Publikation

Lower Extremity Motor Deficits Are Underappreciated in Patient-Reported Outcome Measures: Added Value of Objective Outcome Measures

Wissenschaftlicher Artikel/Review - 26.01.2020

Bereiche
PubMed
DOI

Zitation
Stienen M, Maldaner N, Sosnova M, Joswig H, Corniola M, Regli L, Hildebrandt G, Schaller K, Gautschi O. Lower Extremity Motor Deficits Are Underappreciated in Patient-Reported Outcome Measures: Added Value of Objective Outcome Measures. Neurospine 2020; 17:270-280.
Art
Wissenschaftlicher Artikel/Review (Englisch)
Zeitschrift
Neurospine 2020; 17
Veröffentlichungsdatum
26.01.2020
ISSN (Druck)
2586-6583
Seiten
270-280
Kurzbeschreibung/Zielsetzung

OBJECTIVE
The patient-reported outcome measure (PROM)-based evaluation in lumbar degenerative disc disease (DDD) is today's gold standard but has limitations. We studied the impact of lower extremity motor deficits (LEMDs) on PROMs and a new objective outcome measure.

METHODS
We evaluated patients with lumbar DDD from a prospective 2-center database. LEMDs were graded according to the British Medical Research Council (BMRC; 5 [normal] -0 [no movement]). The PROM-based evaluation included pain (visual analogue scale), disability (Oswestry Disability Index [ODI] & Roland-Morris Disability Index [RMDI]), and health-related quality of life (HRQoL; Short-Form 12 physical component summary/mental component summary & EuroQol-5D index). Objective functional impairment (OFI) was determined as age- and sex-adjusted Timed-Up and Go (TUG) test value.

RESULTS
One hundred five of 375 patients (28.0%) had a LEMD. Patients with LEMD had slightly higher disability (ODI: 52.8 vs. 48.2, p = 0.025; RMDI: 12.6 vs. 11.3, p = 0.034) but similar pain and HRQoL scores. OFI T-scores were significantly higher in patients with LEMD (144.2 vs. 124.3, p = 0.006). When comparing patients with high- (BMRC 0-2) vs. low-grade LEMD (BMRC 3-4), no difference was evident for the PROM-based evaluation (all p > 0.05) but patients with high-grade LEMD had markedly higher OFI T-scores (280.9 vs. 136.0, p = 0.001). Patients with LEMD had longer TUG test times and OFI T-scores than matched controls without LEMDs.

CONCLUSION
Our data suggest that PROMs fail to sufficiently account for LEMD-associated disability, which is common and oftentimes bothersome to patients. The objective functional evaluation with the TUG test appears to be more sensitive to LEMD-associated disability. An objective functional evaluation of patients with LEMD appears reasonable.