1
|
Yagi M, Yamamoto T, Iga T, Ogura Y, Suzuki S, Ozaki M, Takahashi Y, Tsuji O, Nagoshi N, Kono H, Ogawa J, Matsumoto M, Nakamura M, Watanabe K. Development and Validation of Machine Learning-Based Predictive Model for Prolonged Hospital Stay after Decompression Surgery for Lumbar Spinal Canal Stenosis. Spine Surg Relat Res 2024; 8:315-321. [PMID: 38868786 PMCID: PMC11165502 DOI: 10.22603/ssrr.2023-0255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/25/2023] [Indexed: 06/14/2024] Open
Abstract
Introduction Precise prediction of hospital stay duration is essential for maximizing resource utilization during surgery. Existing lumbar spinal stenosis (LSS) surgery prediction models lack accuracy and generalizability. Machine learning can improve accuracy by considering preoperative factors. This study aimed to develop and validate a machine learning-based model for estimating hospital stay duration following decompression surgery for LSS. Methods Data from 848 patients who underwent decompression surgery for LSS at three hospitals were examined. Twelve prediction models, using 79 preoperative variables, were developed for postoperative hospital stay estimation. The top five models were chosen. Fourteen models predicted prolonged hospital stay (≥14 days), and the most accurate model was chosen. Models were validated using a randomly divided training sample (70%) and testing cohort (30%). Results The top five models showed moderate linear correlations (0.576-0.624) between predicted and measured values in the testing sample. The ensemble of these models had moderate prediction accuracy for final length of stay (linear correlation 0.626, absolute mean error 2.26 days, standard deviation 3.45 days). The c5.0 decision tree model was the top predictor for prolonged hospital stay, with accuracies of 89.63% (training) and 87.2% (testing). Key predictors for longer stay included JOABPEQ social life domain, facility, history of vertebral fracture, diagnosis, and Visual Analogue Scale (VAS) of low back pain. Conclusions A machine learning-based model was developed to predict postoperative hospital stay after LSS decompression surgery, using data from multiple hospital settings. Numerical prediction of length of stay was not very accurate, although favorable prediction of prolonged stay was accomplished using preoperative factors. The JOABPEQ social life domain score was the most important predictor.
Collapse
Affiliation(s)
- Mitsuru Yagi
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Department of Orthopedic Surgery, International University of Health and Welfare, School of Medicine, Chiba, Japan
| | - Tatsuya Yamamoto
- Department of Orthopedic Surgery, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | - Takahito Iga
- Department of Orthopedic Surgery, Keiyu Orthopedic Hospital, Gunma, Japan
| | - Yoji Ogura
- Department of Orthopedic Surgery, Tachikawa Hospital, Tokyo, Japan
| | - Satoshi Suzuki
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Ozaki
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yohei Takahashi
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Osahiko Tsuji
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hitoshi Kono
- Department of Orthopedic Surgery, Keiyu Orthopedic Hospital, Gunma, Japan
| | - Jun Ogawa
- Department of Orthopedic Surgery, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
2
|
Kita K, Fujimori T, Suzuki Y, Kaito T, Takenaka S, Kanie Y, Furuya M, Wataya T, Nishigaki D, Sato J, Tomiyama N, Okada S, Kido S. Automated entry of paper-based patient-reported outcomes: Applying deep learning to the Japanese orthopaedic association back pain evaluation questionnaire. Comput Biol Med 2024; 172:108197. [PMID: 38452472 DOI: 10.1016/j.compbiomed.2024.108197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 02/05/2024] [Accepted: 02/18/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Health-related patient-reported outcomes (HR-PROs) are crucial for assessing the quality of life among individuals experiencing low back pain. However, manual data entry from paper forms, while convenient for patients, imposes a considerable tallying burden on collectors. In this study, we developed a deep learning (DL) model capable of automatically reading these paper forms. METHODS We employed the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire, a globally recognized assessment tool for low back pain. The questionnaire comprised 25 low back pain-related multiple-choice questions and three pain-related visual analog scales (VASs). We collected 1305 forms from an academic medical center as the training set, and 483 forms from a community medical center as the test set. The performance of our DL model for multiple-choice questions was evaluated using accuracy as a categorical classification task. The performance for VASs was evaluated using the correlation coefficient and absolute error as regression tasks. RESULT In external validation, the mean accuracy of the categorical questions was 0.997. When outputs for categorical questions with low probability (threshold: 0.9996) were excluded, the accuracy reached 1.000 for the remaining 65 % of questions. Regarding the VASs, the average of the correlation coefficients was 0.989, with the mean absolute error being 0.25. CONCLUSION Our DL model demonstrated remarkable accuracy and correlation coefficients when automatic reading paper-based HR-PROs during external validation.
Collapse
Affiliation(s)
- Kosuke Kita
- Department of Artificial Intelligence Diagnostic Radiology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Takahito Fujimori
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
| | - Yuki Suzuki
- Department of Artificial Intelligence Diagnostic Radiology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Takashi Kaito
- Department of Orthopedic Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - Shota Takenaka
- Department of Orthopedic Surgery, Japan Community Health Care Organization Osaka Hospital, Osaka, Japan
| | - Yuya Kanie
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Masayuki Furuya
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tomohiro Wataya
- Department of Artificial Intelligence Diagnostic Radiology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Daiki Nishigaki
- Department of Artificial Intelligence Diagnostic Radiology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Junya Sato
- Department of Artificial Intelligence Diagnostic Radiology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Noriyuki Tomiyama
- Department of Artificial Intelligence Diagnostic Radiology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Seiji Okada
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Shoji Kido
- Department of Artificial Intelligence Diagnostic Radiology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| |
Collapse
|
3
|
Rezvani M, Ahmadvand A, Yazdanian T, Azimi P, Askariardehjani N. Value of Spinal Infection Treatment Evaluation Score, Pola Classification, and Brighton Spondylodiscitis Score from Decision to Surgery in Patients with Spondylodiscitis: A Receiver-Operating Characteristic Curve Analysis. Asian Spine J 2024; 18:218-226. [PMID: 38650093 PMCID: PMC11065507 DOI: 10.31616/asj.2023.0317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/10/2023] [Accepted: 01/01/2024] [Indexed: 04/25/2024] Open
Abstract
STUDY DESIGN This was a retrospective study. PURPOSE This study aimed to assess the value of the Spinal Infection Treatment Evaluation (SITE) score, Brighton Spondylodiscitis Score (BSDS), and Pola classification to predict the need for surgical intervention in patients with spondylodiscitis. OVERVIEW OF LITERATURE Spondylodiscitis is a rare disease, and the prediction of its outcome is crucial in the decision-making process. METHODS All case records were assessed to extract information on the American Spinal Injury Association (ASIA), Visual Analog Scale (VAS), and Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) scores before and after surgery. The SITE score, Pola classification, and BSDS were recorded. The receiver-operating characteristic (ROC) curve analysis and the area under the curve (AUC) were applied to estimate the predictive ability of the scoring systems. Patients' satisfaction with surgery outcomes was evaluated using the VAS, ASIA, JOABPEQ, and Likert scale for quality-of-life evaluation. RESULTS In all 148 patients, case records were reviewed. The mean±standard deviation age of the patients was 54.6±14.7 years. Of these, 112 patients underwent surgery. The AUC scores were 0.86, 0.81, and 0.73 for the SITE score, BSDS, and Pola classification, respectively. In the comparison of the AUC of ROC curves, SITE score vs. BSDS showed a significantly greater AUC, 0.13 (Z =2.1, p =0.037); SITE score vs. Pola classification, 0.05 (Z =0.82, p =0.412); and Pola classification vs. BSDS, 0.08 (Z =1.22, p =0.219). The optimal cutoff score was 8.5 (sensitivity, 80.6%; specificity, 81.2%) for the SITE score and 9.5 (sensitivity, 52.8%; specificity, 83.0%) for the BSDS in the decision to surgery. VAS back pain and JOABPEQ subscales showed a significant difference when compared with preoperative scores. According to ASIA grading, none of the patients experienced neurological deterioration. Overall, patients' satisfaction was observed. CONCLUSIONS The findings suggest that the SITE score is a useful measure and helps clinicians make clinically sound decisions in patients with spondylodiscitis.
