Longitudinal Discordance Between Functional Recovery and Patient Satisfaction After Lumbar Spine Surgery: A 2-Year Registry Study.

BACKGROUND CONTEXT: Patient-reported outcome measures (PROMs) and satisfaction are used after lumbar spine surgery but capture distinct constructs.

PURPOSE: To characterise 2-year trajectories of disability, health status, improvement, PROM-satisfaction concordance, and associated factors.

STUDY DESIGN/

SETTING

Registry-based longitudinal cohort study at a tertiary referral centre in Singapore.

PATIENT SAMPLE: 748 adults undergoing primary elective lumbar surgery for degenerative disease with at least 1 postoperative satisfaction assessment.

OUTCOME MEASURES: Oswestry Disability Index (ODI; primary), EQ-5D-5L crosswalk index, EQ VAS, satisfaction, minimum important difference (MID), and ODI patient acceptable symptom state (PASS).

METHODS

PROMs were assessed at baseline and follow-up; satisfaction at 3-6 months, 1 year, and 2 years. Linear mixed-effects models assessed PROM trajectories; logistic mixed-effects models assessed MID and PASS achievement; ordered logistic mixed-effects models assessed satisfaction; and multinomial regression assessed ODI MID-satisfaction concordance. No study-specific funding or conflicts of interest were reported.

RESULTS

ODI improved through 1 year then remained stable, whereas EQ-5D plateaued after 3-6 months. Satisfaction remained approximately 84%. ODI MID-satisfaction discordance decreased from 33.8% to 24.2%; at 2 years, discordance was 28.7% for EQ-5D and 57.0% for EQ VAS. Higher baseline ODI increased the odds of MID achievement but decreased the odds of PASS achievement. Sensitivity analyses supported these trajectories despite attrition. Greater ODI and EQ-5D improvements were associated with greater satisfaction; satisfaction without MID achievement was more common among patients with lower baseline disability.

CONCLUSIONS

Disability, health status, and satisfaction followed different trajectories. Change-based thresholds, acceptable states, and satisfaction are complementary, not interchangeable, outcomes.