Using generic measures of functional health and well-being to increase understanding of disease burden.

In theory, generic measures of health status represent basic human values that are relevant to everyone’s functional health and well being regardless of age, disease, or treatment group. They provide “rulers” for measuring and comparing the burden of different diseases and conditions. Functional health rulers focus on what patients are able to do in everyday life and well-being rulers focus on how they feel, in general. In contrast, disease-specific measures focus on specific symptoms and problems that characterize a disease or condition. When the measurement tools are adequate, patient self-assessments are usually very useful in understanding both generic and disease-specific health concepts. In the current issue of Spine, Fanuele and his colleagues provide an excellent example of the usefulness of generic measures of functional health and well being in documenting the burden of spinal conditions for patients participating in the National Spine Network (NSN). They also compare results for patients with spinal conditions with those in the general population and they document the importance of considering comorbid conditions (e.g., CHF, COPD, renal failure, and rheumatoid arthritis), when evaluating the functioning of those with spinal conditions. They report that the Physical Component Summary (PCS) score from the SFD-36 Health Survey was substantially lower—two standard deviations lower—for NSN patients with spinal conditions compared to norms for the general population. Comorbid conditions were also linked to lower PCS scores. A score of 31.4 on the PCS, which they observed for the average NSN patient, is a very low score. Only about 7% of those in the general population score at or below that level on the PCS. The contribution by Fanuele and his colleagues is noteworthy because of its thoroughness in documenting how unique patients are in the NSN, illustrating the use of statistical methods to take into account the impact of comorbid conditions and how to use population norms. Among the more than 1000 studies using the SF-36 that have been published, to the best of my knowledge, this is the first publication to report these comparisons for those with spinal conditions. Although physicians who know well their patients with spinal conditions, may not be surprised at these findings, hopefully they will appreciate the advantages of documenting functional disability in quantitative terms. Standardized methods make it easier to compare and interpret results, and make quantitative adjustments for confounding factors, such as comorbid conditions, possible. It is also noteworthy that the SFD-36 assessment tool used in this study has become widely adopted by patient advocacy organizations, such as the Foundation for Accountability (FACCT), and by health care accrediting organizations, such as the National Committee on Quality Assurance (NCQA). These organizations, employers, and the public at large will be very interested in the results reported by Fanuele and his colleagues and, as the authors anticipate, they will be very interested in the effectiveness of alternative treatments and environmental changes that target those with spinal conditions. The generic measures of functional health and well being used by these authors to document the burden of spinal conditions have also proven useful in evaluating treatment outcomes. The tremendous disability observed among those with spinal conditions in the NSN and the contribvution of comorbid conditions must be taken into account in evaluating their treatment outcomes.