Traumatic spinal injuries remain a critical global public health concern, both in terms of care and costs.

 

As the survival rate and life expectancy of major trauma victims have increased over the years, measuring functional outcomes after traumatic spinal injuries is becoming more urgent. However, there is no universally accepted outcome instrument available that is specifically designed or validated for this patient population, especially for the majority of the patients who primarily sustain an injury to the spinal column, without an associated severe spinal cord injury or poly-trauma.

 

In the absence of a validated condition-specific outcome measure for spine trauma, combinations of available tools have been used including generic, spine specific to degenerative conditions and neurological-functional outcome measures. Besides the limitations in the domains measured by these instruments, not every instrument can be used along the continuum of care.

 

With the scope of developing and validating an outcome instrument for adult spinal trauma patients, the AOSpine Knowledge Forum (KF) Trauma started working on measurement tools that include both the patients’ and health professionals’ perspectives on functioning, disability and health. The aim is to develop and validate a patient reported outcome measure (PROM) to evaluate treatment outcomes and resumption of activities of daily living over time, and a separate surgeon reported outcome measure (SROM) to predict clinical outcome on the short and long term. The final outcome instrument is supposed to be a short and easy questionnaire for the patients and a simple evaluation system for the surgeons, which is applicable all over the world and along the continuum of care.

 

Strategy to develop the PROM and SROM

The PROM is based on the systematic approach of the World Health Organization’s International Classification of Functioning, Disability and Health (ICF). During the initial preparatory phase, all potentially meaningful ICF categories were identified from different perspectives by means of (1) an empirical international multicentre study of patients with traumatic spinal column injuries, (2) a systematic literature review and (3) a multidisciplinary online expert survey. On a second phase, an international and multidisciplinary consensus conference took place, leading to the definition of a Comprehensive and Brief ICF Core Set for spinal trauma patients. On the final phase, the outcome instrument, called AO-PROST (AO Patient Reported Outcome Spine Trauma) will be validated in an international multicentre study.

 

The initial and second phases are completed and being disseminated at international congresses and well-known journals. To learn more about the study design and results, please read the manuscripts published in Spine on January 2015 and May 2015 issues.

 

On the other hand, the SROM development will follow two phases: (1) we will explore the global surgeons’ perspective on the most relevant parameters to predict the functional outcome of cervical, thoracic, thoracolumbar and lumbar spine fractures, making a distinction between the short term (3 months to 2 years post-trauma) and the long term (2 years and longer) in online surveys. (2) An international validation study will assess the reliability and reproducibility of the SROM using real patient cases. The first phase has been completed and the group is working on the draft of the SROM tool for its validation.

 

“After the successful development of simple and validated spinal trauma classification and injury severity systems, our main focus as KF Trauma is at this moment the development of simple, reliable and globally valid outcome tools. With these classification and outcome tools we hope to contribute to the advancement of the care of spinal trauma victims all around the world." says Cumhur Öner, Professor of Spinal Surgery at UMC Utrecht, Utrecht, The Netherlands and Chair elect of the KF Trauma.

 

Please stay tuned for the upcoming publications regarding this new tool for spine trauma patients and surgeons.

 

For further information about Knowledge Forum activities, please visit our website here.