Highlights
- •Patients with cervical spine disease suffer from upper limb functional impairment.
- •No clinical benchmarks exist that define meaningful improvement in the upper limb function following cervical spine surgery.
- •Disabilities of arm, shoulder, and hand (DASH) is a validated outcome measure indicating upper limb disability.
- •This study aimed to establish minimal clinical important difference (MCID) and substantial clinical benefit (SCB) of the DASH score following cervical spine surgery.
- •The MCID of the DASH was –8 points and the SCB was –18 points. These metrics can be used to evaluate minimal and substantial improvement in the upper limb function following cervical spine surgery.
Abstract
BACKGROUND CONTEXT
Patients with cervical spine disease suffer from upper limb disability. At present,
no clinical benchmarks exist for clinically meaningful change in the upper limb function
following cervical spine surgery.
PURPOSE
Primary: to establish clinically meaningful metrics; the minimal clinically important
difference (MCID) and substantial clinical benefit (SCB) of upper limb functional
improvement in patients following cervical spine surgery. Secondary: to identify the
prognostic factors of MCID and SCB of upper limb function following cervical spine
surgery.
STUDY DESIGN
Retrospective cohort study.
PATIENT SAMPLE
Adult patients ≥18 years of age who underwent cervical spine surgery from 2012 to
2016.
OUTCOME MEASURES
Patient-reported outcomes: Neck disability index (NDI) and Disabilities of Arm, Shoulder,
and Hand (DASH).
METHODS
MCID was defined as minimal improvement and SCB as substantial improvement in the
DASH score at last follow-up. The anchor-based methods (ROC analyses) defined optimal
MCID and SCB thresholds with area under curve (AUC) in discriminating improved vs.
non-improved patients. The MCID was also calculated by distribution-based methods:
half standard-deviation (0.5-SD) and standard error of the mean (SEM) method. A multivariable
logistic regression evaluated the impact of baseline factors in achieving the MCID
and SCB in DASH following cervical spine surgery.
RESULTS
Between 2012 and 2016, 1,046 patients with average age of 57±11.3 years, 53% males,
underwent cervical spine surgery. Using the ROC analysis, the threshold for MCID was
–8 points with AUC of 0.73 (95% CI: 0.67–0.79) and the SCB was –18 points with AUC
of 0.88 (95% confidence interval [CI]: 0.85–0.91). The MCID was –11 points by 0.5–SD
and –12 points by SEM-method. On multivariable analysis, patients with myelopathy
had lower odds of achieving MCID and SCB, whereas older patients and those with ≥6
months duration of symptoms had lower odds of achieving DASH MCID and SCB respectively.
CONCLUSIONs
In patients undergoing cervical spine surgery, MCID of –8 points and SCB of –18 points
in DASH improvement may be considered clinically significant. These metrics may enable
evaluation of minimal and substantial improvement in the upper extremity function
following cervical spine surgery.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Spine JournalAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Global maps of non-traumatic spinal cord injury epidemiology: towards a living data repository.Spinal Cord. 2014; 52: 97-109https://doi.org/10.1038/sc.2012.165
- Cervical spondylotic myelopathy: a review of the evidence.Orthop. Clin. North Am. 2010; 41: 193-202https://doi.org/10.1016/j.ocl.2009.12.010
- Myelopathy hand. New clinical signs of cervical cord damage.J. Bone Joint Surg. Br. 1987; 69: 215-219https://doi.org/10.1302/0301-620x.69b2.3818752
- Cervical spondylotic myelopathy: the clinical phenomenon and the current pathobiology of an increasingly prevalent and devastating disorder.Neuroscientist. 2013; 19: 409-421https://doi.org/10.1177/1073858412467377
- Quality of life assessment with the medical outcomes study short form-36 among patients with cervical spondylotic myelopathy.Neurosurgery. 2003; 52: 113-120https://doi.org/10.1097/00006123-200301000-00014
