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Michalak M, Druszcz A, Miś M, Paprocka-Borowicz M, Rosińczuk J. Quality of Life, Disability Level, and Pain Intensity among Patients after Lumbar Disc Surgery: An Observational Three-Month Follow-Up Study. Healthcare (Basel) 2023; 11:3127. [PMID: 38132017 PMCID: PMC10742899 DOI: 10.3390/healthcare11243127] [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: 10/01/2023] [Revised: 11/22/2023] [Accepted: 12/02/2023] [Indexed: 12/23/2023] Open
Abstract
The prevalence of intervertebral disc degeneration in the lumbar region resulting in low back pain is high. One of the treatment options is neurosurgery. Previous studies and systematic reviews demonstrate the need to identify factors that affect the health-related quality of life of patients undergoing surgery. This study aimed to analyze the sociodemographic and clinical factors that affect the quality of life of patients undergoing lumbar disc surgery. A group of 128 patients was assessed for eligibility and qualified by radiological examinations for lumbar disc surgery by a neurosurgeon in the outpatient clinic. Finally, 110 patients were studied and evaluated 24 h and 3 months after surgery. Health-related quality of life (36-Item Short Form Survey, SF-36), disability level (Oswestry Disability Index, ODI), and pain intensity (Visual Analogue Scale, VAS) were assessed. The mean pain intensity before surgery was 7.8 ± 2.3 pts and decreased significantly 24 h after surgery, with a mean score of 3.8 ± 2.4 pts (p = 0.0000). After three months, the increase in pain intensity was at 4.8 ± 2.4 pts, but the score was still significantly better than before surgery (p = 0.0024). The mean ODI score before surgery was 29.3 ± 8.4 pts (slight disability), and three months after surgery, there was an insignificant increase to a mean value of 31.5 ± 10.4 pts (p = 0.0834). There was a statistically significant increase in quality-of-life scores at three months after surgery in the following domains: physical functioning (8.7%; p = 0.0176), bodily pain (26.2%; p = 0.0000), vitality (5.8%; p = 0.0132) and mental health (6.2%; p = 0.0163), and a decrease in role limitations due to physical problems (3.8; p = 0.0013) and general health perception (6.7%; p = 0.0112). In conclusion, the surgical procedure plays an important role in improving the quality of life of patients operated on for intervertebral disc degeneration. It was effective in reducing the pain level, especially 24 h after surgery; however, surgery did not affect the disability level.
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Affiliation(s)
- Monika Michalak
- Department of Nursing and Obstetrics, Wroclaw Medical University, 51-618 Wroclaw, Poland;
| | - Adam Druszcz
- Department of Neurosurgery, Provincial Specialist Hospital in Legnica, 59-220 Legnica, Poland;
| | - Maciej Miś
- Department of Neurosurgery, Specialist Hospital in Walbrzych, 58-309 Walbrzych, Poland;
| | | | - Joanna Rosińczuk
- Department of Nursing and Obstetrics, Wroclaw Medical University, 51-618 Wroclaw, Poland;
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Al Mulhim FA, Alalwan HA, Alkhars AM, Almutairi A, AlSaeed MN, Althabit FM. Prevalence of Low Back Pain and Its Related Risk Factors and Disability Following Lumbar Discectomy: A Single-Center Study. Cureus 2023; 15:e49729. [PMID: 38161856 PMCID: PMC10757580 DOI: 10.7759/cureus.49729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
Abstract
Background Lumbar disc herniation is considered the most common cause of sciatica, which is a contributing factor to disability. Surgical management of lumbar disc herniation in the form of discectomy is superior to conservative management in terms of better recovery and pain relief. However, recurrence, residual back pain, and disability are common expected complications following surgery. Therefore, this study aims to determine the prevalence of low back pain and its related risk factors and disability following discectomy at King Fahad Hospital in the Al-Ahsa region. Methodology A cross-sectional study was conducted at King Fahad Hofuf Hospital in the Al-Ahsa region among patients who were admitted and underwent lumbar spine discectomy in the last six years either due to traumatic or degenerative causes. The study used an anonymous questionnaire consisting of the patient's sociodemographic data, medical and surgical history, spine disease history, and surgical history. The preoperative Glasgow Coma Scale score, neurological status, and American Spinal Cord Impairment Scale score were noted. In addition, immediate postoperative neurological status and minor complications were recorded. Moreover, more than six months postoperatively, the Numeric Analogue Scale and the Oswestry low back pain disability index questionnaire were administered. Results A total of 201 patients were included in the study. The majority of the patients were male (59.7%), with ages ranging from 41 to 60 years (51.7). Most patients underwent one surgery (83.6%) in the form of discectomy alone (90.5%) at L3-L4 (58.7%), for which the intervertebral disc was the most common degenerative indication for surgery. All patients (100%) had low back pain preoperatively, and most patients (50.7%) had no back pain six months postoperatively. Preoperatively, 58.2% had diminished neurological status, while only 29.9% showed a deficit postoperatively. Postoperative low back pain was significantly associated with office-based jobs (p = 0.021, 60.5%) and a high number of surgeries (p = 0.004, 74.1%). The following factors were observed to be risk factors for having lower back pain: six months postoperatively, being unemployed (p = 0.024, odds ratio = 4.38, 338% increased risk), having an office-based job (p = 0.012, odds ratio = 3.98, 298% increased risk), and the underlying cause of the problem being degenerative (p = 0.003, odds ratio = 3.34, 234% increased risk). Low back pain-related severe disability postoperatively was significantly associated with increased age >40 (28-50%; p = 0.045), female gender (p = 0.012, 44.4%), and being unemployed (p = 0.002, 51.4%). The level of disability six months postoperatively was moderate in 40.4% of the patients. Conclusions Lumbar discectomy is a successful procedure for relieving low back pain among patients with degenerative spine disease, with an improvement that involves neurological status. However, residual back pain may still occur in less than half of the patients despite appropriate management, such as being unemployed or office-based employees and having multiple spine surgeries. However, low back pain-related disability is often moderate, with increasing severity seen with increased age, being female, and being unemployed.
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Affiliation(s)
- Fahad A Al Mulhim
- Orthopedic Surgery, King Fahad Hospital Hofuf, Al-Ahsa, SAU
- Orthopedic Surgery, King Faisal University, Al-Ahsa, SAU
| | | | | | | | - Mohammed N AlSaeed
- Orthopedic Surgery, King Fahad Hospital Hofuf, Al-Ahsa, SAU
- Orthopedics, King Fahad Hospital Hofuf, Al-Ahsa, SAU
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Staszkiewicz R, Ulasavets U, Dobosz P, Drewniak S, Niewiadomska E, Grabarek BO. Assessment of quality of life, pain level and disability outcomes after lumbar discectomy. Sci Rep 2023; 13:6009. [PMID: 37045989 PMCID: PMC10097864 DOI: 10.1038/s41598-023-33267-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 04/11/2023] [Indexed: 04/14/2023] Open
Abstract
This study aimed to assess the quality of life of 113 Caucasian patients with intervertebral disc (IVD) degeneration of the lumbosacral (L/S) spine who qualified for microdiscectomy during a 12-month period after surgery. Based on magnetic resonance imaging before the surgery, the degree of radiological advancement of the degenerative changes was determined according to the Pfirrmann grading scale from 1 to 5. To assess pain intensity, the Visual Analog Scale (VAS) was used; the Satisfaction with Life Scale (SWLS) was used to evaluate quality of life; and to assess the degree of ability, the Oswestry Low Back Pain Disability Questionnaire (ODI) was employed. The level of pain, assessed using the VAS, significantly changed in the months following the surgery, with the highest values noted before surgery and the lowest a year after. In turn, the results of the SWLS questionnaire revealed a significant increase in satisfaction with life in the subsequent stages of the study. The conducted correlation analysis revealed significant dependencies in terms of quality of life in regard to pain as well as degree of disability. The level of pain and degree of disability were closely related to the degree of radiological advancement of degenerative changes according to the Pfirrmann grading scale.
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Affiliation(s)
- Rafał Staszkiewicz
- Department of Neurosurgery, 5th Military Clinical Hospital with the SP ZOZ Polyclinic in Krakow, 30-901, Krakow, Poland.
