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Napoli A, Alfieri G, De Maio A, Panella E, Scipione R, Facchini G, Albisinni U, Spinnato P, Nardis PG, Tramutoli R, Lenzi J, Ghanouni P, Bazzocchi A, Perotti S, Schoenfeld AJ, Catalano C. CT-guided Pulsed Radiofrequency Combined with Steroid Injection for Sciatica from Herniated Disk: A Randomized Trial. Radiology 2023; 307:e221478. [PMID: 36975815 PMCID: PMC10323291 DOI: 10.1148/radiol.221478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 01/09/2023] [Accepted: 02/09/2023] [Indexed: 03/29/2023]
Abstract
Background Evidence regarding effective nonsurgical management of sciatica remains limited. Purpose To determine a difference in effectiveness between combined pulsed radiofrequency (PRF) and transforaminal epidural steroid injection (TFESI) treatment versus TFESI alone for sciatic pain due to lumbar disk herniation. Materials and Methods This prospective multicenter double-blind randomized clinical trial was conducted between February 2017 and September 2019 in participants with sciatica due to lumbar disk herniation lasting 12 weeks or longer that was not responsive to conservative treatment. Study participants were randomly assigned to undergo one CT-guided treatment with combined PRF and TFESI (n = 174) or TFESI alone (n = 177). The primary outcome was leg pain severity, as assessed with the numeric rating scale (NRS) (range, 0-10) at weeks 1 and 52 after treatment. Secondary outcomes included Roland-Morris Disability Questionnaire (RMDQ) score (range, 0-24) and Oswestry Disability Index (ODI) score (range, 0-100). Outcomes were analyzed according to the intention-to-treat principle via linear regression. Results Mean age of the 351 participants (223 men) was 55 years ± 16 (SD). At baseline, NRS was 8.1 ± 1.1 in the PRF and TFESI group and 7.9 ± 1.1 in the TFESI group. NRS was 3.2 ± 0.2 in the PRF and TFESI group and 5.4 ± 0.2 in the TFESI group (average treatment effect, 2.3; 95% CI: 1.9, 2.8; P < .001) at week 1 and 1.0 ± 0.2 and 3.9 ± 0.2 (average treatment effect, 3.0; 95% CI: 2.4, 3.5; P < .001), respectively, at week 52. At week 52, the average treatment effect was 11.0 (95% CI: 6.4, 15.6; P < .001) for ODI and 2.9 (95% CI: 1.6, 4.3; P < .001) for RMDQ, favoring the combined PRF and TFSEI group. Adverse events were reported in 6% (10 of 167) of participants in the PRF and TFESI group and in 3% (six of 176) of participants in the TFESI group (eight participants did not complete follow-up questionnaires). No severe adverse events occurred. Conclusion In the treatment of sciatica caused by lumbar disk herniation, pulsed radiofrequency combined with transforaminal epidural steroid injection is more effective for pain relief and disability improvement than steroid injection alone. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Jennings in this issue.
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Affiliation(s)
- Alessandro Napoli
- From the Department of Radiological, Oncological, and Pathological
Sciences, Policlinico Umberto I–Sapienza University of Rome, Viale del
Policlinico 155, Rome 00161, Italy (A.N., G.A., A.D.M., R.S., P.G.N., S.P.,
C.C.); Spine Unit, Centro SaNa Servizi Sanitari Privati, Aprilia, Italy (A.N.,
E.P., R.S., R.T., J.L.); Department of Diagnostic and Interventional Radiology,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (G.F., U.A., P.S., A.B.);
Department of Radiology, Stanford University, Stanford, Calif (P.G.); and
Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard
Medical School, Boston, Mass (A.J.S.)
| | - Giulia Alfieri
- From the Department of Radiological, Oncological, and Pathological
Sciences, Policlinico Umberto I–Sapienza University of Rome, Viale del
Policlinico 155, Rome 00161, Italy (A.N., G.A., A.D.M., R.S., P.G.N., S.P.,
C.C.); Spine Unit, Centro SaNa Servizi Sanitari Privati, Aprilia, Italy (A.N.,
E.P., R.S., R.T., J.L.); Department of Diagnostic and Interventional Radiology,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (G.F., U.A., P.S., A.B.);
Department of Radiology, Stanford University, Stanford, Calif (P.G.); and
Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard
Medical School, Boston, Mass (A.J.S.)
| | - Alessandro De Maio
- From the Department of Radiological, Oncological, and Pathological
Sciences, Policlinico Umberto I–Sapienza University of Rome, Viale del
Policlinico 155, Rome 00161, Italy (A.N., G.A., A.D.M., R.S., P.G.N., S.P.,
C.C.); Spine Unit, Centro SaNa Servizi Sanitari Privati, Aprilia, Italy (A.N.,
E.P., R.S., R.T., J.L.); Department of Diagnostic and Interventional Radiology,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (G.F., U.A., P.S., A.B.);
Department of Radiology, Stanford University, Stanford, Calif (P.G.); and
Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard
Medical School, Boston, Mass (A.J.S.)
| | - Emanuela Panella
- From the Department of Radiological, Oncological, and Pathological
Sciences, Policlinico Umberto I–Sapienza University of Rome, Viale del
Policlinico 155, Rome 00161, Italy (A.N., G.A., A.D.M., R.S., P.G.N., S.P.,
C.C.); Spine Unit, Centro SaNa Servizi Sanitari Privati, Aprilia, Italy (A.N.,
E.P., R.S., R.T., J.L.); Department of Diagnostic and Interventional Radiology,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (G.F., U.A., P.S., A.B.);
Department of Radiology, Stanford University, Stanford, Calif (P.G.); and
Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard
Medical School, Boston, Mass (A.J.S.)
