Beyond the ODI: Qualitative Factors That Contribute to Patient Satisfaction After Lumbar Surgery Despite Failure to Achieve MCID or PASS

Abstract

Study design: Retrospective cohort study with a prospective qualitative component.

Objective: To identify themes contributing to satisfaction following lumbar surgery in patients who improved on global rating of change (GRC) but did not achieve ODI MCID or PASS.

Summary of background data: Outcomes after lumbar surgery are often evaluated using Oswestry Disability Index (ODI), minimal clinically important difference (MCID), and patient acceptable symptom state (PASS). However, these quantitative metrics fail to capture "qualitative" measures of satisfaction.

Materials and methods: Patient reported outcomes (PROMs) were retrospectively collected and evaluated at early (<6 mo) and late (≥6 mo) follow-up. Wilcoxon signed-rank and Fisher's exact tests were used to compare PROMs, MCID, and GRC satisfaction, defined as answering "much better" or "slightly better" on≥6 months GRC. Prospective interviews explored various physical, emotional, and social "themes" using grounded theory. "Thematic saturation" was determined when new patient responses ceased to generate unique themes.

Results: 43 patients reported satisfaction and consented for interview. Statistically significant improvements for VAS back and leg were reported at early and late follow-up, but not for ODI, SF12 PCS, or SF12 MCS. Interviews generated five themes, related to physical independence, healthcare provider and institutional experience, mental wellbeing and pain reduction, personal support, and environmental factors. Thematic saturation occurred after 32 patients. Patients identified improvements in pain, function, and mental wellness, along with positive provider interactions, reputation, social support, and environment, as key contributors to postoperative satisfaction.

Conclusion: Satisfaction after lumbar surgery is impacted by various qualitative factors related to their healthcare team, social support, and other environmental factors, as well as improvements in mental and physical function. These findings underscore key elements beyond the ODI that surgeons should consider to optimize postoperative satisfaction. They may also support the development of new clinical tools to supplement the ODI and existing PROMs by capturing qualitative aspects of satisfaction not routinely assessed.

Level of evidence: 3.

Keywords: GRC; MCID; ODI; PASS; environment; healthcare provider; lumbar; pain; qualitative; satisfaction.