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.