Collapse
Affiliation(s)
- Majid Rezvani
- Department of Neurosurgery, Neuroscience Research Center, Al-Zahra Hospital, School of Medicine, Isfahan University of Medical Sciences, Isfahan,
Iran
| | - Ali Ahmadvand
- Department of Neurosurgery, Isfahan University of Medical Sciences, Isfahan,
Iran
| | | | - Parisa Azimi
- Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Tehran,
Iran
| | | |
Collapse
|
4
|
Zhou AF, Li ZY, Cui XJ, Sng KS, Zhu K, Wang YJ, Shu B, Zhang JP, Yao M. Cross-cultural adaptation of The Japanese Orthopaedic Association Back Pain Evaluation Questionnaire: A methodological systematic review. J Orthop Sci 2023; 28:984-991. [PMID: 36137918 DOI: 10.1016/j.jos.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/04/2022] [Accepted: 08/08/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) is a reliable and sensitive measure of disability to determine functional status and evaluate curative effects in low back pain, it has now been cross-cultural translated into many other languages and adapted for use in different countries. We aim to evaluate the translation procedures and measurement properties of cross-cultural adaptations of the JOABPEQ. METHODS Studies related to cross-cultural adaptation of the JOABPEQ in a specific language/culture were searched in PubMed, Embase, CINAHL, SciELO, PsycINFO, SinoMed, and Web of Science from their inception to March 2022. The Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures and the Consensus-based Standards for the Selection of Health Status Measurement Instruments guideline were used for evaluation. RESULTS Nine different versions of cross-cultural JOABPEQ adaptations in 8 different languages/cultures were included. The adaptation process was not strictly performed, such as standard forward translation and expert committee review were rarely reported. Content validity (8/9), floor and ceiling effects (3/9), reliability (4/9), and interpretability (6/9) were assessed in most of the adaptations, while agreement (2/9), responsiveness (2/9), and the internal consistency (2/9) were not. JOABPEQ can replace functional and quality of life score to reduce the burden of scientific research. CONCLUSION We recommend Persian-Iranian, simplified Chinese-Chinese Mandarin, Thai and Gunaydin G's Turkish adaptations for application. The numerical pain rating scale/visual analogue scale in low back pain and lower extremities, as well as numbness in lower extremities could not be neglected in JOABPEQ adaptations.
Collapse
Affiliation(s)
- Ai-Fang Zhou
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China; School of Rehabilitation, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhuo-Yao Li
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xue-Jun Cui
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Kim Sia Sng
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ke Zhu
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yong-Jun Wang
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Bing Shu
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jian-Ping Zhang
- Shanghai Jinshan District Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China
| | - Min Yao
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
| |
Collapse
|
5
|
Multilevel Decompression Surgery for Degenerative Lumbar Spinal Canal Stenosis Is Similarly Effective With Single-level Decompression Surgery. Spine (Phila Pa 1976) 2022; 47:1728-1736. [PMID: 35917279 DOI: 10.1097/brs.0000000000004447] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/14/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective case series. OBJECTIVE The purpose of this study was to investigate the outcome of multilevel posterior decompression surgery for degenerative lumbar spinal stenosis compared with single-level surgery. SUMMARY OF BACKGROUND DATA The clinical outcomes of multilevel decompression surgery are still controversial because previous studies have not been designed to randomize or adjust the patient background. MATERIALS AND METHODS A retrospective review of prospectively collected data from 659 surgically treated lumbar spinal stenosis patients with a minimum 2-year follow-up was performed. Among them, we compared baseline and 2-year postoperative patient-reported outcomes (PROs) including the Visual Analog Scale and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire scores of 122 patients who underwent three or more levels of surgery (M group) and 304 patients who underwent single-level surgery (S group). Further analyses were performed of 116 paired patients from both groups who were propensity score matched by age and baseline PROs. RESULTS The number of perioperative complications including extradural hematoma, surgical site infection, and spinal fluid leakage [M vs. S: 10 (8%) vs. 19 (6%), P =0.47], and frequency of revision surgery [5 (4%) vs. 23 (8%), P =0.10] were similar between the two groups. In the analysis of propensity score-matched patients, there were comparable improvements in the Visual Analog Scale score for lower back pain (2.6 vs. 2.4, P =0.55), buttock-leg pain (3.1 vs. 3.4, P =0.48), and buttock-leg numbness (2.9 vs. 2.9, P =0.77) in both groups. There were also similar improvements in the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire scores including lower back pain, lumbar function, walking ability, and mental health domains, except for the social life function domain (20.7±26.5 vs. 28.0±27.5, P =0.04). CONCLUSIONS Despite the longer surgical time and a larger volume of estimated blood loss, multilevel decompression surgery showed similar improvement to that of single-level surgery in terms of recovery of PROs and frequency of revision surgery. Multilevel decompression surgery provides good clinical outcomes with acceptable complication and revision rates when selecting appropriate patient and spinal levels.
Collapse
|
6
|
Yagi M, Michikawa T, Yamamoto T, Iga T, Ogura Y, Tachibana A, Miyamoto A, Suzuki S, Nori S, Takahashi Y, Tsuji O, Nagoshi N, Kono H, Ogawa J, Matsumoto M, Nakamura M, Watanabe K. Development and validation of machine learning-based predictive model for clinical outcome of decompression surgery for lumbar spinal canal stenosis. Spine J 2022; 22:1768-1777. [PMID: 35760319 DOI: 10.1016/j.spinee.2022.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 05/31/2022] [Accepted: 06/16/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Although the results of decompression surgery for lumbar spinal canal stenosis (LSS) are favorable, it is still difficult to predict the postoperative health-related quality of life of patients before surgery. PURPOSE The purpose of this study was to develop and validate a machine learning model to predict the postoperative outcome of decompression surgery for patients with LSS. STUDY DESIGN/SETTING A multicentered retrospective study. PATIENT SAMPLE A total of 848 patients who underwent decompression surgery for LSS at an academic hospital, tertiary center, and private hospital were included (age 71±9 years, 68% male, 91% LSS, level treated 1.8±0.8, operation time 69±37 minutes, blood loss 48±113 mL, and length of hospital stay 12±5 days). OUTCOME MEASURES Baseline and 2 years postoperative health-related quality of life. METHODS The subjects were randomly assigned in a 7:3 ratio to a model building cohort and a testing cohort to test the models' accuracy. Twelve predictive algorithms using 68 preoperative factors were used to predict each domain of the Japanese Orthopedic Association Back Pain Evaluation Questionnaire and visual analog scale scores at 2 years postoperatively. The final predictive values were generated using an ensemble of the top five algorithms in prediction accuracy. RESULTS The correlation coefficients of the top algorithms for each domain established using the preoperative factors were excellent (correlation coefficient: 0.95-0.97 [relative error: 0.06-0.14]). The performance evaluation of each Japanese Orthopedic Association Back Pain Evaluation Questionnaire domain and visual analog scale score by the ensemble of the top five algorithms in the testing cohort was favorable (mean absolute error [MAE] 8.9-17.4, median difference [MD] 8.1-15.6/100 points), with the highest accuracy for mental status (MAE 8.9, MD 8.1) and the lowest for buttock and leg numbness (MAE 1.7, MD 1.6/10 points). A strong linear correlation was observed between the predicted and measured values (linear correlation 0.82-0.89), while 4% to 6% of the subjects had predicted values of greater than±3 standard deviations of the MAE. CONCLUSIONS We successfully developed a machine learning model to predict the postoperative outcomes of decompression surgery for patients with LSS using patient data from three different institutions in three different settings. Thorough analyses for the subjects with deviations from the actual measured values may further improve the predictive probability of this model.
Collapse
Affiliation(s)
- Mitsuru Yagi
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo JAPAN
| | - Takehiro Michikawa
- Department of Environmental and Occupational Health, School of Medicine, Toho University, 5-21-16 Omori Nishi, Otaku, Tokyo, Japan
| | - Tatsuya Yamamoto
- Department of Orthopedic Surgery, Japanese Red Cross Shizuoka Hospital, 8-2 Otemachi Aoiku Shizuoka city, Shizuoka, Japan
| | - Takahito Iga
- Department of Orthopedic Surgery, Keiyu Orthopedic Hospital, Tatebayashi-shi Akodacho 2267-1, Gunma, Japan
| | - Yoji Ogura
- Department of Orthopedic Surgery, Tachikawa Hospital, 4-2-22 Nishiki-cho, Tachikawa-shi, Tokyo, Japan
| | - Atsuko Tachibana
- Department of Orthopedic Surgery, Keiyu Orthopedic Hospital, Tatebayashi-shi Akodacho 2267-1, Gunma, Japan
| | - Azusa Miyamoto
- Department of Rehabilitation Medicine, Keiyu Orthopedic Hospital, Tatebayashi-shi Akodacho 2267-1, Gunma, Japan
| | - Satoshi Suzuki
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo JAPAN
| | - Satoshi Nori
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo JAPAN
| | - Yohei Takahashi
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo JAPAN
| | - Osahiko Tsuji
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo JAPAN
| | - Narihito Nagoshi
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo JAPAN
| | - Hitoshi Kono
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo JAPAN
| | - Jun Ogawa
- Department of Orthopedic Surgery, Japanese Red Cross Shizuoka Hospital, 8-2 Otemachi Aoiku Shizuoka city, Shizuoka, Japan
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo JAPAN
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo JAPAN
| | - Kota Watanabe
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo JAPAN.
