Patient-reported outcome trajectories the first 24 months after surgery for cervical spondylotic myelopathy: a Quality Outcomes Database study.

Coexisting medical conditions are increasingly prevalent in surgical populations. The impact of multiple comorbidities on patient-reported outcomes (PROs) and endotypes of frequently co-occurring conditions for cervical spondylotic myelopathy (CSM) remain unclear. This study explores whether CSM patients with multimorbidity have worse baseline and postoperative PROs and less functional improvement after surgery compared to those with few or no comorbidities. The authors also investigated whether distinct comorbidity endotypes exist among CSM surgical patients and whether they influence postoperative outcomes. The prospective Quality Outcomes Database (QOD) was used to assess patients undergoing surgery for CSM. Multimorbidity was defined as ≥ 2 chronic conditions, including diabetes, coronary artery disease, peripheral vascular disease, arthritis, chronic renal disease, chronic obstructive pulmonary disease, Parkinson's disease, multiple sclerosis, depression, and anxiety. Baseline characteristics and 24-month PROs were assessed across multiple-comorbidity status, including modified Japanese Orthopaedic Association (mJOA), Neck Disability Index (NDI), visual analog scale for neck and arm pain, EQ-5D, and patient satisfaction scores. Clusters were identified from the full cohort using k-medoids, revealing subgroups with similar comorbidity endotypes. The final cohort included 1141 CSM patients (83.1% reaching 24-month follow-up), with 761 (66.7%) having 0 or 1 comorbidity and 380 (33.3%) ≥ 2 comorbidities. The multimorbidity cohort was older (mean age 62.6 ± 11.2 vs 59.5 ± 12.0 years, p < 0.001), more likely to be female (52.9% vs 44.7%, p = 0.011), and had a higher BMI (mean 31.1 ± 6.7 vs 29.7 ± 6.2 kg/m2, p < 0.001). Multimorbidity patients exhibited worse mJOA, NDI, and EQ-5D scores at baseline and 24 months (p < 0.05). On multivariable analysis, the total number of comorbidities was not significantly associated with any PRO measures. Four comorbidity clusters were identified: low burden, arthritis, diabetes, and high burden. On one-way ANOVA, the baseline mJOA score was significantly different across clusters (p = 0.003). At 24 months, the mJOA score was significantly lower in the diabetes and high-burden endotypes. Twenty-four-month score change and minimal clinically important difference (MCID) achievement of all PROs remained similar across clusters (p > 0.05). While patients with multimorbidity have worse baseline and postoperative PROs, they achieve similar functional and pain-related improvements following CSM surgery. Similarly, the comorbidity endotypes identified in this QOD cohort suggest that certain patterns of coexisting chronic conditions, such as overlapping diabetes and arthritis, are associated with different levels of disability but may not diminish the effectiveness of surgical intervention.