- Efficacy and safety of surgical decompression in patients with cervical spondylotic myelopathy: results of the AOSpine North America prospective multi-center study.J. Bone Joint Surg. Am. 2013; 95: 1651-1658https://doi.org/10.2106/jbjs.L.00589
- A global perspective on the outcomes of surgical decompression in patients with cervical spondylotic myelopathy: results from the prospective multicenter AOSpine international study on 479 patients.Spine (Phila Pa 1976). 2015; 40: 1322-1328https://doi.org/10.1097/brs.0000000000000988
- Ancillary outcome measures for assessment of individuals with cervical spondylotic myelopathy.Spine (Phila Pa 1976). 2013; 38: S111-S122https://doi.org/10.1097/BRS.0b013e3182a7f499
- Clinical outcome measures and their evidence base in degenerative cervical myelopathy: a systematic review to inform a core measurement set (AO Spine RECODE-DCM).BMJ Open. 2022; 12e057650https://doi.org/10.1136/bmjopen-2021-057650
- Outcome measures and variables affecting prognosis of cervical spondylotic myelopathy: WFNS spine committee recommendations.Neurospine. 2019; 16: 435-447https://doi.org/10.14245/ns.1938196.098
- Recovery priorities in degenerative cervical myelopathy: a cross-sectional survey of an international, online community of patients.BMJ Open. 2019; 9e031486https://doi.org/10.1136/bmjopen-2019-031486
- Validation of the QuickDASH and DASH in patients with distal radius fractures through agreement analysis.Arch. Phys. Med. Rehabil. 2017; 98: 1217-1222https://doi.org/10.1016/j.apmr.2016.11.023
- Measuring the whole or the parts? Validity, reliability, and responsiveness of the Disabilities of the arm, shoulder and hand outcome measure in different regions of the upper extremity.J. Hand Ther. 2001; 14: 128-146
- Dash and Boston questionnaire assessment of carpal tunnel syndrome outcome: what is the responsiveness of an outcome questionnaire?.J Hand Surg Br. 2004; 29: 159-164https://doi.org/10.1016/j.jhsb.2003.10.010
- The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: longitudinal construct validity and measuring self-rated health change after surgery.BMC Musculoskelet Disord. 2003; 4: 11https://doi.org/10.1186/1471-2474-4-11
- Is the disability of arm, shoulder, and hand questionnaire (DASH) also valid and responsive in patients with neck complaints.Spine (Phila Pa 1976). 2009; 34: E130-E138https://doi.org/10.1097/BRS.0b013e318195a28b
- Concurrent validation of the DASH and the QuickDASH in comparison to neck-specific scales in patients with neck pain.Spine (Phila Pa 1976). 2010; 35: 2150-2156https://doi.org/10.1097/BRS.0b013e3181c85151
- 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. 2010; 10: 469-474https://doi.org/10.1016/j.spinee.2010.02.007
- Minimum clinically important difference in SF-36 scores for use in degenerative cervical myelopathy.Spine (Phila Pa 1976). 2018; 43: E1260-e1266https://doi.org/10.1097/brs.0000000000002684
- The minimum clinically important difference of the modified japanese orthopaedic association scale in patients with degenerative cervical myelopathy.Spine (Phila Pa 1976). 2015; 40: 1653-1659https://doi.org/10.1097/brs.0000000000001127
- Minimal clinically important difference of the disabilities of the arm, shoulder and hand outcome measure (DASH) and its shortened version (QuickDASH).J. Orthop. Sports Phys. Ther. 2014; 44: 30-39https://doi.org/10.2519/jospt.2014.4893
- Validation of the disabilities of the arm, shoulder, and hand in patients undergoing cervical spine surgery.Spine (Phila Pa 1976). 2019; 44: 1676-1684https://doi.org/10.1097/brs.0000000000003138
- Understanding the minimal clinically important difference (MCID) of patient-reported outcome measures.Otolaryngol. Head Neck Surg. 2019; 161: 551-560https://doi.org/10.1177/0194599819852604
- How is the minimal clinically important difference established in health-related quality of life instruments? Review of anchors and methods.Health Qual Life Outcomes. 2020; 18: 136https://doi.org/10.1186/s12955-020-01344-w
- Defining substantial clinical benefit following lumbar spine arthrodesis.J. Bone Joint Surg. Am. 2008; 90: 1839-1847https://doi.org/10.2106/jbjs.G.01095