| | - Roberto Scipione
- From the Department of Radiological, Oncological, and Pathological
Sciences, Policlinico Umberto I–Sapienza University of Rome, Viale del
Policlinico 155, Rome 00161, Italy (A.N., G.A., A.D.M., R.S., P.G.N., S.P.,
C.C.); Spine Unit, Centro SaNa Servizi Sanitari Privati, Aprilia, Italy (A.N.,
E.P., R.S., R.T., J.L.); Department of Diagnostic and Interventional Radiology,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (G.F., U.A., P.S., A.B.);
Department of Radiology, Stanford University, Stanford, Calif (P.G.); and
Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard
Medical School, Boston, Mass (A.J.S.)
| | - Giancarlo Facchini
- From the Department of Radiological, Oncological, and Pathological
Sciences, Policlinico Umberto I–Sapienza University of Rome, Viale del
Policlinico 155, Rome 00161, Italy (A.N., G.A., A.D.M., R.S., P.G.N., S.P.,
C.C.); Spine Unit, Centro SaNa Servizi Sanitari Privati, Aprilia, Italy (A.N.,
E.P., R.S., R.T., J.L.); Department of Diagnostic and Interventional Radiology,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (G.F., U.A., P.S., A.B.);
Department of Radiology, Stanford University, Stanford, Calif (P.G.); and
Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard
Medical School, Boston, Mass (A.J.S.)
| | - Ugo Albisinni
- From the Department of Radiological, Oncological, and Pathological
Sciences, Policlinico Umberto I–Sapienza University of Rome, Viale del
Policlinico 155, Rome 00161, Italy (A.N., G.A., A.D.M., R.S., P.G.N., S.P.,
C.C.); Spine Unit, Centro SaNa Servizi Sanitari Privati, Aprilia, Italy (A.N.,
E.P., R.S., R.T., J.L.); Department of Diagnostic and Interventional Radiology,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (G.F., U.A., P.S., A.B.);
Department of Radiology, Stanford University, Stanford, Calif (P.G.); and
Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard
Medical School, Boston, Mass (A.J.S.)
| | - Paolo Spinnato
- From the Department of Radiological, Oncological, and Pathological
Sciences, Policlinico Umberto I–Sapienza University of Rome, Viale del
Policlinico 155, Rome 00161, Italy (A.N., G.A., A.D.M., R.S., P.G.N., S.P.,
C.C.); Spine Unit, Centro SaNa Servizi Sanitari Privati, Aprilia, Italy (A.N.,
E.P., R.S., R.T., J.L.); Department of Diagnostic and Interventional Radiology,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (G.F., U.A., P.S., A.B.);
Department of Radiology, Stanford University, Stanford, Calif (P.G.); and
Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard
Medical School, Boston, Mass (A.J.S.)
| | - Pier Giorgio Nardis
- From the Department of Radiological, Oncological, and Pathological
Sciences, Policlinico Umberto I–Sapienza University of Rome, Viale del
Policlinico 155, Rome 00161, Italy (A.N., G.A., A.D.M., R.S., P.G.N., S.P.,
C.C.); Spine Unit, Centro SaNa Servizi Sanitari Privati, Aprilia, Italy (A.N.,
E.P., R.S., R.T., J.L.); Department of Diagnostic and Interventional Radiology,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (G.F., U.A., P.S., A.B.);
Department of Radiology, Stanford University, Stanford, Calif (P.G.); and
Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard
Medical School, Boston, Mass (A.J.S.)
| | - Roberto Tramutoli
- From the Department of Radiological, Oncological, and Pathological
Sciences, Policlinico Umberto I–Sapienza University of Rome, Viale del
Policlinico 155, Rome 00161, Italy (A.N., G.A., A.D.M., R.S., P.G.N., S.P.,
C.C.); Spine Unit, Centro SaNa Servizi Sanitari Privati, Aprilia, Italy (A.N.,
E.P., R.S., R.T., J.L.); Department of Diagnostic and Interventional Radiology,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (G.F., U.A., P.S., A.B.);
Department of Radiology, Stanford University, Stanford, Calif (P.G.); and
Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard
Medical School, Boston, Mass (A.J.S.)
| | - Jacopo Lenzi
- From the Department of Radiological, Oncological, and Pathological
Sciences, Policlinico Umberto I–Sapienza University of Rome, Viale del
Policlinico 155, Rome 00161, Italy (A.N., G.A., A.D.M., R.S., P.G.N., S.P.,
C.C.); Spine Unit, Centro SaNa Servizi Sanitari Privati, Aprilia, Italy (A.N.,
E.P., R.S., R.T., J.L.); Department of Diagnostic and Interventional Radiology,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (G.F., U.A., P.S., A.B.);
Department of Radiology, Stanford University, Stanford, Calif (P.G.); and
Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard
Medical School, Boston, Mass (A.J.S.)
| | - Pejman Ghanouni
- From the Department of Radiological, Oncological, and Pathological
Sciences, Policlinico Umberto I–Sapienza University of Rome, Viale del
Policlinico 155, Rome 00161, Italy (A.N., G.A., A.D.M., R.S., P.G.N., S.P.,
C.C.); Spine Unit, Centro SaNa Servizi Sanitari Privati, Aprilia, Italy (A.N.,
E.P., R.S., R.T., J.L.); Department of Diagnostic and Interventional Radiology,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (G.F., U.A., P.S., A.B.);
Department of Radiology, Stanford University, Stanford, Calif (P.G.); and
Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard
Medical School, Boston, Mass (A.J.S.)
