title: Accurately measuring outcomes after surgery for adult Chiari I malformation: determining the most valid and responsive instruments.
abstract: BACKGROUND
  There has been a transition to using patient-reported outcome instruments (PROi) to assess surgical effectiveness. However, none of these instruments have been validated for outcomes of adult Chiari I malformation (CMI).
  
  
  OBJECTIVE
  The aim of this study was to determine the relative validity and responsiveness of various PROi in measuring outcomes after surgery for CMI.
  
  
  METHODS
  Fifty patients undergoing suboccipital craniotomy for adult CMI were prospectively followed for 1 year. Baseline and 1-year patient-reported outcomes (visual analog scale for head pain and visual analog scale for neck pain, Neck Disability Index [NDI], Headache Disability Index, SF-12, Zung Self-Rating Depression Scale, and EuroQol-5D [EQ-5D]) were assessed. A level of improvement in general health after surgery was defined as meaningful improvement. Receiver-operating characteristic curves were generated to assess the validity of PROi to discriminate between meaningful improvement and not. The difference between standardized response means (SRMs) in patients reporting meaningful improvement vs not as calculated to determine the relative responsiveness of each outcome instrument.
  
  
  RESULTS
  For pain and disability, the NDI was the most accurate discriminator of meaningful effectiveness (area under the curve: 0.90) and also most responsive to postoperative improvement (standardized response means difference: 1.87). For general health and quality of life, the SF-12 PCS, EQ-5D, and Zung Self-Rating Depression Scale were all accurate discriminators; however, SF-12 Physical Component Scale (SF-12 PCS) and EQ-5D were most accurate. SF-12 PCS was also most responsive.
  
  
  CONCLUSIONS
  For pain and disability, NDI is the most valid and responsive measure of improvement after surgery for CMI. For health-related quality of life, SF-12 PCS and EQ-5D are the most valid and responsive measures. NDI with SF-12 or EQ-5D is the most valid in patients with CMI and should be considered in cost-effectiveness studies.
authors: Department of Neurosurgery, Spinal Column Surgical Outcomes and Quality Research Laboratory, Vanderbilt University, Nashville, Tennessee, USA.
authors: Saniya S
authors: SS
authors: Godil
authors: Scott L
authors: SL
authors: Parker
authors: Scott L
authors: SL
authors: Zuckerman
authors: Stephen K
authors: SK
authors: Mendenhall
authors: Matthew J
authors: MJ
authors: McGirt
mesh_terms: D000328:Adult; D001139:Arnold-Chiari Malformation / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D003399:Craniotomy / Q000379:methods*; D005260:Female; D006261:Headache / Q000175:diagnosis* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D019547:Neck Pain / Q000175:diagnosis* / Q000517:prevention & control*; D017063:Outcome Assessment, Health Care / Q000379:methods; D010147:Pain Measurement / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome