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Bergin SM, Abd-El-Barr MM, Gottfried ON, Goodwin CR, Shaffrey CI, Than KD. Measuring Outcomes in Spinal Deformity Surgery. Neurosurg Clin N Am 2023; 34:689-696. [PMID: 37718115 DOI: 10.1016/j.nec.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Outcome assessment in adult spinal deformity has evolved from radiographic analysis of curve correction to patient-centered perception of health-related quality-of-life. Oswestry Disability Index and the Scoliosis Research Society-22 Patient Questionnaire are the predominantly used patient-reported outcome (PRO) measurements for deformity surgery. Correction of sagittal alignment correlates with improved PRO. Functional outcomes and accelerometer measurements represent newer methods of measuring outcomes but have not yet been widely adopted or validated. Further adoption of a minimum set of core outcome domains will help facilitate international comparisons and benchmarking, and ultimately enhance value-based healthcare.
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Affiliation(s)
- Stephen M Bergin
- Department of Neurosurgery, Division of Spine, Duke University, 2301 Erwin Road, Durham, NC 27710, USA
| | - Muhammad M Abd-El-Barr
- Department of Neurosurgery, Division of Spine, Duke University, 2301 Erwin Road, Durham, NC 27710, USA
| | - Oren N Gottfried
- Department of Neurosurgery, Division of Spine, Duke University, 2301 Erwin Road, Durham, NC 27710, USA
| | - C Rory Goodwin
- Department of Neurosurgery, Division of Spine, Duke University, 2301 Erwin Road, Durham, NC 27710, USA
| | - Christopher I Shaffrey
- Department of Neurosurgery, Division of Spine, Duke University, 2301 Erwin Road, Durham, NC 27710, USA
| | - Khoi D Than
- Department of Neurosurgery, Division of Spine, Duke University, 2301 Erwin Road, Durham, NC 27710, USA.
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Abdullahi A, Aliyu K, Hassan AB, Sokunbi GO, Bello B, Saeys W, Truijen S. Prevalence of chronic non-specific low back pain among caregivers of stroke survivors in Kano, Nigeria and factors associated with it: A cross-sectional study. Front Neurol 2022; 13:900308. [PMID: 36277934 PMCID: PMC9581006 DOI: 10.3389/fneur.2022.900308] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 08/30/2022] [Indexed: 02/03/2023] Open
Abstract
Purpose Low back pain (LBP) may have a specific or non-specific cause such as abnormal posture or repetitive tasks. For instance, lifting and transferring patients during caregiving for stroke survivors may predispose the caregivers to LBP. Objectives The aim of this study is to determine the prevalence of chronic non-specific LBP and factors associated with it in caregivers of stroke survivors. Method The research design used is cross-sectional study design. Participants of the study were caregivers of stroke survivors in Kano, Nigeria who were at least 18 years old. They were included if they had at least one-month experience with caregiving for at least 1 h per day. Presence of LBP and level of disability were assessed using participants' self-report and Rolland Morris Low Back Pain Disability Questionnaire respectively. The data collected was analyzed using descriptive, Chi-square statistics and Binary Logistics Regression. Result Three hundred caregivers with mean age, 33.24 ± 10.32 years in which 207 and 93 were males and females respectively, participated in the study. The results showed that, there was a high prevalence (64.7%) of LBP among the caregivers. The prevalence was significantly associated with gender (p < 0.001), age (p = 0.029), occupation (p < 0.001) and duration of caregiving (p < 0.001) of the study participants. In addition, the result of the regression model showed that, being a female (p = 0.001), a civil servant (p = 0.031), a trader (p = 0.013), and a complete caregiver (0.001); and caregiving for a duration of 5 h or more per day (p = 0.024) are significant predictors of having LBP. Similarly, level of disability due to the presence of LBP among the study participants was significantly associated with gender (p < 0.001), occupation (p < 0.001), duration of caregiving (p = 0.025), and the nature of the caregiving (p < 0.001). Conclusion Informal caregiving for stroke survivors may result in developing chronic non-specific LBP, especially among females, Civil servants, traders, complete caregivers and those with long duration of caregiving. This can add an additional burden on the family in terms of cost of care, result in reduced quality of caregiving and cause psychological stress. Thus, it is important the health of the caregivers of stroke survivors is considered during stroke rehabilitation.
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Affiliation(s)
- Auwal Abdullahi
- Department of Physiotherapy, Bayero University Kano, Kano, Nigeria
- *Correspondence: Auwal Abdullahi
| | - Kamilu Aliyu
- Department of Physiotherapy, Bayero University Kano, Kano, Nigeria
| | - Auwal Bello Hassan
- Department of Medical Rehabilitation (Physiotherapy), College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria
| | | | - Bashir Bello
- Department of Physiotherapy, Bayero University Kano, Kano, Nigeria
| | - Wim Saeys
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium
| | - Steven Truijen
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium
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Vraa M, Pascoe S, Maddox D, Rhon DI, Cleland JA, Young JL. Prevalence and extent of low back pain and low back-related disability in non-care-seeking working-age adults. Musculoskelet Sci Pract 2022; 60:102572. [PMID: 35512483 DOI: 10.1016/j.msksp.2022.102572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To explore the prevalence and extent of low back pain (LBP) and low back-related disability in working-age adults not seeking care. METHODS A convenience sample of 101 working-age adults not seeking care for LBP completed the Oswestry Disability Index (ODI) and Roland-Morris Disability Questionnaire (RMDQ) as measures of disability and completed questionnaires that collected information on various demographic and health-related variables. Those reporting current LBP also completed a Numeric Pain Rating Scale (NPRS). Prevalence was assessed based on a dichotomization of whether any disability or pain was reported and also as a continuous variable to assess the extent of pain and disability present for each participant. RESULTS Of the 101 participants, 72.3% reported some level of disability (ODI mean = 7.91%, RMDQ mean = 2.63) and 46.5% reported some level of pain (NRPS mean = 3.68). Previous care-seeking for LBP was associated with increased odds of reporting disability (ODI odds ratio [OR] 7.91, 95% confidence interval [CI], 2.43 to 31.18; RMDQ OR 2.69, 95% CI, 1.05 to 7.24), as was reporting any current LBP (ODI OR 9.45, 95% CI, 3.15 to 33.21; RMDQ OR 7.03, 95% CI, 2.82 to 18.89). No other demographic or health-related variables were associated with the presence or extent of pain or disability. CONCLUSION Many non-care-seeking individuals reported some level of LBP and/or disability, suggesting that some level of pain and disability may be considered normal, acceptable, or manageable. One-third of individuals with no pain reported some disability.
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Affiliation(s)
- Matthew Vraa
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, WI, USA; Doctor of Physical Therapy Program, Northwest University, Kirkland, WA, USA; Residency in Orthopaedic Physical Therapy, Evidence in Motion, San Antonio, TX, USA.
| | - Stephanie Pascoe
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, WI, USA; Residency in Orthopaedic Physical Therapy, Evidence in Motion, San Antonio, TX, USA; Department of Physical Therapy and Integrative Care, Wardenburg Student Health Center, Boulder, CO, USA
| | - Daniel Maddox
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, WI, USA; Department of Physical Therapy, Ivester College of Health Sciences, Brenau University, Gainesville, GA, USA; Fellowship in Orthopaedic Manual Physical Therapy, Upstream Rehab Institute, Smyrna, GA, USA
| | - Daniel I Rhon
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, WI, USA; Department of Rehabilitation Medicine, Uniformed Services University of Health Sciences, Bethesda, MD, USA
| | - Joshua A Cleland
- Doctor of Physical Therapy Program, School of Medicine, Tufts University, Boston, MA, USA
| | - Jodi L Young
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, WI, USA
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Glowinski S, Bryndal A, Grochulska A. Prevalence and risk of spinal pain among physiotherapists in Poland. PeerJ 2021; 9:e11715. [PMID: 34277152 PMCID: PMC8269737 DOI: 10.7717/peerj.11715] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 06/11/2021] [Indexed: 12/18/2022] Open
Abstract
Background The purpose of this study was to determine the prevalence, symptoms of, and risk factors for spinal pain in physiotherapists, as well as to analyse the correlation between these factors and the nature of the work, anthropometric features of the respondents, and the level of their physical activity. Methods The study was conducted among 240 physiotherapists (71 male and 169 female) with a mean age of 38.7 years. They were divided into three groups: physical therapy (37), kinesitherapy (158) and massage (45). Physiotherapists were evaluated with a specially designed questionnaire, the postural discomfort chart, the Neck Disability Index (NDI) questionnaire, and the Oswestry Disability Index (ODI) questionnaire. Results The analysis showed a 91.7% incidence of spinal pain in physiotherapists (91.1% for kinesitherapy, 97.3% for physical therapy, and 88.9% for massage). The study revealed that 50.2% of physiotherapists indicated one to five pain episodes in their careers. Most respondents reported pain in the lumbosacral spine (82%) and the cervical spine (67%). Most respondents (58.5%) scored the pain as moderate (VAS scale). Carrying (62.6%) and torso bending (37.4%) were indicated as the causes of pain. Conclusions Physiotherapists demonstrate a high prevalence of spinal pain. Physical activity reduces the frequency of pain episodes.
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Affiliation(s)
- Sebastian Glowinski
- Department of Mechanical Engineering/Division of Mechatronics and Automatics, Technical University of Koszalin, Koszalin, Zachodniopomorskie, Poland.,Institute of Health Sciences, Slupsk Pomeranian Academy, Slupsk, Pomorskie, Poland
| | - Aleksandra Bryndal
- Institute of Health Sciences, Slupsk Pomeranian Academy, Slupsk, Pomorskie, Poland
| | - Agnieszka Grochulska
- Institute of Health Sciences, Slupsk Pomeranian Academy, Slupsk, Pomorskie, Poland
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Early Return to Work Has Benefits for Relief of Back Pain and Functional Recovery After Controlling for Multiple Confounds. J Occup Environ Med 2019; 60:901-910. [PMID: 29933319 PMCID: PMC6200378 DOI: 10.1097/jom.0000000000001380] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the effect on health outcomes of an early or immediate return-to-work (RTW) after acute low back pain (LBP). METHODS A longitudinal cohort of workers (N = 557) consulting for uncomplicated LBP were assessed on demographic, pain, occupational, and psychosocial variables. Pain and function were assessed at 3-month postpain onset. We tested the longitudinal effects of an early RTW on 3-month outcomes. RESULTS Pain and function improved more rapidly for workers with an immediate (30.7%) or early (1 to 7 days) RTW (36.8%). Eleven demographic, health, or workplace variables were identified as potential confounds, but controlling for these factors only partially attenuated the benefits of an early RTW. CONCLUSIONS An early RTW improves acute LBP and functional recovery, and alternate confounding explanations only partially eclipse this therapeutic effect.
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Vishwanathan K, Braithwaite I. Responsiveness of Commonly Used Patient- Reported Outcome Instruments in Lumbar Microdiscectomy. Asian Spine J 2019; 13:753-762. [PMID: 31154699 PMCID: PMC6773989 DOI: 10.31616/asj.2018.0334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 02/14/2019] [Indexed: 11/23/2022] Open
Abstract
Study Design Prospective observational cohort study. Purpose To evaluate the comparative responsiveness of Oswestry Disability Index (ODI, version 2.0), 24-item Roland-Morris Disability Questionnaire (RMDQ), 12-item Short-Form Health Survey (SF-12) physical component score (PCS), and SF-12 mental component score (MCS) in patients that underwent micro-discectomy for lumbar disc herniation. Overview of Literature Responsiveness is a context specific term and no study has reported the responsiveness of ODI version 2.0, RMDQ, SF-12 PCS, or SF-12 MCS in discectomy patients. Methods Responsiveness was assessed using distribution-based methods (effect size [ES], standardized response means [SRM ], SRM difference between patients who improved and those who did not show improvement [SRM difference]), and the anchor-based method (area under the curve [AUC] of receiver operating characteristic curves). Values of ES and SRM higher than 0.8, and AUC value higher than 0.7 suggest adequate responsiveness. Outcome instrument demonstrating the highest value of SRM difference and AUC was considered the most responsive. Results Responsiveness was assessed in 98 participants at a mean follow-up time of 12 weeks postoperatively. The overall ES of RMDQ, ODI, SF-12 PCS, and SF-12 MCS was 2.15, 2.11, 2.08, and 0.86, respectively. The overall SRM of ODI, RMDQ, SF-12 PCS, and SF-12 MCS was 1.36, 1.43, 1.24, and 0.65, respectively. The SRM difference in RMDQ, ODI, SF-12 PCS, and SF-12 MCS was 2.64, 2.26, 1.32, and 1.29, respectively. The AUC of ODI, RMDQ, SF-12 PCS, and SF-12 MCS was 0.96, 0.96, 0.83, and 0.83, respectively. Conclusions ODI, RMDQ, SF-12 PCS, and SF-12 MCS demonstrated adequate responsiveness in a homogenous cohort of patients who underwent lumbar micro-discectomy. ODI and RMDQ are equally responsive and, thus, are interchangeable instruments for region specific outcomes. Both the SF-12 PCS and SF-12 MCS can assess the quality of life following lumbar micro-discectomy.