| | | |
Collapse
|
7
|
Yagi M, Suzuki S, Nori S, Takahashi Y, Tsuji O, Nagoshi N, Nakamura M, Matsumoto M, Watanabe K. How Decompression Surgery Improves the Lower Back Pain in Patient with Lumbar Degenerative Stenosis: A Propensity-score-matched Analysis. Spine (Phila Pa 1976) 2022; 47:557-564. [PMID: 34731100 DOI: 10.1097/brs.0000000000004265] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Multicenter retrospective case series of patients treated surgically for lumbar spinal stenosis (LSS). OBJECTIVE We investigated how laminectomy improves lower back pain (LBP) and the factors associated with poor improvement. SUMMARY OF BACKGROUND DATA Lumbar laminectomy is effective for alleviating neurological symptoms caused by LSS, whereas its effect on LBP is still controversial. METHODS A retrospective review of prospectively collected data from 436 patients (age 72 yrs, 69% males) who underwent laminectomy for LSS with 2 years of follow-up. We analyzed the following risk factors for residual LBP by uni- and multivariate analyses: age, sex, smoking, occupation, comorbidities, frailty, joint replacement, vertebral fracture, DISH, HRQOL, complications, and the presence of spinal instability. The LBP of male and female patients was analyzed after propensity score matching of known confounders. Patient-reported outcomes (JOABPEQ and VAS scores) were obtained at baseline and the 2-year postoperative follow-up. RESULTS LBP was significantly improved at 2 years post operation (VAS change 2.3 [95% CI 2.0-2.6], P < 0.01). Fifty-five percent of the patients achieved an MCID, with 67% having no or mild LBP. In the multivariate analysis, sex and baseline LBP were independent risk factors (female: OR 1.9 [1.2-3.0], baseline LBP [VAS≥7.5]: OR 1.9 [1.2-3.1]). Furthermore, the independent risk factors for severe baseline LBP were sex and mental status (female: OR 1.7 [1.1-2.7], P = 0.03, mental status: OR 3.8 [2.4-6.0], P < 0.01). However, an analysis of 102 pairs of propensity-score-matched male and female patients showed no difference in the improvement of LBP (male vs. female: VAS 3.8 ± 2.8 vs. 4.0 ± 2.9, P = 0.61, VAS change 3.1 ± 2.9 vs. 2.7 ± 3.0, P = 0.38). CONCLUSION Decompression surgery for LSS significantly improved LBP. Sex and baseline LBP were risk factors for residual LBP. However, when males and females were matched by confounders, no difference was found in the LBP after surgery. Patients with severe baseline LBP may need further evaluation for their mental status because these patients are likely to have mental problems that potentially contribute to persistent LBP.Level of Evidence: 4.
Collapse
Affiliation(s)
- Mitsuru Yagi
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Shirado O, Arai Y, Iguchi T, Imagama S, Kawakami M, Nikaido T, Ogata T, Orita S, Sakai D, Sato K, Takahata M, Takeshita K, Tsuji T. Formulation of Japanese Orthopaedic Association (JOA) clinical practice guideline for the management of low back pain- the revised 2019 edition. J Orthop Sci 2022; 27:3-30. [PMID: 34836746 DOI: 10.1016/j.jos.2021.06.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/12/2021] [Accepted: 06/22/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The latest clinical guidelines are mandatory for physicians to follow when practicing evidence-based medicine in the treatment of low back pain. Those guidelines should target not only Japanese board-certified orthopaedic surgeons, but also primary physicians, and they should be prepared based entirely on evidence-based medicine. The Japanese Orthopaedic Association Low Back Pain guideline committee decided to update the guideline and launched the formulation committee. The purpose of this study was to describe the formulation we implemented for the revision of the guideline with the latest data of evidence-based medicine. METHODS The Japanese Orthopaedic Association Low Back Pain guideline formulation committee revised the previous guideline based on a method for preparing clinical guidelines in Japan proposed by Medical Information Network Distribution Service Handbook for Clinical Practice Guideline Development 2014. Two key phrases, "body of evidence" and "benefit and harm balance" were focused on in the revised version. Background and clinical questions were determined, followed by literature search related to each question. Appropriate articles were selected from all the searched literature. Structured abstracts were prepared, and then meta-analyses were performed. The strength of both the body of evidence and the recommendation was decided by the committee members. RESULTS Nine background and nine clinical qvuestions were determined. For each clinical question, outcomes from the literature were collected and meta-analysis was performed. Answers and explanations were described for each clinical question, and the strength of the recommendation was decided. For background questions, the recommendations were described based on previous literature. CONCLUSIONS The 2019 clinical practice guideline for the management of low back pain was completed according to the latest evidence-based medicine. We strongly hope that this guideline serves as a benchmark for all physicians, as well as patients, in the management of low back pain.
Collapse
Affiliation(s)
- Osamu Shirado
- Department of Orthopaedic and Spinal Surgery, Aizu Medical Center (AMEC) at Fukushima Medical University, Japan.
| | - Yoshiyasu Arai
- Department of Orthopaedic Surgery, Saiseikai Kawaguchi General Hospital, Japan
| | - Tetsuhiro Iguchi
- Department of Orthopaedic Surgery, Saiseikai Hyogo Prefectural Hospital, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Japan
| | | | - Takuya Nikaido
- Department of Orthopaedic Surgery, Fukushima Medical University, Japan
| | | | - Sumihisa Orita
- Center for Frontier Medical Engineering (CFME), Department of Orthopaedic Surgery, Chiba University, Japan
| | - Daisuke Sakai
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Japan
| | - Kimiaki Sato
- Department of Orthopaedic Surgery, Kurume University, Japan
| | - Masahiko Takahata
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Japan
| | | | - Takashi Tsuji
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Japan
| | | |
Collapse
|
9
|
Yagi M, Suzuki S, Nori S, Okada E, Tsuji O, Nagoshi N, Nakamura M, Matsumoto M, Watanabe K. How Preoperative Motor Weakness Affects the Extent of Recovery After Elective Spine Surgery in Patients with Degenerative Lumbar Spinal Stenosis. Spine (Phila Pa 1976) 2021; 46:1118-1127. [PMID: 33496538 DOI: 10.1097/brs.0000000000003964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective review. OBJECTIVE This study sought to determine how baseline motor weakness (MW) affects elective spine surgery in patients with degenerative lumbar spinal stenosis (LSS). SUMMARY OF BACKGROUND DATA Favorable clinical outcomes have been described for elective spine surgery in patients with LSS. However, the way preoperative MW affects the patient's health-related quality of life (HRQoL) after surgery is not well understood. METHODS A retrospective review of prospectively collected data from 305 surgically treated patients with LSS who had 2-year follow-up was performed (age 71 ± 9 yrs, male 62%). Demographic, radiographic, and clinical outcomes were analyzed at baseline and at 1-year, 2-year, and 3-year postoperation. The Japanese Orthopedic Association Back Pain Evaluation Questionnaire was used to assess the HRQoLs. The HRQoLs were compared between those with or without preop MW. Adjusted multivariate logistic regression analyses were performed to determine whether MW affected HRQoLs. RESULTS One hundred sixteen patients (38%) were categorized as MW+. The patient background including age, sex, presence of degenerative spondylolisthesis, type of surgery, and presence of neurological claudication were similar between the two groups. However, the 1-, 2-, and 3-year postoperative visual analogue scale of back pain, leg pain, leg numbness, the Japanese Orthopedic Association Back Pain Evaluation Questionnaire lumbar function, social life, mental health, and walking ability were all inferior in the MW+ group, whereas a similar percentage of patients achieved a minimum clinically important difference in all subdomains at 3 years. The adjusted multivariate logistic regression analyses showed that having ≥2 muscles with MW, and severity of MW (manual motor test grade) were independent risk factors for both difficulty climbing stairs and walking >15 minutes. (muscles with MW≥2; stair climbing: OR 6.4[2.3-17.4], walking: OR 3.2[1.4-7.3], severity of MW; stair climbing: OR 2.5[1.4-4.4], walking: OR 2.2[1.3-3.7]). CONCLUSION The patients with baseline MW had inferior HRQoL for up to 3 years compared with that of those without MW; however, the amount of improvement in HRQoL was comparable. Timely follow-up is important to find out the deterioration of motor function.Level of Evidence: 4.
Collapse
Affiliation(s)
- Mitsuru Yagi
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Pinheiro JS, Pontes-Silva A, Araujo GGC, Mendes LP, Pires FDO, Fidelis-de-Paula-Gomes CA, Dibai-Filho AV. Structural validity of the Japanese Orthopedic Association back pain evaluation questionnaire in individuals with chronic low back pain. Rev Assoc Med Bras (1992) 2021; 67:1087-1092. [PMID: 34669851 DOI: 10.1590/1806-9282.20210087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 07/13/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The main aim of this study was to evaluate the structural validity of the Brazilian version of the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ). METHODS Individuals with chronic low back pain were included. The data collection of the study occurred by means of online platform. Confirmatory factor analysis was performed. The theoretical version proposed for the JOABPEQ with five domains was tested. The following indices were considered to verify the fit of the model: comparative fit index (CFI), Tucker-Lewis index (TLI), root mean square error of approximation (RMSEA), and chi-square/degrees of freedom (DF). RESULTS The final sample consisted of 175 volunteers, mostly women (68%), adults (mean age of 28.98 years), lean (mean body mass index of 25 kg/m2), with incomplete higher education, single, with mean of pain chronicity of 61.50 months and mean of pain intensity of 6.78 points on the Numeric Pain Scale. Regarding the structure of the JOABPEQ, the original version with five domains was adequate: chi-square/DF=1.52, CFI=0.954, TLI=0.948, and RMSEA=0.055. The factorial load ranges from 0.41 to 0.90. CONCLUSIONS This study confirms the structure of JOABPEQ with 5 domains (low back pain, lumbar function, walking ability, social life function, and mental health) and 25 items in individuals with chronic low back pain.
