title: Early Patient-Reported Outcomes Predict 3-Year Outcomes in Operatively Treated Patients with Adult Spinal Deformity.
abstract: BACKGROUND
  For patients with adult spinal deformity (ASD), surgical treatment may improve their health-related quality of life. This study investigates when the greatest improvement in outcomes occurs and whether incremental improvements in patient-reported outcomes during the first postoperative year predict outcomes at 3 years.
  
  
  METHODS
  Using a multicenter registry, we identified 84 adults with ASD treated surgically from 2008 to 2012 with complete 3-year follow-up. Pairwise t tests and multivariate regression were used for analysis. Significance was set at P < 0.01.
  
  
  RESULTS
  Mean Oswestry Disability Index (ODI) and Scoliosis Research Society-22r total (SRS-22r) scores improved by 13 and 0.8 points, respectively, from preoperatively to 3 years (both P < 0.001). From preoperatively to 6 weeks postoperatively, ODI scores worsened by 5 points (P = 0.049) and SRS-22r scores improved by 0.3 points (P < 0.001). Between 6 weeks and 1 year, ODI and SRS-22r scores improved by 19 and 0.5 points, respectively (both P < 0.001). Incremental improvements during the first postoperative year predicted 3-year outcomes in ODI and SRS-22r scores (adjusted R2= 0.52 and 0.42, respectively). There were no significant differences in the measured or predicted 3-year ODI (P = 0.991) or SRS-22r scores (P = 0.986).
  
  
  CONCLUSIONS
  In surgically treated patients with ASD, the greatest improvements in outcomes occurred between 6 weeks and 1 year postoperatively. A model with incremental improvements from baseline to 6 weeks and from 6 weeks to 1 year can be used to predict ODI and SRS-22r scores at 3 years.
authors.affiliation: Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Amit
authors.initials: A
authors.lastname: Jain
authors.affiliation: Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA. Electronic address: editorialservices@jhmi.edu.
authors.forename: Khaled M
authors.initials: KM
authors.lastname: Kebaish
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Hamid
authors.initials: H
authors.lastname: Hassanzadeh
authors.affiliation: Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA.
authors.forename: Justin K
authors.initials: JK
authors.lastname: Scheer
authors.affiliation: Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Neuman
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA.
authors.forename: Virginie
authors.initials: V
authors.lastname: Lafage
authors.affiliation: Department of Orthopaedic Surgery, New York University, New York, New York, USA.
authors.forename: Shay
authors.initials: S
authors.lastname: Bess
authors.affiliation: Department of Orthopaedic Surgery, New York University, New York, New York, USA.
authors.forename: Themistocles S
authors.initials: TS
authors.lastname: Protopsaltis
authors.affiliation: Department of Orthopaedic Surgery, University of Kansas, Kansas City, Kansas, USA.
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Burton
authors.affiliation: Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Justin S
authors.initials: JS
authors.lastname: Smith
authors.affiliation: Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Shaffrey
authors.affiliation: Department of Orthopaedic Surgery, Baylor University, Waco, Texas, USA.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Hostin
authors.affiliation: Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Ames
mesh_terms: D000328:Adult; D000368:Aged; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D000071066:Patient Reported Outcome Measures; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013122:Spinal Diseases / Q000601:surgery*
keywords: Adult spinal deformity; Oswestry Disability Index; Patient-reported outcomes; Scoliosis Research Society-22r