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Affiliation(s)
- Karthik Vishwanathan
- Charutar Arogya Mandal, Shri Krishna Hospital, Pramukhswami Medical College, Karamsad, India
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Luomajoki HA, Bonet Beltran MB, Careddu S, Bauer CM. Effectiveness of movement control exercise on patients with non-specific low back pain and movement control impairment: A systematic review and meta-analysis. Musculoskelet Sci Pract 2018; 36:1-11. [PMID: 29631119 DOI: 10.1016/j.msksp.2018.03.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 03/04/2018] [Accepted: 03/26/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Patients with low back pain (LBP) and movement control impairment (MVCI) show altered spinal movement patterns. Treatment that aims to change movement behaviour could benefit these patients. OBJECTIVE To assess the effectiveness of movement control exercise (MVCE) in terms of clinically relevant measures (disability and pain) on patients with NSLBP. METHODS A systematic review and meta-analysis were conducted. CINAHL, MEDLINE, PUBMED and PEDro databases were searched for RCT's evaluating MVCE treatment in patients with NSLBP from review inception to April 2017. Authors were contacted to obtain missing data and outcomes. PEDro was used to assess methodological quality of the studies and the GRADE approach was used to assess the overall quality of evidence Data were combined using a random effects meta-analysis and reported as standardized mean differences (SMD). RESULTS Eleven eligible RCT's including a total of 781 patients were found. Results show 'very low to moderate quality' evidence of a positive effect of MVCE on disability, both at the end of treatment and after 12 months (SMD -0.38 95%CI -0.68, -0.09 respectively 0.37 95%CI -0.61,-0.04). Pain intensity was significantly reduced after MVCE at the end of treatment (SMD -0.39 95%CI -0.69, -0.04), but not after 12 months (SMD -0.27, 95%CI -0.62, 0.09). CONCLUSIONS MVCE intervention for people with NSLBP and MVCI appears to be more effective in improving disability compared to other interventions, both over the short and long term. Pain was reduced only in the short term. An important factor is the initial identification of patients with MVCI. Registration of the study: The study protocol registration number is CRD42016036662 on PROSPERO.
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Affiliation(s)
- Hannu Antero Luomajoki
- Zurich University of Applied Sciences ZHAW, School of Health Professions, Institute of Physiotherapy, Technikumstrasse 71, Postfach, 8401 Winterthur, Switzerland.
| | - Maria Beatriz Bonet Beltran
- Zurich University of Applied Sciences ZHAW, School of Health Professions, Institute of Physiotherapy, Technikumstrasse 71, Postfach, 8401 Winterthur, Switzerland.
| | - Silvia Careddu
- Zurich University of Applied Sciences ZHAW, School of Health Professions, Institute of Physiotherapy, Technikumstrasse 71, Postfach, 8401 Winterthur, Switzerland; Physio & Sport Luzern, Bruchstrasse 11, 6003 Luzern, Switzerland.
| | - Christoph Michael Bauer
- Zurich University of Applied Sciences ZHAW, School of Health Professions, Institute of Physiotherapy, Technikumstrasse 71, Postfach, 8401 Winterthur, Switzerland; University of Tampere, School of Medicine, Kalevantie 4, FI-33014, University of Tampere, Tampere, Finland.
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Lee SI, Huang A, Mortazavi B, Li C, Hoffman HA, Garst J, Lu DS, Getachew R, Espinal M, Razaghy M, Ghalehsari N, Paak BH, Ghavam AA, Afridi M, Ostowari A, Ghasemzadeh H, Lu DC, Sarrafzadeh M. Quantitative assessment of hand motor function in cervical spinal disorder patients using target tracking tests. ACTA ACUST UNITED AC 2018; 53:1007-1022. [PMID: 28475202 DOI: 10.1682/jrrd.2014.12.0319] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 12/01/2015] [Indexed: 11/05/2022]
Abstract
Cervical spondylotic myelopathy (CSM) is a chronic spinal disorder in the neck region. Its prevalence is growing rapidly in developed nations, creating a need for an objective assessment tool. This article introduces a system for quantifying hand motor function using a handgrip device and target tracking test. In those with CSM, hand motor impairment often interferes with essential daily activities. The analytic method applied machine learning techniques to investigate the efficacy of the system in (1) detecting the presence of impairments in hand motor function, (2) estimating the perceived motor deficits of CSM patients using the Oswestry Disability Index (ODI), and (3) detecting changes in physical condition after surgery, all of which were performed while ensuring test-retest reliability. The results based on a pilot data set collected from 30 patients with CSM and 30 nondisabled control subjects produced a c-statistic of 0.89 for the detection of impairments, Pearson r of 0.76 with p < 0.001 for the estimation of ODI, and a c-statistic of 0.82 for responsiveness. These results validate the use of the presented system as a means to provide objective and accurate assessment of the level of impairment and surgical outcomes.
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Affiliation(s)
- Sunghoon I Lee
- Computer Science Department, University of California Los Angeles (UCLA), Los Angeles, CA
| | - Alex Huang
- Department of Neurosurgery, UCLA, Los Angeles, CA
| | | | - Charles Li
- Computer Science Department, University of California Los Angeles (UCLA), Los Angeles, CA
| | | | - Jordan Garst
- Department of Neurosurgery, UCLA, Los Angeles, CA
| | - Derek S Lu
- Department of Neurosurgery, UCLA, Los Angeles, CA
| | | | | | | | | | - Brian H Paak
- Department of Neurosurgery, UCLA, Los Angeles, CA
| | | | - Marwa Afridi
- Department of Neurosurgery, UCLA, Los Angeles, CA
| | | | - Hassan Ghasemzadeh
- Computer Science Department, University of California Los Angeles (UCLA), Los Angeles, CA
| | - Daniel C Lu
- Department of Neurosurgery, UCLA, Los Angeles, CA.,Department of Orthopedic Surgery, UCLA, Los Angeles, CA
| | - Majid Sarrafzadeh
- Computer Science Department, University of California Los Angeles (UCLA), Los Angeles, CA
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Chimenti RL, Van Dillen LR, Khoo-Summers L. Use of a Patient-Specific Outcome Measure and a Movement Classification System to Guide Nonsurgical Management of a Circus Performer with Low Back Pain: A Case Report. J Dance Med Sci 2017; 21:185-192. [PMID: 29166989 PMCID: PMC5960992 DOI: 10.12678/1089-313x.21.4.185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Low back pain (LBP) can be detrimental to the career of a circus arts performer, yet there is minimal population-specific literature to guide care. Moreover, reluctance to discontinue training and the need to resume end-range lumbar motion can impede the success of conservative care. The purpose of this case report is to describe the use of a patient-specific outcome measure and a movement classification system to structure a home exercise program (HEP) for an adolescent training to be a circus performer. The patient was a 16-year-old female with a 10-month history of LBP. A Movement System Impairment examination indicated that she had lower abdominal weakness, gluteal weakness, and hip flexors that were short and stiff; hence, extension and rotation were repeated patterns of lumbopelvic movement associated with her LBP symptoms. The patient was seen for 16 visits over 16 weeks. The HEP focused on minimizing lumbopelvic extension and rotation movements while improving abdominal and gluteal strength and hip flexor flexibility. Resumption of acrobatic activities was guided by the Patient-Specific Functional Scale. As measured by this scale, her difficulty with five functional and acrobatic activities decreased from 4/10 at initial evaluation to less than or equal to 1/10 by discharge. It is concluded that using an outcome measure to assess difficulty of activities chosen by the patient and education on how to avoid movement patterns associated with LBP symptoms can help facilitate return to performance.
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Affiliation(s)
- Ruth L Chimenti
- Department of Physical Therapy and Rehabilitation Science at the University of Iowa, Iowa City, Iowa
| | - Linda R Van Dillen
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri
| | - Lynnette Khoo-Summers
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri
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Abstract
UNLABELLED MINI: The authors wanted to determine which existing primary-care low back pain stratification schema is associated with distinct subpopulations. Initial stratification by DMPP identified potentially distinct epidemiological groups. DMPP stratification resulted in discrimination beyond that provided by disability or chronicity risk stratification alone. STUDY DESIGN A cross-sectional study of Canadian patients suffering from low back pain (LBP) seeking primary care. OBJECTIVE The aim of this study was to determine which existing primary care LBP stratification schema is associated with distinct subpopulations as characterized by easily identifiable primary epidemiological factors. SUMMARY OF BACKGROUND DATA LBP is among the most frequent reasons for visits to primary care physicians and a leading cause of years lived with disability. In an effort to improve treatment response/outcomes in LBP primary care, different classification systems have been proposed in an effort to provide more tailored treatment with the intent of improving outcomes. Group-specific risk factors and underlying etiology might suggest a need for, or inform, changes to treatment approaches to optimize LBP outcomes. METHODS Stratification by dominant mechanical pain patterns; chronicity risk; disability severity. Multinomial logistic regression was used to identify the system showing greatest variability in associations with age, sex, obesity, and comorbidity. Once identified, the remaining schemas were incorporated into the model. RESULTS N = 970; mean age: 50 years (range: 18-93); 56% female. Stratification by pain pattern revealed greater variability. Adjusted analysis: Increasing age was associated with greater odds of intermittent, extension-based back- or leg-dominant pain [odds ratio (OR): 1.02 and 1.06; P < 0.01]; being male with leg-dominant pain (ORs > 2; P < 0.01). Overweight/obesity was associated with extension-based leg-dominant pain (OR = 2.6; P < 0.02) and increasing comorbidity with extension-based back-dominant pain (OR = 1.3; P < 0.01). Severe disability was associated only with constant leg pain (OR = 3.9; P < 0.01), and high chronicity risk with extension-based leg-dominant pain (OR = 0.4; P = 0.03). CONCLUSION Dominant mechanical symptom stratification resulted in further discrimination of an epidemiologically distinct and a large subgroup of LBP patients not identified by disability or chronicity risk stratification alone. Findings suggest a need for primary care initiated multidimensional stratification in chronic LBP. LEVEL OF EVIDENCE 3.
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11
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Shearer HM, Côté P, Boyle E, Hayden JA, Frank J, Johnson WG. Who will have Sustainable Employment After a Back Injury? The Development of a Clinical Prediction Model in a Cohort of Injured Workers. JOURNAL OF OCCUPATIONAL REHABILITATION 2017; 27:445-455. [PMID: 27807731 DOI: 10.1007/s10926-016-9678-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Purpose Our objective was to develop a clinical prediction model to identify workers with sustainable employment following an episode of work-related low back pain (LBP). Methods We used data from a cohort study of injured workers with incident LBP claims in the USA to predict employment patterns 1 and 6 months following a workers' compensation claim. We developed three sequential models to determine the contribution of three domains of variables: (1) basic demographic/clinical variables; (2) health-related variables; and (3) work-related factors. Multivariable logistic regression was used to develop the predictive models. We constructed receiver operator curves and used the c-index to measure predictive accuracy. Results Seventy-nine percent and 77 % of workers had sustainable employment at 1 and 6 months, respectively. Sustainable employment at 1 month was predicted by initial back pain intensity, mental health-related quality of life, claim litigation and employer type (c-index = 0.77). At 6 months, sustainable employment was predicted by physical and mental health-related quality of life, claim litigation and employer type (c-index = 0.77). Adding health-related and work-related variables to models improved predictive accuracy by 8.5 and 10 % at 1 and 6 months respectively. Conclusion We developed clinically-relevant models to predict sustainable employment in injured workers who made a workers' compensation claim for LBP. Inquiring about back pain intensity, physical and mental health-related quality of life, claim litigation and employer type may be beneficial in developing programs of care. Our models need to be validated in other populations.
