Authors:Armando Miciano M.D. 1
Robert Castillo, M.S., B.S.Chad Cross, PhD, Pstat(R)2
Presenter:Armando Miciano MD
1. Nevada Rehabilitation Institute, Las Vegas NV2. Crossroads Wellness LLC, Las Vegas NV
American Academy of Physical Medicine & Rehabilitation2014 Annual Assembly, San Diego CA, November 13-16 2014Research – Pain & Spine Medicine: Scientific Presentation
Inclusion of functional measures into outcome determination of individuals with chronic low back pain (CLBP) using a patient-centered approach may provide the factors most potent for care planning.
A core set of measures should include the following five domains: back specific function, generic health status, pain, work disability, and patient satisfaction. [1]
[1] Bombardier C. Spine (Phila Pa 1976). 2000 Dec 15;25(24):3100-3.
Describe a measurement system based on five cardinal constructs of the core set of patient-reported outcome (PRO) measures for CLBP:
1. Symptom quality 2. Pain-related impairment (PRI) 3. Life quality/satisfaction (LQS), 4. Global health status (GHS), and 5. Work disability.
Retrospective study
outpatient PM&R clinic
Individuals with CLBP sub-divided to:
Study group (SG) ◦ n=60◦ defined by those with PROMIS-57 Pain Impact (PROMIS-PI) T-scores >/=60
Comparison group ◦ n=11◦ defined as those with PROMIS-PI <60.
The International Classification of Functioning (ICF) framework (body functions/structures, activity, participation) was used to classify the PRO used: ◦ Numerical Rating Scale (NRS) to describe symptom quality;◦ Pain Disability Questionnaire (PDQ), Modified Oswestry Disability Index (MODI),
and Roland-Morris Questionnaire (RMQ) for PRI; ◦ PROMIS-57 Satisfaction with Social Role (PROMIS-SSR) for LQS; ◦ PROMIS-57 Physical Function (PROMIS-PF) for GHS; and, ◦ Work Productivity & Activity Impairment for work disability.
PDQ=Pain Disability Questionnaire; MODI = Modified Oswestry Disability Index; RMDQ = Roland-Morris Disability Questionnaire; WPAI: GH = Work Productivity & Activity Impairment: General Health
Symptom quality
Pain-related Impairment
Life Satisfaction
Global Health Status
Work Productivity
NumericalRating Scale (NRS)
Generic: i.PDQ
Disease-specific: i.MODI ii.RMDQ
PROMIS-57 - Satisfaction with Social Role
PROMIS-57PhysicalFunction
WPAI: GH
Owing to sample size difference, a nonparametric test, Mann-Whitney U-Test, was used to compare scores between groups.
In all cases a statistically significant difference
was found between groups: ◦ NRS (U=146;p=.006); ◦ PDQ (U=73;p<.001); ◦ MODI (U=46.5;p<.001);◦ RMQ (U=73.5;p<.002); ◦ PROMIS-SSR (U=118.5;p<.001); and, ◦ PROMIS-PF (U=72;p<.001).
Significant positive association between: ◦ SG and impairment
Cramer’s V=.357,p = .004 ◦ SG and employment status
Cramer’s V=.283,p = .005
Significantly greater proportion of the SG: ◦ Had severe/extreme PRI
67% vs. 18%;G2=9.220,p=.005 ◦ Was unemployed
68% vs. 30%;G2=5.207,p=.032 as compared to the comparison group.
Individuals with CLBP and a high pain impact reported:
◦ higher pain severity, ◦ more severe/extreme pain-related impairment, ◦ decreased LQS, ◦ lower GHS, ◦ no work productivity.
Study supports the concept of the five cardinal constructs of the PRO core set for CLBP.
Future research should be on whether patient’s satisfaction with quality of care provided is influenced when these constructs are assessed.