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Assessment of the minimum clinically important difference in neurological function and quality of life after surgery in cervical spondylotic myelopathy patients: a prospective cohort study

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Abstract

Purpose

The purpose of this study was to evaluate the application of the minimum clinically important difference (MCID) concept to postoperative clinical results by using a prospective cohort study in Chinese patients with cervical spondylotic myelopathy (CSM).

Methods

The sample consisted of 113 patients who underwent surgical treatment for CSM in our hospital between February 2008 and November 2012. The preoperative and 1-year postoperative modified Japanese Orthopaedic Association (mJOA) scores, mJOA score recovery rate, physical component summary (PCS) and mental component summary (MCS) of the Short Form 36 were collected. The MCID of each outcome measurement was calculated by four approaches including average change, minimum detectable change, change difference and receiver operating characteristic curve. The responsiveness of each measurement was then analyzed.

Results

The patients presented a statistically significant improvement (p < 0.01) postoperatively in mJOA, PCS, and MCS. The MCID calculated by four approaches varied from 4.09 to 9.62 for the PCS, 3.11 to 7.41 for the MCS, 1.25 to 3.07 for mJOA score, and 31.37 to 44.02 % for mJOA recovery rate. In addition, the improvement of the mJOA score owned the highest responsiveness of the four outcome measurements.

Conclusions

The threshold value of the MCID was determined by the choice of the assessment approach. In addition, the recovery rate of the mJOA score appeared to be the most valid and responsive measure of effectiveness of surgery in CSM patients.

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References

  1. Chang V, Holly LT (2013) Controversies in the management of cervical spondylotic myelopathy. J Neurosurg Sci 57:241–252

    CAS  PubMed  Google Scholar 

  2. Fehlings MG, Arvin B (2009) Surgical management of cervical degenerative disease: the evidence related to indications, impact, and outcome. J Neurosurg Spine 11:97–100. doi:10.3171/2009.5.SPINE09210

    Article  PubMed  Google Scholar 

  3. Grosso MJ, Hwang R, Mroz T, Benzel E, Steinmetz MP (2013) Relationship between degree of focal kyphosis correction and neurological outcomes for patients undergoing cervical deformity correction surgery. J Neurosurg Spine 18:537–544. doi:10.3171/2013.2.SPINE12525

    Article  PubMed  Google Scholar 

  4. Singh A, Gnanalingham K, Casey A, Crockard A (2006) Quality of life assessment using the Short Form-12 (SF-12) questionnaire in patients with cervical spondylotic myelopathy: comparison with SF-36. Spine (Phila Pa 1976) 31:639–643. doi:10.1097/01.brs.0000202744.48633.44

    Article  Google Scholar 

  5. Carreon LY, Glassman SD, Campbell MJ, Anderson PA (2010) Neck Disability Index, Short Form 36 physical component summary, and pain scales for neck and arm pain: the minimum clinically important difference and substantial clinical benefit after cervical spine fusion. Spine J 10:469–474. doi:10.1016/j.spinee.2010.02.007

    Article  PubMed  Google Scholar 

  6. Lauche R, Langhorst J, Dobos GJ, Cramer H (2013) Clinically meaningful differences in pain, disability and quality of life for chronic nonspecific neck pain—a reanalysis of four randomized controlled trials of cupping therapy. Complement Ther Med 21:342–347. doi:10.1016/j.ctim.2013.04.005

    Article  PubMed  Google Scholar 

  7. Auffinger B, Lam S, Shen J, Thaci B, Roitberg BZ (2013) Usefulness of minimum clinically important difference for assessing patients with subaxial degenerative cervical spine disease: statistical versus substantial clinical benefit. Acta Neurochir (Wien) 155:2345–2354. doi:10.1007/s00701-013-1909-4 (discussion 2355)

    Article  Google Scholar 

  8. King JT Jr, McGinnis KA, Roberts MS (2003) Quality of life assessment with the medical outcomes study Short Form 36 among patients with cervical spondylotic myelopathy. Neurosurgery 52:113–120 (discussion 121)

    PubMed  Google Scholar 

  9. Machino M, Yukawa Y, Hida T, Ito K, Nakashima H, Kanbara S, Morita D, Kato F (2012) The prevalence of pre- and postoperative symptoms in patients with cervical spondylotic myelopathy treated by cervical laminoplasty. Spine (Phila Pa 1976) 37:E1383–E1388. doi:10.1097/BRS.0b013e3182684c68

    Article  Google Scholar 

  10. Brozek JL, Guyatt GH, Schunemann HJ (2006) How a well-grounded minimal important difference can enhance transparency of labelling claims and improve interpretation of a patient reported outcome measure. Health Qual Life Outcomes 4:69. doi:10.1186/1477-7525-4-69

