ASD burden is large, warrants same global attention as diabetes, arthritis

LYON, France — Patients with adult spinal deformity scored lower on all SF-36 than patients with self-reported chronic conditions such as arthritis, chronic obstructive pulmonary disease, and hypertension, according to results of a study that was the winner of the 2014 Full Paper Award at the EuroSpine Annual Meeting.

The investigators, part of the European Spine Study Group (ESSG), collected baseline SF-36 scores for 504 patients with adult spinal deformity (ASD) with a mean age of 45.7 years and compared the scores to those of 24,936 people from eight industrialized countries who participated in the International Quality of Life Assessment (IQoLA) Project and had self-reported arthritis, chronic obstructive pulmonary disease, diabetes mellitus and hypertension.

“Adult spinal deformity patients scored significantly lower than any of the four subreported chronic conditions with highest impact on PCS (physical component score) assessed in the IQoLA project,” said Ferran Pellisé, MD.

He said patients with ASD were enrolled in the ESSG prospective multicenter international database. They were older than 18 years and had scoliosis greater than 20° or a sagittal vertical axis greater than 5 cm or pelvic tilt greater than 25° or thoracic kyphosis that exceeded 60°.

The ASD patients comprised four groups, which were all ASD patients, surgical candidates determined by their preoperative health-related quality of life scores, and nonsurgical candidates who either had or did not have previous surgery, he said.

“These groups were not identical and surgical patients appear to be older, had higher BMI and had the highest proportion of degenerative deformities and failed back syndromes,” Pellisé said.

Bodily pain was the domain in which ASD appeared to have the highest impact, he said. The difference in scores for patients with ASD vs. those reporting no medical conditions was greater than -30, indicating a very large effect (>1.3 SD). Self-reported arthritis, the condition with the highest impact on BP in the IQoLA project, presented an adjusted deviation from the reference health group of -14.

The difference in scores for patients with ASD compared with those reporting no medical conditions was greater than -10 on PCS and greater than -5 on MCS or mental component score.

Pellisé and colleagues used the American Society of Anesthesiologists Physical Status Classification System (ASA) to evaluate the impact of comorbidities on the quality of life of surgical patients. When they stratified in this group by ASA score they found ASA grade 1 surgical patients who did not have associated comorbidities, “still scored significantly worse than individuals reporting no medical conditions or reporting other chronic conditions,” Pellisé said.

“Our conclusions are that the global burden of adult spinal deformity is large compared with other self-reported current conditions in the general population. Low ASD health-related quality of life scores are not just the result of additional comorbidities and we believe that the impact of ASD on health-related quality of life warrants the same research and health policy attention as other important chronic diseases,” he said.

Pellisé noted studies with individuals who self-reported their condition might have higher (better) SF-36 scores, which would make the differences greater than expected. – by Susan M. Rapp

Reference:

Pellisé F. Impact on health related quality of life of adult spinal deformity (ASD) compared with other chronic conditions. Presented at: EuroSpine 2014; Oct. 1-3, 2014; Lyon, France.

For more information:

Ferran Pellisé, MD, can be reached at Spine Unit, Hospital Universitari de Traumatologia I Rehabilitació Vall Hebron, Barcelona, Spain; email: 24361fpu@comb.cat.

Disclosure: Pellisé has received grants and research support from DePuy Synthes and K2M and has a consultant agreement with DePuy Synthes.