Objectives: The minimum clinically important difference (MCID) is a commonly used measure to aid in determining significant improvements for patient-reported outcomes (PROs). As MCID and PROs continue to be implemented in shoulder procedures, MCID can greatly differ depending upon the specific patient population, follow-up time, and methodology. In the setting of rotator cuff repair (RCR), there are few studies that discuss the effect of tendon involvement on MCID achievement. Additionally, there is a paucity of literature surrounding the use of the Patient-Reported Outcomes Measurement Information System Global-10 (PROMIS-10) as an anchor question. The purpose of this study was to evaluate the effect of the number of tendons involved in the RCR on MCID achievement. They hypothesis was that larger repairs would be associated with a lower likelihood of meeting MCID. The primary outcome was the American Shoulder and Elbow Surgeons (ASES) score. Secondary outcomes included retear and reoperation rates. Methods: The minimum clinically important difference (MCID) is a commonly used measure to aid in determining significant improvements for patient-reported outcomes (PROs). As MCID and PROs continue to be implemented in shoulder procedures, MCID can greatly differ depending upon the specific patient population, follow-up time, and methodology. In the setting of rotator cuff repair (RCR), there are few studies that discuss the effect of tendon involvement on MCID achievement. Additionally, there is a paucity of literature surrounding the use of the Patient-Reported Outcomes Measurement Information System Global-10 (PROMIS-10) as an anchor question. The purpose of this study was to evaluate the effect of the number of tendons involved in the RCR on MCID achievement. They hypothesis was that larger repairs would be associated with a lower likelihood of meeting MCID. The primary outcome was the American Shoulder and Elbow Surgeons (ASES) score. Secondary outcomes included retear and reoperation rates. Results: A total of 799 patients met inclusion criteria. Most patients were male (n=474, 59.3%) and were 61.2 years old. There were 61.5% of patients who had their dominant shoulder treated with RCR. Patients typically had two tendons repaired (n=369, 46.2%) at least one tendon with a full thickness tear (n=643, 80.5%). Many underwent various concomitant procedures including subacromial decompression (83.9%), biceps tendon procedures (tenotomy or tenodesis) (59.0%), distal clavicle excision (24.2%), and arthroscopic debridement (24.0%). The average case length was 130.1 minutes. There were 36 symptomatic retears (4.5%), 10 revisions (1.3%), and 14 other reoperations (1.8%) within one-year. ASES scores at baseline and one-year were 48.1 and 84.6, respectively, with an average one-year change of +36.6. The one-year ASES MCID was calculated to be 37.9. A total of 52.1% of patients achieved the one-year MCID. A higher proportion of females compared to males (58.2% vs. 47.9%, p=0.004) met MCID. Age and BMI were not associated with MCID achievement (p=0.955, p=0.393, respectively). Patients who were treated for worker’s compensation were less likely to achieve MCID (Worker’s comp that met MCID: 35.9% vs not meeting MCID 64.2%, p=0.014). The number of tendons repaired did not differ between those who met MCID and those who did not (p=0.315). Thickness of the tear and operation on the dominant arm also had no effect on MCID achievement (p=0.837, p=0.915, respectively). Biceps tenotomy was shown to have more patients who met MCID compared to biceps tenodesis (63.0% vs. 48.3%, p=0.032). Those who underwent subacromial decompression more often met MCID than those who did not (p=0.002). Experiencing retear and reoperation were associated with not meeting MCID (p&lt;0.001, p=0.004, respectively) while revision trended towards significance (p=0.055). Conclusions: The average ASES score reported was 84.6, and 52.1% of patients met the one-year MCID. Female sex, biceps tenotomy and subacromial decompression were all associated with achieving MCID, while worker’s compensation, retear, and reoperation were more prevalent in patients who did not meet MCID. The number of tenons involved was shown to have no effect on MCID attainment. This information can help surgeons address patient expectations prior to undergoing RCR surgery.