    Article  PubMed Central  PubMed  Google Scholar 

  11. Juniper EF, Guyatt GH, Willan A, Griffith LE (1994) Determining a minimal important change in a disease-specific Quality of Life Questionnaire. J Clin Epidemiol 47:81–87

    Article  CAS  PubMed  Google Scholar 

  12. Hagg O, Fritzell P, Nordwall A, Swedish Lumbar Spine Study G (2003) The clinical importance of changes in outcome scores after treatment for chronic low back pain. Eur Spine J 12:12–20. doi:10.1007/s00586-002-0464-0

    CAS  PubMed  Google Scholar 

  13. Wells G, Beaton D, Shea B, Boers M, Simon L, Strand V, Brooks P, Tugwell P (2001) Minimal clinically important differences: review of methods. J Rheumatol 28:406–412

    CAS  PubMed  Google Scholar 

  14. van der Roer N, Ostelo RW, Bekkering GE, van Tulder MW, de Vet HC (2006) Minimal clinically important change for pain intensity, functional status, and general health status in patients with nonspecific low back pain. Spine (Phila Pa 1976) 31:578–582. doi:10.1097/01.brs.0000201293.57439.47

    Article  Google Scholar 

  15. Dattani R, Slobogean GP, O’Brien PJ, Broekhuyse HM, Blachut PA, Guy P, Lefaivre KA (2013) Psychometric analysis of measuring functional outcomes in tibial plateau fractures using the Short Form 36 (SF-36), Short Musculoskeletal Function Assessment (SMFA) and the Western Ontario McMaster Osteoarthritis (WOMAC) questionnaires. Injury 44:825–829. doi:10.1016/j.injury.2012.10.020

    Article  CAS  PubMed  Google Scholar 

  16. Bombardier C, Melfi CA, Paul J, Green R, Hawker G, Wright J, Coyte P (1995) Comparison of a generic and a disease-specific measure of pain and physical function after knee replacement surgery. Med Care 33:AS131–AS144

    CAS  PubMed  Google Scholar 

  17. Parker SL, Godil SS, Shau DN, Mendenhall SK, McGirt MJ (2013) Assessment of the minimum clinically important difference in pain, disability, and quality of life after anterior cervical discectomy and fusion: clinical article. J Neurosurg Spine 18:154–160. doi:10.3171/2012.10.SPINE12312

    Article  PubMed  Google Scholar 

  18. Copay AG, Glassman SD, Subach BR, Berven S, Schuler TC, Carreon LY (2008) Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and pain scales. Spine J 8:968–974. doi:10.1016/j.spinee.2007.11.006

    Article  PubMed  Google Scholar 

  19. Parker SL, Mendenhall SK, Shau DN, Adogwa O, Anderson WN, Devin CJ, McGirt MJ (2012) Minimum clinically important difference in pain, disability, and quality of life after neural decompression and fusion for same-level recurrent lumbar stenosis: understanding clinical versus statistical significance. J Neurosurg Spine 16:471–478. doi:10.3171/2012.1.SPINE11842

    Article  PubMed  Google Scholar 

  20. Toledano M, Bartleson JD (2013) Cervical spondylotic myelopathy. Neurol Clin 31:287–305. doi:10.1016/j.ncl.2012.09.003

    Article  PubMed  Google Scholar 

  21. Matsunaga S, Sakou T (2012) Ossification of the posterior longitudinal ligament of the cervical spine: etiology and nature history. Spine (Phila Pa 1976) 37:E309–E314. doi:10.1097/BRS.0b013e318241ad33

    Article  Google Scholar 

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Author notes

    Authors and Affiliations

    1. Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, China

      Feifei Zhou, Yilong Zhang, Yu Sun, Fengshan Zhang, Shengfa Pan & Zhongjun Liu

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    1. Feifei Zhou
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    2. Yilong Zhang
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    3. Yu Sun
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    4. Fengshan Zhang
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    5. Shengfa Pan
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    6. Zhongjun Liu
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    Correspondence to Yu Sun.

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    Additional information

    F. Zhou and Y. Zhang contributed equally to this work.

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    Zhou, F., Zhang, Y., Sun, Y. et al. Assessment of the minimum clinically important difference in neurological function and quality of life after surgery in cervical spondylotic myelopathy patients: a prospective cohort study. Eur Spine J 24, 2918–2923 (2015). https://doi.org/10.1007/s00586-015-4208-3

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    • DOI: https://doi.org/10.1007/s00586-015-4208-3

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