Feeling better is good but feeling good is better


Assessing patients’ acceptability of the state of their symptoms may be a more critical objective measure of surgery outcomes than measuring symptom improvement, a study presented at Eurospine 2011 has found.

Lead author Anne Mannion, Spine Center Division, Department of Research and Development, Schulthess Klinik, Zurich, Switzerland, and her co-authors conducted a retrospective analysis of prospective data collected from patients who had undergone surgery for painful lumbar degenerative conditions during the past five years to compare the two concepts of patients’ perceptions of symptom improvement and patients’ perceptions of acceptability of symptoms.


They assessed the patients’ “acceptability of symptom state” using the Symptom-Specific Well-Being item, which asked patients how satisfied they would be if they had to live with their current symptoms for the rest of their life (ranging from very satisfied to very dissatisfied). They assessed improvement in symptoms status using the Global Treatment Outcome Rating score, which asked patients if surgery had helped their symptoms (from “helped a lot” to “made symptoms worse”). Surgery was deemed to have a good outcome if it helped or helped a lot.


Of the 3,193 patients who were sent the improvement and acceptability questionnaires, 2,945 (92%) responded. Mannion et al found that about three quarters of patients said that their symptoms were helped or helped a lot by surgery. However, overall, less than 50% of patients found their symptoms acceptable (being “satisfied” or “somewhat satisfied”). Mannion said: “Perhaps more worryingly, about 40% are actively dissatisfied or somewhat dissatisfied with their symptoms.” She added even in those who said surgery had helped or helped a lot, 23% were still dissatisfied or somewhat dissatisfied with their current symptoms. Mannion concluded: “The concepts of improvement and acceptable state are both important to consider as outcomes. While measurements of improvement indicate the achievement of a good response to treatment, they tend to paint a more optimistic picture than when the proportion of patients achieving an acceptable state is examined. In striving to continuously improve the quality of care in spinal surgery and to identify seemingly subtle differences between our increasingly successful treatments, a more critical objective may be the achievement of a symptom state considered acceptable by the patient.”


She added that incorporating a question on the acceptability of the symptom state into a patient follow-up questionnaire after surgery would be a simple and worthwhile endeavour.