Background Minimum clinically important difference (MCID) achievement is a more patient-centric metric that evaluates the perception of a significant improvement in symptoms. However, few studies have investigated the factors associated with achieving this threshold earlier rather than later in a patient’s postoperative course of recovery. Objective To determine the baseline factors associated with achievement of an early MCID among patients who underwent a transforaminal, anterior, or lateral lumbar interbody fusion (TLIF, ALIF, LLIF). Methods A single-surgeon database was retrospectively reviewed for patients undergoing primary or revision, 1- or 2-level MIS TLIF, ALIF, or LLIF. Patient reported outcome measurements (PROMs) were recorded using Visual Analogue Scale (VAS) back/leg, Oswestry Disability Index (ODI), and 12-Item Short Form (SF-12) Physical Composite Score (PCS). Early achievement of MCID was defined as having a difference in pre- and postoperative PROM scores that were equal to or greater than the established values at the 6-week or 12-week timepoint. Using simple logistic regression, a cutoff of p≤0.025 was used to determine covariates correlating with early MCID achievement. Using multiple logistic regression, we then completed a post-regression analysis to assess the influence of covariates on timing of MCID achievement across VAS, ODI, and SF-12 PROMs. Results 405 patients were included, with a mean age of 53.8 years and the majority being male (64.2%) and non-obese (50.5%). Mean preoperative VAS back, VAS leg, and ODI scores were 6.4 ± 2.4, 5.6 ± 2.8, and 41.5 ± 16.8, respectively (Table 1). Majority of patients presented with degenerative spondylolisthesis (56.5%), followed by isthmic spondylolisthesis (30.5%), recurrent herniated nucleus pulposus (24.6%), and degenerative scoliosis (9.6%). Majority of procedures were primary (89.0%) in nature, with 42 cases (11.0%) being revision surgeries. Most patients received MIS TLIF (75.1%), while 16.5% received LLIF, and 8.4% received ALIF. 374 1-level procedures (92.3%) and 31 2-level procedures (7.7%) were performed. Mean operative time, blood loss, and postoperative stay was 135.1 minutes, 53.0 milliliters, and 32.7 hours, respectively (Table 2). Most patients demonstrated MCID achievement from 12-weeks to 1-year for back pain. For leg pain, disability, and physical function, majority of patients demonstrated MCID achievement at 6-months and 1-year. By 1-year following fusion and for overall, a majority of subjects (&gt;50%) attained MCID across VAS/ODI/SF-12 PROMs (Table 3). At 6-weeks, patients with higher preoperative VAS and ODI scores demonstrated greater odds of MCID achievement (p&lt;0.001, all). Patients with higher preoperative SF-12 PCS experienced lower odds of SF-12 PCS achievement at 6-weeks (p&lt;0.001). Workers’ Compensation (WC) status was associated with decreased odds of MCID achievement at this timepoint across pain and disability PROMs studied (p≤0.003, all). For VAS back, degenerative spondylolisthesis increased odds for achievement (p=0.023), while for ODI, revision procedures were associated with a decreased odds for 6-week MCID achievement (p=0.034). Arthritis decreased odds of 6-week MCID achievement for SF-12 PCS (p=0.007), while history of myocardial infarction (MI) increased odds of achievement for VAS leg (p=0.034) (Table 4). For 12-weeks, MCID achievement for all PROMs was again more likely among patients with higher preoperative scores (p&lt;0.001, all), with WC associated with decreased odds of achievement (p&lt;0.001, all). In addition, ALIF surgery was associated with decreased odds of 12-week MCID achievement for VAS leg and ODI (p≤0.037, both), while diabetic status was associated with increased odds of attainment for SF-12 PCS (p=0.037) (Table 5). Conclusion Early MCID achievement for back pain, leg pain, disability, and physical function were more likely among patients with worse preoperative PROM values. This suggests that patients who benefit the earliest from lumbar fusion may be limited to individuals who report more severe preoperative symptoms. Furthermore, WC claimants, patients presenting for revision surgery, and those receiving ALIF (vs MIS TLIF/LLIF) are likely to experience delays in clinically meaningful recovery of pain and/or disability following lumbar fusion.

Risk factors for failure to achieve minimal clinically important difference and significant clinical benefit in PROMIS computer adaptive test domains in patients undergoing rotator cuff repair.