- Department of Histology, Cytophysiology and Embryology, Faculty of Medicine in Zabrze, Academy of Silesia, 4-055, Katowice, Poland.
| | - Uladzislau Ulasavets
- Department of Neurosurgery, 5th Military Clinical Hospital with the SP ZOZ Polyclinic in Krakow, 30-901, Krakow, Poland
| | - Paweł Dobosz
- Department of Laryngology, 5th Military Clinical Hospital with the SP ZOZ Polyclinic in Krakow, 30-901, Kraków, Poland
| | - Szymon Drewniak
- Department of Anesthetics, 5th Military Clinical Hospital with the SP ZOZ Polyclinic in Krakow, 30-901, Kraków, Poland
| | - Ewa Niewiadomska
- Department of Epidemiology and Biostatistics, School Health Sciences in Bytom, Medical University of Silesia, 41-902, Bytom, Poland
| | - Beniamin Oskar Grabarek
- Department of Neurosurgery, 5th Military Clinical Hospital with the SP ZOZ Polyclinic in Krakow, 30-901, Krakow, Poland
- Department of Histology, Cytophysiology and Embryology, Faculty of Medicine in Zabrze, Academy of Silesia, 4-055, Katowice, Poland
- Laboratory of Molecular Biology and Virology, 40-851, Katowice, Poland
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Chen X, Lin F, Xu X, Chen C, Wang R. Development, validation, and visualization of a web-based nomogram to predict the effect of tubular microdiscectomy for lumbar disc herniation. Front Surg 2023; 10:1024302. [PMID: 37021092 PMCID: PMC10069648 DOI: 10.3389/fsurg.2023.1024302] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 01/27/2023] [Indexed: 04/07/2023] Open
Abstract
Objective The purpose of this study was to retrospectively collect the relevant clinical data of lumbar disc herniation (LDH) patients treated with the tubular microdiscectomy (TMD) technique, and to develop and validate a prediction model for predicting the treatment improvement rate of TMD in LDH patients at 1 year after surgery. Methods Relevant clinical data of LDH patients treated with the TMD technology were retrospectively collected. The follow-up period was 1 year after surgery. A total of 43 possible predictors were included, and the treatment improvement rate of the Japanese Orthopedic Association (JOA) score of the lumbar spine at 1 year after TMD was used as an outcome measure. The least absolute shrinkage and selection operator (LASSO) method was used to screen out the most important predictors affecting the outcome indicators. In addition, logistic regression was used to construct the model, and a nomogram of the prediction model was drawn. Results A total of 273 patients with LDH were included in this study. Age, occupational factors, osteoporosis, Pfirrmann classification of intervertebral disc degeneration, and preoperative Oswestry Disability Index (ODI) were screened out from the 43 possible predictors based on LASSO regression. A total of 5 predictors were included while drawing a nomogram of the model. The area under the ROC curve (AUC) value of the model was 0.795. Conclusions In this study, we successfully developed a good clinical prediction model that can predict the effect of TMD for LDH. A web calculator was designed on the basis of the model (https://fabinlin.shinyapps.io/DynNomapp/).
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Affiliation(s)
| | | | | | | | - Rui Wang
- Correspondence: Chunmei Chen Rui Wang
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Toyoda H. The Essence of Clinical Practice Guidelines for Lumbar Disc Herniation, 2021: 5. Prognosis. Spine Surg Relat Res 2022; 6:333-336. [PMID: 36051680 PMCID: PMC9381086 DOI: 10.22603/ssrr.2022-0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/15/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Hiromitsu Toyoda
- Department of Orthopaedic Surgery, Osaka City University, Graduate School of Medicine
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Irmak R. Why do we encounter studies with older versions of the Oswestry Disability Index? Awareness of researchers about the version updates and the lifespan of older versions. Work 2022; 72:745-752. [DOI: 10.3233/wor-213639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: The Oswestry Disability Index (ODI) is a common outcome-measure used for assessment of spinal disorders with three officially updated versions. However, there are recently published articles that still use ODI-1.0. This suggests the existence of a block on information flow between developers and end-users. OBJECTIVE: To investigate the articles with missing citation to the latest ODI version, to calculate the life span of previous ODI version and to investigate the existence of a block on information flow. METHODS: PMC-PubMed citation dataset is analyzed by CNA and text processing methods. RESULTS: The most important finding of this study is that there is no block on information flow between developers and users in terms of visibility in citations and full text access restrictions. Three different sub-networks are identified between ODI-1.0 and ODI-2.0 articles. 14% (165) of articles have citation to ODI-1.0 and ODI-2.0 version-articles. The time limit that is required for the new ODI version to become dominant in the literature is between 4 and 9 years. CONCLUSION: There is a missing citation problem in the ODI literature which is not a result of a block on information flow between developers and end-users.
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Affiliation(s)
- Rafet Irmak
- Presidency Library, 4th floor, 3d reading room, Ankara, Turkey. E-mail:
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Wang X, Song WJ, Ruan Y, Li BC, Lü C, Huang N, Fang FF, Gu W. Core muscle functional strength training for reducing the risk of low back pain in military recruits: An open-label randomized controlled trial. JOURNAL OF INTEGRATIVE MEDICINE 2022; 20:145-152. [PMID: 34969649 DOI: 10.1016/j.joim.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 08/26/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Core muscle functional strength training (CMFST) has been reported to reduce injuries to the lower extremity. However, no study has confirmed whether CMFST can reduce the risk of low back pain (LBP). OBJECTIVE This study identified the effects of CMFST on the incidence of LBP in military recruits. DESIGN, SETTING, PARTICIPANTS AND INTERVENTION We performed a prospective, open-label, randomized, controlled study in a population of young healthy male naval recruits from a Chinese basic combat training program. Participants were randomly assigned to either the core group or the control group. In additional to normal basic combat training, recruits in the core group underwent a CMFST program for 12 weeks, while recruits in the control group received no extra training. MAIN OUTCOME MEASURES At the beginning of the study and at the 12th week, the number of participants with LBP was counted, and lumbar muscle endurance was measured. In addition, when participants complained of LBP, they were assessed using the visual analog scale (VAS) and Roland Morris Disability Questionnaire (RMDQ). RESULTS A total of 588 participants were included in the final analysis (295 in the core group and 293 in the control group). The incidence of LBP in the control group was about twice that of the core group over the 12-week study (20.8% vs 10.8%, odds ratio: 2.161-2.159, P < 0.001). The core group had better lumbar muscle endurance at 12 weeks than the control group ([200.80 ± 92.98] s vs [147.00 ± 84.51] s, P < 0.01). There was no significant difference in VAS score between groups, but the core group had a significantly lower RMDQ score at week 12 than the control group (3.33 ± 0.58 vs 5.47 ± 4.41, P < 0.05). CONCLUSION This study demonstrated that the CMFST effectively reduced the incidence of LBP, improved lumbar muscle endurance, and relieved the dysfunction of LBP during basic military training.
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Affiliation(s)
- Xin Wang
- School of Traditional Chinese Medicine, Naval Medical University, Shanghai 200433, China
| | - Wen-Juan Song
- Department of Rehabilitation, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Yi Ruan
- School of Traditional Chinese Medicine, Naval Medical University, Shanghai 200433, China
| | - Bing-Chu Li
- School of Mechanical Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
| | - Can Lü
- Department of Rehabilitation, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Nian Huang
- School of Traditional Chinese Medicine, Naval Medical University, Shanghai 200433, China
| | - Fan-Fu Fang
- Department of Rehabilitation, Changhai Hospital, Naval Medical University, Shanghai 200433, China.
| | - Wei Gu
- School of Traditional Chinese Medicine, Naval Medical University, Shanghai 200433, China.
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Laasik R, Lankinen P, Kivimäki M, Neva MH, Aalto V, Oksanen T, Vahtera J, Mäkelä KT. Return to work after lumbar disc herniation surgery: an occupational cohort study. Acta Orthop 2021; 92:638-643. [PMID: 34269643 PMCID: PMC8635580 DOI: 10.1080/17453674.2021.1951010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Lumbar disc herniation is a common surgically treated condition in the working-age population. We assessed health-related risk factors for return to work (RTW) after excision of lumbar disc herniation. Previous studies on the subject have had partly contradictory findings.Patients and methods - RTW of 389 (n = 111 male, n = 278 female; mean age 46 years, SD 8.9) employees who underwent excision of lumbar disc herniation was assessed based on the Finnish Public Sector Study (FPS). Baseline information on occupation, preceding health, and health-risk behaviors was derived from linkage to national health registers and FPS surveys before the operation. The likelihood of RTW was analyzed using Cox proportional hazard univariable and multivariable modelling.Results - 95% of the patients had returned to work at 12 months after surgery, after on average 78 days of sickness absence. Faster RTW in the univariable Cox model was associated with a small number of sick leave days (< 30 days) before operation (HR 1.3, 95% CI 1.1-1.6); high occupational position (HR 1.6, CI 1.2-2.1); and age under 40 years (HR 1.5, CI 1.1-1.9). RTW was not associated with sex or the health-related risk factors obesity, physical inactivity, smoking, heavy alcohol consumption, poor self-rated health, psychological distress, comorbid conditions, or purchases of pain or antidepressant medications in either the univariable or multivariable model.Interpretation - Almost all employees returned to work after excision of lumbar disc herniation. Older age, manual job, and prolonged sick leave before the excision of lumbar disc herniation were risk factors for delayed return to work after the surgery.