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Affiliation(s)
- Heather M Shearer
- UOIT-CMCC Center for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology, 2000 Simcoe St. North, Oshawa, ON, L1H 7K4, Canada.
- Graduate Education and Research Programs, Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, ON, M2H 3J1, Canada.
| | - Pierre Côté
- UOIT-CMCC Center for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology, 2000 Simcoe St. North, Oshawa, ON, L1H 7K4, Canada
- Canada Research Chair in Disability Prevention and Rehabilitation, University of Ontario Institute of Technology, 2000 Simcoe St. North, Oshawa, ON, L1H 7K4, Canada
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Eleanor Boyle
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| | - Jill A Hayden
- Department of Community Health and Epidemiology, Dalhousie University, 5790 University Avenue, Room 403, Halifax, NS, B3H 1V7, Canada
| | - John Frank
- Chair, Public Health Research and Policy, Usher Institute of Population Health Sciences, University of Edinburgh, Scottish Collaboration for Public Health Research and Policy, First Floor, 20 West Richmond St., Edinburgh, EH4 6AQ, UK
| | - William G Johnson
- Department of Biomedical Informatics, Arizona State University, Samuel C. Johnson Research Bldg., 13212 Shea Blvd., Scottsdale, AZ, 85259, USA
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Lee MK, Yost KJ, McDonald JS, Dougherty RW, Vine RL, Kallmes DF. Item response theory analysis to evaluate reliability and minimal clinically important change of the Roland-Morris Disability Questionnaire in patients with severe disability due to back pain from vertebral compression fractures. Spine J 2017; 17:821-829. [PMID: 28087450 DOI: 10.1016/j.spinee.2017.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 11/08/2016] [Accepted: 01/03/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The majority of validation done on the Roland-Morris Disability Questionnaire (RMDQ) has been in patients with mild or moderate disability. There is paucity of research focusing on the psychometric quality of the RMDQ in patients with severe disability. PURPOSE To evaluate the psychometric quality of the RMDQ in patients with severe disability. STUDY DESIGN/SETTING Observational clinical study. SAMPLE The sample consisted of 214 patients with painful vertebral compression fractures who underwent vertebroplasty or kyphoplasty. OUTCOME MEASURES The 23-item version of the RMDQ was completed at two time points: baseline and 30-day postintervention follow-up. METHODS With the two-parameter logistic unidimensional item response theory (IRT) analyses, we derived the range of scores that produced reliable measurement and investigated the minimal clinically important difference (MCID). RESULTS Scores for 214 (100%) patients at baseline and 108 (50%) patients at follow-up did not meet the reliability criterion of 0.90 or higher, with the majority of patients having disability due to back pain that was too severe to be reliably measured by the RMDQ. Depending on methodology, MCID estimates ranged from 2 to 8 points and the proportion of patients classified as having experienced meaningful improvement ranged from 26% to 68%. A greater change in score was needed at the extreme ends of the score scale to be classified as having achieved MCID using IRT methods. CONCLUSIONS Replacing items measuring moderate disability with items measuring severe disability could yield a version of the RMDQ that better targets patients with severe disability due to back pain. Improved precision in measuring disability would be valuable to clinicians who treat patients with greater functional impairments. Caution is needed when choosing criteria for interpreting meaningful change using the RMDQ.
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Affiliation(s)
- Minji K Lee
- Division of Health Care Policy and Management, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First St SW, Rochester MN 55905, USA.
| | - Kathleen J Yost
- Department of Health Sciences Research, Mayo Clinic, 200 First St SW, Rochester MN 55905, USA
| | - Jennifer S McDonald
- Division of Radiology, Mayo Clinic, 200 First St SW, Rochester MN 55905, USA
| | | | - Roanna L Vine
- Division of Radiology, Mayo Clinic, 200 First St SW, Rochester MN 55905, USA
| | - David F Kallmes
- Division of Radiology, Mayo Clinic, 200 First St SW, Rochester MN 55905, USA
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Della Mora LS, Perruccio AV, Badley EM, Rampersaud YR. Differences among primary care patients with different mechanical patterns of low back pain: a cross-sectional investigation. BMJ Open 2016; 6:e013060. [PMID: 27927661 PMCID: PMC5168682 DOI: 10.1136/bmjopen-2016-013060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To characterise and compare a persistent low back pain (LBP) population based on 4 clinical pain patterns. DESIGN Cross-sectional analysis of patient-reported data. SETTING Patients from 220 primary care practitioners in 3 cities in Ontario, Canada. PARTICIPANTS 1020 individuals seeking LBP care. INCLUSION CRITERIA LBP symptoms lasting 1½-12 months, or unmanageable recurrent symptoms; ages 18+years. EXCLUSION CRITERIA pregnant/1-year postpartum; involved in active litigation or motor vehicle injury; emergent spinal presentations; pain disorder diagnosis; work injury claim; or constant symptoms persisting >12 months postonset. MAIN OUTCOME MEASURE Hall pain pattern subgroups: back dominant pain aggravated by flexion (P1) or extension (P2), or leg dominant constant (P3) or intermittent (P4) pain (multinomial logistic outcome; referent: P1). RESULTS Groups P1 and P2 had the highest proportion of women. P2 and P4 had higher mean ages and comorbidity counts. P3 and P4 had higher proportions of overweight/obese individuals and lower general health scores. Adjusted models: being male and overweight/obese was associated with increased odds of being in P3 (OR 1.64 (95% CI 1.10 to 2.46), and OR 1.74 (1.13 to 2.68), respectively) and P4 (OR 1.87 (1.11 to 3.15) and OR 1.91 (1.06 to 3.42), respectively), and increasing age with increased odds of being in P2 (OR 1.02 (1.01 to 1.03)) and P4 (OR 1.06 (1.04 to 1.08)). Increasing comorbidity count was associated with increased odds of being in P2 (OR 1.14 (1.0 to 1.3)), and better general health scores with decreased odds of being in P3 (OR 0.40 (0.18 to 0.93)). CONCLUSIONS This is the first study to examine the 'Hall system' in a non-rehab primary care population. Subgroups classified according to this system appear to have distinct profiles. Further research is needed to better characterise and determine the prognostic implication of these clinically derived subgroups.
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Affiliation(s)
- Lauren S Della Mora
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Anthony V Perruccio
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Health Care and Outcomes Research, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Arthritis Program, University Health Network, Toronto, Ontario, Canada
- Faculty of Medicine, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth M Badley
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Health Care and Outcomes Research, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Arthritis Program, University Health Network, Toronto, Ontario, Canada
| | - Y Raja Rampersaud
- Arthritis Program, University Health Network, Toronto, Ontario, Canada
- Faculty of Medicine, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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14
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Flavell CA, Gordon S, Marshman L. Classification characteristics of a chronic low back pain population using a combined McKenzie and patho-anatomical assessment. ACTA ACUST UNITED AC 2016; 26:201-207. [PMID: 27744135 DOI: 10.1016/j.math.2016.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 09/27/2016] [Accepted: 10/04/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND Physiotherapists use musculo-skeletal classification systems for patient assessment. Since its early development, the McKenzie lumbar spine assessment (MK) has been incorporated into examination algorithms and combined with a series of patho-anatomical diagnostic tests. No previous studies have used a MK and a combined examination (MK-C) to provide a detailed profile of patients, report and compare the classification characteristics of a chronic low back pain (CLBP) population. OBJECTIVE To report the classification characteristics of a CLBP population using MK and MK-C examinations, and conduct inter-classification comparison of the MK-C for demographics, the Oswestry Disability Index (ODI), Roland Morris Disability Index (RM), Modified Somatic Perceptions Questionnaire (MSPQ), symptom duration and intensity. METHOD A prospective cross-sectional study conducted in a spinal clinic by a MK trained physiotherapist. RESULTS Results were obtained in 150 patients. Using MK, 31% (n = 47) of participants were classified as inconclusive. Following MK-C only 6% of participants remained inconclusive (n = 9). The most frequent MK-C classification was facet joint syndrome (FJS) (49%). Participants with FJS were significantly older than those classified as discogenic (p < 0.001; CI 3.96 ̶ 19.74), or mixed (p < 0.001; CI 5.98 ̶ 36.41). Participants classified as discogenic had significantly higher RM (p = 0.022) and MSPQ (p = 0.005) scores than FJS. CONCLUSION Results indicated that 94% of CLBP patients could be classified using a MK-C. The most common presentation in CLBP was facet joint syndrome. Age, RM and MSPQ appeared to be distinguishing characteristics of this population. Future studies should be conducted to establish the validity and reliability of the MK-C.
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Affiliation(s)
- Carol Ann Flavell
- College of Healthcare Sciences, James Cook University, Douglas Campus, Townsville, Qld, 4811, Australia.
| | - Susan Gordon
- School of Health Sciences, Rehabilitation and Aged Care, Flinders University, Adelaide, SA, 5000, Australia.
| | - Laurence Marshman
- The Townsville Hospital, Angus Smith Drive, Townsville, Qld, 4811, Australia.
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15
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Singh S, Singh K, Gupta R, Kaur N, Bansal P, Singh S. Correlation of quality of life scores to clinical outcome of lumbar epidural steroids in chronic low back pain. Anesth Essays Res 2016; 10:574-579. [PMID: 27746554 PMCID: PMC5062205 DOI: 10.4103/0259-1162.183563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT AND AIM The assessment of severity of low back pain includes subjective questionnaires to quantify the impact on routine life. The objective of current study was to correlate various quality of life (QOL) scores to the clinical outcome measured as improvement in Visual Analog Score (VAS) after interventional treatment. SUBJECTS AND METHODS Fifty-one consecutive chronic low backache patients were assessed for pain intensity using VAS, revised Oswestry Disability Index (ODI), Quebec's, Roland-Morris disability questionnaire (RMDQ), and depression score at presentation. All subjects received interventional therapy complemented with physiotherapy; changes in scores were evaluated at 2 weekly intervals till 12 weeks. TYPE OF STUDY Prospective, observational, cohort study. RESULTS All scores depicted highly significant statistical improvement over baseline scores (P < 0.001). The Pearson correlation of VAS with rest of the scores showed that all variables correlate well with VAS at various time periods till 3 months. However, the best outcome predictor for VAS in QOL scores was Oswestry score as well as depression score which had an additive predictive effect. Among the QOL scores best intercorrelation was found with ODI and RMDQ scores at baseline as well as at all treatment follow-ups. INTERPRETATION AND CONCLUSION ODI and depression score closely parallel trends of reduction in VAS indicating that these scores may be the best outcome predictor after interventional treatment of pain. Among QOL scores ODI and RMDQ evaluated in the current study record comparable degree of physical incapacity; the exception is Quebec's score.
