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How well can the clinician appraise the patient’s perception of the severity and impact of their back problem?

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Abstract

Purpose

A main concern of patients with back problems is pain and its impact on function and quality of life. These are subjective phenomena, and should be probed during the clinical consultation so that the physician can ascertain the extent of the problem. This study evaluated the agreement between clinicians’ and patients’ independent ratings of patient status on the Core Outcome Measures Index (COMI).

Methods

This was an analysis of the data from 5 spine specialists and 108 patients, in two centres. Prior to the consultation, the patient completed the COMI. After the consultation, the clinician (blind to the patient’s version) also completed a COMI. Concordance was assessed by % agreement, Kappa values, Bland–Altman plots, Spearman rank, Intraclass Correlation Coefficients and comparisons of mean values, as appropriate.

Results

Agreement regarding the “main problem” (back pain, leg/buttock pain, sensory disturbances, other) was 83%, Kappa = 0.70 (95%CI 0.58–0.81). Moderate/strong correlations were found between the doctors’ and patients’ COMI-item ratings (0.48–0.74; p < 0.0001), although compared with the patients’ ratings the doctors systematically underestimated absolute values for leg pain (p = 0.002) and dissatisfaction with symptom state (p = 0.002), and overestimated how much the patient’s function was impaired (p = 0.029).

Conclusion

The doctors were able to ascertain the location of the main problem and the multidimensional outcome score with good accuracy, but some individual domains were systematically underestimated (pain, symptom-specific well-being) or overestimated (impairment of function). More detailed/direct questioning on these domains during the consultation might deliver a better appreciation of the impact of the back problem on the patient’s daily life.

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References

  1. Dorr Goold S, Lipkin M Jr (1999) The doctor–patient relationship: challenges, opportunities, and strategies. J Gen Intern Med 14(Suppl 1):S26-33. https://doi.org/10.1046/j.1525-1497.1999.00267.x

    Article  PubMed  Google Scholar 

  2. Tongue JR, Epps HR, Forese LL (2005) Communication skills. Instr Course Lect 54:3–9

    PubMed  Google Scholar 

  3. Becerra Fontal JA, Bago Granell J, Garre Olmo J, Roig Busquets R, Peris Prats F, Villanueva Leal C (2013) Evaluation of health-related quality of life in patients candidate for spine and other musculoskeletal surgery. Eur Spine J 22:1002–1009. https://doi.org/10.1007/s00586-012-2617-0

    Article  PubMed  Google Scholar 

  4. Crawford RW, Murray DW (1997) Total hip replacement: indications for surgery and risk factors for failure. Ann Rheum Dis 56:455–457. https://doi.org/10.1136/ard.56.8.455

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Quintana JM, Bilbao A, Escobar A, Azkarate J, Goenaga JI (2009) Decision trees for indication of total hip replacement on patients with osteoarthritis. Rheumatology (Oxford) 48:1402–1409. https://doi.org/10.1093/rheumatology/kep264

    Article  PubMed  Google Scholar 

  6. Allepuz A, Quintana JM, Espallargues M, Escobar A, Moharra M, Arostegui I (2011) Relationship between total hip replacement appropriateness and surgical priority instruments. J Eval Clin Pract 17:18–25. https://doi.org/10.1111/j.1365-2753.2010.01362.x

    Article  PubMed  Google Scholar 

  7. Mannion AF, Mariaux F, Pittet V, Steiger F, Aepli M, Fekete TF, Jeszenszky D, O’Riordan D, Porchet F (2021) Association between the appropriateness of surgery, according to appropriate use criteria, and patient-rated outcomes after surgery for lumbar degenerative spondylolisthesis. Eur Spine J 30:907–917. https://doi.org/10.1007/s00586-021-06725-3

