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Short Term Health Related Quality of Life and Family Burden after Surgical or Casting Treatment Hiroko Matsumoto, Nicholas Feinberg, Julie Yoshimachi,

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Presentation on theme: "Short Term Health Related Quality of Life and Family Burden after Surgical or Casting Treatment Hiroko Matsumoto, Nicholas Feinberg, Julie Yoshimachi,"— Presentation transcript:

1 Short Term Health Related Quality of Life and Family Burden after Surgical or Casting Treatment Hiroko Matsumoto, Nicholas Feinberg, Julie Yoshimachi, David P. Roye, Behrooz A. Akbarnia, Sumeet Garg, James O. Sanders, David L. Skaggs, John T. Smith, Michael G. Vitale, Children’s Spine Study Group, and Growing Spine Study Group

2 -Disclosures- 1. Hiroko Matsumoto: A; Children's Spine Foundation, Scoliosis Research Society, Pediatric Orthopaedic Society of North America, Cerebral Palsy Foundation. B; Children's Spine Foundation 2. Nick Feinberg: None3. Julie Yoshimachi: None 3. David Roye Jr.: A; Children's Spine Foundation, Scoliosis Research Society, Pediatric Orthopaedic Society of North America, Cerebral Palsy Foundation, BroadWater, Inc., OMeGA Medical Grants, Biomet. B; Travel: Stryker, Cerebral Palsy Foundation, JBJS Reviewer, Other: Cerebral Palsy Foundation, Other: CMO Children of China, Other: CEO President International Healthcare Leadership, Other: CMO Global Health Pass. E; Travel: Biomet, Travel: Medtronic, Travel: DePuy Synthes, Travel: Stryker. 4. Behrooz Akbarnia: A; DePuy Spine, Nuvasive, Ellipse. B; Board: Growing Spine Foundation, Editorial: Journal of Orthopaedic Science, Nuvasive, K2M, Ellipse, K Spine, Board: Scoliosis Research Society, Editorial: Spine, Editorial: Spine Deformity. D; Alphatec Spine, Nuvasive, Ellipse, K Spine, Nocimed. F; DePuy, A Johnson & Johnson Company, K2M, Nuvasive, Springer 5. Sumeet Garg: B; Medtronic 6. James O. Sanders: B; Board: AAOS, Board: Pediatric Orthopaedic Society of North America, Board: Scoliosis Research Society. D; Abbott, Abbvie, GE Healthcare, Hospira 7. David L. Skaggs: B; Biomet, Grand Rounds, Board: Growing Spine Foundation, Board: Growing Spine Study Group, Editorial Board: Journal of Children's Orthopaedics, Medtronic, Orthobullets, Board: Scoliosis Research Society, Editorial: Spine Deformity, Zipline Medical Inc.. C; Paid Presenter/Speaker: Johnson & Johnson, Paid Presenter/Speaker: Medtronic. F; Biomet, Wolters Kluwer Health Lippincott Williams & Wilkins 8. John T. Smith: B; Biomet, Ellipse Technologies, Globus Medical, Spineguard, Synthes, Board: Children's Spine Foundation. F; Synthes 9. M.G. Vitale: A; Children's Spine Foundation, Scoliosis Research Society, Pediatric Orthopaedic Society of North America, Orthopaedic Science Research Foundation, BroadWater, Inc., OMeGA Medical Grants, Biomet, Board: Children's Spine Foundation, Board: Pediatric Orthopaedic Society of North America, Board: International Pediatric Orthopaedic Symposium. B; Stryker, Biomet. E; Travel: Biomet, Travel: Medtronic, Travel: DePuy Synthes, Travel: Stryker, Travel: Fox, Travel: Children's Spine Foundation. 10. Children’s Spine Study Group: A; Children's Spine Foundation, DePuy Synthes 11. Growing Spine Study Group: A; Growing Spine Foundation

3 To describe the changes HRQoL and Family Burden of patients with EOS who underwent treatment with surgery or casting Purpose: Retrospective Study vs.