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Affiliation(s)
- Saru Singh
- Department of Anaesthesia, BPS Government Medical College, Khanpur Kalan, Sonepat, Haryana, India
| | - Kulvinder Singh
- Department of Radiology, BPS Government Medical College, Khanpur Kalan, Sonepat, Haryana, India
| | - Ruchi Gupta
- Department of Anaesthesia, SGRDIMS&R, Amritsar, Punjab, India
| | - Nayyamat Kaur
- Department of Anaesthesia, Government Medical College and Hospital, Chandigarh, India
| | - Pranav Bansal
- Department of Anaesthesia, BPS Government Medical College, Khanpur Kalan, Sonepat, Haryana, India
| | - Sanjeet Singh
- Department of Community Medicine, BPS Government Medical College, Khanpur Kalan, Sonepat, Haryana, India
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16
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Roland-Morris Disability Questionnaire and Oswestry Disability Index: Which Has Better Measurement Properties for Measuring Physical Functioning in Nonspecific Low Back Pain? Systematic Review and Meta-Analysis. Phys Ther 2016; 96:1620-1637. [PMID: 27081203 DOI: 10.2522/ptj.20150420] [Citation(s) in RCA: 153] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 03/31/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Physical functioning is a core outcome domain to be measured in nonspecific low back pain (NSLBP). A panel of experts recommended the Roland-Morris Disability Questionnaire (RMDQ) and Oswestry Disability Index (ODI) to measure this domain. The original 24-item RMDQ and ODI 2.1a are recommended by their developers. PURPOSE The purpose of this study was to evaluate whether the 24-item RMDQ or the ODI 2.1a has better measurement properties than the other to measure physical functioning in adult patients with NSLBP. DATA SOURCES Bibliographic databases (MEDLINE, Embase, CINAHL, SportDiscus, PsycINFO, and Google Scholar), references of existing reviews, and citation tracking were the data sources. STUDY SELECTION Two reviewers selected studies performing a head-to-head comparison of measurement properties (reliability, validity, and responsiveness) of the 2 questionnaires. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist was used to assess the methodological quality of these studies. DATA EXTRACTION The studies' characteristics and results were extracted by 2 reviewers. A meta-analysis was conducted when there was sufficient clinical and methodological homogeneity among studies. DATA SYNTHESIS Nine articles were included, for a total of 11 studies assessing 5 measurement properties. All studies were classified as having poor or fair methodological quality. The ODI displayed better test-retest reliability and smaller measurement error, whereas the RMDQ presented better construct validity as a measure of physical functioning. There was conflicting evidence for both instruments regarding responsiveness and inconclusive evidence for internal consistency. LIMITATIONS The results of this review are not generalizable to all available versions of these questionnaires or to patients with specific causes for their LBP. CONCLUSIONS Based on existing head-to-head comparison studies, there are no strong reasons to prefer 1 of these 2 instruments to measure physical functioning in patients with NSLBP, but studies of higher quality are needed to confirm this conclusion. Foremost, content, structural, and cross-cultural validity of these questionnaires in patients with NSLBP should be assessed and compared.
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17
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Machado GC, Witzleb AJ, Fritsch C, Maher CG, Ferreira PH, Ferreira ML. Patients with sciatica still experience pain and disability 5 years after surgery: A systematic review with meta-analysis of cohort studies. Eur J Pain 2016; 20:1700-1709. [PMID: 27172245 DOI: 10.1002/ejp.893] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2016] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND OBJECTIVE The clinical course of patients with sciatica is believed to be favourable, but there is conflicting evidence on the postoperative course of this condition. We aimed to investigate the clinical course of sciatica following surgery. DATABASES AND DATA TREATMENT An electronic search was conducted on MEDLINE, EMBASE and CINAHL from inception to April 2015. We screened for prospective cohort studies investigating pain or disability outcomes for patients with sciatica treated surgically. Fractional polynomial regression analysis was used to generate pooled means and 95% confidence intervals (CI) of pain and disability up to 5 years after surgery. Estimates of pain and disability (converted to a 0-100 scale) were plotted over time, from inception to last available follow-up time. RESULTS Forty records (39 cohort studies) were included with a total of 13,883 patients with sciatica. Before surgery, the pooled mean leg pain score was 75.2 (95% CI 68.1-82.4) which reduced to 15.3 (95% CI 8.5-22.1) at 3 months. Patients were never fully recovered in the long-term and pain increased to 21.0 (95% CI 12.5-29.5) at 5 years. The pooled mean disability score before surgery was 55.1 (95% CI 52.3-58.0) and this decreased to 15.5 (95% CI 13.3-17.6) at 3 months, and further reduced to 13.1 (95% CI 10.6-15.5) at 5 years. CONCLUSIONS Although surgery is followed by a rapid decrease in pain and disability by 3 months, patients still experience mild to moderate pain and disability 5 years after surgery. WHAT DOES THIS REVIEW ADD?: This review provides a quantitative summary of the postoperative course of patients with sciatica. Patients with sciatica experienced a rapid reduction in pain and disability in the first 3 months, but still had mild to moderate symptoms 5 years after surgery. Although no significant differences were found, microdiscectomy showed larger improvements compared to other surgical techniques.
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Affiliation(s)
- G C Machado
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, NSW, Australia.
| | - A J Witzleb
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, NSW, Australia
| | - C Fritsch
- Department of Physiotherapy, Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
| | - C G Maher
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, NSW, Australia
| | - P H Ferreira
- Faculty of Health Sciences, The University of Sydney, NSW, Australia
| | - M L Ferreira
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, NSW, Australia.,Institute of Bone and Joint Research, The Kolling Institute, Sydney Medical School, The University of Sydney, NSW, Australia
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18
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Karp JF, McGovern J, Marron MM, Gerszten P, Weiner DK, Okonkwo D, Kanter AS. Clinical and neuropsychiatric correlates of lumbar spinal surgery in older adults: results of a pilot study. Pain Manag 2016; 6:543-552. [PMID: 27102978 DOI: 10.2217/pmt.16.9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
AIM To improve selection of older lumbar surgical candidates, we surveyed correlates of functioning and satisfaction with surgery. MATERIALS & METHODS Prospective sample at lumbar spine surgery clinic. Patients (n = 48) were evaluated before surgery and after 3 months. Dependent variables were functioning and surgical satisfaction. RESULTS Baseline variables associated with disability at 3 months included cognitive status and widespread pain. There was clinically significant improvement with moderate effects sizes for anxiety and depression at follow-up. Patients with at least a 30% improvement in disability had better physical health-related quality of life and were less likely to report widespread pain before surgery. CONCLUSION Although preliminary, two novel potential predictors of lumbar surgery outcome include diminished cognitive functioning and widespread pain. Further study of these variables on post-surgical functioning and satisfaction may improve patient selection.
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Affiliation(s)
- Jordan F Karp
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Geriatric Research Education & Clinical Center (GRECC) VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Jonathan McGovern
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Megan M Marron
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Peter Gerszten
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Debra K Weiner
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Geriatric Research Education & Clinical Center (GRECC) VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - David Okonkwo
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Adam S Kanter
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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19
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Jesus-Moraleida FR, Silva JP, Pereira DS, Domingues Dias JM, Correa Dias R, Ferreira ML, Hayden JA, Pereira LSM. Exercise therapy for older adults with low-back pain. Hippokratia 2016. [DOI: 10.1002/14651858.cd012140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Fabianna R Jesus-Moraleida
- Universidade Federal do Ceará; Department of Physical Therapy, Faculty of Medicine; Rua Alexandre Baraúna, 949, 1o andar Fortaleza Ceará Brazil 60430-160
- Universidade Federal de Minas Gerais; Post Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, School of Physical Education, Physical Therapy and Occupational Therapy; Belo Horizonte, Minas Gerais Brazil
| | - Juscelio P Silva
- Universidade Federal de Minas Gerais; Post Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, School of Physical Education, Physical Therapy and Occupational Therapy; Belo Horizonte, Minas Gerais Brazil
| | - Daniele S Pereira
- Universidade Federal de Alfenas; Nursing school; Av. Jovino Fernandes Sales, 2600 Alfenas Minas Gerais Brazil 37130-000
| | - Joao Marcos Domingues Dias
- Universidade Federal de Minas Gerais; Post Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, School of Physical Education, Physical Therapy and Occupational Therapy; Belo Horizonte, Minas Gerais Brazil
| | - Rosangela Correa Dias
- Universidade Federal de Minas Gerais; Post Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, School of Physical Education, Physical Therapy and Occupational Therapy; Belo Horizonte, Minas Gerais Brazil
| | - Manuela L Ferreira
- Sydney Medical School, The University of Sydney; The George Institute for Global Health & Institute of Bone and Joint Research/The Kolling Institute; Sydney NSW Australia
| | - Jill A Hayden
- Dalhousie University; Department of Community Health & Epidemiology; 5790 University Avenue Room 403 Halifax NS Canada B3H 1V7
| | - Leani Souza Màximo Pereira
- Universidade Federal de Minas Gerais; Post Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, School of Physical Education, Physical Therapy and Occupational Therapy; Belo Horizonte, Minas Gerais Brazil
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20
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Fischer CR, Cassilly R, Dyrszka M, Trimba Y, Peters A, Goldstein JA, Spivak J, Bendo JA. Cost-Effectiveness of Lumbar Spondylolisthesis Surgery at 2-Year Follow-up. Spine Deform 2016; 4:48-54. [PMID: 27852500 DOI: 10.1016/j.jspd.2015.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 05/16/2015] [Accepted: 05/23/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The purpose of this study was to determine the cost/quality-adjusted life-year (QALY) of the operative treatment of lumbar spondylolisthesis and identify factors associated with cost-effectiveness at 2 years. METHODS We evaluated patients who underwent surgery for spondylolisthesis. The QALY was determined from the EQ5D. Outcomes were also assessed using the Oswestry Disability Index (ODI). Surgical, neuromonitoring, and anesthesia Current Procedural Terminology (CPT) codes as well as hospital Diagnosis-Related Group codes were used to determine the Medicare direct care costs of surgery. Indirect costs were modeled based on existing literature. A discounting rate of 3% was applied. Analysis was performed to determine which factors were associated with a cost/QALY less than $100,000. RESULTS There were 44 patients who underwent surgery for either degenerative (30) or isthmic spondylolisthesis (14). There were 27 women and 17 men, with an average age at surgery of 59.7 years (standard deviation [SD] = 14.69) and an average follow-up of 2 years (SD = 0.82). The average postoperative improvement in ODI was 24.77 (SD = 23.9), and change in QALY was 0.43 (SD = 0.30). The average cost/QALY at 2 years for direct care costs was $89,065. The average cost/QALY at 2 years for direct plus indirect costs was $112,588. Higher preoperative leg pain and greater leg pain change was associated with a cost/QALY <$100,000 (p < .005, p < .028). The cost-effective group had a higher proportion of patients with disease extent of two or more levels (p = .021). When comparing surgical techniques of anterior-posterior and posterior only, there was no difference in cost-effectiveness. CONCLUSIONS Spondylolisthesis surgery is cost-effective at 2 years, with a QALY change of 0.43 and a direct cost/QALY of $89,065. Higher preoperative leg pain and larger extent of disease was associated with cost-effectiveness. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Charla R Fischer
- Columbia University Medical Center, 630 West 168th St, New York, NY 10032, USA.
| | - Ryan Cassilly
- Columbia University Medical Center, 630 West 168th St, New York, NY 10032, USA
| | - Marc Dyrszka
- Columbia University Medical Center, 630 West 168th St, New York, NY 10032, USA
| | - Yuriy Trimba
- NYU Hospital for Joint Diseases, 333 E 38th St, New York, NY 10016, USA
| | - Austin Peters
- NYU Hospital for Joint Diseases, 333 E 38th St, New York, NY 10016, USA; Oregon Health and Sciences University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA
| | | | - Jeffrey Spivak
- NYU Hospital for Joint Diseases, 333 E 38th St, New York, NY 10016, USA
| | - John A Bendo
- NYU Hospital for Joint Diseases, 333 E 38th St, New York, NY 10016, USA
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21
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Brouwer S, Amick BC, Lee H, Franche RL, Hogg-Johnson S. The Predictive Validity of the Return-to-Work Self-Efficacy Scale for Return-to-Work Outcomes in Claimants with Musculoskeletal Disorders. JOURNAL OF OCCUPATIONAL REHABILITATION 2015; 25:725-32. [PMID: 25990375 PMCID: PMC4636988 DOI: 10.1007/s10926-015-9580-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
PURPOSE To examine the predictive validity of the Return-to-Work Self-Efficacy (RTWSE) Scale in terms of the scale's baseline absolute values and of changes in self-efficacy scores, with the outcome of return-to-work (RTW) status in a sample of injured workers with upper extremity and back musculoskeletal disorders. METHODS RTWSE was measured with a 10-item scale assessing Overall RTWSE and three self-efficacy subdomains: (1) ability to cope with pain, (2) ability to obtain help from supervisor and (3) ability to obtain help from co-workers. Outcome measures included RTW status (yes/no) measured at 6- and 12-month follow-up. RTWSE improvement was defined as an increase in self-efficacy scores between baseline and 6-month follow-up time points. Logistic regression analyses were performed with RTW status as the dependent variable and adjusted for age, gender, educational level, personal income, pain site, pain severity, functional status, and depressive symptoms, and for baseline RTWSE scores in the improvement score analyses. RESULTS A total of 632 claimants completed the baseline telephone interview 1 month post-injury; 446 subjects completed the 6-month interview (71 %) and 383 subjects completed the 12-month interview (61 %). The baseline Pain RTWSE scores were found to be useful to predict RTW status 6 months post-injury, with a trend for baseline Overall RTWSE. Improvements over time in Overall RTWSE and in Co-worker RTWSE were found to be useful to predict 12-month RTW status, with trends for improvements in Supervisor RTWSE and Pain RTWSE. CONCLUSION The study found evidence supporting the predictive validity of the RTWSE scale within 12 months after injury. The RTWSE scale may be a potentially valuable scale in research and in managing work disabled claimants with musculoskeletal disorders.
