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Moses J, Hach S, Mason J, Treacher A. Defining and measuring objective and subjective spinal stiffness: a scoping review. Disabil Rehabil 2023; 45:4489-4502. [PMID: 36516462 DOI: 10.1080/09638288.2022.2152878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/24/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Examine and identify the breadth of definitions and measures of objective and subjective spinal stiffness in the literature, with a focus on clinical implications. METHODS A scoping review was conducted to determine what is known about definitions and measures of the specific term of spinal stiffness. Following the framework by Arksey and O'Malley, eligible peer-reviewed studies identified using PubMed, Ebsco health, and Scopus were included if they reported definitions or measures of spinal stiffness. Using a data abstraction form, the studies were classified into four themes: biomechanical, surgical, pathophysiological, and segmental spinal assessment. To identify similarities and differences between studies, sixteen categories were generated. RESULTS In total, 2426 records were identified, and 410 met the eligibility criteria. There were 350 measures (132 subjective; 218 objective measures) and 93 indicators of spinal stiffness. The majority of studies (n = 69%) did not define stiffness. CONCLUSION This review highlights the breadth of objective and subjective measures that are both clinically and methodologically diverse. There is no consensus regarding a standardised definition of stiffness in the reviewed literature.
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Affiliation(s)
- Joel Moses
- Private Practice, Cambridge, New Zealand
| | - Sylvia Hach
- School of Community Studies, Unitec Institute of Technology, Auckland, New Zealand
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Karela M, Rickard L, Roussou E. The Semantics of 'Hip Pain' and its Impact on Clinical Practice in Patient-Reported Outcome Measures (PROMs) of Disease: Results from a Clinical and Radiological Evaluation Cohort. Mediterr J Rheumatol 2021; 31:389-392. [PMID: 33521570 PMCID: PMC7841094 DOI: 10.31138/mjr.31.4.389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 06/15/2020] [Accepted: 08/30/2020] [Indexed: 12/04/2022] Open
Abstract
Introduction: The item ‘hip pain’ is widely used in questionnaires related to Spondyloarthritis and/or Ankylosing spondylitis (AS), either in clinics with patients being physically present or remotely, as the hip joint is known to affect AS in particular. Patients in clinics often claim to have hip pain. However, by stating “hip” they are referring to variable structures located in the hip region not necessarily related to hip joint itself. Objective: To assess which structure(s) patients mean when referring to hip pain. Methods: A diagram used as a proforma for patients to indicate the site of ‘hip pain’ following a detailed history and examination was used. Radiological imaging was utilised for those patients with multiple sites or clinically unclear causes of “hip” pain. Results: From 54 patients 7 different anatomical sites described which were: Trochanter, (27.2%), hip joint (20.8%), iliac crests (anterior superior [6.9%], posterior superior [8.3%], and anterior inferior [4.1%]), lumbar spine (8.3%), sacroiliac joint (6.9%). More than 1 sites in the same patient: (17.5%). Diagnoses were: Trochanteric bursitis (27%), osteoarthritis of hip and spine, (25%), enthesitis (22%), sacroiliitis (6.7%), synovitis (5%), fibromyalgia (3.4%), and hip dislocation (1.6%). More than 1 diagnosis in same patient: 9.3%. Conclusion: ’hip pain’ as an item used in questionnaires must be interpreted with caution.
