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Cultural Variations in the Minimum Clinically Important Difference Thresholds for SRS-22R After Surgery for Adult Spinal Deformity

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Abstract

Study Design

Longitudinal cohort.

Objective

To calculate the minimum clinically important difference (MCID) threshold values for the Scoliosis Research Society—22R (SRS-22R) in Japanese patients with adult spinal deformity (ASD) and to compare the results with previously reported values in a North American population.

Summary of Background Data

The SRS-22R has been shown to be reliable, valid, and responsive to change in patients with ASD undergoing surgery. The MCID quantifies a threshold value of improvement that is clinically relevant to the patient. We hypothesize that MCID threshold values of SRS-22R differ between different cultural groups.

Methods

We identified ASD patients who completed the SRS-22R preoperatively and the SRS-30 at minimum two years after surgery. Answers to the last seven questions of the SRS-30 were used as anchors to determine the MCID for the SRS-22R Activity, Pain, Appearance, Mental domains, and Total score using receiver operating characteristic (ROC) curve analysis.

Results

A total of 122 (16 male, 106 female) patients were included in the analysis. There was a statistically significant improvement in all domain scores from preoperation to two years postoperation. There was a statistically significant difference in change in domain score among the responses to the anchors (p < .05). The ROC curve analysis yielded MCID values of 0.90 for Activity (area under the curve [AUC] = 0.766), 0.85 for Pain (AUC = 0.637), 1.05 for Appearance (AUC = 0.764), and 0.70 for Mental (AUC = 0.641) domain, 1.05 for Total score (AUC = 0.670). Except for Appearance, these MCID thresholds were higher compared with values reported in patients from North America (Activity = 0.60, Pain = 0.40, Appearance = 1.23, Total = 0.71).

Conclusions

Results of this study showed that cultural variations exist for MCID threshold values for SRS-22 Activity, Pain, Mental domains, and Total score after surgical treatment of ASD.

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References

  1. McCormick JD, Werner BC, Shimer AL. Patient-reported outcome measures in spine surgery. J Am Acad Orthop Surg 2013;21:99–107.

    Article  PubMed  Google Scholar 

  2. Baldus C, Bridwell KH, Harrast J, et al. Age-gender matched comparison of SRS instrument scores between adult deformity and normal adults: are all SRS domains disease specific? Spine (Phila Pa 1976) 2008;33:2214–8.

    Article  Google Scholar 

  3. Berven S, Deviren V, Demir-Deviren S, et al. Studies in the modified Scoliosis Research Society Outcomes Instrument in adults: validation, reliability, and discriminatory capacity. Spine (Phila Pa 1976) 2003;28: 2164–9; discussion 2169.

    Article  Google Scholar 

  4. Bridwell KH, Berven S, Glassman S, et al. Is the SRS-22 instrument responsive to change in adult scoliosis patients having primary spinal deformity surgery? Spine (Phila Pa 1976) 2007;32:2220–5.

    Article  Google Scholar 

  5. Asher M, Min Lai S, Burton D, et al. The reliability and concurrent validity of the Scoliosis Research Society-22 patient questionnaire for idiopathic scoliosis. Spine (Phila Pa 1976) 2003;28:63–9.

    Article  Google Scholar 

  6. Asher M, Min Lai S, Burton D, et al. Scoliosis Research Society-22 patient questionnaire: responsiveness to change associated with surgical treatment. Spine (Phila Pa 1976) 2003;28:70–3.

    Article  Google Scholar 

  7. Hays RD, Woolley JM. The concept of clinically meaningful difference in health-related quality-of-life research. How meaningful is it? Phar-macoeconomics 2000;18:419–23.

    Article  CAS  PubMed  Google Scholar 

  8. Sciubba DM, Scheer JK, Yurter A, et al. Patients with spinal deformity over the age of 75: a retrospective analysis of operative versus non-operative management. Eur Spine J 2016;25:2433–41.

    Article  PubMed  Google Scholar 

  9. Liu S, Schwab F, Smith JS, et al. Likelihood of reaching minimal clinically important difference in adult spinal deformity: a comparison of operative and nonoperative treatment. Ochsner J 2014;14:67–77.

    PubMed  PubMed Central  Google Scholar 

  10. Copay AG, Subach BR, Glassman SD, et al. Understanding the minimum clinically important difference: a review of concepts and methods. Spine J 2007;7:541–6.

    Article  PubMed  Google Scholar 

  11. Wyrwich KW, Tierney WM, Wolinsky FD. Further evidence supporting an SEM-based criterion for identifying meaningful intra-individual changes in health-related quality of life. J Clin Epidemiol 1999;52:861–73.

    Article  CAS  PubMed  Google Scholar 

  12. Jayadevappa R, Malkowicz SB, Wittink M, et al. Comparison of distribution- and anchor-based approaches to infer changes in health-related quality of life of prostate cancer survivors. Health Serv Res 2012;47:1902–25.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Wright A, Hannon J, Hegedus EJ, et al. Clinimetrics corner: a closer look at the minimal clinically important difference (MCID). J Man Manip Ther 2012;20:160–6.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Cook CE. Clinimetrics corner: the minimal clinically important change score (MCID): a necessary pretense. J ManManip Ther 2008;16:E82–3.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Ames C, Gammal I, Matsumoto M, et al. Geographic and ethnic variations in radiographic disability thresholds: analysis of North American and Japanese operative adult spinal deformity populations. Neurosurgery 2016;78:793–801.