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Affiliation(s)
- Sandra Brouwer
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, Building 3217, Room 620, 9713 AV, Groningen, The Netherlands.
- Institute for Work & Health, Toronto, ON, Canada.
| | - Benjamin C Amick
- Institute for Work & Health, Toronto, ON, Canada
- Robert Stempel College of Public Health and Social Work, Department of Health Policy and Management, Miami, FL, USA
| | - Hyunmi Lee
- Institute for Work & Health, Toronto, ON, Canada
| | - Renée-Louise Franche
- Institute for Work & Health, Toronto, ON, Canada
- WorkSafe BC, Vancouver, BC, Canada
- Simon Fraser University, Vancouver, BC, Canada
- University of British Columbia, Vancouver, BC, Canada
| | - Sheilah Hogg-Johnson
- Institute for Work & Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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22
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Nayak NR, Coats JM, Abdullah KG, Stein SC, Malhotra NR. Tracking patient-reported outcomes in spinal disorders. Surg Neurol Int 2015; 6:S490-9. [PMID: 26605111 PMCID: PMC4617013 DOI: 10.4103/2152-7806.166892] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 06/24/2015] [Indexed: 11/22/2022] Open
Abstract
Background: Patient-reported outcome measures (PROMs) quantify health status from the patient's point of view. While the number of published outcomes studies grows each year, so too has the number of instruments being reported, leading to confusion on which instruments are appropriate to use for various spinal conditions. Methods: A broad search was conducted to identify commonly used PROMs in patients undergoing spinal surgery. We searched PubMed for combinations of terms related to anatomic location and a measure of patient-reported outcome in the title or text. We supplemented the search using the “related articles” feature of PubMed and by manually searching the bibliographies of selected articles. Results: Major categories of PROMs in spine surgery include health-related quality-of-life, pain, and disease-specific disability, for which several different instrument options were identified and detailed. The minimal clinically important difference varies between instruments and differentiates statistical significance from clinical significance. In addition, the accurate estimation of costs has become a challenging but intrinsically linked variable to outcomes as increased attention is paid to the relative value of surgical interventions. Conclusion: While a number of PROMs are available for tracking outcomes in spine surgery, only a handful appear to be widely used. At least one instrument from each category should be measured pre- and post-operatively to quantify treatment effect. In addition, while the primary goal is to select the most appropriate instruments for the patient's condition, one should keep in mind sustainability of efforts with regard to patient and administrative burden.
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Affiliation(s)
- Nikhil R Nayak
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - John Mitchell Coats
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Kalil G Abdullah
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Sherman C Stein
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Neil R Malhotra
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
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Validation of the Roland Morris Questionnaire in Colombia to Evaluate Disability in Low Back Pain. Spine (Phila Pa 1976) 2015; 40:1108-14. [PMID: 25943080 DOI: 10.1097/brs.0000000000000963] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN An observational study was performed to validate a scale. OBJECTIVE This study validated the Roland Morris Questionnaire (RMQ) in Colombia. SUMMARY OF BACKGROUND DATA The RMQ is a frequently used instrument for the evaluation of disability in patients with low back pain. The psychometric properties of the RMQ are highly reliable, but a validated version is not available in our country. METHODS The RMQ 24-item scale ranges from 0 (no disability) to 24 (maximum disability) and it was applied to 133 patients older than 18 years of age with low back pain of any etiology and duration. Reliability, validity of content, construct and criterion were evaluated, and the latter was compared with the Oswestry Disability Index 2.1a, SF-36, and the visual analogue scale. Sensitivity to change was evaluated in patients with subacute low back pain, and a pharmacological and/or physical rehabilitation intervention was performed and the effect size of the treatment was calculated with Cohen's d coefficient. RESULTS The patients' average age was 43.4 (16.3) years, out of which 67.7% were females. Internal consistency revealed a coefficient of Cronbach's alpha of 0.86. Intraobserver reliability revealed an intraclass correlation coefficient of 0.92. Construct validity between acute and chronic patients showed no significant differences (P = 0.405). Concurrent criterion validity compared with the Oswestry Disability Index 2.1a revealed a Pearson correlation coefficient of 0.745 which is a very good correlation. The correlation between RMQ and SF-36 was significant. The Pearson correlation between the RMQ and visual analogue scale was r = 0.438 with a P < 0.005. Sensitivity to change had a Cohen's d coefficient of 1.27, which corresponds to a very large effect size. CONCLUSION The RMQ is a useful and reliable instrument for the evaluation of patients with low back pain, and it allows an adequate clinical postintervention follow-up. LEVEL OF EVIDENCE 3.
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Item response theory analysis of the modified Roland-Morris Disability Questionnaire in a population-based study. Spine (Phila Pa 1976) 2015; 40:E366-71. [PMID: 25774468 PMCID: PMC9923782 DOI: 10.1097/brs.0000000000000764] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This is a secondary analysis of a cross-sectional population-based survey. OBJECTIVE Shorten the modified 23-item Roland (mRoland) scale using item response theory (IRT) methods and describe where in the functional disability range each scale is the most precise. SUMMARY OF BACKGROUND DATA The Roland-Morris Disability Questionnaire is recommended for a functional disability outcome measure in patients with low back pain (LBP). One commonly used version is the Roland. It is unknown where in the functional disability range the Roland measures. METHODS One candidate individual with LBP in randomly selected households was interviewed, identifying 694 adults with chronic LBP. To justify the use of a unidimensional 2-parameter logistic IRT model, we performed both exploratory and confirmatory factor analysis. RESULTS Exploratory factor analysis revealed one dominant eigenvalue. Confirmatory factor analysis results indicate that the 1-factor model fit well. IRT analysis revealed variability in the slopes, in the range from 1.07 to 3.10. The marginal reliability, an IRT-based analog to coefficient α, was 0.88. The mRoland produces reliable scores (i.e., with a standard error <0.3) from 1.4 standard deviations below the mean to roughly 0.2 above the mean. CONCLUSION The mRoland measures one construct. The mRoland seems to be an excellent tool for measuring just-below-average levels of functional disability. The mRoland measures high levels of functional disability with relatively poor reliability and may be more appropriate for a less-disabled population with LBP. We demonstrate that the mRoland can be shortened to 11 items with minimal loss of information. We show that there are different ways to go about selecting the set of 11 items that yield short forms with different strengths. LEVEL OF EVIDENCE 3.
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Godil SS, Parker SL, Zuckerman SL, Mendenhall SK, Glassman SD, McGirt MJ. Accurately measuring the quality and effectiveness of lumbar surgery in registry efforts: determining the most valid and responsive instruments. Spine J 2014; 14:2885-91. [PMID: 24768731 DOI: 10.1016/j.spinee.2014.04.023] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 01/15/2014] [Accepted: 04/14/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Prospective registries have emerged as a feasible way to capture real-world care across large patient populations. However, the proven validity of more robust and cumbersome patient-reported outcomes instruments (PROis) must be balanced with what is feasible to apply in large-scale registry efforts. PURPOSE To determine the relative validity and responsiveness of common PROis in accurately determining effectiveness of lumbar fusion for degenerative lumbar spondylolisthesis in registry efforts. STUDY DESIGN Prospective cohort study. PATIENT SAMPLE Fifty-eight patients undergoing transforaminal lumbar interbody fusion (TLIF) for degenerative lumbar spondylolisthesis OUTCOME MEASURES Patient-reported outcome measures for pain (numeric rating scale for back and leg pain [NRS-BP, NRS-LP]), disability (Oswestry Disability Index [ODI]), general health (Short Form [SF]-12), quality of life (QOL) (EuroQol five dimensions [EQ-5D]), and depression (Zung depression scale [ZDS]) were assessed. METHODS Fifty-eight patients undergoing primary TLIF for lumbar spondylolisthesis were entered into an institutional registry and prospectively followed for 2 years. Baseline and 2-year patient-reported outcomes were assessed. To assess the validity of PROis to discriminate between effective and noneffective improvements, receiver operating characteristic curves were generated for each outcomes instrument. An area under the curve (AUC) of ≥0.80 was considered an accurate discriminator. The difference between standardized response means (SRMs) in patients reporting meaningful improvement versus not was calculated to determine the relative responsiveness of each instrument. RESULTS For pain and disability, ODI had AUC=0.94, suggesting it as an accurate discriminator of meaningful improvement. Oswestry Disability Index was most responsive to postoperative improvement (SRM difference: 2.18), followed by NRS-BP and NRS-LP. For general health and QOL, SF-12 physical component score (AUC: 0.90), ZDS (AUC: 0.89), and SF-12 mental component score (AUC: 0.85) were all accurate discriminators of meaningful improvement, however, EQ-5D was most accurate (AUC: 0.97). EuroQol five dimensions was also most responsive (SRM difference: 2.83). CONCLUSIONS For pain and disability, ODI was the most valid and responsive measure of effectiveness of lumbar fusion. Numeric rating scale-BP and NRS-LP should not be used as substitutes for ODI in measuring effectiveness of care in registry efforts. For health-related QOL, EQ-5D was the most valid and responsive measure of improvement, however, SF-12 and ZDS are valid alternatives with less responsiveness.
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Affiliation(s)
- Saniya S Godil
- Department of Neurosurgery, Vanderbilt University, 4005 Village at Vanderbilt, 1500 21st Ave S., Nashville, TN 37232, USA; Spinal Column Surgical Outcomes and Quality Research Laboratory, 4005 Village at Vanderbilt, 1500 21st Ave S., Nashville, TN 37232, USA
| | - Scott L Parker
- Department of Neurosurgery, Vanderbilt University, 4005 Village at Vanderbilt, 1500 21st Ave S., Nashville, TN 37232, USA; Spinal Column Surgical Outcomes and Quality Research Laboratory, 4005 Village at Vanderbilt, 1500 21st Ave S., Nashville, TN 37232, USA
| | - Scott L Zuckerman
- Department of Neurosurgery, Vanderbilt University, 4005 Village at Vanderbilt, 1500 21st Ave S., Nashville, TN 37232, USA; Spinal Column Surgical Outcomes and Quality Research Laboratory, 4005 Village at Vanderbilt, 1500 21st Ave S., Nashville, TN 37232, USA
| | - Stephen K Mendenhall
- Department of Neurosurgery, Vanderbilt University, 4005 Village at Vanderbilt, 1500 21st Ave S., Nashville, TN 37232, USA; Spinal Column Surgical Outcomes and Quality Research Laboratory, 4005 Village at Vanderbilt, 1500 21st Ave S., Nashville, TN 37232, USA
| | - Steven D Glassman
- Norton Leatherman Spine Center, 4950 Norton Healthcare Blvd, Louisville, KY 40241, USA
| | - Matthew J McGirt
- Carolina Neurosurgery and Spine Associates, 225 Baldwin Avenue, Charlotte, NC 28204, USA.