Degenerative lumbar spondylolisthesis is a common cause of back and leg pain influenced by factors like instability, disc degeneration, facet arthropathy, and psychosocial phenotype. Patients' experience of high-severity pain is complex, with significant implications for surgical planning. The goal of this study was to assess the impact of back pain catastrophizing on long-term outcomes following lumbar spondylolisthesis surgery. This study uses the Quality Outcomes Database (QOD) lumbar spondylolisthesis dataset and includes prospectively collected data from the 12 highest-enrolling clinical sites participating in the QOD lumbar module. The authors reviewed patients undergoing single-segment surgery for grade 1 degenerative lumbar spondylolisthesis. Severe baseline numeric rating scale for back pain (NRS-BP) scores (≥ 8) were classified as "catastrophizing," and mild to moderate pain scores (< 8) were classified as "non-catastrophizing." Patient-reported outcomes (PROs) were compared for catastrophizing versus non-catastrophizing patients at 60 months. Univariate and multivariate analyses were conducted to assess the impact of catastrophizing on PROs, with multivariate analysis controlling for variables initially reaching a p value < 0.10. Of the 608 patients in this analysis, 260 (42.8%) experienced catastrophizing while 348 (57.2%) did not. Catastrophizing patients were significantly younger (59.9 ± 12.2 years vs 63.9 ± 11.7 years, p < 0.001), less often had ≥ 4 years of college education (31.2% vs 42.5%, p = 0.004), and more often used private insurance (58.8% vs 47.7%, p = 0.01). The catastrophizing cohort also had higher rates of depression (24.6% vs 17.0%, p = 0.02) and back pain predominance (45.4% vs 32.2%, p < 0.001). Surgical and perioperative characteristics did not significantly differ between cohorts. Although catastrophizing patients typically reported worse PRO scores at both baseline and 60 months, they demonstrated significantly greater improvement and minimal clinically important difference (MCID) achievement across almost all PROs at 60 months (p < 0.05). However, North American Spine Society (NASS) satisfaction scores at 60 months did not differ significantly between cohorts. Multivariate analysis found that catastrophizing significantly predicted 60-month NRS-BP change (β -1.45, 95% CI -1.81 to -1.09; p < 0.001) and MCID achievement (OR 1.98, 95% CI 1.52-2.58; p < 0.001) but not mean NRS-BP score or other metrics, including NASS satisfaction. Despite presenting with worse baseline symptoms, patients with pain catastrophizing experienced substantial and clinically meaningful improvement following surgery for degenerative lumbar spondylolisthesis. Patient satisfaction was comparable between cohorts, reflecting a nuanced balance between greater absolute improvement and persistence of residual symptoms. These findings underscore that catastrophizing should not be viewed as a barrier to surgical success, while pointing to the need for proactive expectation setting and shared decision-making.

Retrospective cohort. The aim was to determine how neck pain and disability improve following anterior cervical discectomy and fusion among patients with myeloradiculopathy. Neck pain and disability have traditionally been assessed using the neck disability index (NDI) and visual analog scale (VAS). Few studies have investigated how neck pain/disability improve differently among patients with symptoms of both myelopathy and radiculopathy. Patients were identified through retrospective review of a prospective surgical database from 2013 to 2020. Patient-reported outcome measures (PROMs) collected included VAS neck and arm, NDI, 12-Item Short Form physical composite score (SF-12 PCS), Patient-Reported Outcomes Measurement Information System physical function (PROMIS PF), and Patient Health Questionnaire 9 (PHQ-9). PROMs were collected preoperatively and up to 1-year postoperatively. Patients were categorized by preoperative symptom severity: high VAS arm (>7); high NDI (>55); high VAS arm and NDI; and moderate symptoms. Linear and logistic regression evaluated the impact of preoperative symptom severity on PROM scores and achievement of minimum clinically important difference (MCID), respectively. A total of 187 patients were included, 98 with neither high VAS arm nor NDI (moderate group), 14 with high NDI, 46 with high VAS arm, and 29 with high NDI and VAS arm. Postoperatively, greater symptom severity was a significant predictor of VAS neck (all timepoints; P ≤0.002, all), VAS arm (6 weeks; P =0.007), NDI (6 weeks to 6 months; P <0.001, all), SF-12 PCS (6 months; P =0.004), P ROMIS PF (6 weeks; P =0.007), and PHQ-9 (6 weeks to 6 months; P <0.001, all). Mean postoperative improvement was different among the four severity groups for VAS arm, NDI, and VAS neck (except for 1-year) ( P ≤0.002, all). Overall MCID achievement rates were significantly greater among higher symptom severity groups across VAS arm and NDI ( P ≤0.003, both). PROM improvement and MCID achievement for NDI, VAS neck, and VAS arm differed based on symptom severity.