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Affiliation(s)
- Raul Laasik
- Department of Orthopaedics and Trauma, Tampere University Hospital, Tampere, Finland
| | - Petteri Lankinen
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland;,Satakunta Central Hospital, Pori, Finland
| | - Mika Kivimäki
- Finnish Institute of Occupational Health, Helsinki, Finland;,Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland;,Department of Epidemiology and Public Health, University College London, London, UK
| | - Marko H Neva
- Department of Orthopaedics and Trauma, Tampere University Hospital, Tampere, Finland
| | - Ville Aalto
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Tuula Oksanen
- Finnish Institute of Occupational Health, Helsinki, Finland;,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Jussi Vahtera
- Department of Public Health, University of Turku, and Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Keijo T Mäkelä
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland;,Correspondence: Keijo T Mäkelä Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
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Ziegler DS, Jensen RK, Storm L, Carreon L, Andersen MO. The Association Between Early Postoperative Leg Pain Intensity and Disability at 1-Year and 2-Year Follow-Up After First-Time Lumbar Discectomy. Global Spine J 2021; 11:81-88. [PMID: 32875841 PMCID: PMC7734259 DOI: 10.1177/2192568219893296] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Longitudinal cohort study. OBJECTIVES To investigate whether a cutoff point in leg pain intensity measured preoperatively or at early follow-up could identify patients at risk of poor outcomes in terms of disability at 1-year and 2-year follow-up after first-time lumbar discectomy, and to identify the characteristics associated with early postoperative leg pain intensity. METHODS From 2010 to 2013, 556 patients underwent lumbar discectomy. Leg pain intensity was measured preoperatively and at early postoperative follow-up and dichotomized according to an established cutoff point on a 0 to 100 visual analogue scale (mild <30, moderate/severe ≥30). The outcome measurement was Oswestry Disability Index (ODI). Generalized estimating equations modelling established the association between leg pain intensity and ODI. Characteristics associated with early postoperative leg pain intensity were identified using common hypothesis tests. RESULTS Moderate/severe leg pain intensity at early follow-up showed a statistically significant association with higher ODI at 1-year and 2-year follow-up compared to mild leg pain intensity (median [interquartile range]: 24 [26] and 26 [26] versus 12 [18] and 10 [20], respectively). Patients reporting moderate/severe leg pain intensity were more often smokers, were more prone to receive social benefits, and were more prone to have chronic back pain. The preoperative measurement of leg pain intensity showed inferior associations. CONCLUSION The proposed cutoff point in leg pain intensity at early follow-up can identify patients at risk of disability at both 1-year and 2-year follow-up after first-time discectomy. Future research should be undertaken to investigate whether patients with moderate/severe leg pain intensity at early postoperative follow-up could benefit from additional or more intensive postoperative interventions.
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Affiliation(s)
- Dorthe Schoeler Ziegler
- Spine Center of Southern Denmark—Part of Lillebaelt Hospital, Middelfart, Denmark,Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark,Dorthe Schoeler Ziegler, Spine Surgery and Research, Spine Center of Southern Denmark, Oestre Hougvej 55, 5500 Middelfart, Denmark.
| | - Rikke Krüger Jensen
- Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Lisbeth Storm
- Spine Center of Southern Denmark—Part of Lillebaelt Hospital, Middelfart, Denmark
| | - Leah Carreon
- Spine Center of Southern Denmark—Part of Lillebaelt Hospital, Middelfart, Denmark,Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Mikkel Oesterheden Andersen
- Spine Center of Southern Denmark—Part of Lillebaelt Hospital, Middelfart, Denmark,Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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Kang SH, Yang JS, Cho SS, Cho YJ, Jeon JP, Choi HJ. A Prospective Observational Study of Return to Work after Single Level Lumbar Discectomy. J Korean Neurosurg Soc 2020; 63:806-813. [PMID: 33181867 PMCID: PMC7671783 DOI: 10.3340/jkns.2020.0227] [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: 08/06/2020] [Accepted: 09/19/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Lumbar disc herniation (LDH) is a common disease, and lumbar discectomy (LD) is a common neurosurgical procedure. However, there is little previous data on return to work (RTW) after LD. This study investigated the period until the RTW after LD prospectively. Clinically, the pain state at the time of RTW also checked. RTW failure rate 6 months after surgery also investigated. METHODS Patients with daily/regular jobs undergoing LD between September 2014 and December 2018 were enrolled. Pain was assessed by the Oswestri Disability Index (ODI) and the Numeric Rate Scale (NRS). Employment type was divided into self-employed, regular and contracted. Monthly telephone interviews were conducted to check RTW status and self-estimated work capability after surgery. RESULTS Sixty-seven patients enrolled in this study. Three patients failed to RTW, and three others resigned within 6 months after surgery. The preoperative NRS and ODI were 7.2±1.2 and 22.1±7.9, respectively. The average time to RTW was 5.1±6.0 weeks. At RTW, NRS was 1.5±1.8 and ODI was 6.3±3.9. Amongst patients that successfully returned to work were 16 self-employed workers, 42 regular employees, and three contracted workers. The time to RTW of self-employed, regular, and contracted workers were 5.9±8.8, 4.2±4.3 and 13.3±2.3 weeks, respectively (p=0.011). Thirty-six of the patients that returned to work self-reported a 22.8±15.6% reduction in work capability at 6 months. CONCLUSION RTW may vary depending on the employment status. In this study, we found that while employment type may affect the length to RTW, most patients were able to RTW and >40% of patients reported no loss of work capabilities 6 months postoperatively, hopefully alleviating some patient hesitation towards LD.
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Affiliation(s)
- Suk-Hyung Kang
- Department of Neurosurgery, Chuncheon Sacred Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Chuncheon, Korea
| | - Jin Seo Yang
- Department of Neurosurgery, Chuncheon Sacred Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Chuncheon, Korea
| | | | - Yong-Jun Cho
- Department of Neurosurgery, Chuncheon Sacred Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Chuncheon, Korea
| | - Jin Pyeong Jeon
- Department of Neurosurgery, Chuncheon Sacred Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Chuncheon, Korea
| | - Hyuk Jai Choi
- Department of Neurosurgery, Chuncheon Sacred Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Chuncheon, Korea
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Ziegler DS, Jensen RK, Thomsen GF, Carreon L, Andersen MO. Returning to Work Within Two Years After First-Time, Single-Level, Simple Lumbar Discectomy: A Multifactorial, Predictive Model. JOURNAL OF OCCUPATIONAL REHABILITATION 2020; 30:274-287. [PMID: 31872381 DOI: 10.1007/s10926-019-09870-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose Continued inability to work has societal and individual consequences. Thus, the factors associated with sustained return to work after lumbar discectomy should be identified. Prior studies of the biopsychosocial factors associated with sustained RTW were primarily based on patient-reported outcome data and have shown conflicting results because of small study samples. In patients undergoing first-time, single-level, simple lumbar discectomy, we describe the time to sustained return to work within 2 years after surgery using outcome data from a national database and identify the pre- and peri-operative factors associated with sustained return to work within 2 years by developing and validating a predictive multivariable model. Methods The time to a sustained return to work within the study period was described using a Kaplan-Meier plot. A temporal validated Cox proportional hazards model examined associations between biopsychosocial factors and return to work. Results In the derivation cohort made up by 351 operated patients who were on sick-leave for more than 3 weeks around the time of surgery, 62% returned to work (median 15 weeks). The probability of sustained return to work was associated with a high education level, positive expectations towards future labor market attachment, pre-operative stable labor market attachment, pre-operative higher physical quality of life, and less disability. Conclusions Through the development and validation of a predictive model, this study identifies a number of patient-related factors associated with sustained return to work after lumbar discectomy, while revealing that most disease-related clinical findings were not associated with the outcome.
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Affiliation(s)
- Dorthe Schoeler Ziegler
- Spine Surgery and Research, Spine Center of Southern Denmark - part of Lillebaelt Hospital, Oestre Hougvej 55, 5500, Middelfart, Denmark.