Collapse
Affiliation(s)
| | - André Pontes-Silva
- Universidade Federal do Maranhão, Programa de Pós-Graduação em Saúde do Adulto - São Luís (MA), Brazil
| | | | - Letícia Padilha Mendes
- Universidade Federal do Maranhão, Departamento de Educação Física - São Luís (MA), Brazil
| | | | | | - Almir Vieira Dibai-Filho
- Universidade Federal do Maranhão, Departamento de Educação Física - São Luís (MA), Brazil.,Universidade Federal do Maranhão, Programa de Pós-Graduação em Educação Física - São Luís (MA), Brazil
| |
Collapse
|
11
|
Obiegbu O. Patient-reported outcomes in lumbar spine surgery. NIGERIAN JOURNAL OF MEDICINE 2021. [DOI: 10.4103/njm.njm_208_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
12
|
Yao M, Xu BP, Li ZJ, Zhu S, Tian ZR, Li DH, Cen J, Cheng SD, Wang YJ, Guo YM, Cui XJ. A comparison between the low back pain scales for patients with lumbar disc herniation: validity, reliability, and responsiveness. Health Qual Life Outcomes 2020; 18:175. [PMID: 32522196 PMCID: PMC7288427 DOI: 10.1186/s12955-020-01403-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 05/11/2020] [Indexed: 12/21/2022] Open
Abstract
Background Although the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ), Numerical Pain Rating Scale (NPRS), Oswestry Disability Index (ODI), Roland Morris Disability Questionnaire (RMDQ), and Short Form 36 Health Survey (SF-36) has shown a preferable psychometric properties in patients with low back pain (LBP), but no study has yet determined these in conservative treatment of patients with lumbar disc herniation (LDH). Thus the current study aimed to compare those scales in LDH patients receiving conservative treatment to select the better option to assess the severity of disease. Methods LDH patients were invited to complete the JOABPEQ, NPRS, ODI, RMDQ, and SF-36 twice. The internal consistency was evaluated by the Cronbach’s α. Test-retest reliability was tested by the intraclass correlation coefficient (ICC). The relationships of these scales were evaluated by the Pearson correlation coefficients (r). The responsiveness was operationalised using the receiver operating characteristic (ROC) curve, as well as the comparison of smallest detectable change (SDC), minimum important change (MIC). Results A total of 353 LDH patients were enrolled. Four subscales of the Chinese JOABPEQ were over 0.70, then the ICCs for the test-retest reliability were over 0.75. For functional status, remarked negative correlations could be seen between JOABPEQ Q2-Q4 and ODI, as well as RMDQ (r = − 0.634 to − 0.752). For general health status, remarkable positive correlations could also be seen between Q5 Mental health and SF-36 PCS (r = 0.724) as well as SF-36 MCS (r = 0.736). Besides, the area under of the curves (AUC) of the JOABPEQ ranged from 0.743 to 0.827, indicating acceptale responsiveness, as well as the NPRS, ODI, and RMDQ. Conclusion NPRS, and ODI or RMDQ is recommended in studies related to LDH patients, while if the quality of life also is needed to observe, the NPRS, and JOABPEQ would be more appropriate rather than SF-36.
Collapse
Affiliation(s)
- Min Yao
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200032, China.,Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200032, China
| | - Bao-Ping Xu
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200032, China.,Lu'an Hospital of Traditional Chinese Medicine, 76 Renmin Road, Anhui Lu'an, 237000, China
| | - Zhen-Jun Li
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200032, China.,Gansu Provincial Hospital of Traditional Chinese Medicine, 418 Guazhou Road, Lanzhou, 730050, Gansu, China
| | - Sen Zhu
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200032, China.,Department of Orthopaedic, Shanghai Pudong Gongli Hospital, Second Military Medical University, 219 Miaopu Road, Shanghai, 200013, China
| | - Zi-Rui Tian
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200032, China.,Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200032, China
| | - De-Hua Li
- Shanghai Guanghua Hospital, 540 Xinhua Road, Shanghai, 200052, China
| | - Jue Cen
- Shanghai Guanghua Hospital, 540 Xinhua Road, Shanghai, 200052, China
| | - Shao-Dan Cheng
- Shanghai Guanghua Hospital, 540 Xinhua Road, Shanghai, 200052, China
| | - Yong-Jun Wang
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200032, China.,Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200032, China
| | - Yan-Ming Guo
- Shanghai Guanghua Hospital, 540 Xinhua Road, Shanghai, 200052, China.
| | - Xue-Jun Cui
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200032, China. .,Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200032, China.
| |
Collapse
|
13
|
Ogura Y, Ogura K, Kobayashi Y, Kitagawa T, Yonezawa Y, Takahashi Y, Yoshida K, Yasuda A, Shinozaki Y, Ogawa J. Minimum clinically important difference of major patient-reported outcome measures in patients undergoing decompression surgery for lumbar spinal stenosis. Clin Neurol Neurosurg 2020; 196:105966. [PMID: 32485521 DOI: 10.1016/j.clineuro.2020.105966] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 03/26/2020] [Accepted: 05/24/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE A minimum clinically important difference (MCID) has been increasingly well known in the current era of patient-centered care because it reflects a smallest change that is meaningful for patients following a clinical intervention. Previous studies suggested MCID values are disease and/or procedure dependent. No MCID values have been reported on the lumbar spinal stenosis (LSS) following decompression surgery despite LSS is the most common spinal disease and the main treatment is decompression surgery. Therefore, this study aimed to determine the MCID values as major outcome measures including the Numeric Rating Scale (NRS) of back pain, leg pain and numbness, Roland-Morris Disability Questionnaire (RMDQ), and Physical Component Summary (PCS) and Mental Component Summary (MCS) of Short Form 8 (SF-8) for patients with LSS undergoing decompression surgery. PATIENTS AND METHODS This is a retrospective cohort study using prospectively collected data from consecutive patients who underwent lumbar decompression without fusion for LSS at a single institution between May 2014 and March 2016. Inclusion criteria were 1) minimum 1-year follow-up 2) a complete set of preoperative and final follow-up questionnaires available, including the NRS, RMDQ, and SF-8. Revision surgery or non-degenerative etiology such as infection or tumor was excluded. MCIDs of each outcome measure were determined using two major approaches, distribution- and anchor-based methods. The distribution-based method uses the distributional characteristics of the sample. This method expresses the observed degree of variation to obtain a standardized metric such as the standard deviation or standard error of measurement. The anchor-based method uses an external criterion known as anchor to determine the factors that should be considered by patients for an important improvement. Anchor-based methods assess how much changes in the measurement instrument correspond with a minimal important change defined on the anchor. We used symptom severity, physical function, and satisfaction scores from Zurich Claudication Questionnaire as anchors for NRS and RMDQ, PCS, and MCS, respectively. RESULTS A total of 126 patients were included. From the anchor-based method, MCIDs were determined to be 2 points for back pain, 4 points for leg pain and numbness, 5 points for RMDQ, 5 points for PCS, and 2 points for MCS. From the distribution-based method, MCIDs were determined to be 2 points for back pain, leg pain and numbness, 3-4 points for RMDQ, 6 points for PCS, and 5 points for MCS. CONCLUSION We first identified the MCIDs of the NRS, RMDQ, and SF-8 specific to patients undergoing decompression surgery for LSS.
Collapse
Affiliation(s)
- Yoji Ogura
- Department of Orthopaedic Surgery, Japanese Red Cross Shizuoka Hospital, Shizuoka, Shizuoka, Japan.
