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CORR Insights®: What Are the MCIDs for PROMIS, NDI, and ODI Instruments Among Patients With Spinal Conditions?

One way to assess value in health care is to divide the benefit to the patient by the number of dollars spent [7]. The increasing emphasis on value-based health care shifted providers’ focus from radiographic to patient-centered outcomes. Consequently, having validated and relevant tools that assess quality of life, functional outcomes, and pain is of critical importance. Patient-reported outcomes measures (PROMs) quantify a variety of endpoints that patients care about: pain, function, activity level, and in some cases, satisfaction [14] and are increasingly being used to evaluate healthcare expenditures, assess costeffectiveness [5], determine compensation [3], risk-stratify patients [10], and predict outcomes [9]. As such, PROMs are important to various stakeholders, including patients, physicians, payers, and healthcare institutions. Physicians who treat patients with spinal disorders use a number of PROMs that cover disease-specific disability, pain, and health-related quality of life; some of these include the Oswestry Disability Index (ODI), Neck Disability Index (NDI), Visual Analog Scale for pain, Short Forms, and EuroQol-5D. While ODI and NDI historically have been the mostcommonly used PROMs, PatientReported Outcomes Measurement Information System (PROMIS) is a relatively new outcome measure that is increasingly being implemented because of its length and ease of use, which decrease the burden on patients. PROMIS uses computer adaptive testing (CAT)-based instruments to measure health outcomes from the patient’s perspective. Prior to CATbased instruments, a patient might have skipped questions (s)he considered irrelevant [11]; this can occur when using traditional PROMs like the ODI or the NDI. By contrast, in a CATbased test like PROMIS, the test automatically eliminates questions determined to be irrelevant by that patient’s answers to earlier questions, which reduces the burden on the patient. This test may also be less prone to floor and ceiling effects [11]. The validity and utility of PROMIS in orthopaedic patients is welldocumented [2, 6], particularly in those undergoing spine surgery [1, 12, 13]. PROMIS data also have been shown to bemore efficient, flexible and precise than those yielded by other PROMs. Several of these studies have reported that PROMIS CAT outperforms ODI and is highly correlated with ODI, Short-Form questionnaires, and other older outcome tools in spine patients, while also taking less time to administer, with fewer questions to answer [12, 13]. Still, the clinical relevance of PROMIS data in patients with spinal disorders has not been determined, particularly for patients’ PROMIS scores on perception of their own health, and what constitutes a meaningful change to the patient. The current study by Hung and colleagues [8] helps to fill this gap by This CORR Insights is a commentary on the article “What Are the MCIDs for PROMIS, NDI, and ODI Instruments Among Patients With Spinal Conditions?” by Hung and colleagues available at: DOI: 10.1097/CORR.0000000000000419. The author certifies that neither he, nor any members of his immediate family, have any commercial associations (such as consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR or The Association of Bone and Joint Surgeons. This CORR Insights comment refers to the article available at DOI: 10.1097/CORR. 0000000000000419. S. Qureshi MD (✉), Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA, Email: qureshis@hss.edu