    Article  PubMed  Google Scholar 

  8. Reitman CA, Hills JM, Standaert CJ, Bono CM, Mick CA, Furey CG, Kauffman CP, Resnick DK, Wong DA, Prather H, Harrop JS, Baisden J, Wang JC, Spivak JM, Schofferman J, Riew KD, Lorenz MA, Heggeness MH, Anderson PA, Rao RD, Baker RM, Emery SE, Watters WC 3rd, Sullivan WJ, Mitchell W, Tontz W Jr, Ghogawala Z (2021) Cervical fusion for treatment of degenerative conditions: development of appropriate use criteria. Spine J. https://doi.org/10.1016/j.spinee.2021.05.023

    Article  PubMed  Google Scholar 

  9. Muller D, Haschtmann D, Fekete TF, Kleinstuck F, Reitmeir R, Loibl M, O’Riordan D, Porchet F, Jeszenszky D, Mannion AF (2022) Development of a machine-learning based model for predicting multidimensional outcome after surgery for degenerative disorders of the spine. Eur Spine J 31:2125–2136. https://doi.org/10.1007/s00586-022-07306-8

    Article  CAS  PubMed  Google Scholar 

  10. Staub L, Aghayev E, Skrivankova V, Lord SJ, Haschtmann D, Mannion A, F. (2020) Development and temporal validation of a prognostic model for 1-year clinical outcome after decompression surgery for lumbar disc herniation. Eur Spine J 29:1742–1751

    Article  PubMed  Google Scholar 

  11. McGirt MJ, Bydon M, Archer KR, Devin CJ, Chotai S, Parker SL, Nian H, Harrell FE Jr, Speroff T, Dittus RS, Philips SE, Shaffrey CI, Foley KT, Asher AL (2017) An analysis from the quality outcomes database, Part 1. Disability, quality of life, and pain outcomes following lumbar spine surgery: predicting likely individual patient outcomes for shared decision-making. J Neurosurg Spine 27:357–369. https://doi.org/10.3171/2016.11.SPINE16526

    Article  PubMed  Google Scholar 

  12. Coran JJ, Koropeckyj-Cox T, Arnold CL (2013) Are physicians and patients in agreement? Exploring dyadic concordance. Health Educ Behav 40:603–611. https://doi.org/10.1177/1090198112473102

    Article  PubMed  Google Scholar 

  13. Lattig F, Fekete TF, O'Riordan D, Mannion AF (2010) Expectations of spinal surgery from the surgeon's and patient's perspectives. In: Swiss Society of Orthopaedics. St Gallen, Switzerland, pp 1040–1048

  14. Ruben MA, Blanch-Hartigan D, Shipherd JC (2018) To Know another’s pain: a meta-analysis of caregivers’ and healthcare providers’ pain assessment accuracy. Ann Behav Med 52:662–685. https://doi.org/10.1093/abm/kax036

    Article  PubMed  Google Scholar 

  15. Perreault K, Dionne CE (2005) Patient-physiotherapist agreement in low back pain. J Pain 6:817–828. https://doi.org/10.1016/j.jpain.2005.07.008

    Article  PubMed  Google Scholar 

  16. Pierre U, Wood-Dauphinee S, Korner-Bitensky N, Gayton D, Hanley J (1998) Proxy use of the Canadian SF-36 in rating health status of the disabled elderly. J Clin Epidemiol 51:983–990. https://doi.org/10.1016/s0895-4356(98)00090-0

    Article  CAS  PubMed  Google Scholar 

  17. Kwoh CK, O’Connor GT, Regan-Smith MG, Olmstead EM, Brown LA, Burnett JB, Hochman RF, King K, Morgan GJ (1992) Concordance between clinician and patient assessment of physical and mental health status. J Rheumatol 19:1031–1037

    CAS  PubMed  Google Scholar 

  18. Sneeuw KC, Sprangers MA, Aaronson NK (2002) The role of health care providers and significant others in evaluating the quality of life of patients with chronic disease. J Clin Epidemiol 55:1130–1143. https://doi.org/10.1016/s0895-4356(02)00479-1