| | - Koichi Ogura
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshiomi Kobayashi
- Department of Orthopaedic Surgery, Japanese Red Cross Shizuoka Hospital, Shizuoka, Shizuoka, Japan
| | - Takahiro Kitagawa
- Department of Orthopaedic Surgery, Japanese Red Cross Shizuoka Hospital, Shizuoka, Shizuoka, Japan
| | - Yoshiro Yonezawa
- Department of Orthopaedic Surgery, Japanese Red Cross Shizuoka Hospital, Shizuoka, Shizuoka, Japan
| | - Yoshiyuki Takahashi
- Department of Orthopaedic Surgery, Japanese Red Cross Shizuoka Hospital, Shizuoka, Shizuoka, Japan
| | - Kodai Yoshida
- Department of Orthopaedic Surgery, Japanese Red Cross Shizuoka Hospital, Shizuoka, Shizuoka, Japan
| | - Akimasa Yasuda
- Department of Orthopaedic Surgery, Japanese Red Cross Shizuoka Hospital, Shizuoka, Shizuoka, Japan
| | - Yoshio Shinozaki
- Department of Orthopaedic Surgery, Japanese Red Cross Shizuoka Hospital, Shizuoka, Shizuoka, Japan
| | - Jun Ogawa
- Department of Orthopaedic Surgery, Japanese Red Cross Shizuoka Hospital, Shizuoka, Shizuoka, Japan
| |
Collapse
|
14
|
Ogura Y, Kobayashi Y, Kitagawa T, Yonezawa Y, Takahashi Y, Yoshida K, Yasuda A, Shinozaki Y, Ogawa J. Outcome measures reflecting patient satisfaction following decompression surgery for lumbar spinal stenosis: Comparison of major outcome measures. Clin Neurol Neurosurg 2020; 191:105710. [DOI: 10.1016/j.clineuro.2020.105710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 01/29/2020] [Accepted: 02/02/2020] [Indexed: 10/25/2022]
|
15
|
Dashtbani M, Dori MM, Hassani M, Omidi-Kashani F. A Survey on the Short-term Outcome of Microlumbar Discectomy with General versus Spinal Anesthesia. Clin Orthop Surg 2019; 11:422-426. [PMID: 31788165 PMCID: PMC6867920 DOI: 10.4055/cios.2019.11.4.422] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 04/22/2019] [Indexed: 12/02/2022] Open
Abstract
Background Surgery on the lower thoracic and lumbosacral spine is possible with both general and spinal anesthesia, but most spine surgeons are reluctant to perform the surgery with spinal anesthesia. We aimed to conduct a survey on the short-term outcome of microlumbar discectomy in the patients who had been treated under general or spinal anesthesia. Methods In this prospective study, we performed a survey on 72 patients who underwent microlumbar discectomy under general anesthesia (group A) or spinal anesthesia (group B). Demographic characteristics, American Society of Anesthesiologists physical status, duration of operation, blood loss, and complications were all documented. Preoperative and early postoperative (at the time of discharge) disability and pain were assessed by using Japanese Orthopedic Association (JOA) scoring system and a visual analog scale questionnaire. Results The two groups were homogenous preoperatively. The mean intraoperative blood loss was less and the mean operating time was shorter in group A than in group B, but there was no statistically significant difference between groups. The rate of postoperative improvement in JOA score and improvement in pain were similar between groups. Anesthetic complications were unremarkable. Conclusions Simple lumbar disc operations in the otherwise healthy patients can be safely performed under either spinal or general anesthesia. Both anesthetic methods led to comparable outcomes with minimal complications.
Collapse
Affiliation(s)
- Mohsen Dashtbani
- Department of Orthopedic Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehrdad Mokaram Dori
- Department of Anesthesiology, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Hassani
- Department of Orthopedic Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farzad Omidi-Kashani
- Department of Orthopedic Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
16
|
Minimally clinically important differences for the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) following decompression surgery for lumbar spinal stenosis. J Clin Neurosci 2019; 69:93-96. [DOI: 10.1016/j.jocn.2019.08.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 08/04/2019] [Indexed: 11/18/2022]
|
17
|
Simplified Chinese Version of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire: Agreement, Responsiveness, and Minimal Important Change for Patients With Chronic Low Back Pain. Spine (Phila Pa 1976) 2018; 43:1438-1445. [PMID: 29659442 DOI: 10.1097/brs.0000000000002692] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Psychometric test of the cross-cultural adaptation the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) in low back pain (LBP) patients. OBJECTIVE To investigate the agreement, responsiveness, and minimal important change (MIC) of the simplified Chinese version of the JOABPEQ in LBP patients. SUMMARY OF BACKGROUND DATA The factor structure, internal consistency, test-retest reliability, validity, floor and ceiling effect of simplified Chinese JOABPEQ have been tested, while the agreement, responsiveness, and MIC were required. METHODS The agreement, responsiveness, and MIC of the simplified Chinese version were assessed by completing the Chinese JOABPEQ twice. Agreement was tested with Bland-Altman plot. Responsiveness was operationalized using receiver operating characteristic analyses. The anchor-based method was used to calculate MIC. RESULTS One hundred sixty-two of 184 patients returned to finish the booklet twice were available for analysis (response rate: 88.0%). While the responsiveness, the area under the curves of each subscale were ranged from 0.746 to 0.875, which meant a good responsiveness. While the MIC (MIC%) of simplified Chinese JOABPEQ was 19.28 (44.98%) for Q1 Low back pain, 15.20 (24.13%) for Q2 Lumbar function, 15.79 (22.76%) for Q3 Walking ability, 9.58 (19.86%) for Q4 Social life function, 7.33 (17.28%) for Q5 Mental health. While compared with the MIC, only the Q3 Walking ability had a positive rating for agreement in the Bland-Altman plot. CONCLUSION The simplified Chinese JOABPEQ has positive agreement of Q3 Walk ability and acceptable to excellent responsiveness of all the subscales. The MICs for subscales of the simplified Chinese JOABPEQ ranged from 7.33 to 19.28 points. LEVEL OF EVIDENCE 3.
Collapse
|
18
|
Cheung PWH, Wong CKH, Cheung JPY. Psychometric validation of the adapted Traditional Chinese version of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ). J Orthop Sci 2018; 23:750-757. [PMID: 30213363 DOI: 10.1016/j.jos.2018.04.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 04/08/2018] [Accepted: 04/16/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND Low back pain is a common health problem encountered by various populations among different countries. This prospective study aimed to translate and cross-culturally adapt the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) into Traditional Chinese and to assess its validity, reliability and sensitivity in Chinese patients experiencing low back pain. METHODS Double forward and single back translation of the JOABPEQ was performed with cross-cultural adaptation. By convenience sampling, the final version of the translated JOABPEQ was administered to Chinese patients attending a specialty outpatient clinic with a history of back pain, followed by the traditional Chinese versions of Oswestry Disability Index (ODI) and Short Form-12 version 2 (SF-12v2). Construct validity of the domains were assessed using Spearman's correlation test. Internal consistency was assessed by Cronbach's alpha (α). Sensitivity of the adapted JOABPEQ was determined by known group comparisons. RESULTS A total of 100 patients were recruited. The translated JOABPEQ demonstrated excellent overall internal consistency (α: 0.912); and good internal consistency for the domains of Lumbar Function, Walking Ability, Social Life Function and Mental Health (α: 0.811, 0.808, 0.788, and 0.827 respectively). Scores of all domains of the translated JOABPEQ had significant correlations (p < 0.01) with ODI at all domains, as well as with almost all domains of SF-12v2 (p < 0.01-0.05). The translated JOABPEQ was sensitive in detecting differences in patients with/without a history of previous spine surgery, and also between patients with acute/acute on chronic versus chronic pain in specific domains. CONCLUSIONS The Traditional Chinese version of JOABPEQ has satisfactory psychometric properties in general, including adequate clinical and construct validity, and internal consistency in assessing Southern-Chinese patients with low back pain. It is demonstrated as a sensitive outcome measure. The translated JOABPEQ is verified for its use in the local clinical setting for patient assessment and future research.
Collapse
Affiliation(s)
| | - Carlos King Ho Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China.
| |
Collapse
|
19
|
Simplified Chinese Version of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire: Cross-cultural Adaptation, Reliability, and Validity for Patients With Low Back Pain. Spine (Phila Pa 1976) 2018; 43:E357-E364. [PMID: 28953707 DOI: 10.1097/brs.0000000000002424] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cross-cultural adaptation and cross-sectional psychometric testing in a convenience sample of patients with low back pain. OBJECTIVE The aim of this study was to translate and adapt the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) into a simplified Chinese version, and assess its reliability and validity. SUMMARY OF BACKGROUND DATA No simplified Chinese version of the JOABPEQ was previously available. METHODS We translated and culturally adapted the original English JOABPEQ to develop a Chinese version, based on cross-cultural adaptation guidelines. Principal component analysis with varimax rotation was used to confirm the factor structure of each subscale. Internal consistency was evaluated with Cronbach alpha. Test-retest reliability was examined in stable patients, who completed the questionnaire again at 4 days to 2 weeks from baseline. The validity of the translated Chinese version was assessed by examining the relationship between the JOABPEQ and Chinese versions of the Roland-Morris Disability Questionnaire (RMDQ), the Oswestry Disability Index (ODI), the Short Form Health Survey (SF-36), and the Numerical Pain Rating Scale. Ceiling and floor effects were considered present if more than 15% of respondents achieved the lowest or highest possible total score. RESULTS The JOABPEQ showed excellent internal consistency (α = 0.886). The test-retest reliability (intraclass correlation coefficients) ranged from 0.951 to 0.977. The convergent validity of the Chinese version was supported by its high correlation with other physical functional status measures (RMDQ, ODI, and SF-36 Physical Function; r values from -0.645 to -0.726), and moderate correlation with other measures (SF-36 Bodily pain and Social functioning subscales; r values 0.426-0.546). Q5 Mental health was highly correlated with SF-36 items (r values 0.337-0.640). There was a floor effect in Q1 low back pain (38, 20.65%). CONCLUSION The results indicate that the simplified Chinese version of the JOABPEQ is a reliable and valid instrument to measure the multidimensional status in patients with low back pain. LEVEL OF EVIDENCE 4.