4 Design: Retrospective, multi-center study of HRQoL after surgery or casting, measured via the EOSQ-24 Participants: Inclusion: Early Onset Scoliosis (EOS) 3.0 – 9.9 years of age Undergoing treatment with growing instrumentation, or casting Able to Complete EOS Questionnaire (EOSQ-24) in English or Spanish Exclusion: Unable to complete EOSQ-24 Outcomes: Health-Related Quality of Life −EOSQ-24 pre-treatment −EOSQ-24 at 6 months post-treatment −EOSQ-24 at 12 months post-treatment Methods

5 Non-Idiopathic Patient Characteristics Total (n) = 58CastingSurgeryP-value Subjects (n)949 Age@Index (yo)2.8 ± 1.66.2 ± 2.8<0.005 Gender56% male49% male Cobb (deg)54.0 ± 24.267.0 ± 18.10.065 Etiology Congenital217 Neuromuscular420 Syndromic312 Days between 1 st and last intervention EOSQ 157.8 ± 63.9418.3 ± 83.1<0.001 Completed Pre-EOSQ (n) 949 Completed Post EOSQ (n) 948 Completed Post- Lengthening EOSQ (n) -39

6 Idiopathic Patient Characteristics Total (n) = 22CastingSurgeryP-value Subjects (n)148 Age@Index (yo)1.7 ± 1.28.5 ± 2.9<0.001 Gender57% male22 % male Cobb (deg)50.1 ± 26.364.1 ± 16.80.19 EtiologyIDIOPATHIC Days between 1 st and last intervention EOSQ 291.1 ± 241.8395.3 ± 76.10.25 Completed Pre-EOSQ (n) 148 Completed Post EOSQ (n) 148 Completed Post- Lengthening EOSQ (n) -6

7 Non-Idiopathic Surgery Total Complications15 Minor Complications12 Major Complications3 Results: Surgical Complications Idiopathic Surgery Total Complications2 Minor Complications2 Major Complications- No records of complications were kept for the casting groups

8 Results: Non-Idiopathic Casting Patients Total (n) = 9Pre-EOSQPost-EOSQP-Value HRQoL Subdomain General Health 70.8 ± 26.466.7 ± 16.7 0.694 Pain/Discomfort 81.9 ± 13.377.8 ± 21.9 0.632 Pulmonary Function 87.5 ± 2581.9 ± 22.9 0.629 Transfer 77.8 ± 32.266.7 ± 16.7 0.374 Physical Function 68.5 ± 39.051.9 ± 27.2 0.309 Daily Living 52.8 ± 42.839.1 ± 40.2 0.494 Fatigue/Energy Level 76.4 ± 32.563.9 ± 36.5 0.454 Emotion 87.5 ± 17.769.6 ± 18.7 0.054 Parental Burden 67.8 ± 26.655.3 ± 20.3 0.279 Financial Burden 61.1 ± 37.562.5 ± 21.6 0.924 Overall HRQoL 74.2 ± 21.962.2 ± 15.5 0.199 Overall Parental Domain 67.8 ± 26.655.3 ± 20.3 0.276 Overall Financial Domain 56.3 ± 36.962.5 ± 21.7 0.668

9 Results: Non-Idiopathic Surgery Patients Total (n) = 49Pre-EOSQPost-EOSQ3 rd EOSQ P-Value (Pre vs. 3 rd EOSQ) HRQoL Subdomain General Health 67.3 ± 20.770.1 ± 19.668.9 ± 20.2 0.722 Pain/Discomfort 74.7 ± 22.974.2 ± 23.273.0 ± 22.5 0.727 Pulmonary Function 74.7 ± 22.985.4 ± 22.187.5 ± 17.7 0.005 Transfer 75.5 ± 28.977.2 ± 27.377.0 ± 24.9 0.799 Physical Function 65.3 ± 40.666.1 ± 33.972.0 ± 29.9 0.392 Daily Living 50 ± 33.450.8 ± 35.150.7 ± 33.4 0.926 Fatigue/Energy Level 67.8 ± 27.574.2 ± 24.569.6 ± 23.8 0.761 Emotion 76.1 ± 22.282.5 ± 20.873.2 ± 20.5 0.530 Parental Burden 58.1 ± 20.562.4 ± 23.261.9 ± 21.9 0.407 Financial Burden 65.6 ± 25.360.1 ± 34.160.5 ± 32.8 0.412 Overall HRQoL 66.8 ± 19.168.5 ± 19.768.0 ± 17.8 0.765 Overall Parental Domain 58.1 ± 20.562.4 ± 23.261.9 ± 21.9 0.407 Overall Financial Domain 65.6 ± 25.360.1 ± 34.160.5 ± 32.8 0.412

