Reaching minimal clinically important difference in adult spinal deformity surgery: a comparison of patients from North America and Japan

Restricted access

OBJECTIVE

The Scoliosis Research Society-22r questionnaire (SRS-22r) has been shown to be reliable, valid, and responsive to change in patients with adult spinal deformity (ASD) undergoing surgery. The minimal clinically important difference (MCID) is the smallest difference in a health-related quality of life score that is considered to be worthwhile or clinically important to the individual. The authors hypothesized that the proportion of patients with ASD achieving an MCID in the SRS-22r score would be different between two culturally different cohorts. The purpose of this study was to compare the proportion of patients with ASD achieving MCID for the SRS-22r domains in North American (NA) and Japanese cohorts.

METHODS

A total of 137 patients from North America (123 women, mean age 60.0 years) and 60 patients from Japan (56 women, mean age 65.5 years) with at least 2 years of follow-up after corrective spine surgery for ASD were included. Except for self-image, published Japanese MCID values of SRS-22r for ASD were higher (function = 0.90, pain = 0.85, self-image = 1.05, subtotal = 1.05) than the published NA MCID values (function = 0.60, pain = 0.40, self-image = 1.23, subtotal = 0.43).

RESULTS

There was a statistically significant improvement in all SRS-22r domain scores at 2 years compared to baseline in both cohorts. Except for mental health (NA = 0.32, Japanese = 0.72, p = 0.005), the mean improvement from baseline to 2 years was similar between the NA and Japanese cohorts. The proportion of patients achieving MCID was higher in North America for function (NA = 51%, Japanese = 30%, p = 0.006), pain (NA = 80%, Japanese = 47%, p < 0.001), and subtotal (NA = 72%, Japanese = 35%, p < 0.001), while there was no significant difference for self-image (NA = 53%, Japanese = 58%, p = 0.454).

CONCLUSIONS

Despite similar improvements in SRS-22r domain scores from baseline to 2 years postoperatively, the proportion of patients reaching SRS-22r MCID for function, pain, and subtotal after ASD surgery was higher in the NA cohort than in the Japanese cohort. This may imply that patients in North America and Japan may value observed changes in clinical status differently.

ABBREVIATIONS ADLs = activities of daily living; ASD = adult spinal deformity; HRQOL = health-related quality of life; LL = lumbar lordosis; MCID = minimal clinically important difference; NA = North American; PI = pelvic incidence; PRO = patient-reported outcome; PT = pelvic tilt; SRS-22r = Scoliosis Research Society-22r questionnaire; SVA = sagittal vertical axis; UIV = upper instrumented vertebra.
Article Information

Contributor Notes

Correspondence Hideyuki Arima: Norton Leatherman Spine Center, Louisville, KY. arihidee@gmail.com.INCLUDE WHEN CITING Published online January 31, 2020; DOI: 10.3171/2019.12.SPINE19593.Disclosures Dr. Glassman reports being an employee of Norton Healthcare; being a consultant for K2M and Medtronic; receiving royalties from Medtronic; receiving clinical or research support for the study from NuVasive; and being a patent holder for Medtronic. Dr. Carreon reports being an employee of Norton Healthcare; receiving funds for travel from the University of Southern Denmark and the University of Louisville; that her institution received research funds from OREF, NIH, ISSG, SRS, TSRH, Pfizer, LifeSciences Corp., IntelliRod, Cerapedics, Medtronic, Empirical Spine, and the NeuroPoint Alliance; being a member of the Editorial Advisory Board of Spine Deformity, The Spine Journal, and Spine; and being a member of the University of Louisville IRB and the Research Committee of the SRS.
Headings
References
  • 1

    Ames CGammal IMatsumoto MHosogane NSmith JSProtopsaltis T: Geographic and ethnic variations in radiographic disability thresholds: analysis of North American and Japanese operative adult spinal deformity populations. Neurosurgery 78:7938012016

    • Search Google Scholar
    • Export Citation
  • 2

    Ames CPSmith JSPellisé FKelly MAlanay AAcaroğlu E: Artificial intelligence based hierarchical clustering of patient types and intervention categories in adult spinal deformity surgery: towards a new classification scheme that predicts quality and value. Spine (Phila Pa 1976) 44:9159262019

    • Search Google Scholar
    • Export Citation
  • 3

    Ames CPSmith JSScheer JKBess SBederman SSDeviren V: Impact of spinopelvic alignment on decision making in deformity surgery in adults: a review. J Neurosurg Spine 16:5475642012

    • Search Google Scholar
    • Export Citation
  • 4

    Arima HCarreon LYGlassman SDYamato YHasegawa TTogawa D: Cultural variations in the minimum clinically important difference thresholds for SRS-22R after surgery for adult spinal deformity. Spine Deform 7:6276322019

    • Search Google Scholar
    • Export Citation
  • 5

    Asher MMin Lai SBurton DManna B: Discrimination validity of the Scoliosis Research Society-22 patient questionnaire: relationship to idiopathic scoliosis curve pattern and curve size. Spine (Phila Pa 1976) 28:74782003