Collapse
|
20
|
Azimi P, Yazdanian T, Benzel EC. Determination of minimally clinically important differences for JOABPEQ measure after discectomy in patients with lumbar disc herniation. JOURNAL OF SPINE SURGERY 2018; 4:102-108. [PMID: 29732429 DOI: 10.21037/jss.2018.03.11] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background It is crucial to define if changes in patient-reported outcome (PRO) measure correspond to relevant clinical improvements. Aim of this study was to determine minimally clinically important differences (MCID) of the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) in patients with lumbar disc herniation (LDH) to assess surgical success. Methods A total of 127 patients with LDH consecutively referred to our clinic were enrolled into this prospective study between March 2012 and August 2015. All participants completed the JOABPEQ and the Oswestry Disability Index (ODI) score before surgery, and at 1 year after surgery. Surgical success was defined based on clinical consensus of the team and be used as anchor. The MCID value of the JOABPEQ subscales were estimated using two anchor-based methods: (I) average change procedure (responsiveness); and (II) receiver operating characteristic (ROC) curve analysis. Results The mean age of patients was 51.2±9.4 years, and there were 68 (53.5%) male. A total of 83.5% (106 cases) showed improvement based on the clinical consensus of the spine surgeon team at last follow-up. To assess surgical success, the two MCID calculation methods generated two optimal prediction thresholds on the JOABPEQ subscales (low back pain: 19.1, 22.4; lumbar function: 21.3, 24.2; walking ability: 24.5, 27.9; social life function: 14.3, 17.1; and mental health: 12.8, 14.8) for ROC analysis and average change procedure, respectively (P<0.002 for all of subscales in two methods). For all five subscales, the sensitivity and specificity were between 61.2 and 81.1 with AUC greater than 0.70. Conclusions These findings support the value of the MCID to assess surgical success for the JOABPEQ subscales in patients with LDH. This estimate may be a useful tool in clinical practice.
Collapse
Affiliation(s)
- Parisa Azimi
- Functional Neurosurgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Taravat Yazdanian
- School of Medicine, Capital Medical University, Beijing 100069, China
| | - Edward C Benzel
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| |
Collapse
|
21
|
Azimi P, Benzel EC. The Low-Back Outcome Scale and the Oswestry disability index: are they reflective of patient satisfaction after discectomy? A cross sectional study. JOURNAL OF SPINE SURGERY 2018; 3:554-560. [PMID: 29354731 DOI: 10.21037/jss.2017.09.07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background The Low-Back Outcome Scale (LBOS) of Greenough and Fraser and the Oswestry disability index (ODI) were compared to the patient satisfaction index (PSI) in lumbar disc herniation (LDH) surgery. Methods A total of 134 patients who underwent discectomy were followed through assessment of pre- and post-surgical satisfaction by the PSI, the LBOS, and the ODI. The LBOS were rated as satisfied if the outcomes were excellent or good and as dissatisfied if fair and poor. Considering the ODI, clinically satisfied was defined as a 13-point improvement from the baseline ODI scores. Phi (Φ) correlation analysis was used to study the correlation among the PSI, the LBOS and the ODI scores as proxy for patients' satisfaction. Results Mean age of patients was 48.9 years. Significant improvement from the pre- to post-operative ODI scores was observed. Post-surgical satisfaction based on the PSI, the ODI, and the LBOS were 70.9%, 76.8%, and 81.3%, respectively. Regarding patient satisfaction, there were weak associations between LBOS vs. PSI and ODI vs. PSI (Φ=-0.054, P=0.533) and (Φ=-0.129, P=0.136), respectively. Conclusions Our study showed that the ODI and the LBOS were not reflective of patients' satisfaction after discectomy.
Collapse
Affiliation(s)
- Parisa Azimi
- Functional Neurosurgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Edward C Benzel
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| |
Collapse
|
22
|
Poletto PR, Gobbo DKP, Gotfryd AO, Catania SN, Sousa DDC, Pereira SBS. Cultural adaptation, reliability and validity of Japanese Orthopaedic Association Back Pain Evaluation Questionnaire to Brazilian Portuguese. EINSTEIN-SAO PAULO 2017; 15:313-321. [PMID: 29091153 PMCID: PMC5823045 DOI: 10.1590/s1679-45082017ao3890] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 06/28/2017] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To describe the translation and cultural adaptation of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire into Brazilian Portuguese, and verifies the reliability and validity of this new version. METHODS A cross-cultural adaptation of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire was performed using the following steps: translation, back-translation, committee review, and pre-testing phase (50 subjects). The psychometric properties were evaluated by application of the questionnaire to 102 patients. Reliability was assessed by homogeneity and stability of measures. The criterion-related validity was tested by comparing scores of Japanese Orthopaedic Association Back Pain Evaluation Questionnaire to Oswestry and Medical Outcomes Study 36 - Item Short questionnaires. RESULTS Excellent internal consistency was found in both test (Cronbach's α of 0.90) and re-test (Cronbach's α of 0.91). The Japanese Orthopaedic Association Back Pain Evaluation Questionnaire showed good reliability and the correlations ranged from reasonable (0.64) to very good (r=0.91). CONCLUSION The Brazilian Portuguese version of Medical Outcomes Study 36 - Item Short was easy to apply and understand. The questionnaire had a great impact on assessment and multidimensional care of patients with low back pain.
Collapse
|
23
|
Preliminary Results of Relationship between Preoperative Walking Ability and Magnetic Resonance Imaging Morphology in Patients with Lumbar Canal Stenosis: Comparison between Trefoil and Triangle Types of Spinal Stenosis. Asian Spine J 2017; 11:580-585. [PMID: 28874976 PMCID: PMC5573852 DOI: 10.4184/asj.2017.11.4.580] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 01/26/2017] [Accepted: 01/31/2017] [Indexed: 01/06/2023] Open
Abstract
Study Design Cross-sectional. Purpose To examine the relationship between magnetic resonance imaging (MRI) morphology stenosis grades and preoperative walking ability in patients with lumbar canal stenosis (LCS). Overview of Literature No previous study has analyzed the correlation between MRI morphology stenosis grades and walking ability in patients with LCS. Methods This prospective study included 98 consecutive patients with LCS who were candidates for surgery. Using features identified in T2-weighted axial magnetic, stenosis type was determined at the maximal stenosis level, and only trefoil and triangle stenosis grade types were considered because of sufficient sample size. Intraobserver and interobserver reliability were assessed by calculating weighted kappa coefficients. Symptom severity was evaluated via the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ). Walking ability was assessed using the Self-Paced Walking Test (SPWT) and JOABPEQ subscales. Demographic characteristics, SPWT scores, and JOABPEQ scores were compared between patients with trefoil and triangle stenosis types. Results The mean patient age was 58.1 (standard deviation, 8.4) years. The kappa values of the MRI morphology stenosis grade types showed a perfect agreement between the stenosis grade types. The trefoil group (n=53) and triangle group (n=45) showed similar preoperative JOABPEQ subscale scores (e.g., low back pain, lumbar function, and mental health) and were not significantly different in age, BMI, duration of symptoms, or lumbar stenosis levels (all p>0.05); however, trefoil stenosis grade type was associated with a decreased walking ability according to the SPWT and JOABPEQ subscale scores. Conclusions These findings suggest preoperative walking ability is more profoundly affected in patients with trefoil type stenosis than in those with triangle type stenosis.
Collapse
|
24
|
Jung KS, Jung JH, Jang SH, Bang HS, In TS. The reliability and validity of the Korean version of the Japanese orthopaedic association back pain evaluation questionnaire. J Phys Ther Sci 2017; 29:1250-1253. [PMID: 28744058 PMCID: PMC5509602 DOI: 10.1589/jpts.29.1250] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 04/30/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to establish the reliability and validity of the
Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) translated
into Korean for use with patients’ low back pain. [Subjects and Methods] Sixty-two
subjects with low back pain, 28 men and 34 women, participated in the study. Reliability
was determined by using the intra class correlation coefficient and Cronbach’s alpha for
internal consistency. Validity was examined by correlating the JOABPEQ scores with the 36
item short form health survey (SF 36). [Results] Test-retest reliability was 0.75–0.83.
The criterion-related validity was established by comparison with the Korean version of
the SF 36. [Conclusion] The Korean version of the JOABPEQ was shown to be a reliable and
valid instrument for assessing low back pain.
