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Development and Testing of an Expectations Survey for Patients Undergoing Lumbar Spine Surgery
Carol A. Mancuso, MD1; Frank P. Cammisa, MD1; Andrew A. Sama, MD1; Alexander P. Hughes, MD1; Hassan M.K. Ghomrawi, PhD, MPH1; Federico P. Girardi, MD1
1 Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for C.A. Mancuso: mancusoc@hss.edu
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Investigation performed at the Hospital for Special Surgery, New York, NY

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Oct 02;95(19):1793-1800. doi: 10.2106/JBJS.L.00338
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Patients’ expectations of lumbar spine surgery have not been obtained with valid and reliable scales derived from patients’ perspectives. The objective of this cross-sectional study was to develop and to test a patient-derived expectations survey.


The survey was developed in three phases. Phase 1 involved interviews with patients with open-ended questions about expectations and assembly of a draft survey. Phase 2 involved administering the survey twice to assess test-retest reliability. Phase 3 involved selection of final items based on concordance of responses and clinical relevance, and the development of a scoring rubric.


In Phase 1, 118 preoperative patients with diverse lumbar spine diagnoses volunteered 583 expectations, from which thirty-one discrete categories were discerned and became the items for the draft survey. In Phase 2, another fifty-six preoperative patients completed the draft survey twice, four days apart. In Phase 3, twenty-one items were retained for the final survey addressing symptom relief, return to basic mobility, resumption of activities, and improvement in psychosocial well-being. An overall score was calculated on the basis of the number of expectations and amount of improvement expected and ranged from 0 to 100 points; a higher score indicates more expectations. For patients in Phase 2, the mean scores for both administrations were 66 and 65 points, the Cronbach alpha coefficients for both administrations were 0.90 and 0.92, and the intraclass correlation coefficient between scores was 0.86.


We developed a patient-derived survey that is valid, reliable, and applicable to diverse diagnoses and includes physical and psychosocial expectations. The survey generates an overall score that is easy to calculate and to interpret, and thus fills a gap in the assessment of lumbar spine surgery by offering a practical and comprehensive way to record patients’ expectations.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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