From the Patient’s Point of View: Patient- Centered Outcomes in Spine Surgery

Introduction: A patient-centered approach to outcomes assessment necessitates knowledge of the outcomes that patients deem most important for their quality of life and overall health. To assess patient expectations with regard to seeking spine care, we conducted a prospective study of what outcome metrics were deemed most valuable to patients seeking evaluation at a tertiary spine surgery center. Materials & Methods: Patients seeking evaluation at an academic spine surgery practice at Thomas Jefferson University in Philadelphia were offered a survey at intake. The two-question survey explored the issues most important for consulting a neurosurgeon. Survey data was acquired over three months in early 2010. Of the surveys distributed, 335 responded, with 147 patients completing the full survey and 188 responding to the first question alone. Results: Pain was the primary impetus for patients seeking evaluation: 73.4% of the total surveyed group reported that pain in the back or neck was one of the major concerns for their visit. Similarly, 51% of responders indicated that pain in the back or neck was the single most important issue they wanted addressed. Frequency of responses dropped significantly for the next responses, including weakness/numbness in the leg (39.7%), problems walking (39.7%), pain shooting down the leg (30.7%), and problems sleeping (30.1%). Conclusions: It is possible that current outcomes measures for spine surgery, including the VAS, ODI, SF-36, and EQ-5D, are either excessive or insufficient and should be adjusted to reflect patient concerns. Changing these measures, enforcing conformance with patientcentered choices of which outcome measures are most valuable, would be one approach to producing patient-specific outcomes measures in spine surgery. Alternatively, present measures may be more comprehensive, and by reducing measures to what patients care about, the quality of data captured may be limited. To determine future directions for patientcentered care, similar surveys should be rigorously conducted, reviewed, and compared to validated outcomes. Categories: Miscellaneous, Neurosurgery