Avoid common mistakes on your manuscript.
Dear Editor,
We would like to congratulate the authors on the publication of the literature review showing the heterogeneity of patient reported outcome measures (PROMs) used in trauma patients [1].
The authors indicate that currently in the UK, the Trauma Audit Research Network (TARN) collects data up to 6 months. We believe this would in general be considered as rather a short-term follow-up period. In the discussion, a follow-up of at least 2 years (and up to 10 years) is recommended, which we would also favor to be able to evaluate long-term follow-up results. Also, it was interesting to read that the TARN database only gathered Euroqol 5-Dimension (EQ-5D) and Glasgow Outcome Score Extended (GOSE). It can be questioned whether these are appropriate to measure the outcomes of the trauma patient populations adequately. We agree with the authors that it is important to measure the quality of life (QoL) and functional outcomes adequately.
We were pleased to read that in this perspective the authors indicate the importance and comprehensiveness of the International Classification of Functioning, Disability and Health (ICF) system of the World Health Organization. On the other hand, we were very surprised that the AO Spine PROST (Patient Reported Outcome Spine Trauma) was not found in their literature search, thus, also not mentioned in the article. The AO Spine PROST is a disease-specific PROM for spine trauma patients, which was developed by the AO Spine Knowledge Forum Trauma following a multi-phase process. The systematic approach and methodology of the ICF were used as the basis for the development of the tool. This ICF classification system consists of more than 1400 categories to describe and classify individuals’ functioning, disability, and health. In the preparatory phase of the project, four different studies were completed. Three studies aimed to identify relevant ICF categories from different perspectives: research, [2] expert, [3] and patient perspective [4]. A fourth study investigated various response scales for their potential use in the tool [5]. In the next phase, out of 159 identified relevant ICF categories, 25 were selected as core categories during an international consensus conference [6]. Subsequently, the AO Spine PROST was developed by clustering those 25 core ICF categories into 19 items and implementing the items into the selected response scale [7].
It is important to realize that the main focus of the available measurement instruments used among spine trauma patients concerns pain. This also applies to the suggested PROMs by the authors: the NDI (Neck Disability Index), ODI (Oswestry Disability Index), or TDI (Total Disability Index). However, pain seems not to be the main issue in the recovery of spine trauma patients, rather functional impairments [4]. Therefore, the AO Spine PROST aims to measure the functional level and health status specifically after the traumatic event. This is reflected by the unique approach of the tool with a scale that ranges from 0 to 100, in which 0 indicates no function at all, and 100 the pre-injury level of function and health. The tool consists of a total of 19 questions that capture a broad range of aspects of functioning, such as walking and household activities, but also social life, emotional function, urinating, and bowel movement.
To the best of our knowledge, currently the AO Spine PROST has been, or is being, translated into 17 languages: Arabic, Dutch, English, Filipino, French, German, Hindi, Mandarin Chinese, Nepali, Norwegian, Portuguese, Romanian, Slovak, Spanish, Swahili, Thai, and Turkish. Out of these, the validation of 3 languages have been published so far: Dutch, English, and Nepali [8,9,10].
The AO Spine PROST has been developed for measuring outcomes among spine trauma patients. However, we believe it could also serve as an adequate basis for the development among other trauma patient populations. Thus, in response to the authors’ question: yes, we can do better. We would encourage colleagues around the world to investigate the applicability and validity of the AO Spine PROST among other specific trauma patient populations. Together with the many translations the tool has the potential to be useful in an international setting both for research and clinical purposes, and contribute to the improvement of the quality of health care in trauma patients.
Change history
09 March 2023
A Correction to this paper has been published: https://doi.org/10.1007/s00068-023-02249-1
References
Andrzejowski P, Holch P, Giannoudis PV. Measuring functional outcomes in major trauma: can we do better? Eur J Trauma Emerg Surg. 2022;48(3):1683–98.
Oner FC, Jacobs WC, Lehr AM, Sadiqi S, Post MW, Aarabi B, et al. Toward the development of a universal outcome instrument for spine trauma: a systematic review and content comparison of outcome measures used in spine trauma research using the ICF as reference. Spine (Phila Pa 1976). 2016;41(4):358–67.
Oner FC, Sadiqi S, Lehr AM, Dvorak MF, Aarabi B, Chapman JR, et al. Towards the development of an outcome instrument for spinal trauma: an international survey of spinal surgeons. Spine (Phila Pa 1976). 2015;40(2):E91-6.
Oner FC, Sadiqi S, Lehr AM, Aarabi B, Dunn RN, Dvorak MF, et al. Toward developing a specific outcome instrument for spine trauma: an empirical cross-sectional multicenter ICF-based study by AOSpine knowledge forum Trauma. Spine (Phila Pa 1976). 2015;40(17):1371–9.
Sadiqi S, Lehr AM, Post MW, Vaccaro AR, Dvorak MF, Oner FC. Toward a specific outcome instrument for spinal trauma: how to measure function and health. Spine (Phila Pa 1976). 2015;40(10):E578-86.
Sadiqi S, Lehr AM, Post MW, Jacobs WC, Aarabi B, Chapman JR, et al. The selection of core international classification of functioning, disability, and health (ICF) categories for patient-reported outcome measurement in spine trauma patients-results of an international consensus process. Spine J. 2016;16(8):962–70.
Sadiqi S, Lehr AM, Post MW, Dvorak MF, Kandziora F, Rajasekaran S, et al. Development of the AOSpine patient reported outcome spine Trauma (AOSpine PROST): a universal disease-specific outcome instrument for individuals with traumatic spinal column injury. Eur Spine J. 2017;26(5):1550–7.
Sadiqi S, Post MW, Hosman AJ, Dvorak MF, Chapman JR, Benneker LM, et al. Reliability, validity and responsiveness of the Dutch version of the AOSpine PROST (Patient Reported Outcome Spine Trauma). Eur Spine J. 2021;30(9):2631–44.
Sadiqi S, Dvorak MF, Vaccaro AR, Schroeder GD, Post MW, Benneker LM, et al. Reliability and validity of the english version of the AOSpine PROST (Patient Reported Outcome Spine Trauma). Spine (Phila Pa 1976). 2020;45(17):E1111–8.
Dhakal GR, Sadiqi S, Dhakal R, Dhungana S, Yadav PK, Shah G, et al. Reliability and validity of the adapted Nepali version of the AO spine patient reported outcome spine Trauma. J Nepal Health Res Counc. 2022;19(4):730–9.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
The original online version of this article was revised due to a retrospective Open Access order.
Rights and permissions
This article is published under an open access license. Please check the 'Copyright Information' section either on this page or in the PDF for details of this license and what re-use is permitted. If your intended use exceeds what is permitted by the license or if you are unable to locate the licence and re-use information, please contact the Rights and Permissions team.
About this article
Cite this article
Sadiqi, S., Oner, F.C. A disease-specific patient reported outcome instrument for spine trauma is developed, validated and available! Re: Andrzejowski et al. Measuring functional outcomes in major trauma: can we do better?. Eur J Trauma Emerg Surg 49, 1605–1606 (2023). https://doi.org/10.1007/s00068-022-02167-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00068-022-02167-8