- Department of Regional Health Research, University of Southern Denmark, J.B. Winsloews Vej 19, 3, 5000, Odense C, Denmark.
| | - Rikke Krüger Jensen
- Nordic Institute of Chiropractic and Clinical Biomechanics, Campusvej 55, 5230, Odense M, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| | - Gert Frank Thomsen
- Department of Occupational Medicine, Hospital of Southwest Jutland, Oestergade 81 - 83, 6700, Esbjerg, Denmark
| | - Leah Carreon
- Spine Surgery and Research, Spine Center of Southern Denmark - part of Lillebaelt Hospital, Oestre Hougvej 55, 5500, Middelfart, Denmark
- Department of Regional Health Research, University of Southern Denmark, J.B. Winsloews Vej 19, 3, 5000, Odense C, Denmark
| | - Mikkel Oesterheden Andersen
- Spine Surgery and Research, Spine Center of Southern Denmark - part of Lillebaelt Hospital, Oestre Hougvej 55, 5500, Middelfart, Denmark
- Department of Regional Health Research, University of Southern Denmark, J.B. Winsloews Vej 19, 3, 5000, Odense C, Denmark
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Presurgical Psychological Evaluation: Risk Factor Identification and Mitigation. J Clin Psychol Med Settings 2019; 27:396-405. [PMID: 31473887 DOI: 10.1007/s10880-019-09660-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Presurgical psychological evaluations (PPEs) are becoming an established component of the surgical process, though methods of conducting PPEs are variable. There is a lack of clarity about the goals of PPEs, the types of information that should be included, and the process for integrating information and making recommendations to the referring physicians/surgeons. This review proposes an empirically supported model for PPEs that is systematic, but flexible enough to be utilized across the broad range of surgical evaluations. This five-step method is termed the Risk Identification and Mitigation (RIM) model and is discussed in detail. The RIM model presented in this review can both serve as a structure to be utilized in under-researched PPE areas and as a stimulus for future empirical investigations.
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de Wit M, Wind H, Hulshof CTJ, Frings-Dresen MHW. Person-related factors associated with work participation in employees with health problems: a systematic review. Int Arch Occup Environ Health 2018; 91:497-512. [PMID: 29700608 PMCID: PMC6002456 DOI: 10.1007/s00420-018-1308-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 04/18/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE The objective of this systematic review was to explore and provide systematically assessed information about the association between person-related factors and work participation of people with health problems. The research question was: what is the association between selected person-related factors and work participation of workers with health problems? METHODS A systematic review was carried out in PubMed and PsycINFO to search for original papers published between January 2007 and February 2017. The risk of bias of the studies included was assessed using quality assessment tools from the Joanna Briggs Institute. The quality of evidence was assessed using the GRADE framework for prognostic studies. RESULTS In total, 113 studies were included, all of which addressed the association between person-related factors and work participation. The factors positively associated with work participation were positive expectations regarding recovery or return to work, optimism, self-efficacy, motivation, feelings of control, and perceived health. The factors negatively associated with work participation were fear-avoidance beliefs, perceived work-relatedness of the health problem, and catastrophizing. Different coping strategies had a negative or a positive relationship with work participation. CONCLUSIONS The results of this review provide more insight into the associations between different cognitions and perceptions and work participation. The results of this study suggest that person-related factors should be considered by occupational- and insurance physicians when they diagnose, evaluate or provide treatment to employees. Further research is required to determine how these physicians could obtain and apply such information and whether its application leads to a better quality of care.
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Affiliation(s)
- Mariska de Wit
- Department Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health research institute, PO Box 22700, 1100 DE, Amsterdam, The Netherlands.
| | - Haije Wind
- Department Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health research institute, PO Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - Carel T J Hulshof
- Department Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health research institute, PO Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - Monique H W Frings-Dresen
- Department Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health research institute, PO Box 22700, 1100 DE, Amsterdam, The Netherlands
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Alodaibi FA, Fritz JM, Thackeray A, Koppenhaver SL, Hebert JJ. The Fear Avoidance Model predicts short-term pain and disability following lumbar disc surgery. PLoS One 2018; 13:e0193566. [PMID: 29505603 PMCID: PMC5837292 DOI: 10.1371/journal.pone.0193566] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 02/13/2018] [Indexed: 11/30/2022] Open
Abstract
Objective To examine the prognostic value of the Fear Avoidance Model (FAM) variables when predicting pain intensity and disability 10-weeks postoperative following lumbar disc surgery. Methods We recruited patients scheduled for first-time, single level lumbar disc surgery. The following aspects of the FAM were assessed at preoperative baseline and after 10 postoperative weeks: numeric pain rating scale (0–10) for leg and back pain intensity separately, Pain Catastrophizing Scale (PCS), Fear Avoidance Beliefs Questionnaire (FABQ), Beck Depression Inventory (BDI), Oswestry Disability Questionnaire (ODI), and the International Physical Activity Questionnaire (IPAQ). Multivariate regression models were used to examine the best combination of baseline FAM variables to predict the 10-week leg pain, back pain, and disability. All multivariate models were adjusted for age and sex. Results 60 patients (30 females, mean [SD] age = 40.4 [9.5]) were enrolled. All FAM measures correlated with disability at baseline. Adding FAM variables to each of the stepwise multiple linear regression model explained a significant amount of the variance in disability (Adj. R2 = .38, p < .001), leg pain intensity (Adj. R2 = .25, p = .001), and back pain intensity Adj. R2 = .32, p < .001 at 10-weeks). After adjusting for age and gender, BDI and FABQ-work subscale were the only significant predictors added to each of the prediction models for the 10-week clinical outcome (leg pain, back pain, and ODI). Conclusion BDI and FABQ-work subscale variables are associated with baseline pain intensity and disability and predict short-term pain and disability following lumbar disc surgery. Measuring these variables in patients being considered for lumbar disc surgery may improve patient outcome.
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Affiliation(s)
- Faris A. Alodaibi
- Department of Rehabilitation Science, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
- * E-mail: ,
| | - Julie M. Fritz
- School of Health, Department of Physical Therapy, University of Utah, Salt Lake City, UT, United States of America
| | - Anne Thackeray
- School of Health, Department of Physical Therapy, University of Utah, Salt Lake City, UT, United States of America
| | - Shane L. Koppenhaver
- Baylor University Doctoral Physical Therapy Program, Waco, TX, United States of America
| | - Jeffrey J. Hebert
- School of Psychology and Exercise Science, Murdoch University, Murdoch, Western Australia, Australia
- Faculty of Kinesiology, University of New Brunswick, New Brunswick, Canada
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15
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Asher AL, Devin CJ, Archer KR, Chotai S, Parker SL, Bydon M, Nian H, Harrell FE, Speroff T, Dittus RS, Philips SE, Shaffrey CI, Foley KT, McGirt MJ. An analysis from the Quality Outcomes Database, Part 2. Predictive model for return to work after elective surgery for lumbar degenerative disease. J Neurosurg Spine 2017; 27:370-381. [DOI: 10.3171/2016.8.spine16527] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVECurrent costs associated with spine care are unsustainable. Productivity loss and time away from work for patients who were once gainfully employed contributes greatly to the financial burden experienced by individuals and, more broadly, society. Therefore, it is vital to identify the factors associated with return to work (RTW) after lumbar spine surgery. In this analysis, the authors used data from a national prospective outcomes registry to create a predictive model of patients’ ability to RTW after undergoing lumbar spine surgery for degenerative spine disease.METHODSData from 4694 patients who underwent elective spine surgery for degenerative lumbar disease, who had been employed preoperatively, and who had completed a 3-month follow-up evaluation, were entered into a prospective, multicenter registry. Patient-reported outcomes—Oswestry Disability Index (ODI), numeric rating scale (NRS) for back pain (BP) and leg pain (LP), and EQ-5D scores—were recorded at baseline and at 3 months postoperatively. The time to RTW was defined as the period between operation and date of returning to work. A multivariable Cox proportional hazards regression model, including an array of preoperative factors, was fitted for RTW. The model performance was measured using the concordance index (c-index).RESULTSEighty-two percent of patients (n = 3855) returned to work within 3 months postoperatively. The risk-adjusted predictors of a lower likelihood of RTW were being preoperatively employed but not working at the time of presentation, manual labor as an occupation, worker’s compensation, liability insurance for disability, higher preoperative ODI score, higher preoperative NRS-BP score, and demographic factors such as female sex, African American race, history of diabetes, and higher American Society of Anesthesiologists score. The likelihood of a RTW within 3 months was higher in patients with higher education level than in those with less than high school–level education. The c-index of the model’s performance was 0.71.CONCLUSIONSThis study presents a novel predictive model for the probability of returning to work after lumbar spine surgery. Spine care providers can use this model to educate patients and encourage them in shared decision-making regarding the RTW outcome. This evidence-based decision support will result in better communication between patients and clinicians and improve postoperative recovery expectations, which will ultimately increase the likelihood of a positive RTW trajectory.