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Vincent JI, Macdermid JC, Grewal R, Sekar VP, Balachandran D. Translation of oswestry disability index into Tamil with cross cultural adaptation and evaluation of reliability and validity(§). Open Orthop J 2014; 8:11-9. [PMID: 24563681 PMCID: PMC3928668 DOI: 10.2174/1874325001408010011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 01/02/2014] [Accepted: 01/03/2014] [Indexed: 11/22/2022] Open
Abstract
STUDY DESIGN Prospective longitudinal validation study. OBJECTIVE To translate and cross-culturally adapt the Oswestry Disability Index (ODI) to the Tamil language (ODI-T), and to evaluate its reliability and construct validity. SUMMARY OF BACKGROUND DATA ODI is widely used as a disease specific questionnaire in back pain patients to evaluate pain and disability. A thorough literature search revealed that the Tamil version of the ODI has not been previously published. METHODS The ODI was translated and cross-culturally adapted to the Tamil language according to established guidelines. 30 subjects (16 women and 14 men) with a mean age of 42.7 years (S.D. 13.6; Range 22 - 69) with low back pain were recruited to assess the psychometric properties of the ODI-T Questionnaire. Patients completed the ODI-T, Roland-Morris disability questionnaire (RMDQ), VAS-pain and VAS-disability at baseline and 24-72 hours from the baseline visit. RESULTS The ODI-T displayed a high degree of internal consistency, with a Cronbach's alpha of 0.92. The test-retest reliability was high (n=30) with an ICC of 0.92 (95% CI, 0.84 to 0.96) and a mean re-test difference of 2.6 points lower on re-test. The ODI-T scores exhibited a strong correlation with the RMDQ scores (r = 0.82) p<0.01, VAS-P (r = 0.78) p<0.01 and VAS-D (r = 0.81) p<0.01. Moderate to low correlations were observed between the ODI-T and lumbar ROM (r = -0.27 to -0.53). All the hypotheses that were constructed apriori were supported. CONCLUSION The Tamil version of the ODI Questionnaire is a valid and reliable tool that can be used to measure subjective outcomes of pain and disability in Tamil speaking patients with low back pain.
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Affiliation(s)
- Joshua Israel Vincent
- University of Western Ontario, Faculty of Health Sciences, Department of Health and Rehabilitation Sciences, London, Ontario, Canada and Clinical Outcomes Research Laboratory, Roth and McFarlane Hand and Upper Limb Center, St Joseph's Health care London, London, Ontario, Canada
| | - Joy Christine Macdermid
- McMaster University, School of Rehabilitation Science, Hamilton, Ontario, Canada and Co-Director of Clinical Outcomes Research Laboratory, Roth and McFarlane Hand and Upper Limb Center, St Joseph's Health care London, London, Ontario, Canada
| | - Ruby Grewal
- University of Western Ontario, Department of Surgery, London, Ontario, Canada and Co-Director of Clinical Outcomes Research Laboratory, Roth and McFarlane Hand and Upper Limb Center, St Joseph's Health care London, London, Ontario, Canada
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Karp JF, Yu L, Friedly J, Amtmann D, Pilkonis PA. Negative affect and sleep disturbance may be associated with response to epidural steroid injections for spine-related pain. Arch Phys Med Rehabil 2013; 95:309-15. [PMID: 24060493 DOI: 10.1016/j.apmr.2013.09.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 09/11/2013] [Accepted: 09/12/2013] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To describe whether negative affect and sleep impairment are associated with the clinical effect of epidural steroid injections (ESIs) for low back pain. DESIGN Observational study; patients were evaluated before ESI and 1 and 3 months after ESI. SETTING Spine center and related treatment sites. PARTICIPANTS Participants (N=158) seeking treatment for low back pain with or without radiculopathy. INTERVENTION ESI for low back pain with or without radiculopathy. MAIN OUTCOME MEASURES We assessed the dependent (global pain severity for back and leg pain, pain behavior, pain interference) and independent variables (depression, sleep disturbance, and covariates of back pain response) with the Patient-Reported Outcome Measurement Information System (PROMIS) and legacy measures. Outcome was assessed cross-sectionally using multiple regression and longitudinally with path analysis. RESULTS After 1 month, sleep disturbance was the only predictor for the global ratings of improvement in back pain (R(2)=16.8%) and leg pain (R(2)=11.4%). The proportions of variance explained by sleep disturbance and negative affect for all dependent variables were greater at 3 months than 1 month. Mediation analysis was significant for negative affect for the 3-month outcomes on PROMIS pain behavior (β=.87, P<.01) and pain interference (β=.37, P<.01). There was no evidence of mediation by sleep disturbance for any outcome. CONCLUSIONS Negative affect and sleep disturbance are associated with worse outcomes after ESI. Further research is needed to determine if treatment of negative affect and sleep disturbance prior to or concurrently with ESI will improve outcomes.
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Affiliation(s)
- Jordan F Karp
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
| | - Lan Yu
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Janna Friedly
- Department of Rehabilitation, University of Washington, Seattle, WA
| | - Dagmar Amtmann
- Department of Rehabilitation, University of Washington, Seattle, WA
| | - Paul A Pilkonis
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
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In response. Spine (Phila Pa 1976) 2013; 38:1524. [PMID: 23900115 DOI: 10.1097/brs.0b013e31829cb81f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Abstract
STUDY DESIGN Validation of a translated, culturally adapted questionnaire. OBJECTIVE To translate and culturally adapt a Polish version of the Oswestry Disability Index (ODI) and to validate its use in Polish patients. SUMMARY OF BACKGROUND DATA The ODI is among the most popular questionnaires used to evaluate back pain-related disability. To our knowledge no validated Polish version of the index was available at the time our study was initiated. METHODS The questionnaire was translated and culturally adapted by 2 independent translators and approved by expert committee. Final version was included in the booklet consisting in addition of a previously validated Roland-Morris disability questionnaire, VAS for low back and leg and 3 Likert scale questions (pain medications, pain frequency, disability). It was tested on 169 patients with chronic low back pain, 164 (97%) of them were enrolled, and 84 of 164 (53%) returned the completed retest booklet within 2 to 14 days after the baseline test. There were no differences between the 2 groups in demographic and clinical parameters. Test-retest reliability, internal consistency, and construct validity were investigated. RESULTS The mean ODI (standard deviation [SD]) was 48.45 (18.94); minimum 2, maximum 94. The Cronbach α for baseline questionnaires (n = 164) was 0.90. Concurrent validity, measured by comparing ODI responses with the results of the Roland-Morris disability questionnaire score was very good (r = 0.607, P < 0.001). The correlation with VAS back was fair (r = 0.37, P < 0.001) and with VAS leg was good (r = 0.56, P < 0.001). The tested ODI had excellent test-retest reliability, the intraclass correlation coefficient was 0.97 and standard error of measurements was 3.54, the resulting minimal detectable changes at the 95% confidence level was 10. CONCLUSION The results of this study indicate that the Polish version of the ODI is a reliable and valid instrument for the measurement of disability in Polish-speaking patients with lower back pain.
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Abstract
There is much evidence to suggest that psychological and social issues are predictive of pain severity, emotional distress, work disability, and response to medical treatments among persons with chronic pain. Psychologists can play an important role in the identification of psychological and social dysfunction and in matching personal characteristics to effective interventions as part of a multidisciplinary approach to pain management, leading to a greater likelihood of treatment success. The assessment of different domains using semi-structured clinical interviews and standardized self-report measures permits identification of somatosensory, emotional, cognitive, behavioral and social issues in order to facilitate treatment planning. In this paper, we briefly describe measures to assess constructs related to pain and intervention strategies for the behavioral treatment of chronic pain and discuss related psychiatric and substance abuse issues. Finally, we offer a future look at the role of integrating pain management in clinical practice in the psychological assessment and treatment for persons with chronic pain.
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Smeets R, Köke A, Lin CW, Ferreira M, Demoulin C. Measures of function in low back pain/disorders: Low Back Pain Rating Scale (LBPRS), Oswestry Disability Index (ODI), Progressive Isoinertial Lifting Evaluation (PILE), Quebec Back Pain Disability Scale (QBPDS), and Roland-Morris Disability Questionnaire (RDQ). Arthritis Care Res (Hoboken) 2012; 63 Suppl 11:S158-73. [PMID: 22588742 DOI: 10.1002/acr.20542] [Citation(s) in RCA: 148] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Rob Smeets
- Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, and Maastricht University, School of Caphri, Maastricht, Limburg, The Netherlands.
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Development of a French-Canadian version of the Oswestry Disability Index: cross-cultural adaptation and validation. Spine (Phila Pa 1976) 2012; 37:E439-44. [PMID: 22037523 DOI: 10.1097/brs.0b013e318233eaf9] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cross-cultural translation and psychometric testing. OBJECTIVE To translate, culturally adapt, and validate the Oswestry Disability Index (ODI) version 2.0 for the French-Canadian population. SUMMARY OF BACKGROUND DATA Many authors have recommended the administration of standardized instruments, rather than the creation of new scales, and advocate the adaptation of validated questionnaires in other languages. The application of these scales in different countries and by cultural groups necessitates cross-cultural adaptation. Many scales evaluate the functional incapacity resulting from low back pain. The ODI is among the most commonly used for this purpose. METHODS The French-Canadian ODI (ODI-FC) was developed by cross-cultural adaptation following internationally recommended methodology: forward translation, back translation, expert committee revision, and clinical evaluation of the prefinal version. Psychometric testing was performed on 72 patients with chronic low back pain. The subjects were recruited from a physiatry department in a university hospital and from a private practice physiatry clinic. They came from the Montreal area. The psychometric testing included internal consistency (Cronbach α), test-retest reliability (intraclass correlation coefficient) with a time interval set at 48 hours, and construct validity, comparing the ODI-FC with the Roland-Morris Disability Questionnaire and the Quebec Back Pain Disability Scale (Pearson correlation coefficient). RESULTS In 44.4% of the subjects, the average duration of low-back pain varied between 1 and 5 years. Average score for the ODI-FC was 29.2. Good internal consistency was found (Cronbach α = 0.88). Reliability was excellent, with intraclass correlation coefficient = 0.92 (95% confidence interval, 0.87-0.95). Construct validity results revealed excellent correlations between the ODI and the Quebec Back Pain Disability Scale (r = 0.90) and between the ODI and the Roland-Morris Disability Questionnaire (r = 0.84). CONCLUSION Cross-cultural translation and adaptation of the ODI-FC were successful. Psychometric testing determined that the instrument was homogeneous, reliable, and valid. It could be employed in future clinical trials in Canada and possibly in other French-speaking countries.
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The efficacy of systematic active conservative treatment for patients with severe sciatica: a single-blind, randomized, clinical, controlled trial. Spine (Phila Pa 1976) 2012; 37:531-42. [PMID: 21494193 DOI: 10.1097/brs.0b013e31821ace7f] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective single-blind, randomized, clinical, controlled trial. OBJECTIVE To evaluate the efficacy of active conservative treatment and to compare 2 active conservative treatment programs for patients with severe sciatica. SUMMARY OF BACKGROUND DATA Reviews have demonstrated little or no efficacy for passive conservative treatment modalities in patients suffering from sciatica. The results for surgery are conflicting. Cohort studies have shown excellent results for active treatment modalities in patients with sciatica. METHODS One hundred eighty-one consecutive patients with radicular pain below the knee were examined at the baseline, at 8 weeks, and at 1 year after the treatment. Participants were randomized into 2 groups: (1) symptom-guided exercises + information + advice to stay active and (2) sham exercises + information + advice to stay active. Symptom-guided exercises consisted of a variety of back-related exercises given in accordance with a written algorithm in which symptoms or response to exercises determined the exercises given (http://www.sygehuslillebaelt.dk/wm345075, click exercises). Sham exercises were optional, designed to increase general blood circulation, and had no targeted effect on the back. The information was comprehensive and included anatomy, pathogenesis, and how discs heal without surgery. The advice included encouragement to stay as active as possible but to reduce activity if leg pain increased. The use of medication was optional, but only paracetamol and nonsteroidal anti-inflammatory drugs were recommended. RESULTS A mean of 4.8 treatment sessions were provided. All patients experienced statistically significant and clinically important improvements in global assessment, functional status, pain, vocational status, and clinical findings. The symptom-guided exercise group improved significantly more than the sham exercise group in most outcomes. CONCLUSION Active conservative treatment was effective for patients who had symptoms and clinical findings that would normally qualify them for surgery. Although participating patients had greater faith in the sham exercises before treatment, the symptom-guided exercises were superior for most outcomes.
