Systematic Review Patient Reported Outcomes in Adult Spinal Deformity Surgery: A Bibliometric Analysis

Study design: Bibliometric analysis. Objectives: To identify patient-reported outcomes (PROs) used in adult spinal deformity (ASD) research over the past decade, their frequency, and usage trends. Summary of background data: The emphasis on PROs is increasing along with the demand for evidence-based medicine. However, there is currently no standardization or consensus on which PROs ought to be used in ASD. Methods: Five top orthopedics journals were reviewed from 2004 to 2013 for clinical studies of surgical intervention in ASD that report PROs. Publication year, level of evidence (LOE), and PROs were collected for each article. Errors and inconsistencies of PRO score reporting were analyzed for the 3 most commonly used PROs. Results: A total of 84 PRO studies were published in ASD literature over the period studied. The number of PRO studies published increased from 1 in 2004 to 16 in 2013. We identified 24 unique PROs. The Oswestry Disability Index (ODI) was the most frequently used single instrument (47.8%), followed by the Scoliosis Research Society (SRS)-22 (35.6%) and SRS-24 (21.1%), and Short Form-36 (SF-36) and visual analog scale (VAS) were tied (13.3%). The combined use of SRS instruments exceeded ODI use. LOE 4 was most common (42.9%), and no LOE 1 studies were identified. Incomplete preoperative and postoperative PRO scores was the most common reporting inconsistency, occurring in 16% of articles using ODI, 58% of articles using SRS-24, and 22% of articles using SRS-22. Conclusions: The frequency of studies using PROs in ASD research has increased over the past decade, yet quality studies and standardization are lacking. In general, the ODI and SRS instruments are emerging as standards in ASD surgery; however, frequent use of many uncommon PROs presents a challenge for interstudy comparisons. Additionally, of the top 5 instruments used, only SF-36 is routinely used for cost-effectiveness studies, making procedure costeoutcome decisions difficult. 2015 Scoliosis Research Society.