Measuring outcomes in adult spinal deformity surgery: a systematic review to identify current strengths, weaknesses and gaps in patient-reported outcome measures

Sayf S.A. Faraj, Miranda L. van Hooff, Roderick M. Holewijn, David W. Polly, Tsjitske M. Haanstra, Marinus de Kleuver

Research output: Contribution to journalReview articlepeer-review

16 Scopus citations


Purpose: Adult spinal deformity (ASD) causes severe disability, reduces overall quality of life, and results in a substantial societal burden of disease. As healthcare is becoming more value based, and to facilitate global benchmarking, it is critical to identify and standardize patient-reported outcome measures (PROMs). This study aims to identify the current strengths, weaknesses, and gaps in PROMs used for ASD. Methods: Studies were included following a systematic search in multiple bibliographic databases between 2000 and 2015. PROMs were extracted and linked to the outcome domains of WHO’s International Classification of Functioning and Health (ICF) framework. Subsequently, the clinimetric quality of identified PROMs was evaluated. Results: The literature search identified 144 papers that met the inclusion criteria, and nine frequently used PROMs were identified. These covered 29 ICF outcome domains, which could be grouped into three of the four main ICF chapters: body function (n = 7), activity and participation (n = 19), environmental factors (n = 3), and body structure (n = 0). A low quantity (n = 3) of papers was identified that studied the clinimetric quality of PROMs. The Scoliosis Research Society (SRS)-22 has the highest level of clinimetric quality for ASD. Conclusions: Outcome domains related to mobility and pain were well represented. We identified a gap in current outcome measures regarding neurological and pulmonary function. In addition, no outcome domains were measured in the ICF chapter body structure. These results will serve as a foundation for the process of seeking international consensus on a standard set of outcome domains, accompanied PROMs and contributing factors to be used in future clinical trials and spine registries.

Original languageEnglish (US)
Pages (from-to)2084-2093
Number of pages10
JournalEuropean Spine Journal
Issue number8
StatePublished - Aug 1 2017

Bibliographical note

Funding Information:
This project was registered with the Core Outcome Measures in Effectiveness Trials (COMET) database ( ) and is supported by the AO Spine Knowledge Forum Deformity and the Scoliosis Research Society. Guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) [] and recent publications on the development of a Core Outcome Set (COS) [] were applied.

Funding Information:
This research was supported by AOSpine International through the AOSKF Deformity. AOSpine is a clinical division of the AO Foundation—an independent medically guided not-for-profit organization.

Funding Information:
This study received financial support from AOSpine International through the AOSpine Knowledge Forum Deformity.

Publisher Copyright:
© 2017, The Author(s).


  • Adult spinal deformity surgery
  • Functioning
  • ICF
  • Patient-reported outcome measures
  • Value-based care


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