    Article  PubMed  Google Scholar 

  16. Crawford 3rd CH, Glassman SD, Bridwell KH, et al. The minimum clinically important difference in SRS-22R Total Score, Appearance, Activity and Pain domains after surgical treatment of adult spinal deformity. Spine (Phila Pa 1976) 2015;40:377–81.

    Article  Google Scholar 

  17. Hashimoto H, Sase T, Arai Y, et al. Validation of a Japanese version of the Scoliosis Research Society-22 Patient Questionnaire among idiopathic scoliosis patients in Japan. Spine (Phila Pa 1976) 2007;32:E141–6.

    Article  Google Scholar 

  18. Asher M, Min Lai S, Burton D, et al. Discrimination validity of the Scoliosis Research Society-22 patient questionnaire: relationship to idiopathic scoliosis curve pattern and curve size. Spine (Phila Pa 1976) 2003;28:74–8.

    Article  Google Scholar 

  19. SRS-30 Patient Questionnaire/Score Sheet [Scoliosis Research Society web site]. Available at: https://www.srs.org/UserFiles/file/outcomes/srs-30.pdf. Accessed January 10, 2017.

  20. Jaeschke R, Singer J, Guyatt GH. Measurement of health status. Ascertaining the minimal clinically important difference. Control Clin Trials 1989;10:407–15.

    Article  CAS  PubMed  Google Scholar 

  21. Sciubba DM, Scheer JK, Smith JS, et al. Which daily functions are most affected by stiffness following total lumbar fusion: comparison of upper thoracic and thoracolumbar proximal endpoints. Spine (Phila Pa 1976) 2015;40:1338–44.

    Article  Google Scholar 

  22. Glassman SD, Schwab F, Bridwell KH, et al. Do 1–year outcomes predict 2-year outcomes for adult deformity surgery? Spine J 2009 ;9: 317–22.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, Shizuoka, 431-3192, Japan

    Hideyuki Arima MD, PhD, Yu Yamato MD, PhD, Tomohiko Hasegawa MD, PhD, Sho Kobayashi MD, PhD, Go Yoshida MD, Tomohiro Banno MD, Yuki Mihara MD, Hiroki Ushirozako MD & Yukihiro Matsuyama MD, PhD

  2. Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY, 40202, USA

    Hideyuki Arima MD, PhD, Leah Y. Carreon MD, MSc, Steven D. Glassman MD & Shin Oe MD

  3. Department of Orthopaedic Surgery, University of Louisville School of Medicine, 550 S. Jackson Street, 1st Floor ACB, Louisville, KY, 40202, USA

    Hideyuki Arima MD, PhD & Steven D. Glassman MD

  4. Division of Geriatric Musculoskeletal Health, Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-Ku, Hamamatsu-city, Shizuoka, 431-3192, Japan

    Daisuke Togawa MD, PhD

  5. Department of Orthopaedic Surgery, Hamamatsu Medical Center, Hamamatsu, Shizuoka, 431-3192, Japan

    Tatsuya Yasuda MD

Authors
  1. Hideyuki Arima MD, PhD
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  2. Leah Y. Carreon MD, MSc
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  3. Steven D. Glassman MD
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  4. Yu Yamato MD, PhD
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  5. Tomohiko Hasegawa MD, PhD
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  6. Daisuke Togawa MD, PhD
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  7. Sho Kobayashi MD, PhD
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  8. Go Yoshida MD
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  9. Tatsuya Yasuda MD
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  10. Tomohiro Banno MD
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  11. Shin Oe MD
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  12. Yuki Mihara MD
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  13. Hiroki Ushirozako MD
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  14. Yukihiro Matsuyama MD, PhD
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Corresponding author

Correspondence to Hideyuki Arima MD, PhD.

Additional information

Author disclosures: HA (none), LYC (other from Spine, other from Spine Journal, other from University of Louisville, other from Scoliosis Research Society, personal fees from Washington University, personal feesfrom AO Spine, personal fees from Norton Healthcare, grants from Orthopedic Research and Educational Fund, grants from Scoliosis Research Society, grants from Norton Healthcare James R. Petersdorf, personal fees from University of Louisville, personal fees from Association for Collaborative Spine Research, personal fees from Center for Spine Surgery and Research, Region of Southern Denmark, other from NuVasive, outside the submitted work), SDG (paid employee of Norton Healthcare; receives institutional grants from Norton Healthcare, patents and royalties from Medtronic), YY (none), TH (none), DT (other from Medtronic Sofamor Danek, Inc [Memphis, TN], other from Japan Medical Dynamic Marketing Inc. [Tokyo, Japan], other from Meitoku Medical Institute Jyuzen Memorial Hospital [Hamamatsu, Japan], during the conduct of the study), SK (none), GY (none), TY (none), TB (none), SO (has a donated fund laboratory by Medtronic Sofamor Danek, Inc [Memphis, TN], Japan Medical Dynamic Marketing Inc. [Tokyo, Japan], and Meitoku Medical Institute Jyuzen Memorial Hospital [Hamamatsu, Japan], YM (none), HU (none), YM (none).IRB approval: This study was reviewed and approved by the Hamamatsu University School of Medicine Institutional Review Board.

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Arima, H., Carreon, L.Y., Glassman, S.D. et al. Cultural Variations in the Minimum Clinically Important Difference Thresholds for SRS-22R After Surgery for Adult Spinal Deformity. Spine Deform 7, 627–632 (2019). https://doi.org/10.1016/j.jspd.2018.10.003

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  • DOI: https://doi.org/10.1016/j.jspd.2018.10.003

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