    Article  PubMed  Google Scholar 

  19. Hewlett SA (2003) Patients and clinicians have different perspectives on outcomes in arthritis. J Rheumatol 30:877–879

    PubMed  Google Scholar 

  20. Mannion AF, Elfering A, Staerkle R, Junge A, Grob D, Semmer NK, Jacobshagen N, Dvorak J, Boos N (2005) Outcome assessment in low back pain: how low can you go? Eur Spine J 14:1014–1026

    Article  PubMed  Google Scholar 

  21. Ferrer M, Pellise F, Escudero O, Alvarez L, Pont A, Alonso J, Deyo R (2006) Validation of a minimum outcome core set in the evaluation of patients with back pain. Spine 31:1372–1379; discussion 1380

  22. Deyo RA, Battié M, Beurskens AJHM, Bombardier C, Croft P, Koes B, Malmivaara A, Roland M, Von Korff M, Waddell G (1998) Outcome measures for low back pain research. A proposal for standardized use. Spine 23:2003–2013

    Article  CAS  PubMed  Google Scholar 

  23. Fankhauser C, Mutter U, Aghayev E, Mannion AF (2012) Validity and responsiveness of the Core Outcome Measures Index (COMI) for the neck. Eur Spine J 21:101–114

    Article  CAS  PubMed  Google Scholar 

  24. Mannion AF, Porchet F, Kleinstück F, Lattig F, Jeszenszky D, Bartanusz V, Dvorak J, Grob D (2009) The quality of spine surgery from the patient’s perspective: part 1. The Core Outcome Measures Index (COMI) in clinical practice. Eur Spine J 18:367–373

    Article  PubMed  PubMed Central  Google Scholar 

  25. Abdeldaiem A, Saweeres ESB, Shehab-Eldien AA, Mannion AF, Rehan Youssef A (2020) Cross-cultural adaptation and validation of the Arabic version of the Core Outcome Measures Index for the back (COMI-back) in patients with non-specific low back pain. Eur Spine J 29:2413–2430. https://doi.org/10.1007/s00586-020-06530-4

    Article  PubMed  Google Scholar 

  26. Cohen J (1968) Weighted kappa: nominal scale agreement with provision for scaled disagreement or partial credit. Psychol Bull 70:213–220. https://doi.org/10.1037/h0026256

    Article  CAS  PubMed  Google Scholar 

  27. Ranganathan P, Pramesh CS, Aggarwal R (2017) Common pitfalls in statistical analysis: measures of agreement. Perspect Clin Res 8:187–191. https://doi.org/10.4103/picr.PICR_123_17

    Article  PubMed  PubMed Central  Google Scholar 

  28. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  CAS  PubMed  Google Scholar 

  29. Sullivan GM, Feinn R (2012) Using effect size-or why the P value is not enough. J Grad Med Educ 4:279–282. https://doi.org/10.4300/JGME-D-12-00156.1

    Article  PubMed  PubMed Central  Google Scholar 

  30. Terwee CB, Bot SD, de Boer MR, van der Windt DA, Knol DL, Dekker J, Bouter LM, de Vet HC (2007) Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol 60:34–42

    Article  PubMed  Google Scholar 

  31. Bland JM, Altman DG (1995) Comparing methods of measurement: why plotting difference against standard method is misleading. Lancet 346:1085–1087

    Article  CAS  PubMed  Google Scholar 

  32. Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW (1990) Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. JBJS A 72A:403–408

    Article  Google Scholar 

  33. Aaen J, Austevoll IM, Hellum C, Storheim K, Myklebust TA, Banitalebi H, Anvar M, Brox JI, Weber C, Solberg T, Grundnes O, Brisby H, Indrekvam K, Hermansen E (2022) Clinical and MRI findings in lumbar spinal stenosis: baseline data from the NORDSTEN study. Eur Spine J 31:1391–1398. https://doi.org/10.1007/s00586-021-07051-4