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Affiliation(s)
- Anthony L. Asher
- 1Department of Neurological Surgery, Carolina Neurosurgery and Spine Associates, and Neurological Institute, Carolinas Healthcare System, Charlotte, North Carolina
| | - Clinton J. Devin
- 2Department of Orthopedic Surgery and Neurological Surgery, Vanderbilt Spine Center,
| | - Kristin R. Archer
- 3Department of Orthopedic Surgery, Vanderbilt Spine Center, and
- 4Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Silky Chotai
- 2Department of Orthopedic Surgery and Neurological Surgery, Vanderbilt Spine Center,
| | - Scott L. Parker
- 2Department of Orthopedic Surgery and Neurological Surgery, Vanderbilt Spine Center,
| | - Mohamad Bydon
- 5Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
| | - Hui Nian
- 6Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Frank E. Harrell
- 6Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Theodore Speroff
- 7Geriatric Research Education Clinical Center, Tennessee Valley Health System, Veterans Health Administration, Nashville, Tennessee
- 8Departments of Medicine and Biostatistics, Division of General Internal Medicine and Public Health, Center for Health Services Research, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Robert S. Dittus
- 7Geriatric Research Education Clinical Center, Tennessee Valley Health System, Veterans Health Administration, Nashville, Tennessee
- 8Departments of Medicine and Biostatistics, Division of General Internal Medicine and Public Health, Center for Health Services Research, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Sharon E. Philips
- 6Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Christopher I. Shaffrey
- 9Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia; and
| | - Kevin T. Foley
- 10Department of Neurosurgery, University of Tennessee Health Sciences Center, Semmes-Murphey Neurologic & Spine Institute, Memphis, Tennessee
| | - Matthew J. McGirt
- 1Department of Neurological Surgery, Carolina Neurosurgery and Spine Associates, and Neurological Institute, Carolinas Healthcare System, Charlotte, North Carolina
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KIM S, JEON K. Effects of a Complex Intervention Exercise Program on Lumbar Extension Strength and Stability in Female Patients with Lower Back Pain. IRANIAN JOURNAL OF PUBLIC HEALTH 2017; 46:854-855. [PMID: 28828331 PMCID: PMC5558082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Soonyoung KIM
- Dept. of Physical Education, Gachon University, Gyeonggi-Do, Republic of Korea
| | - Kyoungkyu JEON
- Sport Science Institute, Incheon National University, Incheon, Republic of Korea,Division of Sport Science, Incheon National University, Incheon, Republic of Korea,Corresponding Author:
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Jabłońska R, Ślusarz R, Królikowska A, Haor B, Zając M. Assessment and Determinants of Spinal Pain in the Course of Disc Disorders Treated Surgically. Med Sci Monit 2016; 22:4446-4454. [PMID: 27865095 PMCID: PMC5119686 DOI: 10.12659/msm.898252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Intervertebral disc disease is defined as a complex of structural changes in the aftermath of disorders of mutual elements, the structure of which form the discus intervertebralis and the spinal canal. The present work assessed pain in patients who were surgically treated due to spinal discopathy and analyzed factors that determine the condition. Material/Methods The research was carried on a group of 187 patients diagnosed with discopathy of the lumbosacral and cervical segment. The data are discussed in the context of medical records and the Visual Analogue Scale used for pain assessment. We used a prospective study plan with a 3-time assessment. Results The pain level observed among patients prior to the procedure (M=6.52) was higher than after 7 days (M=3.15) and 6 months from the operation (M= 3.45). The highest level of pain (M=6.88), with a relatively high consistency among the patients (SD=2.25), was observed in the case of left-side hernia (H=7.31; p=0.023). The influence of the analyzed factors on pain experience markedly increased by the third assessment (R2=0.14), and was strongly associated with the type of work performed by the patient. Conclusions Surgical operation significantly reduces pain in patients with disc disorders. The level of pain is predominantly affected by the location of the hernia and the type of work performed by the patient.
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Affiliation(s)
- Renata Jabłońska
- Department of Neurological and Neurosurgical Nursing, Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Robert Ślusarz
- Department of Neurological and Neurosurgical Nursing, Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Agnieszka Królikowska
- Department of Neurological and Neurosurgical Nursing, Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Beata Haor
- Department of Neurological and Neurosurgical Nursing, Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Magdalena Zając
- Department of Psychology, Kazimierz Wielki University in Bydgoszcz, Bydgoszcz, Poland
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Adogwa O, Elsamadicy AA, Mehta AI, Vasquez RA, Cheng J, Karikari IO, Bagley CA. Association Between Baseline Affective Disorders and 30-Day Readmission Rates in Patients Undergoing Elective Spine Surgery. World Neurosurg 2016; 94:432-436. [DOI: 10.1016/j.wneu.2016.07.045] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 07/10/2016] [Accepted: 07/11/2016] [Indexed: 01/22/2023]
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Jeon K, Kim T, Lee SH. Effects of muscle extension strength exercise on trunk muscle strength and stability of patients with lumbar herniated nucleus pulposus. J Phys Ther Sci 2016; 28:1418-21. [PMID: 27313342 PMCID: PMC4905881 DOI: 10.1589/jpts.28.1418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 01/19/2016] [Indexed: 12/03/2022] Open
Abstract
[Purpose] The purpose of this study was to provide the data for constructing an
integrated exercise program to help restore muscle strength and stability through
extension strength exercise in adult females with lumbar disc herniation. [Subjects and
Methods] An 8-week exercise program for lumbar muscle extension strength and stabilization
was performed by 26 females older than 20 with lumbar disc herniation findings. [Results]
Significant differences were found in lumbar extension muscle strength at every angle of
lumbar flexion after participation in the 8-week stabilization exercise program; but there
was no significant difference in the weight distribution index. [Conclusion] An integrated
exercise program aiming to strengthen lumbar spine muscles, reduce pain and stabilize the
trunk can help to maintain muscle strength and balance. In addition, improvement in
extension strength is expected to be helpful in daily life by securing the range of joint
motion and improving the strength and stability.
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Affiliation(s)
- Kyoungkyu Jeon
- Sport Science Institute, Incheon National University, Republic of Korea
| | - Taeyoung Kim
- Department of Physical Education, College of Education, Hankuk University of Foreign Studies, Republic of Korea
| | - Sang-Ho Lee
- Department of Physical Education, College of Education, Hankuk University of Foreign Studies, Republic of Korea
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Sex differences in subjective and objective measures of pain, functional impairment, and health-related quality of life in patients with lumbar degenerative disc disease. Pain 2016; 157:1065-1071. [DOI: 10.1097/j.pain.0000000000000480] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Janssens L, Brumagne S, Claeys K, Pijnenburg M, Goossens N, Rummens S, Depreitere B. Proprioceptive use and sit-to-stand-to-sit after lumbar microdiscectomy: The effect of surgical approach and early physiotherapy. Clin Biomech (Bristol, Avon) 2016; 32:40-8. [PMID: 26795132 DOI: 10.1016/j.clinbiomech.2015.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 12/22/2015] [Accepted: 12/29/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Individuals with non-specific low back pain show decreased reliance on lumbosacral proprioceptive signals and slower sit-to-stand-to-sit performance. However, little is known in patients after lumbar microdiscectomy. METHODS Patients were randomly assigned into transmuscular (n=12) or paramedian lumbar surgery (n=13). After surgery, the same patients were randomly assigned into individualized active physiotherapy starting 2 weeks after surgery (n=12) or usual care (n=13). Primary outcomes were center of pressure displacement during ankle and back muscles vibration (to evaluate proprioceptive use), and the duration of five sit-to-stand-to-sit movements, evaluated at 2 (baseline), 8 and 24 weeks after surgery. FINDINGS Two weeks after surgery, all patients showed smaller responses to back compared to ankle muscles vibration (P<0.05). Patients that underwent a transmuscular surgical procedure and patients that received physiotherapy switched to larger responses to back muscles vibration at 24 weeks, compared to 2 weeks after surgery (P<0.005), although not seen in the paramedian group and usual care group (P>0.05). Already 8 weeks after surgery, the physiotherapy group needed significantly less time to perform five sit-to-stand-to-sit movements compared to the usual care group (P<0.05). INTERPRETATION Shortly after lumbar microdiscectomy, patients favor reliance on ankle proprioceptive signals over lumbosacral proprioceptive reliance to maintain posture, which resembles the behavior of patients with non-specific low back pain. However, early active physiotherapy after lumbar microdiscectomy facilitated higher reliance on lumbosacral proprioceptive signals and early improvement of sit-to-stand-to-sit performance. Transmuscular lumbar surgery favoured recovery of lumbosacral proprioception 6 months after surgery. CLINICAL TRIAL NUMBER NCT01505595.