    • Search Google Scholar
    • Export Citation
  • 6

    Asher MMin Lai SBurton DManna B: The reliability and concurrent validity of the Scoliosis Research Society-22 patient questionnaire for idiopathic scoliosis. Spine (Phila Pa 1976) 28:63692003

    • Search Google Scholar
    • Export Citation
  • 7

    Asher MMin Lai SBurton DManna B: Scoliosis Research Society-22 patient questionnaire: responsiveness to change associated with surgical treatment. Spine (Phila Pa 1976) 28:70732003

    • Search Google Scholar
    • Export Citation
  • 8

    Baldus CBridwell KHHarrast JEdwards CIIGlassman SHorton W: Age-gender matched comparison of SRS instrument scores between adult deformity and normal adults: are all SRS domains disease specific? Spine (Phila Pa 1976) 33:221422182008

    • Search Google Scholar
    • Export Citation
  • 9

    Berven SDeviren VDemir-Deviren SHu SSBradford DS: Studies in the modified Scoliosis Research Society Outcomes Instrument in adults: validation, reliability, and discriminatory capacity. Spine (Phila Pa 1976) 28:216421692003

    • Search Google Scholar
    • Export Citation
  • 10

    Blendon RJLeitman RMorrison IDonelan K: Satisfaction with health systems in ten nations. Health Aff (Millwood) 9:1851921990

  • 11

    Bridwell KHBerven SGlassman SHamill CHorton WC IIILenke LG: Is the SRS-22 instrument responsive to change in adult scoliosis patients having primary spinal deformity surgery? Spine (Phila Pa 1976) 32:222022252007

    • Search Google Scholar
    • Export Citation
  • 12

    Copay AGSubach BRGlassman SDPolly DW JrSchuler TC: Understanding the minimum clinically important difference: a review of concepts and methods. Spine J 7:5415462007

    • Search Google Scholar
    • Export Citation
  • 13

    Crawford CH IIIGlassman SDBridwell KHBerven SHCarreon LY: 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) 40:3773812015

    • Search Google Scholar
    • Export Citation
  • 14

    Glassman SDCarreon LYShaffrey CIPolly DWOndra SLBerven SH: The costs and benefits of nonoperative management for adult scoliosis. Spine (Phila Pa 1976) 35:5785822010

    • Search Google Scholar
    • Export Citation
  • 15

    Glassman SDSchwab FBridwell KHShaffrey CHorton WHu S: Do 1-year outcomes predict 2-year outcomes for adult deformity surgery? Spine J 9:3173222009

    • Search Google Scholar
    • Export Citation
  • 16

    Hashimoto HSase TArai YMaruyama TIsobe KShouno Y: Validation of a Japanese version of the Scoliosis Research Society-22 Patient Questionnaire among idiopathic scoliosis patients in Japan. Spine (Phila Pa 1976) 32:E141E1462007

    • Search Google Scholar
    • Export Citation
  • 17

    Hays RDWoolley JM: The concept of clinically meaningful difference in health-related quality-of-life research. How meaningful is it? Pharmacoeconomics 18:4194232000

    • Search Google Scholar
    • Export Citation
  • 18

    Hosogane NAmes CMatsumoto MYagi MMatsuyama YTaneichi H: Ethnic variations in radiographic parameters and SRS-22 scores in adult spinal deformity: a comparison between North American and Japanese patients above 50 years of age with minimum 2-year follow-up. Clin Spine Surg 31:2162212018

    • Search Google Scholar
    • Export Citation
  • 19

    Kurata JHWatanabe YMcBride CKawai KAndersen R: A comparative study of patient satisfaction with health care in Japan and the United States. Soc Sci Med 39:106910761994

    • Search Google Scholar
    • Export Citation
  • 20

    O’Brien MKuklo TBlanke KLenke L: Spinal Deformity Study Group Radiographic Measurement Manual. Memphis: Medtronic Sofamor Danek USA2005

    • Search Google Scholar
    • Export Citation
  • 21

    Sciubba DMScheer JKYurter ASmith JSLafage VKlineberg E: Patients with spinal deformity over the age of 75: a retrospective analysis of operative versus non-operative management. Eur Spine J 25:243324412016

    • Search Google Scholar
    • Export Citation
  • 22

    Smith JSLafage VShaffrey CISchwab FLafage RHostin R: Outcomes of operative and nonoperative treatment for adult spinal deformity: a prospective, multicenter, propensity-matched cohort assessment with minimum 2-year follow-up. Neurosurgery 78:8518612016

    • Search Google Scholar
    • Export Citation
  • 23

    Togawa DHasegawa TYamato YYoshida GKobayashi SYasuda T: Postoperative disability after long corrective fusion to the pelvis in elderly patients with spinal deformity. Spine (Phila Pa 1976) 43:E804E8122018

    • Search Google Scholar
    • Export Citation
TrendMD
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 168 168 168
Full Text Views 20 20 20
PDF Downloads 21 21 21
EPUB Downloads 0 0 0
PubMed
Google Scholar