Meeting Patient Expectations and Achieving a Minimal Clinically Important Difference for Back Disability, Back Pain, and Leg Pain May Provide Predictive Utility for Achieving Patient Satisfaction Among Lumbar Decompression Patients

Abstract

Objective: Our study evaluates minimum clinically important difference (MCID) achievement for back pain/leg pain/disability and meeting preoperative expectations as predictors of patient satisfaction after minimally invasive lumbar decompression (MIS-LD) surgery.

Methods: Single/multilevel MIS-LD procedures were identified. Patient-reported outcome measures (preoperative/postoperative), expectations (preoperative), and satisfaction (postoperative) were collected for visual analog scale (VAS) back/VAS leg/Oswestry Disability Index (ODI). Student's t-test assessed patient-reported outcome measure improvement from preoperative baseline. Correlations between outcome and satisfaction scores were evaluated using the Pearson correlation coefficient and categorized according to strength of relationship. MCID achievement and meeting expectations were evaluated as predictors of postoperative patient satisfaction with simple linear regression. Comparison of meeting expectations or achieving MCID as predictors of satisfaction scores was performed using a post hoc Suest test comparison of standardized β-coefficients.

Results: A total of 329 patients were included. All outcomes improved from baselines (P < 0.001, all) at all postoperative time points and demonstrated strong and negative correlations with satisfaction scores (P < 0.001, all). Majority of patients had their expectations met for ODI/VAS back/VAS leg and achieved MCID for ODI/VAS back/VAS leg at all time points and overall. Both MCID achievement and meeting preoperative expectations demonstrated significant associations with satisfaction scores at all time points for ODI/VAS back/VAS leg. Post hoc analysis of predictors of patient satisfaction in pain and disability demonstrated that MCID achievement was an equivalent predictor to meeting patient preoperative expectations at all postoperative time points.

Conclusion: Pain/disability improved after MIS-LD; improvement was strongly correlated with postoperative satisfaction. Meeting expectations/MCID achievement is associated with satisfaction. MCID achievement was equivalent to meeting expectations in predicting satisfaction at all postoperative time points for pain/disability.

Keywords: Back pain; Disability; Expectations; Leg pain; Lumbar decompression; Minimum clinically important difference; Satisfaction.