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Affiliation(s)
- Lotte Janssens
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium; Hasselt University, Biomedical Research Institute, Diepenbeek, Belgium.
| | - Simon Brumagne
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium.
| | - Kurt Claeys
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium; KU Leuven Department of Rehabilitation Sciences, Campus Brugge, Bruges, Belgium.
| | | | - Nina Goossens
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium.
| | - Sofie Rummens
- Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium.
| | - Bart Depreitere
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium.
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Romanzini AE, Carvalho ECD, Galvão CM. Recuperação cirúrgica retardada: análise do conceito. Rev Bras Enferm 2015. [DOI: 10.1590/0034-7167.2015680526i] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMOObjetivo:analisar o conceito de recuperação cirúrgica retardada.Método:o modelo de análise de conceito de Rodgers guiou os mecanismos processuais do estudo. Revisão integrativa foi conduzida para alcançar a segunda atividade do modelo adotado. As bases de dados PubMed, CINAHL, EMBASE e LILACS foram selecionadas para a busca dos estudos primários.Resultados:Foram incluídos 66 estudos primários e sua a análise permitiu identificar seis atributos, os quais se inter-relacionam e subsidiam a definição do conceito investigado. Experiência prévia (relacionada à cirurgia, fatores fisiológicos, psíquicos ou ambientais), foi o antecedente identificado. Os consequentes foram expressos por manifestações clínicas, reintervenções, dependência de cuidados e redução na qualidade de vida.Conclusão:a definição do conceito foi construída e identificados os antecedentes e consequentes. O uso e significado do conceito recuperação cirúrgica retardada apontam para o uso do qualificador "prejudicada" em substituição ao termo "retardada".
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Abstract
BACKGROUND Civilian trauma literature suggests sexual dimorphism in outcomes after trauma. Because women represent an increasing demographic among veterans, the question remains if war trauma outcomes, like civilian trauma outcomes, differ between genders. QUESTIONS/PURPOSES (1) Do women service members develop different conditions resulting in long-term disability compared with men service members after injuries sustained during deployment? (2) Do women service members have more or less severe disability after deployment injury compared with men service members? (3) Are men or women more likely to return to duty after combat injury? METHODS The Department of Defense Trauma Registry was queried for women injured during deployment from 2001 to 2011. The subjects were then queried in the Physical Evaluation Board database to determine each subject's return-to-duty status and what disabling conditions and disability percentages were assigned to those who did not return to duty. Frequency of disabling conditions, disability percentages, and return-to-duty rates for 368 women were compared with a previously published cohort of 450 men service members, 378 of whom had orthopaedic injuries. RESULTS Women who were unable to return to duty had a higher frequency of arthritic conditions (58% [48 of 83] of women versus 35% [133 of 378] of men, p=0.002; relative risk [RR], 1.64; 95% confidence interval [CI], 1.307-2.067) and lower frequencies of general chronic pain (1% [one of 83] of women versus 19% [59 of 378] of men, p<0.001; RR, 0.08; 95% CI, 0.011-0.549) and neurogenic pain disorders (1% [one of 83] of women versus 7% [27 of 378] of men, p=0.0410; RR, 0.169; 95% CI, 0.023-1.224). Women had more severely rated posttraumatic stress disorder (PTSD) compared with men (38%±23% versus 19%±17%). Forty-eight percent (64 of 133) of battle-injured women were unable to return to active duty, resulting in a lower return-to-duty rate compared with men (34% [450 of 1333]; p=0.003). CONCLUSIONS After deployment-related injury, women have higher rates of arthritis, lower rates of pain disorders, and more severely rated PTSD compared with men. Women are unable to return to duty more often than men injured in combat. These results suggest some difference between men's and women's outcomes after deployment injury, important information for military and Veterans Administration providers seeking to minimize postdeployment disability. LEVEL OF EVIDENCE Level III, prognostic study.
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Predictors of reoperation-free survival following decompression-alone lumbar spine surgery for on-the-job injuries. Clin Neurol Neurosurg 2015; 135:41-5. [DOI: 10.1016/j.clineuro.2015.04.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 03/25/2015] [Accepted: 04/05/2015] [Indexed: 11/20/2022]
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Ylikoski A, Martikainen K, Sieminski M, Partinen M. Parkinson's disease and insomnia. Neurol Sci 2015; 36:2003-10. [PMID: 26099862 DOI: 10.1007/s10072-015-2288-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 06/11/2015] [Indexed: 11/30/2022]
Abstract
There is a broad spectrum of sleep disturbances observed in Parkinson's disease (PD). The prevalence of symptoms of insomnia and chronic inability to sleep and their association with other sleep disorders were studied. Altogether 1447 randomly selected Parkinson patients, aged 43-89 years, participated in a questionnaire study. A structured questionnaire with 207 items was based on the Basic Nordic Sleep questionnaire. Questions on demographics, PD, REM Sleep Behavior Disorder, and other issues were included. The response rate was 59 % (N = 854), and of these 81 % returned fully answered questionnaire (N = 689). Prevalence of chronic inability to sleep was 36.9 % (95 % CI 33.3-40.5). Difficulty of initiating sleep was 18.0 % (95 % CI 15.1-20.9), disrupted sleep 81.54 % (78.5-84.4), awakenings during night 31.3 % (27.8-34.8), early morning awakenings 40.4 % (36.8-44.1) and non-restorative sleep 38.5 % (34.8-42.1). In the logistic regression models, poor quality of life and restless legs syndrome correlated significantly with chronic insomnia disorder. Disrupted sleep and early morning awakenings were the most common insomnia symptoms. PD patients do not seem to have difficulties in sleep initiation. Insomnia symptoms including disruptive sleep and non-restorative sleep are common in patients with Parkinson's disease. Inability to sleep is more common as comorbidity than a single sleep problem.
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Affiliation(s)
- Ari Ylikoski
- Vitalmed Research Center, Helsinki Sleep Clinic, Sitratori 3, 00420, Helsinki, Finland. .,Department of Neurology, Hospital of Laakso, Helsinki, Finland.
| | | | - Mariusz Sieminski
- Department of Adult Neurology, Medical University of Gdansk, Gdansk, Poland
| | - Markku Partinen
- Vitalmed Research Center, Helsinki Sleep Clinic, Sitratori 3, 00420, Helsinki, Finland.,Department of Clinical Neurosciences, Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland
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Ylikoski A, Martikainen K, Partinen M. Parkinson's disease and restless legs syndrome. Eur Neurol 2015; 73:212-219. [PMID: 25792198 DOI: 10.1159/000375493] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 01/25/2015] [Indexed: 11/19/2022]
Abstract
AIMS Various sleep-related complications are common in Parkinson's disease (PD). The prevalence of restless legs syndrome (RLS) and its association with other symptoms were studied. METHODS Altogether, 1,447 Parkinson patients, aged 43-89, participated in a questionnaire study. RESULTS The response rate was 59.0% and of these, 68% returned fully answered questionnaires (n = 577). RLS occurred in 20.3% of the PD subjects. In patients with RLS, the symptoms occurred in 81.9% at least once weekly. The degree of severity was moderate in 42.7%, severe in 23.9% and very severe in 15.4%. Daytime sleepiness, fatigue, chronic insomnia, sleep maintenance insomnia, intense dreaming, and low quality of life were more common in patients with RLS than in patients without RLS. The occurrence of early onset RLS (onset ≤ age of 45 years) was 4.2%. The occurrences of late onset (>45 years) drug naïve RLS and late onset RLS (with dopaminergic medication) were 5.4 and 10.4%, respectively. CONCLUSION In patients with PD, the early onset of RLS resembles idiopathic RLS with typical gender distribution and familial trait. Late onset of RLS is more common than idiopathic RLS.