| | - Alberto Bazzocchi
- From the Department of Radiological, Oncological, and Pathological
Sciences, Policlinico Umberto I–Sapienza University of Rome, Viale del
Policlinico 155, Rome 00161, Italy (A.N., G.A., A.D.M., R.S., P.G.N., S.P.,
C.C.); Spine Unit, Centro SaNa Servizi Sanitari Privati, Aprilia, Italy (A.N.,
E.P., R.S., R.T., J.L.); Department of Diagnostic and Interventional Radiology,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (G.F., U.A., P.S., A.B.);
Department of Radiology, Stanford University, Stanford, Calif (P.G.); and
Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard
Medical School, Boston, Mass (A.J.S.)
| | - Stefano Perotti
- From the Department of Radiological, Oncological, and Pathological
Sciences, Policlinico Umberto I–Sapienza University of Rome, Viale del
Policlinico 155, Rome 00161, Italy (A.N., G.A., A.D.M., R.S., P.G.N., S.P.,
C.C.); Spine Unit, Centro SaNa Servizi Sanitari Privati, Aprilia, Italy (A.N.,
E.P., R.S., R.T., J.L.); Department of Diagnostic and Interventional Radiology,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (G.F., U.A., P.S., A.B.);
Department of Radiology, Stanford University, Stanford, Calif (P.G.); and
Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard
Medical School, Boston, Mass (A.J.S.)
| | - Andrew J. Schoenfeld
- From the Department of Radiological, Oncological, and Pathological
Sciences, Policlinico Umberto I–Sapienza University of Rome, Viale del
Policlinico 155, Rome 00161, Italy (A.N., G.A., A.D.M., R.S., P.G.N., S.P.,
C.C.); Spine Unit, Centro SaNa Servizi Sanitari Privati, Aprilia, Italy (A.N.,
E.P., R.S., R.T., J.L.); Department of Diagnostic and Interventional Radiology,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (G.F., U.A., P.S., A.B.);
Department of Radiology, Stanford University, Stanford, Calif (P.G.); and
Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard
Medical School, Boston, Mass (A.J.S.)
| | - Carlo Catalano
- From the Department of Radiological, Oncological, and Pathological
Sciences, Policlinico Umberto I–Sapienza University of Rome, Viale del
Policlinico 155, Rome 00161, Italy (A.N., G.A., A.D.M., R.S., P.G.N., S.P.,
C.C.); Spine Unit, Centro SaNa Servizi Sanitari Privati, Aprilia, Italy (A.N.,
E.P., R.S., R.T., J.L.); Department of Diagnostic and Interventional Radiology,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (G.F., U.A., P.S., A.B.);
Department of Radiology, Stanford University, Stanford, Calif (P.G.); and
Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard
Medical School, Boston, Mass (A.J.S.)
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Rutzen AT, Annes RD, da Silva SG. Clinical and functional outcomes in patients submitted to early versus late surgery for lumbar disc herniation: A systematic review. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Sencan S, Erdem D, Gunduz OH, Bilim S, Duruoz MT. Reliability and validity of the Istanbul Low Back Pain Disability Index in lumbosacral radiculopathy. J Back Musculoskelet Rehabil 2021; 34:813-820. [PMID: 33935066 DOI: 10.3233/bmr-200339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Lumbosacral radiculopathy is associated with a broad range of complaints; therefore, specific disability measurements should be validated for this condition. OBJECTIVES The aim of this study was to investigate the validity and reliability of the Istanbul Low Back Pain Disability Index (ILBPDI) in lumbosacral radiculopathy. METHODS Patients diagnosed with radiculopathy caused by a disc herniation were included. Disability and quality of life were evaluated with the Oswestry Disability Index (ODI) and Short Form-36 (SF-36), respectively. The severity of low back pain and leg pain were evaluated using a Numeric Rating Scale (NRS). The reliability of the ILBPDI was assessed using the Cronbach's alpha coefficient. The relation of ILBPDI with SF-36, ODI, NRS-back and NRS-leg scores were analyzed for convergent validity. The relation of the ILBPDI with age, body mass index (BMI), and disease duration was analyzed for divergent validity. Factor analysis was used to establish the internal construct validity. RESULTS One hundred patients (55% female) were included in this study. The Cronbach's alpha coefficient was 0.92. The ILBPDI was found to be correlated with the ODI (rho: 0.619, p< 0.005) and NRS-leg score (rho: 0.597, p< 0.005), but not with NRS-back score (rho: 0.164, p> 0.05). The ILBPDI was significantly correlated with physical functioning (rho: -0.638, p< 0.005), bodily pain (rho: -0.488, p< 0.005), general health (rho: -0.264, p= 0.008) and social function (rho: -0.372, p< 0.005) subscales of SF-36 (convergent validity). The ILBPDI was not correlated with age, BMI, or disease duration (divergent validity). Factor analysis showed that the scale had three-factors which were correlated to bending forward, standing, and sitting activities. CONCLUSION The ILBPDI is a valid and reliable instrument in patients with lumbosacral radiculopathy.
