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ABSTRACT: PURPOSE: To review and summarize the current knowledge regarding the outcome measures used to evaluate scoliosis surgery. METHODS: Literature review. RESULTS: Outcome instruments should be tested to ensure that they have adequate metric characteristics: content and construct validity, reliability, and responsiveness. In the evaluation of scoliosis, generic instruments to assess health-related quality of life (HRQL) have been used, such as the SF-36 questionnaire and the EuroQol5D instrument. Nonetheless, it is preferable to use disease-specific instruments for this purpose, such as the SRS-22 Patient Questionnaire and the quality of life profile for spinal deformities (QLPSD). More recently, these generic and disease-specific instruments have been complemented with the use of super-specific instruments; i.e., those assessing a single aspect of the condition or specific populations with the condition. The patients' perception of their trunk deformity and body image has received particular attention, and several instruments are available to evaluate these aspects, such as the Walter-Reed Visual Assessment Scale (WRVAS), the Spinal Appearance Questionnaire (SAQ), and the Trunk Appearance Perception Scale (TAPS). The impacts of brace use can also be measured with specific scales, including the Bad Sobernheim Stress Questionnaire (BSSQ) and the Brace Questionnaire (BrQ). The available instruments to evaluate the treatment for non-idiopathic scoliosis have not been sufficiently validated and analyzed. CONCLUSIONS: Evaluation of scoliosis treatment should include the patient's perspective, which can be obtained with the use of patient-reported outcome measures.
European Spine Journal 05/2012; · 1.97 Impact Factor
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European Spine Journal 03/2010; 19(3):513-4. · 1.97 Impact Factor
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ABSTRACT: The responsiveness of an instrument measuring health-related quality of life is an important indication of its construct validity. The SRS-22 Patient Questionnaire has become the most widely used patient-reported outcome instrument in the clinical evaluation of patients with idiopathic scoliosis. The responsiveness of the SRS-22 following surgical treatment in patients with idiopathic scoliosis has not been fully assessed. The aim of this study is to evaluate this factor by calculating the minimal important differences (MIDs) of the SRS-22 Questionnaire. The study included 91 patients with idiopathic scoliosis (77 females and 14 males), who underwent surgical treatment; mean age at the time of surgery was 18.1 years. Patients completed the SRS-22 questionnaire before surgery and at a follow-up visit (mean follow-up, 45.6 months). At follow-up, patients rated their overall situation as related to before surgery with a four-point Likert scale: 1-Worse, 2-Same, 3-Better, 4-Much Better. This evaluation represented the global perceived effect (GPE) and served as the anchor criterion for calculating the MID. MIDs were calculated using two approaches. The anchor-based MID (MID-A) was defined as the mean preoperative/follow-up difference in SRS-22 scores in the group of patients who stated they were much better than before surgery (GPE = 4). Using the same anchor criterion, the optimal cut-off value able to identify patients that had clearly improved was determined on a receiver operating characteristic (ROC) curve. In addition, the distribution-based MID (MID-D) was calculated by the standard error of measurement method. The MID-As found for the different subscales and the sum score were: pain 0.6, function 0.3, image 1.3, mental health 0.3, average sum score 0.6, and raw sum score 13.1. The cut-off values on the ROC curve were: pain 0.2, function 0.0, image 1.6, mental health 0.4, average sum score 0.4, and raw sum score 10. The MID-Ds were: pain 0.6, function 0.8, image 0.5, mental health 0.4, average sum score 0.5, and raw sum score 6.8. As was expected, the MID values differed according to the calculation method used. In light of the fact that the MID-As for the function and mental health subscales are below the measurement error of the instrument, it seems preferable to use the MID-D values for determining subscale changes. If the purpose is to analyze sum score changes (either the raw or average values), the MID-A is preferable because it includes the patient's evaluation of the results of surgery.
European Spine Journal 07/2009; 18(12):1898-904. · 1.97 Impact Factor
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ABSTRACT: Spine surgery may be associated with profuse intraoperative bleeding that often requires blood transfusions. In recent years several techniques have been developed to avoid allogenic transfusions and their potential complications to surgical patients. In this study we review and analyse the role of preoperative recombinant human erythropoietin (rHuEPO) administration in spine surgery as a blood conservation strategy. Between 1998 and 2002, a total of 250 patients scheduled for spine surgery were included in our blood-sparing program: 114 patients (group 1), operated on before rHuEPO approval (2000), underwent preoperative autologous blood donation (ABD) alone, and 136 patients operated on after rHuEPO approval (groups 2 and 3) received rHuEPO while undergoing ABD. Adding rHuEPO to ABD resulted in higher haemoglobin and haematocrit values the day of surgery, more ABD units retrieved per patient and, consequently, reduced allogenic transfusion requirements. The effectiveness of rHuEPO as the only preoperative blood conservation technique was evaluated in ten patients with a predicted blood loss of less than 30% of their total volume, scheduled for lumbar surgery. Data from these patients were matched with those from a similar group of patients who had undergone ABD. Patients receiving rHuEPO alone had higher haemoglobin levels the day of surgery than did patients in the ABD program. Neither group required allogenic transfusions. Conclusions: preoperative rHuEPO is useful for reducing allogenic blood requirements in elective spine surgery. In patients with an expected blood loss of around 50% of blood volume, rHuEPO improves ABD, minimising preoperative anaemia and increasing the number of ABD units collected. In patients with expected blood loss below 30% of total volume, rHuEPO administration may replace ABD.
European Spine Journal 11/2004; 13 Suppl 1:S40-9. · 1.97 Impact Factor