10 Results: Idiopathic Casting Patients Total (n) = 14Pre-EOSQPost-EOSQP-Value HRQoL Subdomain General Health 73.2 ± 18.274.10 ± 17.9 0.897 Pain/Discomfort 91.9 ± 17.487.5 ± 14.9 0.474 Pulmonary Function 93.8 ± 11.387.5 ± 19.5 0.309 Transfer 98.2 ± 6.485.7 ± 18.2 0.02 Physical Function 88.1 ± 19.369.0 ± 22.6 0.02 Daily Living 82.1 ± 23.961.6 ± 12.9 0.009 Fatigue/Energy Level 84.6 ± 15.683.9 ± 14.5 0.905 Emotion 96.6 ± 7.789.3 ± 9.3 0.034 Parental Burden 78.7 ± 20.377.5 ± 19.2 0.878 Financial Burden 75 ± 29.969.6 ± 27.0 0.623 Overall HRQoL 85.2 ± 13.079.8 ± 9.7 0.224 Overall Parental Domain 78.7 ± 20.377.5 ± 19.2 0.878 Overall Financial Domain 75 ± 29.969.6 ± 27.0 0.623

11 Results: Idiopathic Surgery Patients Total (n) = 8Pre-EOSQPost-EOSQ3 rd EOSQ P-Value (Pre vs. 3 rd EOSQ) HRQoL Subdomain General Health 82.8 ± 15.290.6 ± 10.477.1 ± 25.4 0.608 Pain/Discomfort 70.3 ± 26.564.1 ± 21.168.8 ± 23.7 0.911 Pulmonary Function 70.3 ± 26.587.5 ± 16.591.7 ± 9.3 0.08 Transfer 100 ± 091.7 ± 18.695 ± 10 0.177 Physical Function 95.2 ± 8.786.3 ± 12.795 ± 10 0.964 Daily Living 89.1 ± 14.6 83.3 ± 18.6 0.529 Fatigue/Energy Level 90.6 ± 12.173.4 ± 26.870.8 ± 25.7 0.077 Emotion 81.3 ± 13.960.9 ± 15.979.2 ± 18.6 0.814 Parental Burden 79.0 ± 9.575.7 ± 10.575 ± 19.7 0.622 Financial Burden 45.8 ± 26.735.7 ± 32.337.5 ± 40.2 0.533 Overall HRQoL 81.9 ± 9.676.2 ± 9.178.6 ± 21.1 0.703 Overall Parental Domain 79.0 ± 9.675.7 ± 10.575 ± 19.7 0.622 Overall Financial Domain 45.8 ± 26.735.7 ± 32.337.5 ± 40.2 0.648

12 Result Highlights EtiologyTreatmentDomainChange (%)P-Value Idiopathic Surgical Pulmonary Function +300.08 Fatigue / Energy Level -220.077 Casting Transfer-130.02 Daily Living-250.009 Physical Function -220.02 Emotion-80.034 Non-Idiopathic Surgical Pulmonary Function +170.005 CastingEmotion-200.054

13 Conclusions Patients treated surgically (idiopathic and not idiopathic) had an improved parental impression of patient pulmonary function but little change in other aspects of HRQoL By contrast, casting appears to be associated with decreasing QoL scores in multiple domains

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