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Affiliation(s)
- Savas Sencan
- Department of Physical Medicine and Rehabilitation, Marmara University Faculty of Medicine, Division of Pain Medicine, Istanbul, Turkey
| | - Didem Erdem
- Department of Physical Medicine and Rehabilitation, Marmara University Faculty of Medicine, Division of Rheumatology, Istanbul, Turkey
| | - Osman Hakan Gunduz
- Department of Physical Medicine and Rehabilitation, Marmara University Faculty of Medicine, Division of Pain Medicine, Istanbul, Turkey
| | - Serhad Bilim
- Department of Physical Medicine and Rehabilitation, Marmara University Faculty of Medicine, Division of Pain Medicine, Istanbul, Turkey
| | - Mehmet Tuncay Duruoz
- Department of Physical Medicine and Rehabilitation, Marmara University Faculty of Medicine, Division of Rheumatology, Istanbul, Turkey
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Wilby MJ, Best A, Wood E, Burnside G, Bedson E, Short H, Wheatley D, Hill-McManus D, Sharma M, Clark S, Baranidharan G, Price C, Mannion R, Hutchinson PJ, Hughes DA, Marson A, Williamson PR. Surgical microdiscectomy versus transforaminal epidural steroid injection in patients with sciatica secondary to herniated lumbar disc (NERVES): a phase 3, multicentre, open-label, randomised controlled trial and economic evaluation. LANCET RHEUMATOLOGY 2021; 3:e347-e356. [PMID: 33969319 PMCID: PMC8080892 DOI: 10.1016/s2665-9913(21)00036-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background The optimal invasive treatment for sciatica secondary to herniated lumbar disc remains controversial, with a paucity of evidence for use of non-surgical treatments such as transforaminal epidural steroid injection (TFESI) over surgical microdiscectomy. We aimed to investigate the clinical and cost-effectiveness of these options for management of radicular pain secondary to herniated lumbar disc. Methods We did a pragmatic, multicentre, phase 3, open-label, randomised controlled trial at 11 spinal units across the UK. Eligible patients were aged 16–65 years, had MRI-confirmed non-emergency sciatica secondary to herniated lumbar disc with symptom duration between 6 weeks and 12 months, and had leg pain that was not responsive to non-invasive management. Participants were randomly assigned (1:1) to receive either TFESI or surgical microdiscectomy by an online randomisation system that was stratified by centre with random permuted blocks. The primary outcome was Oswestry Disability Questionnaire (ODQ) score at 18 weeks. All randomly assigned participants who completed a valid ODQ at baseline and at 18 weeks were included in the analysis. Safety analysis included all treated participants. Cost-effectiveness was estimated from the EuroQol-5D-5L, Hospital Episode Statistics, medication usage, and self-reported resource-use data. This trial was registered with ISRCTN, number ISRCTN04820368, and EudraCT, number 2014-002751-25. Findings Between March 6, 2015, and Dec 21, 2017, 163 (15%) of 1055 screened patients were enrolled, with 80 participants (49%) randomly assigned to the TFESI group and 83 participants (51%) to the surgery group. At week 18, ODQ scores were 30·02 (SD 24·38) for 63 assessed patients in the TFESI group and 22·30 (19·83) for 61 assessed patients in the surgery group. Mean improvement was 24·52 points (18·89) for the TFESI group and 26·74 points (21·35) for the surgery group, with an estimated treatment difference of −4·25 (95% CI −11·09 to 2·59; p=0·22). There were four serious adverse events in four participants associated with surgery, and none with TFESI. Compared with TFESI, surgery had an incremental cost-effectiveness ratio of £38 737 per quality-adjusted life-year gained, and a 0·17 probability of being cost-effective at a willingness-to-pay threshold of £20 000 per quality-adjusted life-year. Interpretation For patients with sciatica secondary to herniated lumbar disc, with symptom duration of up to 12 months, TFESI should be considered as a first invasive treatment option. Surgery is unlikely to be a cost-effective alternative to TFESI. Funding Health Technology Assessment programme of the National Institute for Health Research (NIHR), UK.
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Affiliation(s)
- Martin John Wilby
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Correspondence to: Mr Martin J Wilby, Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK
| | - Ashley Best
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Eifiona Wood
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Girvan Burnside
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Emma Bedson
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Hannah Short
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Dianne Wheatley
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Daniel Hill-McManus
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Manohar Sharma
- Department of Pain Medicine, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Simon Clark
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | | | - Cathy Price
- Pain Clinic, Solent NHS Trust, Highpoint Venue, Bursledon, Southampton, UK
| | - Richard Mannion
- Academic Division of Neurosurgery, University of Cambridge, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Peter J Hutchinson
- Academic Division of Neurosurgery, University of Cambridge, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Anthony Marson
- Department of Pharmacology and Therapeutics, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Paula R Williamson
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
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Liu CH, Yeh TC, Kung YY, Tseng HP, Yang CJ, Hong TY, Cheng CM, Yang JL, Wu TP, Hsieh JC, Chen FP. Changes in resting-state functional connectivity in nonacute sciatica with acupuncture modulation: A preliminary study. Brain Behav 2020; 10:e01494. [PMID: 31922698 PMCID: PMC7010574 DOI: 10.1002/brb3.1494] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/25/2019] [Accepted: 11/13/2019] [Indexed: 12/18/2022] Open
Abstract
AIMS To investigate the functional connectivity (FC) in nonacute sciatica and the neuronal correlation of acupuncture analgesia. METHODS A prospective study employing resting-state functional magnetic resonance imaging was conducted. Twelve sciatica patients were enrolled to receive six or 18 acupoints of acupuncture treatment twice a week for 4 weeks. Regional homogeneity (ReHo) and seed-based FC were performed. RESULTS Regional homogeneity analysis demonstrated a greater alteration in the right posterior cingulate cortex (PCC) during the pre-acupuncture phase than during the postacupuncture phase. Compared to that of healthy controls, the PCC-seeded FC (default mode network, DMN) of sciatica patients exhibited hyperconnectivity of PCC-FC with the PCC-bilateral insula, cerebellum, inferior parietal lobule, right medial prefrontal cortex, and dorsal anterior cingulate cortex during the pre-acupuncture phase as well as hypoconnectivity of PCC-FC with the right cerebellum, left precuneus, and left dorsal medial prefrontal cortex during the postacupuncture phase. Correlation analysis between PCC-seeded FC and behavior measurements revealed a positive association with the duration of sciatica in the right inferior parietal lobule prior to acupuncture treatment. CONCLUSIONS Acupuncture in chronic sciatica patients is associated with normalized DMN activity and modulation of descending pain processing. The changes in the subclinical endophenotype of brain FC after acupuncture treatment may provide clues for understanding the mechanism of acupuncture-mediated analgesia in chronic pain.
