflict of interest
This article was partially funded by a Depuy Synthes Research Grant.
- 2.McCarthy I, O’Brien M, Ames C, Robinson C, Errico T, Polly DW et al (2014) Incremental cost-effectiveness of adult spinal deformity surgery: observed quality-adjusted life years with surgery compared with predicted quality-adjusted life years without surgery. Neurosurg Focus 36(5):E3PubMedCrossRefGoogle Scholar
- 5.Alonso J, Ferrer M, Gandek B, Ware JE, Aaronson NK, Mosconi P et al (2004) Health-related quality of life associated with chronic conditions in eight countries: results from the International Quality of Life Assessment (IQOLA) Project. Qual Life Res Int J Qual Life Asp Treat Care Rehabil 13(2):283–298CrossRefGoogle Scholar
- 7.Obeid I, Lafage V, Alanay A, Vital J-M, Gille O, Bourgli A (2013) Global tilt: a new sagittal plane parameter combining spinal balance and pelvic compensatory mechanisms. VancouverGoogle Scholar
- 8.Pellisé F, Domingo-Sàbat M, Alanay A, Bagó J, Vila-Casademunt A, Villanueva C et al (2012) Impact of radiographic parameters on HRQoL in adult spinal deformity. The “Lordosis Gap” better than Lumbar Lordosis? Abstracts for Oral Presentations for EuroSpine, May Amsterdam. Eur Spine J 21(S3):269–337CrossRefGoogle Scholar
- 11.Cohen J (1998) Statistical Power Analysis for the Behavioral Sciences, 2nd edn. Lawrence Erlbaum Associates, HillsdaleGoogle Scholar
- 13.Fu K-MG, Bess S, Schwab F, Lafage V, Smith JS, Ames CP et al (2012) Health impact comparison of different disease states and population norms to adult spinal deformity (ASD): a call for medical attention. Podium presentation, ChicagoGoogle Scholar