Retrospective Review. Evaluate the influence of the 12-Item veterans Rand (VR-12) physical component score (PCS) on patient-reported outcome measures (PROMs) in an outpatient lumbar decompression (LD) cohort. The influence of baseline VR-12 PCS on postoperative clinical outcomes has not been evaluated in patients undergoing outpatient LD. Patients undergoing primary, elective, 1/2-level outpatient LD with baseline VR-12 PCS scores were retrospectively identified from a prospectively maintained single-surgeon database. Cohorts were preoperative VR-12 PCS<30 and VR-12 PCS≥30. Patient/perioperative characteristics and preoperative/postoperative 6-week/final follow-up (FF) PROMs were collected. Physical health PROMs included the VR-12 PCS, 12-Item Short Form (SF-12) PCS, patient-reported outcome measure information system-physical function (PROMIS-PF), visual analog scale (VAS)-back/leg, and Oswestry disability index (ODI). Mental health PROMs included the VR-12/SF-12 mental component score (MCS) and the patient-health questionnaire-9 (PHQ-9). Average FF was 13.8±8.9 months postoperatively. PROM improvements at 6 weeks/FF and minimal clinically important difference (MCID) achievement rates were determined. χ 2 analysis and the Student's t tests compared demographics, perioperative data, and preoperative PROMs. Multivariate linear/logistic regression compared postoperative PROMs, PROM improvements, and MCID achievement rates. Six weeks postoperatively, VR-12 PCS<30 reported worse baseline PROMs ( P ≤0.042, all) and worse scores except VR-12/SF-12 MCS ( P ≤0.043, all). Compared with VR-12 PCS≥30, VR-12 PCS<30 had worse FF VR-12 PCS, SF-12 PCS/MCS, PROMIS-PF, PHQ-9, and VAS-Back ( P ≤0.033, all). VR-12 PCS<30 experienced greater 6-week improvements in VR-12/SF-12 PCS, PHQ-9, VAS-Back, and ODI ( P ≤0.039, all). VR-12 PCS<30 had greater FF improvements in VR-12/SF-12 PCS, PHQ-9, and ODI ( P ≤0.001, all) and greater overall MCID achievement in VR-12 PCS/MCS, SF-12 PCS, PHQ-9, and ODI ( P ≤0.033, all). VR-12 PCS<30 patients-reported worse baseline/postoperative mental/physical health scores. However, they reported greater improvements in physical function, depressive burden, back pain, and disability by 6 weeks and FF and experienced greater MCID achievement for physical functioning, mental health, and disability scores.

P137. Preliminary analysis on the influence of workers’ compensation status on outcomes of anterior lumbar interbody fusion at L5-S1

Differences in Capture Rates of Patient-Reported Outcome Measures Between Ambulatory Surgery Centers and Hospitals From the American Joint Replacement Registry.

Factors associated with achieving minimum clinically important differences in EuroQol-5 Dimensions-5 levels scores following surgery for adult spinal deformity.