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Affiliation(s)
- Ching-Hsiung Liu
- Department of Neurology, Lotung Poh-Ai Hospital, Ilan, Taiwan.,Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Integrated Brain Research Unit, Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tzu-Chen Yeh
- Integrated Brain Research Unit, Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Brain Science, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yen-Ying Kung
- Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Center for Traditional Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, Yang-Ming University, Taipei, Taiwan
| | - Hung-Pin Tseng
- Department of Neurology, Lotung Poh-Ai Hospital, Ilan, Taiwan
| | - Ching-Ju Yang
- Integrated Brain Research Unit, Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Brain Science, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tzu-Yi Hong
- Integrated Brain Research Unit, Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Brain Science, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chou-Ming Cheng
- Integrated Brain Research Unit, Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jen-Lin Yang
- Center for Traditional Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, Yang-Ming University, Taipei, Taiwan
| | - Ta-Peng Wu
- Center for Traditional Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jen-Chuen Hsieh
- Integrated Brain Research Unit, Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Brain Science, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Fang-Pey Chen
- Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Center for Traditional Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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6
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Liu CH, Kung YY, Lin CL, Yang JL, Wu TP, Lin HC, Chang YK, Chang CM, Chen FP. Therapeutic Efficacy and the Impact of the "Dose" Effect of Acupuncture to Treat Sciatica: A Randomized Controlled Pilot Study. J Pain Res 2019; 12:3511-3520. [PMID: 32021387 PMCID: PMC6942513 DOI: 10.2147/jpr.s210672] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 11/29/2019] [Indexed: 12/15/2022] Open
Abstract
Purpose To investigate the required sample size for and feasibility of a full-scale randomized controlled trial examining the impact of the “dose” effect of acupuncture in treating sciatica. Patients and methods Fifty-seven patients with sciatica, aged 35–70 years, were recruited and screened. Thirty-one participants were randomly assigned to receive “low-dose” manual acupuncture (MAL) (n= 15) or “high-dose” manual acupuncture (MAH) (n=16). The acupuncture treatment was administered twice weekly for 4 weeks. The primary outcome was the visual analog scale (VAS) score at baseline and after 4 weeks of acupuncture treatment. Secondary outcomes included the Roland Disability Questionnaire for Sciatica (RDQS), the Sciatica Bothersomeness Index (SBI), and the World Health Organization Quality of Life in the Brief Edition (WHOQOL-BREF) scores at baseline and after 4 weeks of acupuncture treatment. Results Thirty patients completed the study. For all patients, acupuncture achieved significant improvement in the VAS (5.48±2.0, p<0.001), RDQS (3.18±2.83, p=0.004), and SBI (2.85±3.23, p=0.008) scores, but not in the WHOQOL-BREF scores. In the between-group analysis, the assessed scales showed no significant differences between the MAL and MAH groups. However, based on the level of chronicity, the MAH group demonstrated greater improvement in the outcomes and a significant benefit in the physical subscale of the WHOQOL-BREF (p<0.05). Conclusion Results of this pilot study indicate that acupuncture is safe and may effectively relieve symptoms and disability in patients with non-acute sciatica. MAL was as effective as MAH in treating sciatica. A subsequent trial with a larger sample size (estimated at n=96) is required to confirm whether patients with a high level of chronicity would benefit from MAH treatment. Trial registration NCT03489681.
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Affiliation(s)
- Ching-Hsiung Liu
- Department of Neurology, Lotung Poh-Ai Hospital, Ilan, Taiwan, Republic of China.,Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - Yen-Ying Kung
- Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China.,Center for Traditional Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - Chun-Liang Lin
- Department of Neurology, Lotung Poh-Ai Hospital, Ilan, Taiwan, Republic of China
| | - Jen-Lin Yang
- Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China.,Center for Traditional Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - Ta-Peng Wu
- Center for Traditional Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China
| | - Hong-Chun Lin
- Center for Traditional Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China
| | - Yang-Kai Chang
- Center for Traditional Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China
| | - Ching-Mao Chang
- Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China.,Center for Traditional Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - Fang-Pey Chen
- Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China.,Center for Traditional Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China
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Understanding sciatica: illness and treatment beliefs in a lumbar radicular pain population. A qualitative interview study. BJGP Open 2019; 3:bjgpopen19X101654. [PMID: 31581116 PMCID: PMC6970588 DOI: 10.3399/bjgpopen19x101654] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 05/23/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Several pathological processes contribute to lumbar radicular pain (LRP), commonly known as sciatica. It is not known how patients rationalise the experience of sciatica or understand the diagnosis. Providing clinicians with a better understanding of how patients conceptualise sciatica will help them to tailor information for patients on the management and treatment of the condition. AIM To understand patients' beliefs regarding their illness following a diagnosis of LRP, how these beliefs were developed, and the impact of illness beliefs on treatment beliefs. DESIGN & SETTING Qualitative interview study from a single NHS musculoskeletal interface service (in Wales, UK). METHOD Thirteen patients recently diagnosed with LRP were consecutively recruited. Individual semi-structured interviews were recorded and transcribed. Data were analysed using a thematic approach. RESULTS Four main themes were generated: (1) the illness experience (2) the concept of sciatica, (3) treatment beliefs, and (4) the desire for credible information. CONCLUSION The diagnosis of LRP is often communicated and understood within a compressive conceptual illness identity. Explaining symptoms with a compressive pathological model is easily understood by patients but may not accurately reflect the spectrum of pathological processes known to contribute to radicular pain. This model appears to inform patient beliefs about treatments. Clinicians should take care to fully explain the pathology prior to shared decision-making with patients.