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Affiliation(s)
- Mayuri Karela
- Barking Havering and Redbridge University Hospitals NHS Trust, Rheumatology and Rehabilitation, King George Hospital, Ilford, United Kingdom
| | - Lloyd Rickard
- Barts and The London School of Medicine and Dentistry, London, United Kingdom
| | - Euthalia Roussou
- Barking Havering and Redbridge University Hospitals NHS Trust, Rheumatology and Rehabilitation, King George Hospital, Ilford, United Kingdom.,Barts and The London School of Medicine and Dentistry, London, United Kingdom
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Variola A, Zanolin ME, Cipriano G, Macchioni P, Martinis F, Pasetti A, Grassi M, Geccherle A, Marchetta A, McGonagle D, Tinazzi I. The IBIS-Q [IBd Identification of Spondyloarthritis Questionnaire]: A Novel Tool to Detect Both Axial and Peripheral Arthritis in Inflammatory Bowel Disease Patients. J Crohns Colitis 2020; 14:1680-1686. [PMID: 32413102 DOI: 10.1093/ecco-jcc/jjaa096] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Both peripheral and axial spondyloarthritis [SpA] occur in inflammatory bowel disease [IBD] and represent the commonest extra-intestinal manifestation. We aimed to develop an easy and quick questionnaire through psychometric analysis, to identify peripheral and axial SpA in IBD patients within an integrated combined multidisciplinary rheumatological-gastroenterology clinic. METHODS Initially, SpA-IBD experts generated a 42-item list covering SpA manifestations including spinal, articular, and entheseal involvement. The new questionnaire was administered before routine clinical IBD assessment. On the same day, rheumatological assessment, blinded to both history and questionnaire results, was performed to explore the presence of the Assessment of SpondyloArthritis International Society [ASAS] criteria for SpA, diagnostic criteria for fibromyalgia [FM], and non-specific low back pain [NSLB]. Factorial analysis of questionnaire items to identify the main factors-receiver operating characteristic [ROC] curves for sensitivity/specificity and Youden index for cut-off-were performed. RESULTS Of the 181 consecutive patients, 56 met the ASAS SpA criteria [prevalence of 30%] with 10 new cases detected [5.5%: seven peripheral and three axial]. Through the psychometric and factorial analysis, we selected 14 items for the final questionnaire [named IBIS-Q]. The IBIS-Q was quick and performed well for detection of axial SpA and peripheral SpA (area under the curve [AUC] 0.88 with 95% confidence interval [CI] 0.830.93). A cut-off of three positive questions had a sensitivity 93% and specificity 77% for SpA patient identification. CONCLUSIONS The IBIS-Q is a useful and simple tool to use in IBD clinics for SpA detection, with a good statistical performance. Further studies are needed to validate it.
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Affiliation(s)
| | - Maria Elisabetta Zanolin
- Department of Diagnostics and Public Health, Unit of Epidemiology and Medical Statistics, University of Verona, Verona, Italy
| | - Giovanni Cipriano
- Clinical Research Unit, Azienda Ospedaliera-Universitaria Integrata, Verona, Italy
| | | | - Federica Martinis
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Annalisa Pasetti
- Unit of Gastroenterology, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Mario Grassi
- Medical and Genomic Statistics Unit, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | | | | | - Dennis McGonagle
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust & University of Leeds, Leeds, UK
| | - Ilaria Tinazzi
- Rheumatology Unit, IRCCS Sacro Cuore Don Calabria, Negrar, Italy
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Ford JJ, Kaddour O, Gonzales M, Page P, Hahne AJ. Clinical features as predictors of histologically confirmed inflammation in patients with lumbar disc herniation with associated radiculopathy. BMC Musculoskelet Disord 2020; 21:567. [PMID: 32825815 PMCID: PMC7442978 DOI: 10.1186/s12891-020-03590-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 08/13/2020] [Indexed: 11/29/2022] Open
Abstract
Background An understanding of the clinical features of inflammation in low back pain with or without leg symptoms may allow targeted evaluations of anti-inflammatory treatment in randomised-controlled-trials and clinical practice. Purpose This study evaluated the diagnostic accuracy of clinical features to predict the presence/absence of histologically confirmed inflammation in herniated disc specimens removed at surgery in patients with lumbar disc herniation and associated radiculopathy (DHR). Study design Cohort Study. Methods Disc material from patients with DHR undergoing lumbar discectomy was sampled and underwent histological/immunohistochemistry analyses. Control discs were sampled from patients undergoing surgical correction for scoliosis. Baseline assessment comprising sociodemographic factors, subjective examination, physical examination and psychosocial screening was conducted and a range of potential clinical predictors of inflammation developed based on the existing literature. Multi-variate analysis was undertaken to determine diagnostic accuracy. Results Forty patients with DHR and three control patients were recruited. None of the control discs had evidence of inflammation compared to 28% of patients with DHR. Predictors of the presence of histologically confirmed inflammation included back pain < 5/10, symptoms worse the next day after injury, lumbar flexion range between 0 and 30° and a positive clinical inflammation score (at least 3 of: constant symptoms, morning pain/stiffness greater than 60-min, short walking not easing symptoms and significant night symptoms). The model achieved a sensitivity of 90.9%, a specificity of 92.9%, and a predictive accuracy of 92.3%. Conclusion In a sample of patients with lumbar DHR a combination of clinical features predicted the presence or absence of histologically confirmed inflammation. Clinical relevance These clinical features may enable targeted anti-inflammatory treatment in future RCTs and in clinical practice.