Collapse
Affiliation(s)
- Kyoung-Sim Jung
- Department of Occupational Therapy, Semyung University, Republic of Korea
| | - Jin-Hwa Jung
- Department of Occupational Therapy, Semyung University, Republic of Korea
| | - Sang-Hun Jang
- Department of Physical Therapy, Gimcheon University, Republic of Korea
| | - Hyun-Soo Bang
- Department of Physical Therapy, Gimcheon University, Republic of Korea
| | - Tae-Sung In
- Department of Physical Therapy, Gimcheon University, Republic of Korea
| |
Collapse
|
25
|
Alfayez SM, Bin Dous AN, Altowim AA, Alrabiei QA, Alsubaie BO, Awwad WM. The validity and reliability of the Arabic version of the Japanese Orthopedic Association Back Pain Evaluation Questionnaire: Can we implement it in Saudi Arabia? J Orthop Sci 2017; 22:618-621. [PMID: 28416189 DOI: 10.1016/j.jos.2017.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 03/31/2017] [Accepted: 04/03/2017] [Indexed: 02/09/2023]
Abstract
BACKGROUND The Japanese Orthopedic Association designed their back pain evaluation questionnaire (JOABPEQ) which was proven to be feasible, reliable and valid. The questionnaire's validity and reliability were confirmed when it was implemented in patients with different cultural background. Since the JOABPEQ still has not been utilized in any of the Arabic countries, we present the Arabic version with its validity and reliability. METHODS After ensuring an optimal forward-backward translation of the JOABPEQ, the Arabic version was distributed among 151 patients visiting our clinics from December 2015 to February 2016. The reliability was tested using Cronbach's alpha. The convergent validity was assessed through aggregating and correlating the questionnaire's items with their previously designed and validated subscales described in the JOABPEQ validity study by Fukui et al. (four items for social function, seven for mental health, six for lumbar function, five for walking ability and four for low back pain); Spearman's correlation matrix was used. The correlation coefficient had to be greater than 0.40 for each item with its corresponding subscale to be satisfactory. Scores underwent descriptive analysis, and Mann-Whitney u test was performed to compare between categorical subgroups. RESULTS 151 spine patients completed the questionnaire. The mean age (range) was 34.9 (10-72) years. The male respondents were 61 (40.4%) and the females were 90 (59.6%). The result of Cronbach's alpha for internal consistency (reliability) was 0.87 for the 25 items. The validity was confirmed since the correlation coefficient was greater than 0.4 for each item with only its relevant subscale. CONCLUSION the Arabic version of the JOABPEQ is valid, reliable and feasible in assessing patients with spine disorders. We believe the JOABPEQ with its different versions are suitable questionnaires to be used across nations and can serve as a unified tool in conducting research and exchanging information in the future.
Collapse
Affiliation(s)
- Saud Mohammed Alfayez
- Orthopedic Department, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Abdullah Nasser Bin Dous
- Orthopedic Department, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | | | | | - Bandar Obaid Alsubaie
- Orthopedic Department, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Waleed Mohammad Awwad
- Orthopedic Department, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| |
Collapse
|
26
|
Kasai Y, Fukui M, Takahashi K, Ohtori S, Takeuchi D, Hashizume H, Kanamori M, Hosono N, Kanchiku T, Wada E, Sekiguchi M, Konno S, Kawakami M. Verification of the sensitivity of functional scores for treatment results - Substantial clinical benefit thresholds for the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ). J Orthop Sci 2017; 22:665-669. [PMID: 28365168 DOI: 10.1016/j.jos.2017.02.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 02/13/2017] [Accepted: 03/14/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Validity and reliability of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) had already been verified as the patients' self-rating assessment of low back pain and lumbar spinal disease and, the present study demonstrated the responsiveness of this measure. METHODS 192 subjects who were determined by medical instructors of the Japanese Society for Spine Surgery and Related Research were analyzed. They had completed a series of treatment and both surveys before and after the treatment. Authors investigated rates of concordance between assessment by physicians and subjective assessment by patients. The mean, standard deviation, minimum, 25th percentile, median, 75th percentile and maximum values for pre-treatment, post-treatment, and acquired points were calculated, and then, we also investigated the trend between subjective assessment by patients and mean acquired points for each JOABPEQ domain and substantial clinical benefit thresholds for the JOABPEQ. RESULTS Symptom changes as assessed by physicians did not coincide with those by patients, and acquired points in each JOABPEQ domain were significantly increased with improved self-rating by patients. In addition, patients who rated symptom changes as "slightly improved" showed a mean acquired points of ≥20, and those reporting "improved" showed a 25th percentile points of the acquired points of ≥20 approximately. CONCLUSION A significant correlation was noted between the self-rating of patients and acquired points JOABPEQ, suggesting that ≥20 acquired points can be interpreted as substantial clinical benefit thresholds for the JOABPEQ.
Collapse
Affiliation(s)
- Yuichi Kasai
- Department of Spinal Surgery and Medical Engineering, Mie University Graduate School of Medicine, Japan.
| | - Mitsuru Fukui
- Laboratory of Statistics, Osaka City University Faculty of Medicine, Osaka, Japan
| | - Kazuhisa Takahashi
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Daisaku Takeuchi
- Department of Orthopedic Surgery, Dokkyo Medical University School of Medicine, Shimotsuga-gun, Tochigi Prefecture, Japan
| | - Hiroshi Hashizume
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | | | - Noboru Hosono
- Department of Orthopedic Surgery, Japan Community Health Care Organization Osaka Hospital, Osaka, Japan
| | - Tsukasa Kanchiku
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Eiji Wada
- Spine and Spinal Cord Center, Osaka Police Hospital, Osaka, Japan
| | - Miho Sekiguchi
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Shinichi Konno
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Mamoru Kawakami
- Department of Orthopaedic Surgery, Wakayama Medical University Kihoku Hospital, Ito gun, Wakayama Prefecture, Japan
| |
Collapse
|
27
|
Poosiripinyo T, Paholpak P, Jirarattanaphochai K, Kosuwon W, Sirichativapee W, Wisanuyotin T, Laupattarakasem P, Sukhonthamarn K, Jeeravipoolvarn P, Sakakibara T, Kasai Y. The Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ): A validation of the reliability of the Thai version. J Orthop Sci 2017; 22:34-37. [PMID: 27793440 DOI: 10.1016/j.jos.2016.10.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 09/06/2016] [Accepted: 10/04/2016] [Indexed: 02/09/2023]
Abstract
BACKGROUND The Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) was developed by the Japanese Orthopedic Association (JOA) for assessment of lower back pain and lumbar spinal disease. We aimed to translate the JOABPEQ into Thai and test its reliability and validity in the Thai context. METHODS The original JOABPEQ was translated into Thai in accordance with international recommendations. Then 180 lumbar spinal disease patients (mean age 58.58 ± 11.97, 68.3% female) were asked to complete the Thai version of the JOABPEQ twice at 2-week intervals. Test-retest reliability was analyzed using the intra-class correlation coefficient (ICC). Internal consistencies were analyzed using Cronbach's alpha, while the construct validity was compared with the Thai version of the modified SF-36, and tested using the Spearman's rank correlation coefficient. RESULTS The Thai JOABPEQ showed satisfactory test-retest reliability in all parameters (Intra-class Correlation Coefficient 0.761-0.862). The variables low back pain, walking ability, social life function, and mental health had satisfactory internal consistency (the respective Cronbach's α was 0.798, 0.721, 0.707, and 0.795). Only the lumbar function parameter showed moderate reliability (Cronbach's α = 0.654). All of the variables in the Thai JOABPEQ had a statistically positive correlation with the correspondent Thai SF-36 subscales (Spearman's rank correlation p value < 0.05). CONCLUSION The Thai version of JOABPEQ had satisfactory internal consistency, test-retest reliability, and construct validity; it can be used as a reliable tool for assessing quality of life for lumbar spinal disease patients in Thailand.
Collapse
Affiliation(s)
- Thanate Poosiripinyo
- Department of Orthopedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Permsak Paholpak
- Department of Orthopedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand.
| | - Kitti Jirarattanaphochai
- Department of Orthopedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Weerachai Kosuwon
- Department of Orthopedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Winai Sirichativapee
- Department of Orthopedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Taweechok Wisanuyotin
- Department of Orthopedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Pat Laupattarakasem
- Department of Orthopedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Kamolsak Sukhonthamarn
- Department of Orthopedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Polasak Jeeravipoolvarn
- Department of Orthopedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Toshihiko Sakakibara
- Department of Spinal Surgery and Biomedical Engineering, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Yuichi Kasai
- Department of Spinal Surgery and Biomedical Engineering, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| |
Collapse
|
28
|
Aksekili MAE, Aktekin L, Korkmazer S, Akyol M, Kılıçarslan K, Tosun N. The Japanese Orthopedic Association Back Pain Evaluation Questionnaire: A Turkish validation study. J Orthop Sci 2016; 21:718-722. [PMID: 27452738 DOI: 10.1016/j.jos.2016.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 06/05/2016] [Accepted: 06/29/2016] [Indexed: 02/09/2023]
Abstract
BACKGROUND The aim of this study was to apply cross-cultural adaptation and validity assessment to the Turkish translation of the Japanese Orthopedic Association Back Pain Evaluation Questionnaire applied to patients conservatively monitored for lumbar disc hernia and narrowing of the lumbar canal. METHODS The questionnaire was translated into Turkish based on guidelines. In respect of the comprehensibility of the obtained pre-final version of the questionnaire, a pilot test was applied to 20 healthy individuals. The patients were requested to complete the final version of the questionnaire after an orthopedic and physical therapy assistant doctor (resident) had completed the diagnosis and demographic information. To evaluate the retest reliability, the test was applied a second time, 14 days (±3 days) after the first application, again in the Orthopedics and Physical Therapy Outpatient Clinic. RESULTS The study was completed with a total of 215 individuals, comprising 107 patients and 108 healthy volunteers. When Turkish version of the questionnaire scale was evaluated of the patients and healthy volunteers together, the internal consistency was determined at the levels of Cronbach's α excellent. The lowest correlations of all the questionnaire scale items with the scale sub-dimensions was at the level of r = 0.509, which demonstrated that there was a sufficient validity level of the Turkish translated questionnaire scale. A statistically significant direct correlation at a high level was seen between the pre and post points in all the scale sub-dimensions. CONCLUSIONS The results of the current study showed that Turkish version of the questionnaire had sufficient reliability and validity in the evaluation of low back pain and resulting dysfunction and disability in patients with LDH and narrowing of the lumbar canal.