- Index for rating diagnostic tests.Cancer. 1950; 3: 32-35https://doi.org/10.1002/1097-0142(1950)3:1<32::aid-cncr2820030106>3.0.co;2-3
- Assessing the responsiveness of functional scales to clinical change: an analogy to diagnostic test performance.J. Chronic Dis. 1986; 39: 897-906https://doi.org/10.1016/0021-9681(86)90038-x
- Receiver operating characteristic curve in diagnostic test assessment.J Thorac Oncol. 2010; 5: 1315-1316https://doi.org/10.1097/JTO.0b013e3181ec173d
- glmulti: an R package for easy automated model selection with (generalized) linear models.J Stat Softw. 2010; 34: 1-29
- Model selection: an integral part of inference.Biometrics. 1997; 53: 603-618
- Construct validity and reliability of the disability of arm, shoulder and hand questionnaire for upper extremity complaints in rheumatoid arthritis.J. Rheumatol. 2008; 35: 2334-2338https://doi.org/10.3899/jrheum.080067
- Validity, reliability and ease of use of the disabilities of arm, shoulder and hand questionnaire in adults following stroke.Disabil. Rehabil. 2017; 39: 2504-2511https://doi.org/10.1080/09638288.2016.1229364
- Characteristics of upper limb impairment related to degenerative cervical myelopathy: development of a sensitive hand assessment (graded redefined assessment of strength, sensibility, and prehension version myelopathy).Neurosurgery. 2020; 86: E292-e299https://doi.org/10.1093/neuros/nyz499
- Measuring disability of the upper extremity: a rationale supporting the use of a regional outcome measure.J. Hand Ther. 1999; 12: 269-274https://doi.org/10.1016/s0894-1130(99)80063-5
- Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The upper extremity collaborative group (UECG).Am. J. Ind. Med. 1996; 29: 602-608https://doi.org/10.1002/(sici)1097-0274(199606)29:6<602::Aid-ajim4>3.0.Co;2-l
- Can the patient-centered outcomes research institute become relevant to controlling medical costs and improving value?.Jama. 2011; 306: 2020-2021https://doi.org/10.1001/jama.2011.1621
- A clinical prediction rule for functional outcomes in patients undergoing surgery for degenerative cervical myelopathy: analysis of an international prospective multicenter data set of 757 subjects.J. Bone Joint Surg. Am. 2015; 97: 2038-2046https://doi.org/10.2106/jbjs.O.00189
- Predicting the minimum clinically important difference in patients undergoing surgery for the treatment of degenerative cervical myelopathy.Neurosurg Focus. 2016; 40: E14https://doi.org/10.3171/2016.3.Focus1665
- A systematic review of clinical and surgical predictors of complications following surgery for degenerative cervical myelopathy.J Neurosurg Spine. 2016; 24: 77-99https://doi.org/10.3171/2015.3.Spine14971
- Predictors of patient satisfaction following 1- or 2-level anterior cervical discectomy and fusion: insights from the quality outcomes database.J Neurosurg Spine. 2019; 30: 1-9https://doi.org/10.3171/2019.6.Spine19426
Article info
Publication history
Published online: January 25, 2023
Accepted:
January 18,
2023
Received in revised form:
December 24,
2022
Received:
September 25,
2022
Footnotes
FDA device/drug status: Not applicable.
Author disclosures: SJ: Nothing to disclose. JKG: Nothing to disclose. BHP: Nothing to disclose. JKZ: Nothing to disclose. AY: Nothing to disclose. CFD: Nothing to disclose. JMK: Nothing to disclose. MR-C: Nothing to disclose. RSL: Nothing to disclose. CAM: Nothing to disclose. PS: Nothing to disclose. NA: Royalties: Thieme Medical Publishers (Unknown number of options, <1% ownership), Royalties: Springer Publishing Company (Unknown number of options, <1% ownership). BP: Nothing to disclose. WZR: Stock Ownership: Acera (Unknown number of options, <1% ownership), Consulting: Globus (Unknown number of options, <1% ownership), Consulting: DePuy Synthes (Unknown number of options, <1% ownership), Consulting: Nuvasive (Unknown number of options, <1% ownership), Consulting: Corelink (Unknown number of options, <1% ownership), Consulting: Pacira (Unknown number of options, <1% ownership).
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