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Affiliation(s)
- Jon J Ford
- College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria, 3085, Australia.
| | - Omar Kaddour
- Back in Form Physiotherapy, Ascot Vale, Victoria, Australia
| | | | - Patrick Page
- Box Hill Radiology, Epworth Eastern Hospital, Box Hill, Victoria, Australia
| | - Andrew J Hahne
- College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria, 3085, Australia
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The Evolving Case Supporting Individualised Physiotherapy for Low Back Pain. J Clin Med 2019; 8:jcm8091334. [PMID: 31466408 PMCID: PMC6780711 DOI: 10.3390/jcm8091334] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 08/22/2019] [Accepted: 08/22/2019] [Indexed: 02/06/2023] Open
Abstract
Low-back pain (LBP) is one of the most burdensome health problems in the world. Guidelines recommend simple treatments such as advice that may result in suboptimal outcomes, particularly when applied to people with complex biopsychosocial barriers to recovery. Individualised physiotherapy has the potential of being more effective for people with LBP; however, there is limited evidence supporting this approach. A series of studies supporting the mechanisms underpinning and effectiveness of the Specific Treatment of Problems of the Spine (STOPS) approach to individualised physiotherapy have been published. The clinical and research implications of these findings are presented and discussed. Treatment based on the STOPS approach should also be considered as an approach to individualised physiotherapy in people with LBP.
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Ford JJ, Richards MC, Surkitt LD, Chan AYP, Slater SL, Taylor NF, Hahne AJ. Development of a Multivariate Prognostic Model for Pain and Activity Limitation in People With Low Back Disorders Receiving Physiotherapy. Arch Phys Med Rehabil 2018; 99:2504-2512.e12. [PMID: 29852152 DOI: 10.1016/j.apmr.2018.04.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 03/19/2018] [Accepted: 04/21/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To identify predictors for back pain, leg pain, and activity limitation in patients with early persistent low back disorders (LBDs). DESIGN Prospective inception cohort study. SETTING Primary care private physiotherapy clinics in Melbourne, Australia. PARTICIPANTS Individuals (N=300) aged 18-65 years with low back and/or referred leg pain of ≥6 weeks and ≤6 months duration. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Numeric rating scales for back pain and leg pain as well as the Oswestry Disability Scale. RESULTS Prognostic factors included sociodemographics, treatment related factors, subjective/physical examination, subgrouping factors, and standardized questionnaires. Univariate analysis followed by generalized estimating equations were used to develop a multivariate prognostic model for back pain, leg pain, and activity limitation. Fifty-eight prognostic factors progressed to the multivariate stage where 15 showed significant (P<.05) associations with at least 1 of the 3 outcomes. There were 5 indicators of positive outcome (2 types of LBD subgroups, paresthesia below waist, walking as an easing factor, and low transversus abdominis tone) and 10 indicators of negative outcome (both parents born overseas, deep leg symptoms, longer sick leave duration, high multifidus tone, clinically determined inflammation, higher back and leg pain severity, lower lifting capacity, lower work capacity, and higher pain drawing percentage coverage). The preliminary model identifying predictors of LBDs explained up to 37% of the variance in outcome. CONCLUSIONS This study evaluated a comprehensive range of prognostic factors reflective of both the biomedical and psychosocial domains of LBDs. The preliminary multivariate model requires further validation before being considered for clinical use.