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8
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Horng YS, Hou WH, Liang HW. Responsiveness of the modified lower extremity functional scale in patients with low back pain and sciatica: A comparison with pain intensity and the modified Roland-Morris Disability Scale. Medicine (Baltimore) 2019; 98:e15105. [PMID: 30946376 PMCID: PMC6455991 DOI: 10.1097/md.0000000000015105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
We tested the responsiveness of the modified Lower Extremity Functional Scale (LEFS) for patients with low back pain (LBP) and sciatica and made a comparison with the modified Roland-Morris Disability Scale for sciatica (RMS-L) and self-reported pain intensity measured by visual analogue scale (VAS).One hundred and forty-eight participants were recruited from 2 university hospitals. The evaluation included demographic data, LBP history, and the modified LEFS, RMS-L, and VAS, with a follow-up one month later. Several responsiveness statistics were calculated.The study followed 132 participants, approximately 25% reported improvement. Guyatt responsiveness index (GRI) was 0.8 or higher for 3 measures, while standardized response means were 0.8 or higher for the RMS-L and VAS, but only 0.6 for the modified LEFS among improved group. According to ROC analysis, the modified LEFS had an area under curve (AUC) similar to that of the modified RMS-L, but significantly smaller than that of the VAS.The responsiveness of the modified LEFS was moderate but not superior to the VAS or RMS-L. Although, the modified LEFS could not replace the RMS-L or VAS, it could still be used as a complementary measure since these three measurements covered different body function, activity and participation domains.
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Affiliation(s)
- Yi-Shiung Horng
- Department of Rehabilitation Medicine, Taipei Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, New Taipei City
- Department of Medicine, Tzu Chi University, Hualien
| | - Wen-Hsuan Hou
- School of Gerontology Health Management and Master Program in Long-Term Care, College of Nursing, Taipei Medical University
| | - Huey-Wen Liang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan, ROC
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Williams NH, Jenkins A, Goulden N, Hoare Z, Hughes DA, Wood E, Foster NE, Walsh D, Carnes D, Sparkes V, Hay EM, Isaacs J, Konstantinou K, Morrissey D, Karppinen J, Genevay S, Wilkinson C. Lessons learnt from a discontinued randomised controlled trial: adalimumab injection compared with placebo for patients receiving physiotherapy treatment for sciatica (Subcutaneous Injection of Adalimumab Trial compared with Control: SCIATiC). Trials 2018; 19:408. [PMID: 30064491 PMCID: PMC6069989 DOI: 10.1186/s13063-018-2801-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 07/09/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adalimumab, a biological treatment targeting tumour necrosis factor α, might be useful in sciatica. This paper describes the challenges faced when developing a new treatment pathway for a randomised controlled trial of adalimumab for people with sciatica, as well as the reasons why the trial discussed was stopped early. METHODS A pragmatic, parallel group, randomised controlled trial with blinded (masked) participants, clinicians, outcome assessment and statistical analysis was conducted in six UK sites. Participants were identified and recruited from general practices, musculoskeletal services and outpatient physiotherapy clinics. They were adults with persistent symptoms of sciatica of 1 to 6 months' duration with moderate to high level of disability. Eligibility was assessed by research physiotherapists according to clinical criteria, and participants were randomised to receive two doses of adalimumab (80 mg then 40 mg 2 weeks later) or saline placebo subcutaneous injections in the posterior lateral thigh. Both groups were referred for a course of physiotherapy. Outcomes were measured at baseline, 6-week, 6-month and 12-month follow-up. The main outcome measure was disability measured using the Oswestry Disability Index. The planned sample size was 332, with the first 50 in an internal pilot phase. RESULTS The internal pilot phase was discontinued after 10 months from opening owing to low recruitment (two of the six sites active, eight participants recruited). There were several challenges: contractual delays; one site did not complete contract negotiations, and two sites signed contracts shortly before trial closure; site withdrawal owing to patient safety concerns; difficulties obtaining excess treatment costs; and in the two sites that did recruit, recruitment was slower than planned because of operational issues and low uptake by potential participants. CONCLUSIONS Improved patient care requires robust clinical research within contexts in which treatments can realistically be provided. Step changes in treatment, such as the introduction of biologic treatments for severe sciatica, raise complex issues that can delay trial initiation and retard recruitment. Additional preparatory work might be required before testing novel treatments. A randomised controlled trial of tumour necrosis factor-α blockade is still needed to determine its cost-effectiveness in severe sciatica. TRIAL REGISTRATION Current Controlled Trials, ISRCTN14569274 . Registered on 15 December 2014.