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Cho HY, Kim EH, Kim J. Effects of the CORE Exercise Program on Pain and Active Range of Motion in Patients with Chronic Low Back Pain. J Phys Ther Sci 2014; 26:1237-40. [PMID: 25202188 PMCID: PMC4155227 DOI: 10.1589/jpts.26.1237] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 02/16/2014] [Indexed: 01/07/2023] Open
Abstract
[Purpose] This study aimed to identify the effects of the CORE exercise program on pain
and active range of motion (AROM) in patients with chronic low back pain. [Subjects and
Methods] Thirty subjects with chronic low back pain were randomly allocated to two groups:
the CORE group (n = 15) and the control group (n = 15). The CORE group performed the CORE
exercise program for 30 minutes a day, 3 times a week, for 4 weeks, while the control
group did not perform any exercise. The visual analog scale (VAS) and an algometer were
used to measure pain, and pain-free AROM in the trunk was measured before and after the
intervention. [Results] The CORE group showed significantly decreased VAS scores at rest
and during movement and had a significantly increased pressure pain threshold in the
quadratus lumborum and AROM in the trunk compared with those in the control group.
[Conclusion] This study demonstrated that the CORE exercise program is effective in
decreasing pain and increasing AROM in patients with chronic low back pain. Thus, the CORE
exercise program can be used to manage pain and AROM in patients with chronic low back
pain.
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Affiliation(s)
- Hwi-Young Cho
- Department of Physical Therapy, College of Health Science, Gachon University, Republic of Korea
| | - Eun-Hye Kim
- Department of Physical Therapy, College of Health Science, Korea University, Republic of Korea ; BK21 Program in Public Health Sciences Program, Korea University Graduated School, Republic of Korea
| | - Junesun Kim
- Department of Physical Therapy, College of Health Science, Korea University, Republic of Korea
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Grøvle L, Haugen AJ, Keller A, Ntvig B, Brox JI, Grotle M. Prognostic factors for return to work in patients with sciatica. Spine J 2013; 13:1849-57. [PMID: 24060231 DOI: 10.1016/j.spinee.2013.07.433] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 06/26/2013] [Accepted: 07/10/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Little is known about the prognostic factors for work-related outcomes of sciatica caused by disc herniation. PURPOSE To identify the prognostic factors for return to work (RTW) during a 2-year follow-up among sciatica patients referred to secondary care. STUDY DESIGN/SETTING Multicenter prospective cohort study including 466 patients. Administrative data from the National Sickness Benefit Register were accessed for 227 patients. PATIENT SAMPLE Two samples were used. Sample A comprised patients who at the time of inclusion in the cohort reported being on partial sick leave or complete sick leave or were undergoing rehabilitation because of back pain/sciatica. Sample B comprised patients who, according to the sickness benefit register, at the time of inclusion received sickness benefits or rehabilitation allowances because of back pain/sciatica. OUTCOME MEASURES In Sample A, the outcome was self-reported return to full-time work at the 2-year follow-up. In Sample B, the outcome was time to first sustained RTW, defined as the first period of more than 60 days without receiving benefits from the register. METHODS Significant baseline predictors of self-reported RTW at 2 years (Analysis A) were identified by multivariate logistic regression. Significant predictors of time to sustained RTW (Analysis B) were identified by multivariate Cox proportional hazard modeling. Both analyses included adjustment for age and sex. To assess the effect of surgery on the probability of RTW, analyses similar to A and B were performed, including the variable surgery (yes/no). RESULTS One-fourth of the patients were still out of work at the 2-year follow-up. In Sample A (n=237), younger age, better general health, lower baseline sciatica bothersomeness, less fear-avoidance work, and a negative straight-leg-raising test result were significantly associated with a higher probability of RTW at the 2-year follow-up. Surgery was not significantly associated with the outcome. In Sample B (n=125), history of sciatica, duration of the current sciatica episode more than 3 months, greater sciatica bothersomeness, fear-avoidance work, and back pain were significantly associated with a longer time to sustained RTW. Surgery was significantly negatively associated with time to sustained RTW both in univariate (hazard ratio [HR] 0.60; 95% confidence interval [CI] 0.39, 0.93; p=.02) and in multivariate (HR 0.49; 95% CI 0.31, 0.79; p=.003) analyses. CONCLUSIONS The baseline factors associated with RTW identified in multivariate analysis were age, general health, history of sciatica, duration of the current episode, baseline sciatica bothersomeness, fear-avoidance work, back pain, and the straight-leg-raising test result. Surgical treatment was associated with slower RTW, but surgical patients were more severely affected than patients treated without surgery; so, this finding should be interpreted with caution.
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Affiliation(s)
- Lars Grøvle
- Department of Rheumatology, Østfold Hospital Trust, Postboks 16, 1603 Fredrikstad, Norway.
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Dall TM, Gallo P, Koenig L, Gu Q, Ruiz D. Modeling the indirect economic implications of musculoskeletal disorders and treatment. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2013; 11:5. [PMID: 23497029 PMCID: PMC3602091 DOI: 10.1186/1478-7547-11-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 01/16/2013] [Indexed: 12/23/2022] Open
Abstract
Background Musculoskeletal disorders impose a substantial economic burden on American society, but few studies have examined the economic benefits associated with treating such disorders. The purpose of this research is to estimate the indirect economic implications of activity limitations associated with musculoskeletal disorders and to quantifying the potential economic gains from elective surgery to treat arthritis of the knee and hip. Methods Using regression analysis with the National Health Interview Survey (2004-2010 data, n=185,829 adults) we quantify the relationship between severity of activity limitations (walking, sitting, standing, etc.) and employment, household income, missed work days, and receipt of supplemental security income for disability. Activity limitations are combined to create an index similar to the Functional Ability Index from the Short Form 36 Health Questionnaire (SF-36) often used in clinical trials to measure patient functional mobility. This index is included in the regression analyses. We use data from published, prospective clinical trials to establish the improvement in patient functional ability following surgery to treat arthritis of the knee and hip. Results Improved physical function is associated with higher likelihood of employment, higher household income and fewer missed work days for those who are employed, and reduced likelihood of receiving supplemental security income for disability. The magnitude of the impact and statistical significance vary by activity limitation and severity. Each percentage point increase in the index value is associated with a 2-percentage-point increase in the odds of being employed, a 3-percentage-point-day decline in work days missed and an additional $180 in annual household income if employed, and a 2-percentage-point decline in the odds of receiving supplemental security income for disability. All estimates are statistically significant at the 0.05 level. Conclusions Using a large, representative sample of non-institutionalized adults in the U.S., we find that physical activity limitations are associated with worse economic outcomes across multiple economic metrics. Combined with estimates of improved functional ability following knee and hip surgery, we quantify some of the economic benefits of surgery for arthritis of the knee and hip. This information helps improve understanding of the societal benefits of medical treatment for musculoskeletal conditions.
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Affiliation(s)
- Timothy M Dall
- IHS Global Inc,, 1150 Connecticut Ave,, NW, Suite 401, Washington, DC, 20036, USA.
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Ishida K, Tsushima E, Umeno Y, Satoh S. Factors Associated with the Oswestry Disability Index Score One Month after Lumbar Discectomy. J Phys Ther Sci 2012. [DOI: 10.1589/jpts.24.415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Kazuhiro Ishida
- Department of Rehabilitation, Eniwa Hospital
- Department of Development and Aging, Division of Health Sciences, Hirosaki University Graduate School of Health Sciences
| | - Eiki Tsushima
- Department of Development and Aging, Division of Health Sciences, Hirosaki University Graduate School of Health Sciences
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Grøvle L, Haugen AJ, Keller A, Natvig B, Brox JI, Grotle M. Poor agreement found between self-report and a public registry on duration of sickness absence. J Clin Epidemiol 2011; 65:212-8. [PMID: 21852072 DOI: 10.1016/j.jclinepi.2011.05.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2011] [Revised: 05/14/2011] [Accepted: 05/23/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the agreement between self-report and a public registry regarding the occurrence and duration of sickness absence (SA) in patients with sciatica. STUDY DESIGN AND SETTING Observational 2-year longitudinal study including 227 patients. Self-report SA data were obtained by postal questionnaires covering recall periods of 3, 6, and 12 months and compared with data from the Norwegian National Sickness Benefit Register. RESULTS The percent agreement on the occurrence of SA between self-report and registry was above 85% for all three recall periods. The patients overestimated the duration of their SA by 2.4 (95% confidence interval, 1.1-3.7) weeks for the 3-month recall period. The 95% limits of agreement were generally wide, varying from -12.5 to 17.3 weeks for the 3-month recall period to -38.8 to 37.2 weeks for the 12-month period. For the 3-, 6-, and 12-month recall periods, 48.1%, 29.8%, and 27.3% of the patients reported an SA duration that differed by ≤1 week from that recorded in the registry. CONCLUSION Mainly because of low precision, the agreement on the duration of SA was poor for all three recall periods. The agreement between self-report and registry regarding the occurrence of SA was good.