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Affiliation(s)
- Jon J Ford
- Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria, Australia.
| | - Matt C Richards
- Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - Luke D Surkitt
- Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - Alexander Y P Chan
- Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - Sarah L Slater
- Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - Nicholas F Taylor
- Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - Andrew J Hahne
- Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria, Australia
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Arnbak B, Jurik AG, Jensen TS, Manniche C. Association Between Inflammatory Back Pain Characteristics and Magnetic Resonance Imaging Findings in the Spine and Sacroiliac Joints. Arthritis Care Res (Hoboken) 2018; 70:244-251. [DOI: 10.1002/acr.23259] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 04/11/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Bodil Arnbak
- Spine Centre of Southern Denmark and Hospital Lillebaelt, Middelfart and University of Southern Denmark Odense Denmark
| | - Anne G. Jurik
- Spine Centre of Southern Denmark and Hospital Lillebaelt, Middelfart and University of Southern Denmark Odense Denmark
- Aarhus University Hospital Aarhus Denmark
| | - Tue S. Jensen
- Spine Centre of Southern Denmark and Hospital Lillebaelt, Middelfart and University of Southern Denmark Odense Denmark
- Nordic Institute of Chiropractic and Clinical Biomechanics Odense Denmark
| | - Claus Manniche
- Spine Centre of Southern Denmark and Hospital Lillebaelt, Middelfart and University of Southern Denmark Odense Denmark
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Arnbak B, Manniche C, Jurik AG, Jensen TS. Reply. Arthritis Rheumatol 2017; 69:1126. [DOI: 10.1002/art.40010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 12/01/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Bodil Arnbak
- Hospital Lillebaelt, Middelfart, Denmark, and University of Southern DenmarkOdense Denmark
| | - Claus Manniche
- Hospital Lillebaelt, Middelfart, Denmark, and University of Southern DenmarkOdense Denmark
| | - Anne Grethe Jurik
- Hospital Lillebaelt, Middelfart, Denmark, University of Southern Denmark, Odense, Denmark, and Aarhus University HospitalAarhus Denmark
| | - Tue Secher Jensen
- Hospital Lillebaelt, Middelfart, Denmark, and University of Southern DenmarkOdense Denmark
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Arnbak B, Hendricks O, Hørslev-Petersen K, Jurik AG, Pedersen SJ, Østergaard M, Hermansen LT, Loft AG, Jensen TS, Manniche C. The discriminative value of inflammatory back pain in patients with persistent low back pain. Scand J Rheumatol 2016; 45:321-8. [DOI: 10.3109/03009742.2015.1105289] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- B Arnbak
- Research Department, Spine Centre of Southern Denmark, Hospital Lillebaelt, Middelfart, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - O Hendricks
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
- King Christian X Hospital for Rheumatic Diseases, Graasten, Denmark
| | - K Hørslev-Petersen
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
- King Christian X Hospital for Rheumatic Diseases, Graasten, Denmark
| | - AG Jurik
- Research Department, Spine Centre of Southern Denmark, Hospital Lillebaelt, Middelfart, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - SJ Pedersen
- Copenhagen Centre for Arthritis Research, Centre for Rheumatology and Spine Diseases, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - M Østergaard
- Copenhagen Centre for Arthritis Research, Centre for Rheumatology and Spine Diseases, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - LT Hermansen
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
- King Christian X Hospital for Rheumatic Diseases, Graasten, Denmark
| | - AG Loft
- Department of Medicine, Hospital Lillebaelt, Vejle, Denmark
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - TS Jensen
- Research Department, Spine Centre of Southern Denmark, Hospital Lillebaelt, Middelfart, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - C Manniche