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Parkitny L, McAuley JH, Walton D, Pena Costa LO, Refshauge KM, Wand BM, Di Pietro F, Moseley GL. Rasch analysis supports the use of the Depression, Anxiety, and Stress Scales to measure mood in groups but not in individuals with chronic low back pain. J Clin Epidemiol 2012; 65:189-98. [DOI: 10.1016/j.jclinepi.2011.05.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 05/18/2011] [Accepted: 05/23/2011] [Indexed: 10/17/2022]
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Konstantinou K, Beardmore R, Dunn KM, Lewis M, Hider SL, Sanders T, Jowett S, Somerville S, Stynes S, van der Windt DAWM, Vogel S, Hay EM. Clinical course, characteristics and prognostic indicators in patients presenting with back and leg pain in primary care. The ATLAS study protocol. BMC Musculoskelet Disord 2012; 13:4. [PMID: 22264273 PMCID: PMC3293000 DOI: 10.1186/1471-2474-13-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 01/20/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low-back related leg pain with or without nerve root involvement is associated with a poor prognosis compared to low back pain (LBP) alone. Compared to the literature investigating prognostic indicators of outcome for LBP, there is limited evidence on prognostic factors for low back-related leg pain including the group with nerve root pain. This 1 year prospective consultation-based observational cohort study will describe the clinical, imaging, demographic characteristics and health economic outcomes for the whole cohort, will investigate differences and identify prognostic indicators of outcome (i.e. change in disability at 12 months), for the whole cohort and, separately, for those classified with and without nerve root pain. In addition, nested qualitative studies will provide insights on the clinical consultation and the impact of diagnosis and treatment on patients' symptom management and illness trajectory. METHODS Adults aged 18 years and over consulting their General Practitioner (GP) with LBP and radiating leg pain of any duration at (n = 500) GP practices in North Staffordshire and Stoke-on-Trent, UK will be invited to participate. All participants will receive a standardised assessment at the clinic by a study physiotherapist and will be classified according to the clinically determined presence or absence of nerve root pain/involvement. All will undergo a lumbar spine MRI scan. All participants will be managed according to their clinical need. The study outcomes will be measured at 4 and 12 months using postal self-complete questionnaires. Data will also be collected each month using brief postal questionnaires to enable detailed description of the course of low back and leg pain over time. Clinical observations and patient interviews will be used for the qualitative aspects of the study. DISCUSSION This prospective clinical observational cohort will combine self-reported data, comprehensive clinical and MRI assessment, together with qualitative enquiries, to describe the course, health care usage, patients' experiences and prognostic indicators in an adult population presenting in primary care with LBP and leg pain with or without nerve root involvement.
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Affiliation(s)
- Kika Konstantinou
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Staffordshire ST5 5BG, UK.
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Kim DK, Oh CH, Lee MS, Yoon SH, Park HC, Park CO. Prevalence of Lumbar Disc Herniation in Adolescent Males in Seoul, Korea: Prevalence of Adolescent LDH in Seoul, Korea. KOREAN JOURNAL OF SPINE 2011; 8:261-6. [PMID: 26064143 PMCID: PMC4461737 DOI: 10.14245/kjs.2011.8.4.261] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 09/25/2011] [Accepted: 10/09/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The authors surveyed the prevalence and the clinical character of lumbar disc herniation (LDH) in Korean male adolescents, and the usefulness of current conscription criteria. METHODS The data of 39,673 nineteen-year-old males that underwent a conscription examination at the Seoul Regional Korean Military Manpower Administration (MMA) from October 2010 to May 2011 were investigated. For those diagnosed as having lumbar disc herniation, prevalences, subject characteristics, herniation severities, levels of herniation, and modified Korean Oswestry low back pain disability scores by MMA physical grade were evaluated. The analysis was performed using medical certificates, medical records, medical images, and electromyographic and radiologic findings. RESULTS The prevalence of adolescent LDH was 0.60%(237 of the 39,673 study subjects), and the prevalence of serious adolescent LDH with thecal sac compression or significant discogenic spinal stenosis was 0.28%(110 of the 39,673 study subjects). Of the 237 adolescent LDH cases, 105 (44.3%) were of single level LDH and 132 (55.7%) were of multiple level LDH, and the L4-5 level was the most severely and frequently affected. Oswestry back pain disability scores increased with herniation severity (p<0.01), and were well correlated with MMA grade. CONCLUSIONS In this large cohort of 19-year-old Korean males, the prevalence of adolescent LDH was 0.60% and the prevalence of serious adolescent LDH, which requires management, was relatively high at 0.28%. MMA physical grade was confirmed to be a useful measure of the disability caused by LDH.
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Affiliation(s)
- Do-Keun Kim
- Department of Neurosurgery, College of Medicine, Inha University, Incheon, Korea
| | - Chang Hyun Oh
- Seoul Regional Military Manpower Administration, Seoul, Korea
| | - Myoung Seok Lee
- Seoul Regional Military Manpower Administration, Seoul, Korea
| | - Seung Hwan Yoon
- Department of Neurosurgery, College of Medicine, Inha University, Incheon, Korea
| | - Hyung-chun Park
- Department of Neurosurgery, College of Medicine, Inha University, Incheon, Korea
| | - Chong Oon Park
- Department of Neurosurgery, College of Medicine, Inha University, Incheon, Korea
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Falavigna A, Teles AR, Braga GLD, Barazzetti DO, Lazzaretti L, Tregnago AC. Instrumentos de avaliação clínica e funcional em cirurgia da coluna vertebral. COLUNA/COLUMNA 2011. [DOI: 10.1590/s1808-18512011000100012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Alguns dos indivíduos submetidos à cirurgia de coluna vertebral terão desfechos pós-operatório desfavoráveis, independente do êxito técnico. Esse insucesso gera aumento da morbidade e dos custos socioeconômicos. Sabe-se que fatores psicossociais interferem na impressão do sujeito. Com o propósito de identificá-los, tem-se estimulado a busca de preditores prognósticos por meio de instrumentos de triagem. Porém, a eleição do mais adequado pode ser difícil, já que existe um grande número de questionários. Entre os aspectos abordados por eles, podemos citar: incapacidade funcional, qualidade de vida, satisfação, dor, depressão, distúrbios do humor e atividade funcional. O trabalho objetiva revisar as particularidades, indicações e limitações dos instrumentos de avaliação do paciente com doença na coluna vertebral.
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Dionne CE, Le Sage N, Franche RL, Dorval M, Bombardier C, Deyo RA. Five questions predicted long-term, severe, back-related functional limitations: evidence from three large prospective studies. J Clin Epidemiol 2011; 64:54-66. [DOI: 10.1016/j.jclinepi.2010.02.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Revised: 02/08/2010] [Accepted: 02/13/2010] [Indexed: 11/27/2022]
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Steppan J, Meaders T, Muto M, Murphy KJ. A metaanalysis of the effectiveness and safety of ozone treatments for herniated lumbar discs. J Vasc Interv Radiol 2010; 21:534-48. [PMID: 20188591 DOI: 10.1016/j.jvir.2009.12.393] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Revised: 10/20/2009] [Accepted: 12/03/2009] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To determine statistically significant effects of oxygen/ozone treatment of herniated discs with respect to pain, function, and complication rate. MATERIALS AND METHODS Random-effects metaanalyses were used to estimate outcomes for oxygen/ozone treatment of herniated discs. A literature search provided relevant studies that were weighted by a study quality score. Separate metaanalyses were performed for visual analog scale (VAS), Oswestry Disability Index (ODI), and modified MacNab outcome scales, as well as for complication rate. Institutional review board approval was not required for this retrospective analysis. RESULTS Twelve studies were included in the metaanalyses. The inclusion/exclusion criteria, patient demographics, clinical trial rankings, treatment procedures, outcome measures, and complications are summarized. Metaanalyses were performed on the oxygen/ozone treatment results for almost 8,000 patients from multiple centers. The mean improvement was 3.9 for VAS and 25.7 for ODI. The likelihood of showing improvement on the modified MacNab scale was 79.7%. The means for the VAS and ODI outcomes are well above the minimum clinically important difference and the minimum (significant) detectable change. The likelihood of complications was 0.064%. CONCLUSIONS Oxygen/ozone treatment of herniated discs is an effective and extremely safe procedure. The estimated improvement in pain and function is impressive in view of the broad inclusion criteria, which included patients ranging in age from 13 to 94 years with all types of disc herniations. Pain and function outcomes are similar to the outcomes for lumbar discs treated with surgical discectomy, but the complication rate is much lower (<0.1%) and the recovery time is significantly shorter.
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Rihn JA, Berven S, Allen T, Phillips FM, Currier BL, Glassman SD, Nash DB, Mick C, Crockard A, Albert TJ. Defining value in spine care. Am J Med Qual 2010; 24:4S-14S. [PMID: 19890180 DOI: 10.1177/1062860609349214] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Spinal disorders are extremely common, debilitating, and costly to the payer and to society as a whole. The rate and cost of various spinal treatments are increasing at an astonishing rate, but it is unclear whether the resulting quality of spinal care is improving. Rather than focusing solely on quality improvement measures or cost-saving measures, there is a recent emphasis on the value of health care. Defining the value of spine care depends on a standardized, accurate method of measuring outcomes and costs. It is important that the outcomes measured are patient centered and that both the outcomes and costs are measured over time with long-term follow-up. The purpose of this article is to review current methods for measuring outcomes and propose a means by which the value of spine care can be more clearly defined.
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Affiliation(s)
- Jeffrey A Rihn
- Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Rothman Institute, Philadelphia, Pennsylvania 19107, USA.
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Marois E, Durand MJ. Does participation in interdisciplinary work rehabilitation programme influence return to work obstacles and predictive factors? Disabil Rehabil 2009; 31:994-1007. [PMID: 19037769 DOI: 10.1080/09638280802428374] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Musculoskeletal disorders evolve into long-term work disabilities in--10% of work-injury cases. From a prevention perspective, screening for predictive factors and obstacles associated with long-term work disability appear to offer a promising avenue for work rehabilitation. However, knowledge of the factors at play during the chronic phase remains limited. This study aims to explore the presence of a relationship between the predictive factors and obstacles identified at the time of admission to an interdisciplinary work rehabilitation programme and return to work upon completion of the programme, in individuals with a long-term work disability. METHOD A descriptive correlational study involving 222 individuals assessed using the Work Disability Diagnostic Interview and who participated in the PREVICAP work rehabilitation programme. RESULTS The general model accurately predicts the work status of 77% of the participants. Seven to nine factors were found to be associated with return to work in each model produced (3). Those factors were mainly psychosocial and work-related in nature and differ according to gender. Unexpectedly, certain obstacles observed at the time of admission to the programme appear to have a protective effect and thus promote participants' return to work. CONCLUSION The results obtained support the hypothesis that screening for predictive factors and obstacles at the time of admission of a work rehabilitation programme for individuals with a long-term work disability allows for more effective intervention regarding these factors, and in all likelihood, promotes return to work.
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Affiliation(s)
- Elyse Marois
- Evaluation, Development and Professional Reintegration Programme, Jewish Rehabilitation Hospital, Laval, Quebec, Canada.
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Development of the Italian version of the Oswestry Disability Index (ODI-I): A cross-cultural adaptation, reliability, and validity study. Spine (Phila Pa 1976) 2009; 34:2090-5. [PMID: 19730216 DOI: 10.1097/brs.0b013e3181aa1e6b] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Evaluation of the psychometric properties of a translated, culturally adapted questionnaire. OBJECTIVE Translating, culturally adapting, and validating the Italian version of the Oswestry Disability Index (ODI-I), allowing its use in Italian-speaking patients with low back pain inside and outside Italy. SUMMARY OF BACKGROUND DATA Growing attention is devoted to standardized outcome measures to improve interventions for low back pain. A translated form of the ODI in patients with low back pain has never been validated within the Italian population. METHODS The ODI-I questionnaire was developed involving forward-backward translation, final review by an expert committee and test of the prefinal version to establish as better as possible proper correspondence with the original English latest version (2.1a). Psychometric testing included factor analysis, reliability by internal consistency (Cronbach alpha) and test-retest repeatability (Intraclass Coefficient Correlation), concurrent validity by comparing the ODI-I to Visual Analogue Scale, (Pearson correlation), and construct validity by comparing the ODI-I to Roland Morris Disability Questionnaire, RMDQ, and to Short Form Health Survey, Short Form Health Survey-36 (Pearson correlation). RESULTS The authors required a 3-month period before achieving a shared version of the ODI-I. The questionnaire was administered to 126 subjects, showing satisfying acceptability. Factor analysis demonstrated a 1-factor structure (45% of explained variance). The questionnaire showed high internal consistency (alpha = 0.855) and good test-retest reliability (ICC = 0.961). Concurrent validity was confirmed by a high correlation with Visual Analogue Scale (r = 0.73, P < 0.001), Construct validity revealed high correlations with RMDQ (r = 0.819, P < 0.001), and with Short Form Health Survey-36 domains, highly significant with the exception of Mental Health (r = -0.139, P = 0.126). CONCLUSION The ODI outcome measure was successfully translated into Italian, showing good factorial structure and psychometric properties, replicating the results of existing language versions of the questionnaire. Its use is recommended in research practice.