    Article  PubMed  Google Scholar 

  34. Tabolli S, Sampogna F, Pagliarello C, Paradisi A, Spagnoli A, Abeni D (2012) Disease severity evaluation among dermatological out-patients: a comparison between the assessments of patients and physicians. J Eur Acad Dermatol Venereol 26:213–218. https://doi.org/10.1111/j.1468-3083.2011.04038.x

    Article  CAS  PubMed  Google Scholar 

  35. Frymoyer JW, Frymoyer NP (2002) Physician-patient communication: a lost art? J Am Acad Orthop Surg 10:95–105. https://doi.org/10.5435/00124635-200203000-00005

    Article  PubMed  Google Scholar 

  36. Tongue JR, Jenkins L, Wade A (2009) Low-touch surgeons in a high-touch world. In: AAOS Now. American Academy of Orthopaedic Surgeons

  37. de Vet HC, Terwee CB, Knol DL, Bouter LM (2006) When to use agreement versus reliability measures. J Clin Epidemiol 59:1033–1039

    Article  PubMed  Google Scholar 

  38. Marquie L, Raufaste E, Lauque D, Marine C, Ecoiffier M, Sorum P (2003) Pain rating by patients and physicians: evidence of systematic pain miscalibration. Pain 102:289–296

    Article  PubMed  Google Scholar 

  39. Sari O, Temiz C, Golcur M, Aydogan U, Tanoglu A, Ezgu MC, Tehli O (2015) Pain perception differences between patients and physicians: a pain severity study in patients with low back pain. Turk Neurosurg 25:461–468. https://doi.org/10.5137/1019-5149.JTN.13481-14.1

    Article  PubMed  Google Scholar 

  40. Crocker JC, Ricci-Cabello I, Parker A, Hirst JA, Chant A, Petit-Zeman S, Evans D, Rees S (2018) Impact of patient and public involvement on enrolment and retention in clinical trials: systematic review and meta-analysis. BMJ 363:k4738. https://doi.org/10.1136/bmj.k4738

    Article  PubMed  PubMed Central  Google Scholar 

  41. Müller D, Haschtmann D, Fekete TF, Kleinstück F, Reitmeir R, Loibl M, O’Riordan D, Porchet F, Jeszenszky D, Mannion AF (2022) Development of a machine-learning based model for predicting multidimensional outcome after surgery for degenerative disorders of the spine. Eur Spine J 31:2125–2136. https://doi.org/10.1007/s00586-022-07306-8

    Article  PubMed  Google Scholar 

  42. Macnab I (1973) Chapter 14. Pain and disability in degnerative disc disease. Clin Neurosurg 20:193–196

  43. Lattig F, Grob D, Kleinstueck FS, Porchet F, Jeszenszky D, Bartanusz V, O’Riordan D, Mannion AF (2009) Ratings of global outcome at the first post-operative assessment after spinal surgery: how often do the surgeon and patient agree? Eur Spine J 18:386–439

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. ISICO (Italian Scientific Spine Institute), Milan, Italy

    F. Zaina, S. Donzelli & M. Lusini

  2. Spine Centre, Schulthess Klinik, Lengghalde 2, 8008, Zürich, Switzerland

    U. Mutter, F. S. Kleinstueck & A. F. Mannion

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  1. F. Zaina
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  2. U. Mutter
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  3. S. Donzelli
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  4. M. Lusini
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  5. F. S. Kleinstueck
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  6. A. F. Mannion
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Correspondence to A. F. Mannion.

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Zaina, F., Mutter, U., Donzelli, S. et al. How well can the clinician appraise the patient’s perception of the severity and impact of their back problem?. Eur Spine J 33, 39–46 (2024). https://doi.org/10.1007/s00586-023-08023-6

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  • DOI: https://doi.org/10.1007/s00586-023-08023-6

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