- Research Department, Spine Centre of Southern Denmark, Hospital Lillebaelt, Middelfart, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Juanola Roura X, Collantes Estévez E, León Vázquez F, Torres Villamor A, García Yébenes MJ, Queiro Silva R, Gratacós Masmitja J, García Criado E, Giménez S, Carmona L. Reccomendations for the detection, study and referral of inflammatory low-back pain in primary care. ACTA ACUST UNITED AC 2014; 11:90-8. [PMID: 25241260 DOI: 10.1016/j.reuma.2014.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 04/11/2014] [Accepted: 04/14/2014] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To design a strategy for the early detection and referral of patients with possible spondyloarthritis based on recommendations developed, agreed upon, and directed to primary care physicians. METHODS We used a modified RAND/UCLA methodology plus a systematic literature review. The information was presented to a discussion group formed by rheumatologists and primary care physicians. The group studied the process map and proposed recommendations and algorithms that were subsequently submitted in two Delphi rounds to a larger group of rheumatologists and primary care physicians. The final set of recommendations was derived from the analysis of the second Delphi round. RESULTS We present the recommendations, along with their mean level of agreement, on the early referral of patients with possible spondyloarthritis. The panel recommends that the study of chronic low back pain in patients under 45 years be performed in four phases 1) clinical: key questions, 2) clinical: extra questions, 3) physical examination, and 4) additional tests. CONCLUSIONS The level of agreement with these simple recommendations is high. It is necessary to design strategies for the education and sensitization from rheumatology services to maintain an optimal collaboration with primary care and to facilitate referral to rheumatology departments.
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Affiliation(s)
- Xavier Juanola Roura
- Servicio de Reumatología, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, España; Institut d'Investigació Biomédica de Bellvitge, Barcelona, España; Grupo de Estudio de las Espondiloartritis de la SER
| | - Eduardo Collantes Estévez
- Instituto Maimónides de Investigación Biomédica de Córdoba,, Córdoba, España; Servicio de Reumatología, Hospital Universitario Reina Sofía, Córdoba, España; Universidad de Córdoba, Córdoba, España; Grupo de Estudio de las Espondiloartritis de la SER
| | - Fernando León Vázquez
- Centro de Salud Universitario San Juan de la Cruz, Pozuelo de Alarcón, Madrid, España
| | | | | | - Rubén Queiro Silva
- Hospital Universitario Central de Asturias, Oviedo, Asturias, España; Grupo de Estudio de las Espondiloartritis de la SER
| | - Jordi Gratacós Masmitja
- Hospital Parc Taulí, Sabadell, Barcelona, España; Grupo de Estudio de las Espondiloartritis de la SER
| | - Emilio García Criado
- Unidad de Gestión Clínica Fuensanta, Córdoba, España; Sociedad Española de Médicos de Atención Primaria (SEMERGEN-AP)
| | - Sergio Giménez
- Unidad de Gestión Clínica Limonar, Málaga, España; Sociedad Española de Médicos de Atención Primaria (SEMERGEN-AP)
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Solmaz D, Akar S, Soysal O, Akkoc Y, Can G, Gerdan V, Birlik M, Onen F, Akkoc N. Performance of different criteria sets for inflammatory back pain in patients with axial spondyloarthritis with and without radiographic sacroiliitis. Clin Rheumatol 2014; 33:1475-9. [PMID: 24770795 DOI: 10.1007/s10067-014-2622-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 04/08/2014] [Accepted: 04/08/2014] [Indexed: 10/25/2022]
Abstract
It is important to recognize inflammatory back pain (IBP) for an early diagnosis of ankylosing spondylitis (AS). Assessment of Spondyloarthritis International Society (ASAS) has recently published new criteria set for diagnosing IBP. In the present study, we evaluated the performance of the new ASAS IBP criteria and to compare the performance of IBP criteria sets in axial spondyloarthritis (axSpA) patients with and without radiographic sacroiliitis. The study sample included a total of 274 patients with a diagnosis of axSpA and 50 patients with a diagnosis of chronic (>3 months) mechanical back pain (MBP). A face-to-face interview by using a standardized questionnaire addressing all the components of IBP was performed. Data about HLA-B27 status and C-reactive protein levels were obtained from the patients' charts. There were significantly more male patients (P < 0.001) in the AS group (68.6 %) than in the non-radiographic axSpA group (29.6 %) and also than in the MBP group (37.5 %). Among the criteria sets, the Calin criteria showed the best sensitivity (91.2 %), and the Berlin criteria showed the best specificity (82.4 %) in differentiation of IBP from MBP. If the morning stiffness item of the Calin criteria was defined as lasting >30 min (Calin 30), the specificity improved (72.9 %), but at a price of loss in sensitivity (82.4 %). In this study, new ASAS criteria for IBP performed almost as good as but not better than the existing criteria sets. Performances of the criteria sets were quite comparable in the differentiation of IBP from MBP in patients with and without radiographic sacroiliitis.
