Degenerative cervical spine patients who are aware of their preoperative scores demonstrate better patient-reported outcome measures (PROMs) than those who do not, new research has found. The randomised controlled trial, conducted in a tertiary care neurosurgical unit in Portugal—the results of which were presented by Pedro Valente Aguiar (University of Porto, Porto, Portugal) at EUROSPINE 2022 (19–21 October; Milan, Italy) —sought to assess the impact of recall bias of preoperative status on postoperative PROMs of patients submitted to surgery due to degenerative spine disease.
According to Aguiar et al, the results indicate that “providing preoperative scores to patients upon postoperative PROM fulfilment might influence postoperative results”. However, “further research is necessary to increase the reliability of PROMs in clinical practice”, they add.
All patients submitted to surgery at the Portuguese institution with valid questionnaires from January 2019 to April 2020 due to degenerative lumbar or cervical spine disease were enrolled, and two computer-generated randomised groups were created.
The intervention group was sent postoperative questionnaires including preoperative answers, while patients in the control group were sent the same PROMs without the preoperative scores. The study’s primary endpoint was the median postoperative Core Outcome Measure Index (COMI) score.
A total of 236 patients were randomized (118 for each group) and valid results were obtained for 147 patients (81 lumbar, 44 from the intervention group; and 66 cervical, 29 from the intervention group), from which 88 (60%) were females, with a median age of 58 years. Both groups shared similar baseline clinical characteristics and preoperative scores.
The median postoperative COMI scores and interquartile ranges (IQR) were 4.20 (IQR: 2.3–6) and 5.45 (IQR: 3.75–7.4) for the intervention and control groups, respectively (Wilcoxon, p=0.02). This difference was reached mainly due to cervical spine patients as median postoperative COMI score was 3.95 (IQR: 2.2–5.32) in the intervention group and 5.1 (IQR: 4–8.4) in the control group (Wilcoxon, p=0.01). No significant difference was reached for lumbar patients.
Speaking to Spinal News International, Aguiar said: “As the spine community strives to best understand and apply PROMs in clinical practice, the originality of our study stemmed from the fact that we tried to mitigate memory bias, a factor proven to impact accurate PROMs assessment by providing patients with additional information. This research might change the way we evaluate spine PROMs, as soon postoperative PROMs might be delivered including preoperative answers.”