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Affiliation(s)
- Nefyn H. Williams
- Department of Health Services Research, University of Liverpool, Waterhouse Block B, 1-5 Brownlow Street, Liverpool, L69 3GL UK
| | - Alison Jenkins
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | - Nia Goulden
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | - Zoe Hoare
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | | | - Eifiona Wood
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | - Nadine E. Foster
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - David Walsh
- Arthritis Research UK Pain Centre and National Institute for Health Research Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Dawn Carnes
- Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, London, UK
| | - Valerie Sparkes
- School of Healthcare Science, Cardiff University, Cardiff, UK
| | - Elaine M. Hay
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - John Isaacs
- National Institute for Health Research Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, UK
| | - Kika Konstantinou
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Dylan Morrissey
- Centre for Sports and Exercise Medicine, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jaro Karppinen
- Medical Research Centre Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | | | - Clare Wilkinson
- School of Healthcare Sciences, Bangor University, Bangor, UK
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10
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Williams NH, Jenkins A, Goulden N, Hoare Z, Hughes DA, Wood E, Foster NE, Walsh DA, Carnes D, Sparkes V, Hay EM, Isaacs J, Konstantinou K, Morrissey D, Karppinen J, Genevay S, Wilkinson C. Subcutaneous Injection of Adalimumab Trial compared with Control (SCIATiC): a randomised controlled trial of adalimumab injection compared with placebo for patients receiving physiotherapy treatment for sciatica. Health Technol Assess 2017; 21:1-180. [PMID: 29063827 DOI: 10.3310/hta21600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Biological treatments such as adalimumab (Humira®; AbbVie Ltd, Maidenhead, UK) are antibodies targeting tumour necrosis factor alpha, released from ruptured intervertebral discs, which might be useful in sciatica. Recent systematic reviews concluded that they might be effective, but that a definitive randomised controlled trial was needed. Usual care in the NHS typically includes a physiotherapy intervention. OBJECTIVES To test whether or not injections of adalimumab plus physiotherapy are more clinically effective and cost-effective than injections of saline plus physiotherapy for patients with sciatica. DESIGN Pragmatic, parallel-group, randomised controlled trial with blinded participants and clinicians, and an outcome assessment and statistical analysis with concurrent economic evaluation and internal pilot. SETTING Participants were referred from primary care and musculoskeletal services to outpatient physiotherapy clinics. PARTICIPANTS Adults with persistent symptoms of sciatica of 1-6 months' duration and with moderate to high levels of disability. Eligibility was assessed by research physiotherapists according to clinical criteria for diagnosing sciatica. INTERVENTIONS After a second eligibility check, trial participants were randomised to receive two doses of adalimumab (80 mg and then 40 mg 2 weeks later) or saline injections. Both groups were referred for a course of physiotherapy. MAIN OUTCOME MEASURES Outcomes were measured at the start, and after 6 weeks' and 6 months' follow-up. The main outcome measure was the Oswestry Disability Index (ODI). Other outcomes: leg pain version of the Roland-Morris Disability Questionnaire, Sciatica Bothersomeness Index, EuroQol-5 Dimensions, 5-level version, Hospital Anxiety and Depression Scale, resource use, risk of persistent disabling pain, pain trajectory based on a single question, Pain Self-Efficacy Questionnaire, Tampa Scale of Kinesiophobia and adverse effects. SAMPLE SIZE To detect an effect size of 0.4 with 90% power, a 5% significance level for a two-tailed t-test and 80% retention rate, 332 participants would have needed to be recruited. ANALYSIS PLAN The primary effectiveness analysis would have been linear mixed models for repeated measures to measure the effects of time and group allocation. An internal pilot study would have involved the first 50 participants recruited across all centres. The primary economic analysis would have been a cost-utility analysis. RESULTS The internal pilot study was discontinued as a result of low recruitment after eight participants were recruited from two out of six sites. One site withdrew from the study before recruitment started, one site did not complete contract negotiations and two sites signed contracts shortly before trial closure. In the two sites that did recruit participants, recruitment was slow. This was partly because of operational issues, but also because of a low rate of uptake from potential participants. LIMITATIONS Although large numbers of invitations were sent to potential participants, identified by retrospective searches of general practitioner (GP) records, there was a low rate of uptake. Two sites planned to recruit participants during GP consultations but opened too late to recruit any participants. CONCLUSION The main failure was attributable to problems with contracts. Because of this we were not able to complete the internal pilot or to test all of the different methods for primary care recruitment we had planned. A trial of biological therapy in patients with sciatica still needs to be done, but would require a clearer contracting process, qualitative research to ensure that patients would be willing to participate, and simpler recruitment methods. TRIAL REGISTRATION Current Controlled Trials ISRCTN14569274. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 60. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Nefyn H Williams
- School of Healthcare Sciences, Bangor University, Bangor, UK.,Betsi Cadwaladr University Health Board, Bangor, UK
| | - Alison Jenkins
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | - Nia Goulden
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | - Zoe Hoare
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | - Dyfrig A Hughes
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | - Eifiona Wood
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | - Nadine E Foster
- Research Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - David A Walsh
- Arthritis Research UK Pain Centre Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, Nottingham, UK
| | - Dawn Carnes
- Centre for Primary Care and Public Health, Bart's and the London School of Medicine and Dentistry, London, UK
| | - Valerie Sparkes
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Elaine M Hay
- Research Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - John Isaacs
- National Institute for Health Research Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - Kika Konstantinou
- Research Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Dylan Morrissey
- Centre for Sports and Exercise Medicine, William Harvey Research Institute, Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jaro Karppinen
- Medical Research Centre Oulu, University of Oulu, Oulu, Finland
| | - Stephane Genevay
- Rheumatology Department, Geneva University Hospitals, Geneva, Switzerland
| | - Clare Wilkinson
- School of Healthcare Sciences, Bangor University, Bangor, UK
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Abstract
STUDY DESIGN This was a cross-sectional study. OBJECTIVE We sought to test the psychometric properties of the modified lower extremity functional scale (LEFS) for low back pain (LBP). SUMMARY OF BACKGROUND DATA Low back and lower extremities are anatomically and functionally related, and radiating leg pain is common among patients with LBP. The LEFS is a reliable and valid questionnaire for patients with lower extremity conditions caused by musculoskeletal disorders, although its utility in LBP with or without radiating leg pain has not been tested. METHODS We recruited subjects with LBP from physical medicine and rehabilitation outpatient clinics whose age was at least 18 years. The evaluation included demographic data, back pain history, pain intensity by the visual analogue scale, the Roland-Morris Disability Questionnaire, and the modified LEFS, in which "lower limb problem" was substituted with "low back/lower limb problem" in the introductory sentence of the questionnaire. Data from 242 patients were analyzed for the psychometric properties of the modified LEFS, including floor and ceiling effects, internal consistency, test-retest reliability, dimensionality, and construct validity. RESULTS The modified LEFS had no floor or ceiling effects, high internal consistency (Cronbach α: 0.94), and good test-retest reliability (intraclass correlation coefficient[2,1]: 0.86). Principal component analysis identified one major factor that had an eigenvalue of 9.9 and explained 49.6% of the total variance. The correlations between the modified LEFS and Roland-Morris Disability Questionnaire was high (Pearson correlation coefficient: -0.71). The modified LEFS also discriminated well between the subgroups of LBP with unilateral leg pain and those with bilateral leg pain. CONCLUSION The modified LEFS had satisfactory psychometric properties in patients with LBP and could serve as a supplementary outcome measure to assess their activity limitations.