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Affiliation(s)
- Lars Grøvle
- Department of Rheumatology, Østfold Hospital Trust, Fredrikstad, Norway.
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Petersen SM, Scott DR. Application of a classification system and description of a combined manual therapy intervention: a case with low back related leg pain. J Man Manip Ther 2011; 18:89-96. [PMID: 21655391 DOI: 10.1179/106698110x12640740712572] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Low back pain and leg pain commonly occur together. Multiple factors can cause low back related leg pain; therefore, identification of the source of symptoms is required in order to develop an appropriate intervention program. The patient in this case presented with low back and leg pain. A patho-mechanism based classification is described in combination with the patient's subjective and objective examination findings to guide treatment. The patient's symptoms improved marginally with intervention addressing primarily the musculoskeletal impairments and with intervention addressing primarily the neurodynamic impairments. Full functional improvements were attained with a manual therapy intervention directed at both mechanisms simultaneously. The approach described in this case address a mixed pathology utilizing passive accessory and passive physiological lumbar mobilizations in combination with lower extremity neurodynamic mobilization. The patient reported complete resolution of symptoms after a total of seven visits over a period of 6 weeks. While specific guidelines do not yet exist for treatment based on the classification approach utilized, this case report provides an example of manual therapy to address low back related leg pain of mixed pathology.
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Predictors of vocational prognosis after herniated lumbar disc: a two-year follow-up study of 2039 patients diagnosed at hospital. Spine (Phila Pa 1976) 2011; 36:E791-7. [PMID: 21224759 DOI: 10.1097/brs.0b013e3181ef6243] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A register study with 2 years of follow up. OBJECTIVE To identify predictors of an unfavorable vocational prognosis after hospital contact for herniated lumbar disc (HLD). SUMMARY OF BACKGROUND DATA There is sparse information about vocational prognosis among HLD patients diagnosed at hospital. METHODS We followed all in- and outpatients diagnosed with HLD at a Danish University Hospital 2001 to 2005 eligible for the labor market in the Danish National Register on Public Transfer Payments (n = 2039). Clinical data were obtained from the Danish National Patient Register. The outcome measure was unfavorable vocational prognosis defined as less than 40 weeks of employment within the second year after hospital contact. Cox proportional hazards models were used. RESULTS Altogether 41.8% had an unfavorable vocational prognosis. The outcome was associated with unskilled work Hazard Ratio (HR) 2.1 (95% confidence interval [CI] = 1.5-2.8), skilled work HR 1.9 (CI = 1.3-2.7), and semi academic work HR 1.5 (CI = 1.1-2.0) as compared with academic work and less than 40 weeks of employment within year two before hospital contact HR 2.1 (CI = 1.9-2.5). Further negative prognostic factors were lumbar fusion alone HR 1.4 (CI = 1.1-1.8) and in combination with discectomy HR 1.6 (CI = 1.2-2.2) as compared with nonsurgical treatment, ethnicity other than Danish HR 1.55 (CI = 1.2-1.8), and female gender HR 1.2 (CI = 1.1-1.4). Discectomy, age, and year of inclusion were not associated with the outcome. CONCLUSION The risk of an unfavorable vocational prognosis after hospital contact for HLD was substantial. Nonacademic work and less than 40 weeks of employment within year two before hospital contact were the strongest prognostic factors, but also lumbar fusion alone and in combination with discectomy, ethnicity, and gender had a negative influence. There seems to be a need for actions addressing these patient categories to avoid long-term sick leave and premature withdrawal from the labor market.
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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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Clinical outcomes of patients with lumbar disc herniation, selected for one-level open-discectomy and microdiscectomy. 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 2010; 19:1450-8. [PMID: 20502926 DOI: 10.1007/s00586-010-1431-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2008] [Revised: 04/24/2010] [Accepted: 05/02/2010] [Indexed: 10/19/2022]
Abstract
The aim of our study was twofold: firstly, to compare the preoperative and postoperative results at mid-term follow-up periods along with the data of the control group. Secondly, to evaluate the effectiveness among open-discectomy and microdiscectomy surgical groups. In the present study, we investigated a cohort of 100 patients with the lumbar disc herniation causing low back pain compared to 100 subjects of the control group with the non-specific low back pain by applying physical activity, pain scale, Short Form 36 General Health Questionnaire and additional postoperative records of patient's satisfaction and complications level, consumption of analgesics, and return to work status. The quantitative analysis of all questionnaires showed substantial differences in the preoperative and postoperative groups. The best results were achieved at the second year follow-up period. However, there were no statistically significant differences in both the examined surgical subgroups (p > 0.05). In addition, we estimated from moderate to great statistical significance (p < 0.01-0.05) among preoperative and overall postoperative results: PHC and MHC in the SF-36, Oswestry and VAS. The total increased satisfaction, reherniation rate and return to work frequency comprised 40, 9 and 64%, respectively. The analgesics were still indicated for 21% of the patients. The results of the present study suggest of sufficient decompression in both surgical groups, as the health-related quality of life parameters (Oswestry, VAS and SF-36) were defined as clinically improved. Regardless of persisted minor pain in both areas, it remained greater in the low back than in the leg, which should be held for beneficial to decompressive surgery.
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The impact of workers' compensation on outcomes of surgical and nonoperative therapy for patients with a lumbar disc herniation: SPORT. Spine (Phila Pa 1976) 2010; 35:89-97. [PMID: 20023603 PMCID: PMC2828633 DOI: 10.1097/brs.0b013e3181c68047] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective randomized and observational cohorts. OBJECTIVE To compare outcomes of patients with and without workers' compensation who had surgical and nonoperative treatment for a lumbar intervertebral disc herniation (IDH). SUMMARY OF BACKGROUND DATA Few studies have examined the association between worker's compensation and outcomes of surgical and nonoperative treatment. METHODS Patients with at least 6 weeks of sciatica and a lumbar IDH were enrolled in either a randomized trial or observational cohort at 13 US spine centers. Patients were categorized as workers' compensation or nonworkers' compensation based on baseline disability compensation and work status. Treatment was usual nonoperative care or surgical discectomy. Outcomes included pain, functional impairment, satisfaction and work/disability status at 6 weeks, 3, 6, 12, and 24 months. RESULTS Combining randomized and observational cohorts, 113 patients with workers' compensation and 811 patients without were followed for 2 years. There were significant improvements in pain, function, and satisfaction with both surgical and nonoperative treatment in both groups. In the nonworkers' compensation group, there was a clinically and statistically significant advantage for surgery at 3 months that remained significant at 2 years. However, in the workers' compensation group, the benefit of surgery diminished with time; at 2 years no significant advantage was seen for surgery in any outcome (treatment difference for SF-36 bodily pain [-5.9; 95% CI: -16.7-4.9] and physical function [5.0; 95% CI: -4.9-15]). Surgical treatment was not associated with better work or disability outcomes in either group. CONCLUSION Patients with a lumbar IDH improved substantially with both surgical and nonoperative treatment. However, there was no added benefit associated with surgical treatment for patients with workers' compensation at 2 years while those in the nonworkers' compensation group had significantly greater improvement with surgical treatment.
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Ritter C, Bingel U. Neuroimaging the genomics of pain processing--a perspective. Neuroscience 2009; 164:141-55. [PMID: 19467296 DOI: 10.1016/j.neuroscience.2009.05.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Revised: 05/11/2009] [Accepted: 05/18/2009] [Indexed: 11/19/2022]
Abstract
The significant inter-individual variability in pain behavior and its contributing factors remains a pervasive clinical challenge and has generated intense scientific investigations in this field. Recent studies indicate that our genes considerably influence nociceptive information processes, how our nociceptive system copes with peripheral injury, and the individual response to analgesic treatments. Neuroimaging studies of pain are beginning to link such genetic influences with physiological processes in the human brain. This review presents the pioneering endeavors of the hybrid approach of neuroimaging pain genes in humans and identifies potential future directions.
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Affiliation(s)
- C Ritter
- Department of Neurology, Christian-Albrechts-University Kiel, Germany
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The Michel Benoist and Robert Mulholland yearly European Spine Journal Review. 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. [DOI: 10.1007/s00586-008-0857-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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