Responsiveness of the PROMIS Global Health-10 Survey compared with the Oswestry Disability Index in patients undergoing 1- and 2-level lumbar fusions.

Abstract

The aim of this study was to investigate the responsiveness of the mental health T-score (MHT) and physical health T-score (PHT) of the Patient-Reported Outcomes Measure Information System Global Health-10 Survey (PROMIS-10) compared with the Oswestry Disability Index (ODI) and to determine if the patient-reported outcome measures (PROMs) provided a similar assessment of patient outcomes. A total of 379 patients who underwent 1- or 2-level lumbar fusions between June 2021 and June 2023 were analyzed in this retrospective study. All patients completed their preoperative PROMs as well as their 3-, 6-, and 12-month follow-up PROMs. A responsiveness analysis to assess floor and ceiling effects, the correlation between the PHT and ODI as well as the MHT and ODI, and effect size indices (ESIs) was conducted to determine the responsiveness and construct validation of the MHT and PHT compared with the ODI. Neither the ODI nor the MHT or PHT demonstrated a floor effect; however, up to 16% of the study cohort showed a ceiling effect with the PROMIS, whereas no patients reached the maximum score for the ODI. The PHT was strongly correlated with the ODI score at all time points with the correlation coefficients ranging between -0.71 and -0.82, while the MHT showed weak to moderate correlation (r = 0.48-0.67). The ESI demonstrated that the ODI was the most responsive of the tools assessed followed by the PHT; the MHT was noted to show limited responsiveness. The PROMIS-10 PHT provided similar responsiveness and construct validity as seen with the ODI at detecting functional changes after elective lumbar fusion. The PROMIS-10 MHT provides valuable insight into the patient's current mental health but was not overly responsive to change. The ODI remains the most responsive and accurate tool to assess low back function and postoperative improvement, but the PROMIS-10 can provide additional meaningful data that could be used to augment information gained from the ODI.