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Bailey CS, Dvorak MF, Thomas KC, Boyd MC, Paquett S, Kwon BK, France J, Gurr KR, Bailey SI, Fisher CG. Comparison of thoracolumbosacral orthosis and no orthosis for the treatment of thoracolumbar burst fractures: interim analysis of a multicenter randomized clinical equivalence trial. J Neurosurg Spine 2009; 11:295-303. [PMID: 19769510 DOI: 10.3171/2009.3.spine08312] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The authors compared the outcome of patients with thoracolumbar burst fractures treated with and without a thoracolumbosacral orthosis (TLSO).
Methods
As of June 2002, all consecutive patients satisfying the following inclusion criteria were considered eligible for this study: 1) the presence of an AO Classification Type A3 burst fractures between T-11 and L-3, 2) skeletal maturity and age < 60 years, 3) admission within 72 hours of injury, 4) initial kyphotic deformity < 35°, and 5) no neurological deficit. The study was designed as a multicenter prospective randomized clinical equivalence trial. The primary outcome measure was the score based on the Roland-Morris Disability Questionnaire assessed at 3 months postinjury. Secondary outcomes are assessed until 2 years of follow-up have been reached, and these domains included pain, functional outcome and generic health-related quality of life, sagittal alignment, length of hospital stay, and complications. Patients in whom no orthotic was used were encouraged to ambulate immediately following randomization, maintaining “neutral spinal alignment” for 8 weeks. The patients in the TLSO group began being weaned from the brace at 8 weeks over a 2-week period.
Results
Sixty-nine patients were followed to the primary outcome time point, and 47 were followed for up to 1 year. No significant difference was found between treatment groups for any outcome measure at any stage in the follow-up period. There were 4 failures requiring surgical intervention, 3 in the TLSO group and 1 in the non-TLSO group.
Conclusions
This interim analysis found equivalence between treatment with a TLSO and no orthosis for thoracolumbar AO Type A3 burst fractures. The influence of a brace on early pain control and function and on long-term 1- and 2-year outcomes remains to be determined. However, the authors contend that a thoracolumbar burst fracture, in exclusion of an associated posterior ligamentous complex injury, is inherently a very stable injury and may not require a brace.
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Affiliation(s)
| | - Marcel F. Dvorak
- 2Vancouver Hospital and Health Sciences, University of British Columbia, Vancouver, British Columbia
| | - Kenneth C. Thomas
- 3Department of Surgery (Orthopedics) and Neurosciences, University of Calgary, Alberta, Canada; and
| | - Michael C. Boyd
- 2Vancouver Hospital and Health Sciences, University of British Columbia, Vancouver, British Columbia
| | - Scott Paquett
- 2Vancouver Hospital and Health Sciences, University of British Columbia, Vancouver, British Columbia
| | - Brian K. Kwon
- 2Vancouver Hospital and Health Sciences, University of British Columbia, Vancouver, British Columbia
| | - John France
- 4Orthopedics Department, University of West Virginia, Morgantown, West Virginia
| | - Kevin R. Gurr
- 1London Health Science Centre, University of Western Ontario, London, Ontario
| | - Stewart I. Bailey
- 1London Health Science Centre, University of Western Ontario, London, Ontario
| | - Charles G. Fisher
- 2Vancouver Hospital and Health Sciences, University of British Columbia, Vancouver, British Columbia
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Moser T, Cohen-Solal J, Bréville P, Buy X, Gangi A. Évaluation de la douleur en radiologie interventionnelle du rachis. ACTA ACUST UNITED AC 2008; 89:1901-6. [DOI: 10.1016/s0221-0363(08)74785-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Khorsan R, Coulter ID, Hawk C, Choate CG. Measures in chiropractic research: choosing patient-based outcome assessments. J Manipulative Physiol Ther 2008; 31:355-75. [PMID: 18558278 DOI: 10.1016/j.jmpt.2008.04.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Revised: 01/15/2008] [Accepted: 02/24/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Outcome assessment normally used in research can support the therapeutic process by tracking patient symptoms and function and offering a common language to clinicians and researchers. This study's objectives were to (1) identify patient-based outcomes assessments used in published chiropractic studies, (2) describe a framework for identifying appropriate sets of measures, and (3) address the challenges associated with these measures relevant to chiropractic. METHODS This literature review identified and evaluated the most commonly used to outcome measures in chiropractic research. Instruments were evaluated in terms of feasibility, practicality, economy, reliability, validity, and responsiveness to clinical change. A search of PubMed and Index to Chiropractic Literature (from inception to June 2006) was performed. RESULTS A total of 1166 citations were identified. Of these, 629 were selected as relevant. The most common patient-based outcomes assessments instruments identified were the Oswestry Pain/Disability Index, Visual Analog Scale, and Short Form 36. CONCLUSIONS The integration of outcome measures is consistent with current national initiatives to enhance health care quality through performance measurement and can also be used to further the field of chiropractic health care research. Outcome measures are both a research tool and a means by which providers can consistently measure health care quality. Based upon this review, there is a wide range of outcome measures available for use in chiropractic care. Those most commonly cited in the literature are the numeric rating scale, Visual Analog Scale, Oswestry Pain/Disability Index, Roland-Morris Low Back Pain and Disability Questionnaire, and Short Form 36.
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Affiliation(s)
- Raheleh Khorsan
- Integrative Medicine and Military Medical Research, Samueli Institute, Corona del Mar, CA 92625, USA.
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Siebenga J, Leferink VJM, Segers MJM, Elzinga MJ, Bakker FC, Ten DH, Rommens PM, Patka P. A prospective cohort study comparing the VAS spine score and Roland-Morris disability questionnaire in patients with a type A traumatic thoracolumbar spinal fracture. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2008; 17:1096-100. [PMID: 18575897 DOI: 10.1007/s00586-008-0705-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2008] [Revised: 05/23/2008] [Accepted: 06/03/2008] [Indexed: 11/25/2022]
Abstract
The Roland Morris Disability Questionnaire (RMDQ-24) and the VAS spine score have been regularly used to measure functional outcome in patients with back pain. The RMDQ-24 is primarily used in degenerative disease of the spine and the VAS Spine is used in trauma patients. The aim of this study is to compare these scores and to see if there is a correlation in patients with a traumatic thoracolumbar spinal fracture. Prospective cohort study comparing the RMDQ-24 and the VAS spine score in patients with a traumatic type A fracture thoracolumbar spine fracture. Fifteen non-operatively patients (group one) completed 118 questionnaires and 17 operatively treated patients (group two) completed 140 questionnaires. Group one scored an average of 6.6 and 65.9 for the RMDQ-24 and VAS Spine, in group two this was 5.1 and 82.9. Spearman's correlation test showed a significant correlation, in group one 0.83 and for the second group 0.87. RMDQ-24 and VAS Spine have a strong positive correlation in measuring disability in a group of patients with back pain because of a spinal fracture. In both non-operatively and operatively treated groups this correlation is significant.
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Affiliation(s)
- J Siebenga
- Atrium Medisch Centrum Parkstad, Postbus 4446, 6401 CX, Heerlen, The Netherlands.
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Vogler D, Paillex R, Norberg M, de Goumoëns P, Cabri J. Validation transculturelle de l’Oswestry disability index en français. ACTA ACUST UNITED AC 2008; 51:379-85. [DOI: 10.1016/j.annrmp.2008.03.006] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2008] [Accepted: 03/28/2008] [Indexed: 11/29/2022]
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Cross-cultural adaptation and validation of the Argentinean version of the Roland-Morris Disability Questionnaire. Spine (Phila Pa 1976) 2008; 33:1391-5. [PMID: 18496354 DOI: 10.1097/brs.0b013e318173dc8f] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Psychometric testing of a translated, culturally adapted questionnaire. OBJECTIVE Argentinean Roland-Morris Disability Questionnaire (RMDQ) validation and cross-cultural adaptation for its use in Argentinean population with lumbar pain. SUMMARY OF BACKGROUND DATA The RMDQ is one of the most widely used and validated instruments for measuring disability in low back pain. However, no validated Argentine version of the Test was available at the time our study was initiated. MATERIALS AND METHODS The RMDQ Argentinean cross-cultural adaptation was tested among 132 chronic lumbar pain patients, of which, 50 completed the pre-final RMDQ questionnaire and did a retest 24 hours later. The data gathered, as well as the absent response rate and the conflictive sentences for the patient were reviewed. There were no sentences marked as conflictive, therefore, the RMDQ (final) was handed out to another 82 patients. The interclass correlation coefficient was used to assess reliability and internal consistency by means of the Cronbach's alpha. The convergent validity was assessed calculating Pearson's correlation coefficient comparing the RMDQ's results with: the amount of pain (EVA), the range of movement of the spine, and the tightening of the hamstrings by means of the Active Knee Extension Test (through digital inclinometry). RESULTS Reliability Test-retest (24 hours): interclass correlation coefficient: 0.940 (P < 0.01). Internal consistency reached 0.904 Cronbach's alpha. The RMDQ's convergent validity calculating Pearson's correlation coefficient was r: 0.544 (P < 0.01) for EVA and r: -0.378 (P < 0.01) for range of movement from T1, which is in agreement with previous results published in similar studies. Concurrent validity was assessed correlating the RMDQ results with the Argentinean Oswestry Disability Index calculating Pearson's Coefficient and it proved very good, r: 0.811 (P < 0.01). CONCLUSION The results of the study show that the Argentinean version of the RMDQ is reliable and valid as a lumbar disability measurement tool. The authors recommend this tool for future clinical studies.
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Timing makes a difference: early nurse case management intervention and low back pain. Prof Case Manag 2008; 12:316-27; quiz 328-9. [PMID: 18030151 DOI: 10.1097/01.pcama.0000300404.07948.86] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF STUDY * To examine whether early nurse contacts influenced workers' satisfaction with their nurse case management, their healthcare, and the way the firm was treating their injury.* To examine whether early nurse contacts influenced self-reported measures of back pain and returns to work. PRIMARY PRACTICE SETTING(S) Workers with low back pain resulting in workers' compensation claims. METHODOLOGY AND SAMPLE To quantify the influence of nurse case management on workers' satisfaction with their treatment by the firm and their healthcare provider, as well return to work, we follow 747 Marriott workers with incident episodes of low back pain in a prospective analysis. Predictors of outcomes include demographics, injury severity, and the timing of nurse case manager and work supervisor contacts. RESULTS While early contacts do not have much impact on satisfaction with the treatment by the healthcare provider, early nurse case management contacts improve worker satisfaction with the firm's treatment of their claim, increasing satisfaction by 0.5 standard deviations (on a 4-point scale). The change in odds ratio with respect to a contact during the first week after injury is 8, indicating a 50-percentage point increase in the likelihood of continual employment. IMPLICATIONS FOR CM PRACTICE *Among workers with low back pain, early nurse case management contacts improved workers' satisfaction with their healthcare provider and their treatment by the firm.* Contacts made during the first week after the injury were most valuable, but in our sample it did not matter when during that first week the contact was made (as long as it was within the first week).* Early nurse case management contacts substantially improved the odds of continual employment, dominating the influence of age, job satisfaction, and the expectation of a good recovery.
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