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Cross-cultural adaptation and validation of simplified Chinese version of the Roland-Morris Disability Questionnaire. Spine (Phila Pa 1976) 2012; 37:875-80. [PMID: 22020608 DOI: 10.1097/brs.0b013e31823b0460] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN The Roland-Morris Disability Questionnaire (RMDQ) was translated and then adapted and validated. OBJECTIVE Translation of the RMDQ into simplified Chinese characters (SCRMDQ), and its cross-cultural adaptation and validation in patients with low back pain with or without radicular leg pain. SUMMARY OF BACKGROUND DATA The RMDQ is used worldwide and versions in traditional Chinese characters are available in Hong Kong and Taiwan. But there is no version in simplified Chinese characters for use in Mainland China. METHODS The original version of the RMDQ was translated and back-translated, and then cross-cultural adaptation of the simplified Chinese version was performed following published guidelines. The SCRMDQ was validated in 150 patients, 30 of whom finished the prefinal SCRMDQ and helped determine the final version. The remaining 120 patients were asked to complete the final SCRMDQ, simplified Chinese Oswestry Disability Index (SCODI), and visual analogue scale. Reliability was assessed with the final version using internal consistency by the Cronbach α coefficient and intraclass correlation coefficient; structural validity was evaluated by correspondence analysis. Then comparison of SCRMDQ and SCODI was performed. RESULTS A total of 116 patients in the final validation study finished the questionnaires completely. Their mean age was 52.17 ± 11.95 years (range, 22-78 yr) and the mean low back pain duration was 42.04 ± 60.94 months (range, 2-480 mo). The average time taken was 4.11 ± 1.48 minutes (range, 2-9 min) on SCRMDQ and 7.37 ± 3.98 minutes (range, 3-30 min) on SCODI. The mean SCRMDQ, SCODI, and visual analogue scale scores were 14.07 ± 4.79 (range, 2-24), 23.98 ± 10.38 (range, 2-47), and 57.17 ± 20.72 (range, 0-95), respectively. In the final test, the Cronbach α for internal consistency was 0.826 and intraclass correlation coefficient was 0.947; both showed adequate acceptance. Positive and statistically significant correlations were found between SCRMDQ and SCODI (r = 0.791, P < 0.01) and visual analogue scale (r = 0.493, P < 0.01), indicating sufficient structural validation. Most patients preferred SCRMDQ to SCODI, because it was simpler to understand and easier to finish. CONCLUSION The SCRMDQ was reliable and valid as a low back pain measurement tool in patients with or without radicular leg pain in Mainland China. The further use and research with the questionnaire were recommended.
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[Optimized assessment of the outcome in patients with radicular back pain of the lumbar spine. The modified NASS questionnaire]. Schmerz 2011; 25:552-7. [PMID: 21938605 DOI: 10.1007/s00482-011-1099-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND The purpose of the study was to present a reliable instrument with easy application to assess the outcome and improvement of therapy in patients with radicular symptoms of the lumbar spine. METHODS Data from patients who underwent microdiscectomy because of lumbar radicular symptoms were collected and analyzed and interviews were performed using the well-known North American Spine Society (NASS) lumbar spine questionnaire (17 items) before and after the intervention. In addition patient data including comorbidities were collected. By calculating effect size (ES) and standardized response mean (SRM) for each item of the questionnaire, the questions with the highest change before and after the intervention could be selected. RESULTS A total of 139 patients undergoing microdiscectomy for lumbar radicular symptoms due to a disc herniation were included in the analysis. Concerning the three dimensions pain, neurological symptoms and impairment of activities in daily life, the questions with best predictive value (high ES and SRM) were selected. According to their clinical relevance eight questions of the NASS questionnaire were finally selected for the short form. CONCLUSION This short, significant and easy to use questionnaire is in our opinion a useful instrument to assess the course of patients with radicular back pain and especially to measure and monitor the outcome of therapeutic interventions, in addition to conventional clinical diagnostics and examinations. This novel instrument could be a useful tool for improving quality assurance in conventional and interventional pain management of these patients.
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