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Affiliation(s)
- Dilek Solmaz
- Department of Internal Medicine, Division of Rheumatology, School of Medicine, Dokuz Eylul University, 35340, Inciralti, Turkey
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12
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Anaya A, Plantmason L, Dhaliwal G. Back attack. J Gen Intern Med 2014; 29:255-9. [PMID: 23733373 PMCID: PMC3889930 DOI: 10.1007/s11606-013-2487-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Revised: 03/25/2013] [Accepted: 04/10/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Andres Anaya
- />School of Medicine, University of California, San Francisco, San Francisco, CA USA
| | - Lee Plantmason
- />Department of Emergency Medicine, University of Southern California and the Los Angeles County Medical Center, 2051 Marengo Street Inpatient Tower Room C1A100, Los Angeles, CA 90033 USA
| | - Gurpreet Dhaliwal
- />Department of Medicine, University of California, San Francisco and the San Francisco Veterans Affairs Medical Center, San Francisco, CA USA
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Alnaqbi KA, Touma Z, Passalent L, Johnson SR, Tomlinson GA, Carty A, Inman RD. Development, sensibility, and reliability of the Toronto Axial Spondyloarthritis Questionnaire in inflammatory bowel disease. J Rheumatol 2013; 40:1726-35. [PMID: 23996291 DOI: 10.3899/jrheum.130048] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE There is an unacceptable delay in the diagnosis of axial spondyloarthritis (axSpA) in its early stages among patients at high risk, in particular those with inflammatory bowel disease (IBD). Our objectives were to develop a sensible and reliable questionnaire to identify undetected axSpA among patients with IBD. METHODS Literature was reviewed for item generation in the Toronto axSpA Questionnaire on IBD (TASQ-IBD). Sensibility of the questionnaire was assessed among healthcare professionals and patients. This assessment was related to purpose and framework (clinical function, clinical justification, and clinical applicability), face validity, comprehensiveness [oligo-variability (limiting the questionnaire to important items) and transparency], replicability, content validity, and feasibility. The test-retest reliability study was administered to 77 patients with established IBD and axSpA. Kappa agreement coefficients and absolute agreement were calculated for items. RESULTS Three domains included IBD, inflammatory back symptoms, and extraaxial features. The entry criterion required a patient to have IBD and back pain or stiffness that ever persisted for ≥ 3 months. Iterative sensibility assessment involved 16 items and a diagram of the back. Kappa coefficients ranged from 0.81-1.00 for each item. Absolute agreement across all items ranged from 91% to 100%. CONCLUSION TASQ-IBD is a newly developed, sensible, and reliable case-finding questionnaire to be administered to patients with IBD who have ever had chronic back pain or stiffness persisting for ≥ 3 months. It should facilitate identification and timely referral of patients with IBD to rheumatologists and minimize the delay in diagnosis of axSpA. Consequently, it should assess the prevalence of axSpA in IBD.
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Affiliation(s)
- Khalid A Alnaqbi
- From the Department of Medicine, Division of Rheumatology, University of Toronto, Toronto Western Hospital, Toronto; Al Ain Hospital, Medical Institute, Al Ain, United Arab Emirates; and Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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