Are We Considering the Whole Patient? The Impact of Physical and Mental Health on the Outcomes of Spine Care

Abstract

Study Design. Retrospective, observational. Objective. To evaluate the influence of baseline health status on the physical and mental health (MH) outcomes of spine patients. Summary of Background Data. Spine conditions can have a significant burden on both the physical and MH of patients. To date, few studies have evaluated the outcomes of both dimensions of health, particularly in nonoperative populations. Materials and Methods. At their first visit to a multidisciplinary spine clinic, 2668 nonoperative patients completed the Patient-reported Outcomes Measurement Information System-Global Health (PROMIS-GH) instrument and a questionnaire evaluating symptoms and goals of care. Patients were stratified by their baseline percentile score of the MH and physical health (PH) components of the PROMIS-GH. Four groups of patients were compared based on the presence or absence of bottom quartile PH or MH scores. The primary end point was the achievement of a minimal clinically important difference (MCID) on the MH or PH components at follow-up. Multivariate regression assessed the predictors of MCID achievement. Results. After controlling for demographics, symptoms, and goals, each 1-point increase in baseline PROMIS-GH mental score reduced the odds of achieving MH MCID by 9.0% (P<0.001). Conversely, each 1-point increase in baseline GH-physical score increased the odds of achieving MCID by 4.5% (P=0.005). Each 1-point increase in baseline GH-physical score reduced the odds of achieving PH MCID by 12.5% (P<0.001), whereas each 1-point increase in baseline GH-mental score increased the odds of achieving MCID by 5.0% (P<0.001). Conclusions. Spine patients presenting with the lowest levels of physical or MH were most likely to experience clinically significant improvement in those domains. However, lower levels of physical or mental health made it less likely that patients would experience significant improvement in the alternative domain. Physicians should evaluate and address the complex spine population holistically to maximize improvement in both physical and mental health status.