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Development of an expectations survey for patients undergoing cervical spine surgery
Carol A Mancuso1, Frank P Cammisa, Andrew A Sama
1*Hospital for Special Surgery, Weill Cornell Medical College, New York, NY; and †Hospital for Special Surgery, New York, NY.
Study Design:
Cross-sectional analysis of patient-reported preoperative data.
Objective:
To develop a valid and reliable patient-derived expectations survey for patients undergoing cervical spine surgery.
Summary Of Background Data:
Measuring expectations is an important component in the assessment of patients undergoing cervical spine surgery. However, there currently are no uniform methods to measure expectations.
Methods:
This study was conducted in 3 phases. In phase 1, patients were queried with open-ended questions about what they expected as a result of surgery. Their responses were grouped into categories that became the items in the draft survey. During phase 2, another group of patients completed the draft survey twice to establish test-retest reliability. In phase 3, items were selected on the basis of concordance and clinical relevance and a scoring rubric was developed.
Results:
Phase 1: 25 patients with radiculopathy, myelopathy, or previous surgery with failed fusion (nonunion) (mean age, 55 yr, 44% women) volunteered 114 expectations from which 31 categories were discerned and became the items in the draft survey. Phase 2: another 25 patients completed the survey twice before surgery, a mean of 5 days apart. Phase 3: 21 items were retained for the final survey addressing pain, numbness, physical limitations, and psychological well-being. An overall score can be calculated ranging from 0 to 100 that incorporates number of items expected and degree of improvement expected. For patients in phase 2, scores for the first and second administrations were 58 and 57, Cronbach α coefficients were 0.90 and 0.93, and the intraclass correlation coefficient between scores was 0.90.
Conclusion:
We developed a valid and reliable patient-derived expectations survey for patients undergoing cervical spine surgery that addresses expectations for physical and psychological well-being and generates an easy-to-interpret overall score. The survey can be used clinically and for research and fills a gap in the comprehensive preoperative assessment of patients undergoing cervical spine surgery.