Limited studies have compared minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) with anterior lumbar interbody fusion (ALIF) for the treatment of isthmic spondylolisthesis. This study aims to compare perioperative variables, patient-reported outcome measures (PROMs), and minimal clinically important difference (MCID) achievement rates between these surgical approaches. Patients with isthmic spondylolisthesis undergoing primary, single-level MIS TLIF or ALIF were identified in a surgical database. Patients were divided into MIS TLIF and ALIF cohorts. Demographics and perioperative characteristics were collected and compared between groups using the chi square test or Student t-test. PROMs including the Patient-Reported Outcomes Measurement Information System Physical Function, 12-Item Short Form Physical Composite Score, visual analog scale (VAS) back, VAS leg, and Oswestry Disability Index were collected at preoperative, 6-, 12-week, 6-month, 1-, and 2-year time points. Mean PROMs were compared using the Student t-test for independent samples. MCID attainment was determined using established values in the literature; achievement rates by grouping were compared using chi square analysis. One hundred seventy-one patients were included, 121 MIS TLIF and 50 ALIF. No demographic differences were observed. Mean surgical times were 139.7 minutes (MIS TLIF) and 165.5 minutes (ALIF) (P < 0.001). No other perioperative differences were observed. Mean estimated blood loss values were 63.8 mL (MIS TLIF) and 73.7 mL (ALIF). Mean postoperative lengths of stay were 43.9 hours (MIS TLIF) and 42.5 hours (ALIF). Mean PROMs did not markedly differ among groups at any time point. MCID attainment was markedly higher among MIS TLIF patients for the Oswestry Disability Index at 6 weeks (P = 0.046) and 12 weeks (P = 0.007), Patient-Reported Outcomes Measurement Information System Physical Function at 12 weeks (P = 0.015), and VAS leg at 6 weeks (P = 0.031) and 12 weeks (P = 0.045). No other notable differences were observed among MCID achievement by grouping. While single-level ALIF demonstrated markedly higher surgical times, other perioperative characteristics and PROMs were comparable among ALIF and MIS TLIF patients. Although MCID achievement rates were generally lower for disability and leg pain among ALIF patients, significance was not reached at 6 months, 1 year, or during the overall postoperative period after fusion.

INTRODUCTION: Access to surgical subspeciality care is difficult to measure. Cervical spondylotic myelopathy (CSM) is a disease with high rate of progression without surgical intervention and, thus, longer symptom duration and initial symptom severity are surrogates for access to surgical care. The prospective Quality Outcomes Database (QOD) may provide insight into access to care for patients seeking surgery for CSM. METHODS: 1141 patients in the QOD with CSM underwent surgery. Access to care was measured by symptom duration (primary outcome) and baseline patient reported outcomes (PROs) including Neck Disability Index (NDI), Visual Analogue Scale-Neck Pain (VAS-NP), Visual Analogue Scale-Arm Pain (VAS-AP) and modified Japanese Orthopedic Association score (mJOA) (secondary outcomes). Multivariate logistic regression models including gender, race/ethnicity, insurance and socioeconomic status (SES) were created to predict symptom duration and baseline PROs. RESULTS: On multivariate modeling, prolonged symptom duration (&gt;12m) was associated with Medicaid (OR 1.81, CI 1.08-3.08) and workers compensation (OR 0.39 CI 0.15-0.95). Similarly, modeling demonstrated an association between Medicaid and worse baseline NDI (β 0.37 CI 0.16-0.59), neck pain (β 0.23 CI 0.01-0.46) and mJOA (β -0.24 CI -0.47 to -0.01). Additionally, African-Americans (β 0.28 CI 0.13-0.43) were more likely to have a worse baseline NDI. Other variables associated with worse baseline PROs were SES for NDI (β -0.10 CI -0.15 to -0.04), VAS-NP (β -0.09 CI -0.14 to -0.03), VAS-AP (β -0.1 CI -0.15 to -0.04) and mJOA (β 0.08 CI 0.02-0.14) and educational level for NDI (β -0.18 CI -0.29 to -0.07), VAS-NP (β -0.26 CI -0.38 to -0.15), and VAS-AP (β -0.17 CI -0.28 to -0.05). CONCLUSIONS: For patients with CSM, disparities exist in access to care. Medicaid patients particularly suffer from prolonged symptom duration and worse baseline disease status before access to surgical care.