Collapse
Affiliation(s)
- Mehmet Atıf Erol Aksekili
- Yıldırım Beyazıt University School of Medicine, Atatürk Education and Research Hospital, Department of Orthopaedic Surgery, Ankara, Turkey.
| | - Lale Aktekin
- Yıldırım Beyazıt University, Atatürk Education and Research Hospital, Physical Therapy and Rehabilitation Clinic, Ankara, Turkey
| | - Selçuk Korkmazer
- Yıldırım Beyazıt University School of Medicine, Atatürk Education and Research Hospital, Department of Orthopaedic Surgery, Ankara, Turkey
| | - Mesut Akyol
- Yıldırım Beyazıt University, Department of Biostatistics, Ankara, Turkey
| | - Kasım Kılıçarslan
- Yıldırım Beyazıt University School of Medicine, Atatürk Education and Research Hospital, Department of Orthopaedic Surgery, Ankara, Turkey
| | - Nihat Tosun
- Yıldırım Beyazıt University School of Medicine, Atatürk Education and Research Hospital, Department of Orthopaedic Surgery, Ankara, Turkey
| |
Collapse
|
29
|
Narita W, Takatori R, Arai Y, Nagae M, Tonomura H, Hayashida T, Ogura T, Fujiwara H, Kubo T. Prevention of neurological complications using a neural monitoring system with a finger electrode in the extreme lateral interbody fusion approach. J Neurosurg Spine 2016; 25:456-463. [DOI: 10.3171/2016.1.spine151069] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Extreme lateral interbody fusion (XLIF) is a minimally disruptive surgical procedure that uses a lateral approach. There is, however, concern about the development of neurological complications when this approach is used, particularly at the L4–5 level. The authors performed a prospective study of the effects of a new neural monitoring system using a finger electrode to prevent neurological complications in patients treated with XLIF and compared the results to results obtained in historical controls.
METHODS
The study group comprised 36 patients (12 male and 24 female) who underwent XLIF for lumbar spine degenerative spondylolisthesis or lumbar spine degenerative scoliosis at L4–5 or a lower level. Using preoperative axial MR images obtained at the mid-height of the disc at the treated level, we calculated the psoas position value (PP%) by dividing the distance from the posterior border of the vertebral disc to the posterior border of the psoas major muscle by the anteroposterior diameter of the vertebral disc. During the operation, the psoas major muscle was dissected using an index finger fitted with a finger electrode, and threshold values of the dilator were recorded before and after dissection. Eighteen cases in which patients had undergone the same procedure for the same indications but without use of the finger electrode served as historical controls. Baseline clinical and demographic characteristics, PP values, clinical results, and neurological complications were compared between the 2 groups.
RESULTS
The mean PP% values in the control and finger electrode groups were 17.5% and 20.1%, respectively (no significant difference). However, 6 patients in the finger electrode group had a rising psoas sign with PP% values of 50% or higher. The mean threshold value before dissection in the finger electrode group was 13.1 ± 5.9 mA, and this was significantly increased to 19.0 ± 1.5 mA after dissection (p < 0.001). A strong negative correlation was found between PP% and threshold values before dissection, but there was no correlation with threshold values after dissection. The thresholds after dissection improved to 11 mA or higher in all patients. There were no serious neurological complications in any patient, but there was a significantly lower incidence of transient neurological symptoms in the finger electrode group (7 [38%] of 18 cases vs 5 [14%] of 36 cases, p = 0.047).
CONCLUSIONS
The new neural monitoring system using a finger electrode may be useful to prevent XLIF-induced neurological complications.
Collapse
Affiliation(s)
- Wataru Narita
- 1Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine; and
- 2Spine Surgery and Related Research Center, Nantan General Hospital, Nantan City, Kyoto, Japan
| | - Ryota Takatori
- 1Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine; and
| | - Yuji Arai
- 1Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine; and
| | - Masateru Nagae
- 1Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine; and
| | - Hitoshi Tonomura
- 1Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine; and
| | - Tatsuro Hayashida
- 2Spine Surgery and Related Research Center, Nantan General Hospital, Nantan City, Kyoto, Japan
| | - Taku Ogura
- 2Spine Surgery and Related Research Center, Nantan General Hospital, Nantan City, Kyoto, Japan
| | - Hiroyoshi Fujiwara
- 1Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine; and
| | - Toshikazu Kubo
- 1Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine; and
| |
Collapse
|
30
|
Cross-cultural adaptation, reliability and validity of the Turkish version of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire. J Orthop Sci 2016; 21:295-8. [PMID: 26898339 DOI: 10.1016/j.jos.2016.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 01/12/2016] [Accepted: 01/16/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Low back pain is among the most common musculoskeletal system disorders. Outcome measures are needed for the measurement of function, to establish a treatment program, and for monitoring the improvement in low back pain. There exist several questionnaires enquiring about function in low back pain. One of these is Japanese Orthopaedic Association Back Pain Evaluation Questionnaire, whose reliability and validity were previously established. Other than the original version of the questionnaire, only its Persian version exists. The present study aims to investigate the cross-cultural adaptation, reliability and validity of the Turkish version of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire. METHODS The study included 103 patients with low back pain. For reliability assessment of the questionnaire, test-retest and internal consistency analyses were performed. The results of test-retest analysis were assessed by Intraclass Correlation Coefficient method. For internal consistency, Cronbach Alpha value was used. Validity analyses of the questionnaire were performed by construct validity. For construct validity, convergent validity was tested. Convergent validity of the questionnaire was calculated via its correlation with suitable subscales of the Short Form-36 and the total score of the Oswestry Disability Index by using Pearson's correlation coefficient. RESULTS Intraclass Correlation Coefficient values for test-retest reliability were found to be in the range of 0.765-0.924, which indicate a sufficient level of test-retest reliability. Cronbach's Alpha value was found to be 0.804 indicating a high internal consistency. Pearson's correlation coefficient between Japanese Orthopaedic Association Back Pain Evaluation Questionnaire to Short Form-36 and Oswestry Disability Index values were ranged between 0.424 and -0.810, indicating a good correlation. CONCLUSIONS Considering all these data, it was concluded that the Turkish version of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire is valid and reliable.
Collapse
|
31
|
Nayak NR, Coats JM, Abdullah KG, Stein SC, Malhotra NR. Tracking patient-reported outcomes in spinal disorders. Surg Neurol Int 2015; 6:S490-9. [PMID: 26605111 PMCID: PMC4617013 DOI: 10.4103/2152-7806.166892] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 06/24/2015] [Indexed: 11/22/2022] Open
Abstract
Background: Patient-reported outcome measures (PROMs) quantify health status from the patient's point of view. While the number of published outcomes studies grows each year, so too has the number of instruments being reported, leading to confusion on which instruments are appropriate to use for various spinal conditions. Methods: A broad search was conducted to identify commonly used PROMs in patients undergoing spinal surgery. We searched PubMed for combinations of terms related to anatomic location and a measure of patient-reported outcome in the title or text. We supplemented the search using the “related articles” feature of PubMed and by manually searching the bibliographies of selected articles. Results: Major categories of PROMs in spine surgery include health-related quality-of-life, pain, and disease-specific disability, for which several different instrument options were identified and detailed. The minimal clinically important difference varies between instruments and differentiates statistical significance from clinical significance. In addition, the accurate estimation of costs has become a challenging but intrinsically linked variable to outcomes as increased attention is paid to the relative value of surgical interventions. Conclusion: While a number of PROMs are available for tracking outcomes in spine surgery, only a handful appear to be widely used. At least one instrument from each category should be measured pre- and post-operatively to quantify treatment effect. In addition, while the primary goal is to select the most appropriate instruments for the patient's condition, one should keep in mind sustainability of efforts with regard to patient and administrative burden.
Collapse
Affiliation(s)
- Nikhil R Nayak
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - John Mitchell Coats
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Kalil G Abdullah
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Sherman C Stein
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Neil R Malhotra
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| |
Collapse
|
32
|
Takahashi Y. Early VAS reduction speed predicts the treatment outcome in acute low back pain. ACTA ACUST UNITED AC 2015. [DOI: 10.11154/pain.30.148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Yuzuru Takahashi
- Sannoh Orthopedic Clinic
- Department of Orthopedic Surgery, Sannoh Hospital
| |
Collapse
|