Neurosurgery Resident Physician Dell Medical School at The University of Texas at Austin
Introduction: The primary objective of this study is to establish pre-operative patient-reported outcome measures (PROM) thresholds that can predict whether Adolescent Idiopathic Scoliosis (AIS) patients are likely to experience a significant improvement in post-operative outcomes, defined as achieving at least one Minimum Clinically Important Differences (MCID). The PROMs analyzed include function, pain, self-image, and mental health scores.
Methods: PROMs were recorded at preoperative, 1-year post-operative, and 2-year post-operative intervals. The MCID was defined as a change of at least 1 point in any PROM score, representing the smallest difference considered clinically meaningful by patients. Logistic regression models were developed to estimate the likelihood of achieving MCID based on pre-operative scores. ROC curve analysis and Youden’s J statistic were employed to establish preliminary thresholds, followed by cross-validation and grid search to fine-tune the cut-offs. The ROC-AUC scores were compared across PROMs to identify the most predictive metrics.
Results: The cohort consisted of 184 AIS patients with a mean age of 15.1 years (range: 12-18 years). The majority of the patients were female (69.3%). Analysis of PROMs revealed that pain was the most predictive metric for identifying significant post-operative improvement at 2 years, with a strong ROC-AUC score of 0.85. Self-image and mental health PROMs also demonstrated robust predictive capabilities, with ROC-AUC scores of 0.83 and 0.82, respectively. Further fine-tuning of PROM thresholds identified optimal cut-offs for predicting improvement. For pain, a threshold of 0.40 was determined, resulting in a fine-tuned AUC score of 0.83. The self-image threshold was set at 0.70, which yielded an AUC score of 0.89. For mental health, the optimal threshold was found to be 0.45, with an associated AUC score of 0.90.
Conclusion : Pre-operative PROMs, especially pain, self-image, and mental health scores, can be effective predictors of significant post-operative improvements for AIS patients. The identified thresholds provide valuable insights for clinical decision-making, allowing clinicians to better target those patients most likely to benefit from surgery. These results highlight the importance of integrating PROM assessments into the pre-operative evaluation process.
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