To date, no prior study has established procedure-specific minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) thresholds for anterior combined latissimus dorsi and teres major (LDTM) tendon transfer in irreparable anterosuperior rotator cuff tears (IASRCTs). This study aimed to establish these patient-centered benchmarks in a cohort with a minimum 5-year follow-up. We retrospectively reviewed 31 patients (33 shoulders) who underwent a single-stage anterior LDTM transfer for IASRCTs and completed a minimum 5-year follow-up. Patient-reported outcome measures (PROMs) included the American Shoulder and Elbow Surgeons (ASES) score, visual analog scale (VAS) for pain, Constant score, and activities of daily living requiring internal rotation (ADLIR) score. The MCID was calculated as one-half of the standard deviation of the change score for each PROMs. PASS thresholds were derived from receiver operating characteristic analysis, using postoperative satisfaction as the external anchor. At a mean follow-up of 83.0 ± 7.4 months, all PROMs improved significantly (P < .001). Distribution-based MCID thresholds were 10.5 (ASES), 0.9 (VAS), 10.5 (Constant), and 8.6 (ADLIR). Corresponding MCID achievement rates were 77.4%, 87.1%, 74.2%, and 87.1%, respectively. Anchor-based PASS thresholds were ASES ≥75, VAS ≤2, Constant ≥60, and ADLIR ≥78; these were achieved by 64.5%, 80.6%, 77.4%, and 71.0% of patients, respectively. Age showed a significant negative correlation with ASES MCID (r_pb = -0.53, P = .002) and ADLIR MCID (r_pb = -0.41, P = .021). Male sex correlated positively with ASES PASS attainment (φ = 0.46, P = .010). No other baseline variables were significantly associated with MCID or PASS (all P > .05). This study is the first to establish clinically meaningful MCID and PASS thresholds for anterior LDTM transfer in patients with IASRCTs at a minimum 5-year follow-up. Most patients achieved substantial improvements that were deemed acceptable by the patients. These procedure-specific benchmarks provide practical targets for clinical assessment and patient counseling and serve as reference values for future outcome research.

IntroductionThe impact of upadacitinib on rheumatoid arthritis (RA) symptoms was evaluated during the first 12 weeks of treatment via patient-reported outcomes (PROs) using a mobile health application (app).MethodsParticipating rheumatologists from the CorEvitas RA Registry (prospective, observational cohort) recruited patients with RA initiating upadacitinib treatment. A modified version of the ArthritisPower® app was used to collect PROs, including the Routine Assessment of Patient Index Data 3 (RAPID3), duration of morning joint stiffness, and the Patient-Reported Outcomes Measurement Information System (PROMIS)-Fatigue 7a Short Form at baseline and weeks 1–4, 8, and 12. RAPID3 responses over time were assessed using Kaplan–Meier estimation to determine the proportion of patients achieving disease activity improvement and minimal clinically important difference (MCID). Results were analyzed for all patients initiating upadacitinib and a subsample of TNF inhibitor (TNFi)-experienced patients with moderate to severe disease at baseline.ResultsA total of 103 patients with RA initiating upadacitinib (62.1% TNFi-experienced) were included. At week 12, 53 patients (51.4%) completed the study and provided PRO data via the app. Among all patients, improvements in RAPID3, pain, morning stiffness, and fatigue were observed at week 1 and were maintained or further improved through week 12. At week 12, 37.5% of patients achieved RAPID3 low disease activity. Starting at week 1, improvements in RAPID3 disease activity category (19.4% of patients) and achievement of MCID (16.3%) were reported, with nearly 50% of patients achieving these outcomes by week 4 (RAPID3 category: 48.8%; MCID: 49.2%) and 60% by week 12 (RAPID3 category: 59.6%; MCID: 59.8%). TNFi-experienced patients generally reported similar outcomes. Patient-reported medication convenience and compliance were generally high.ConclusionsIn this real-world cohort of patients with RA, treatment with upadacitinib was associated with early and significant improvement in RAPID3, pain, morning stiffness, and fatigue regardless of prior TNFi experience. Clinically meaningful improvement in RAPID3 patient-reported disease activity was observed as early as week 1, with continued improvement reported through week 12.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40744-023-00594-6.

Predictors of the efficacy of epidural steroid injections for structural lumbar degenerative pathology