TY - JOUR
T1 - Comparing the performance of comorbidity indices in predicting functional status, health-related quality of life, and total health care use in older adults with back pain
AU - Rundell, Sean D.
AU - Resnik, Linda
AU - Heagerty, Patrick J.
AU - Kumar, Amit
AU - Jarvik, Jeffrey G.
N1 - Funding Information:
1Department of Rehabilitation Medicine, University of Washington, Seattle, WA. 2Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, Seattle, WA. 3Department of Health Services, Policy and Practice, Brown University, Providence, RI. 4Research, Providence VA Medical Center, Providence, RI. 5Department of Biostatistics, University of Washington, Seattle, WA. 6Department of Physical Therapy, Northern Arizona University, Flagstaff, AZ. 7Department of Radiology, University of Washington, Seattle, WA. 8Department of Health Services, University of Washington, Seattle, WA. 9Department of Neurological Surgery, University of Washington, Seattle, WA. The Back pain Outcomes using Longitudinal Data study received Internal Review Board approval from the University of Washington Human Subjects Division (application number 39051). This research was supported by the Foundation for Physical Therapy Research’s Center on Health Services Training and Research Pilot Study Program grant. The Back pain Outcomes using Longitudinal Data study was supported by grants 1R01HS01922201 and 1R01HS022972-01 from the Agency for Healthcare Research and Quality. Dr Jarvik is a founder and stockholder of Physiosonix (an ultrasound company), consults for HealthHelp (a utilization review service), is a section editor for UpToDate (Wolters Kluwer Health; medical resource software), and is a coeditor of the book Evidence-Based Neuroimaging Diagnosis and Treatment (Springer). The other authors certify that they have no affiliations with or financial involvement in any organization or entity with a direct financial interest in the subject matter or materials discussed in the article. Address correspondence to Dr Sean Rundell, University of Washington, Box 356490, 1959 NE Pacific Street, Seattle, WA 98195. E-mail: srundell@uw.edu U Copyright 2020 Journal of Orthopaedic & Sports Physical Therapy®
Publisher Copyright:
© 2020 Movement Science Media. All rights reserved.
PY - 2020
Y1 - 2020
N2 - • OBJECTIVE: To determine how well the functional comorbidity index (FCI) predicts outcomes in older adults with back pain compared to Quan's modification of the Charlson comorbidity index (Quan-Charlson comorbidity index) and the Elixhauser comorbidity index. • DESIGN: Secondary analysis of a prospective cohort study. • METHODS: We included 5155 adults 65 years of age or older with new primary care visits for back pain. Comorbidity was measured using diagnosis codes 12 months prior to the new visit. Outcomes of functional limitation (Roland-Morris Disability Questionnaire), health-related quality of life (European Quality of Life-5 Dimensions [EQ-5D]), and total health care use (sum of relative value units) were measured 12 months after the new visit. We compared multivariable models containing preselected prognostic factors. • RESULTS: Spearman correlation coefficients among the indices were 0.70 or greater. Multivariable models for the Roland-Morris Disability Questionnaire had similar R2 and root-mean-square error (RMSE) of prediction when using the FCI (R2 = 0.190; RMSE, 6.19), Quan-Charlson comorbidity index (R2 = 0.185; RMSE, 6.20), or Elixhauser comorbidity index (R2 = 0.189; RMSE, 6.19). Multivariable models for the EQ-5D score showed small differences in R2 and RMSE when using the FCI (R2 = 0.157; RMSE, 0.163), Quan-Charlson comorbidity index (R2 = 0.148; RMSE, 0.164), or Elixhauser comorbidity index (R2 = 0.154; RMSE, 0.163). Multivariable models for health care use had similar Akaike information criterion (AIC) values when using the FCI (AIC = 10.04), Quan-Charlson comorbidity index (AIC = 10.04), or Elixhauser comorbidity index (AIC = 10.01). • CONCLUSION: All indices performed similarly in predicting outcomes. There does not seem to be an advantage to using one index over another for older adults with back pain. There is still a need to develop better function-based risk-adjustment models that improve prediction of functional outcomes versus standard comorbidity indices.
AB - • OBJECTIVE: To determine how well the functional comorbidity index (FCI) predicts outcomes in older adults with back pain compared to Quan's modification of the Charlson comorbidity index (Quan-Charlson comorbidity index) and the Elixhauser comorbidity index. • DESIGN: Secondary analysis of a prospective cohort study. • METHODS: We included 5155 adults 65 years of age or older with new primary care visits for back pain. Comorbidity was measured using diagnosis codes 12 months prior to the new visit. Outcomes of functional limitation (Roland-Morris Disability Questionnaire), health-related quality of life (European Quality of Life-5 Dimensions [EQ-5D]), and total health care use (sum of relative value units) were measured 12 months after the new visit. We compared multivariable models containing preselected prognostic factors. • RESULTS: Spearman correlation coefficients among the indices were 0.70 or greater. Multivariable models for the Roland-Morris Disability Questionnaire had similar R2 and root-mean-square error (RMSE) of prediction when using the FCI (R2 = 0.190; RMSE, 6.19), Quan-Charlson comorbidity index (R2 = 0.185; RMSE, 6.20), or Elixhauser comorbidity index (R2 = 0.189; RMSE, 6.19). Multivariable models for the EQ-5D score showed small differences in R2 and RMSE when using the FCI (R2 = 0.157; RMSE, 0.163), Quan-Charlson comorbidity index (R2 = 0.148; RMSE, 0.164), or Elixhauser comorbidity index (R2 = 0.154; RMSE, 0.163). Multivariable models for health care use had similar Akaike information criterion (AIC) values when using the FCI (AIC = 10.04), Quan-Charlson comorbidity index (AIC = 10.04), or Elixhauser comorbidity index (AIC = 10.01). • CONCLUSION: All indices performed similarly in predicting outcomes. There does not seem to be an advantage to using one index over another for older adults with back pain. There is still a need to develop better function-based risk-adjustment models that improve prediction of functional outcomes versus standard comorbidity indices.
KW - Comorbidity measures
KW - Risk adjustment
KW - Spine
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U2 - 10.2519/jospt.2020.8764
DO - 10.2519/jospt.2020.8764
M3 - Article
C2 - 32116102
AN - SCOPUS:85080839702
SN - 0190-6011
VL - 50
SP - 143
EP - 148
JO - Journal of Orthopaedic and Sports Physical Therapy
JF - Journal of Orthopaedic and Sports Physical Therapy
IS - 3
ER -