Can a generic patient reported outcome measure substitute a condition specific measure at assessing care effectiveness in low back pain?

Abstract

Quality of care assessments beside the provider level should also include the patient perspective, however, there aren't widespread solutions for this approach. One possibility is to apply a generic, thus, widely applicable Patient Reported Outcomes Measure (PROM) to assess care outcomes. Taking this notion into consideration, this study aimed to investigate if a generic questionnaire can reliably substitute a disease-specific questionnaire when measuring care effectiveness with patient-reported outcome measures among patients with low back pain. Between January and December 2019, we conducted a before and after survey in three Hungarian hospitals. Adults with confirmed low back pain expecting spinal surgery were eligible to enter the study. SF-36 Health Survey (SF-36) and Roland‐Morris Disability Questionnaire (RMDQ) were used. Multivariate linear regression analyses were conducted to explore the relationship between the results of the two questionnaires and how service provider, sex, and education level could explain the differences in the calculated PROM-based performance measures. During the pre-intervention survey, 11 individuals decided to either not sign the consent form or complete the questionnaire. As a result, 116 individuals participated in the first – baseline – survey and 86 in the second – follow-up – survey. The drop-out rate varied by providers: the lowest rate was 15%, and the highest 39%. Of the SF-36 subscale-based performance measures, role limitations due to physical health and physical functioning significantly correlated with the RMDQ performance measure. Considering the necessary minimum clinically important difference, the explanatory analysis showed that the SF-36 physical functioning subscale-based and the RMDQ-based performance measures established the same performance rank-order among the participating hospitals. The physical functioning subscale of the SF-36 provided similar results to the RMDQ regarding care effectiveness. Thus, the SF-36 may be able to measure and compare care effectiveness among providers in low-back pain. If future studies investigating other health conditions come to the same conclusion, then the SF-36 could be used by itself to incorporate the patient perspective into health care quality assessments, thereby increasing comparability and lowering administrative costs.