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Published on: August 7, 2018
Patient-reported Outcomes Measurement Information System Score Analysis in Diagnosis and Treatment Evaluation of
Gabriel G Boebel1, Christian E Wright1, Mahara Mohseni1
1Department of Orthopaedic Surgery, Washington University School of Medicine.
Background:
Compared with adults, children with intervertebral disc herniation often face delayed diagnoses due to atypical presentations and symptom overlap with other musculoskeletal disorders. While non-operative treatments such as physical therapy and NSAIDs are typically first-line, they may be insufficient in severe cases, where discectomy can be effective but carries a risk of recurrence. PROMIS (Patient-Reported Outcomes Measurement Information System) offers standardized measures of patient-reported pain and function. This study aims to evaluate PROMIS Pain Interference (Pain) and Mobility scores in pediatric disc herniation patients compared with the population average and assess treatment outcomes between non-operative and surgical cohorts.
Methods:
A retrospective cohort analysis included patients <18 years of age with diagnosed disc herniation. Data included demographics, disc location, and PROMIS Pain and Mobility scores at presentation and final follow-up. Patients were categorized into non-operative (eg, physical therapy, pain management) and surgical (discectomy) groups. PROMIS scores were compared with the normative population (mean = 50±10). Statistical analyses included one-sample t tests and linear mixed-effects models (α=0.05).
Results:
Eighty patients (median age 16) met the inclusion criteria; 42 received non-operative care, and 38 underwent surgery. At presentation, mean PROMIS Pain was 59±7, and Mobility was 35±6, both significantly different from the norm (P<0.0001). Surgical patients had worse baseline scores (Mobility: surgical 32.7±5.6 vs. non-operative 37±6.7; Pain: surgical 62±7.5 vs. non-operative 57±5.7, P<0.05). Mobility improved significantly post-surgery compared with non-operative care (Mobility improvement: surgical +9.1±11.9 points vs. non-operative +4.2±6.8 points, P<0.001), though final scores were similar. Pain improvements in both groups at final follow-up showed no significant difference between treatment modalities.
Conclusion:
Pediatric patients with disc herniations experience significant pain and limited mobility. Patients who elect for discectomy present with worse pain and decreased mobility at baseline. However, those who undergo surgery can expect quicker relief of symptoms, and despite initially worse function, ultimately achieve outcome scores comparable to patients successfully managed non-operatively. Our study further validates that PROMIS scores effectively quantify symptom burden in pediatric disc herniation and reflect treatment response, supporting their use in this population.
Level Of Evidence:
Level III-retrospective comparative study.
