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Gustafsson MEAK, Schiøttz-Christensen B, Petersen TL, Jepsen R, Wedderkopp N, Brønd JC, O'Neill SFD. Walking performance in individuals with lumbar spinal stenosis- possible outcome measures and assessment of known-group validity. Spine J 2024:S1529-9430(24)00115-3. [PMID: 38499067 DOI: 10.1016/j.spinee.2024.03.006] [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: 11/08/2023] [Revised: 03/07/2024] [Accepted: 03/12/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND CONTEXT One of the primary goals of treatments received by individuals with lumbar spinal stenosis with neurogenic claudication is to improve walking ability. Thus, a thorough and valid assessment of walking ability in patients with lumbar spinal stenosis is needed. Duration of continuous walking and steps per day could be relevant when evaluating walking ability in daily living. PURPOSE To describe and evaluate a method for estimating continuous walking periods in daily living and to evaluate the known-group validity of steps per day in individuals with lumbar spinal stenosis. STUDY DESIGN This is a cross-sectional observational study. PATIENT SAMPLE The study contains three study groups: individuals with lumbar spinal stenosis, individuals with low back pain, and a background population from the Lolland-Falster Health Study (LOFUS). OUTCOME MEASURES Participants in all three study groups wore an accelerometer on the thigh for seven days. METHODS Accelerometer data were processed to summarize the continuous walking periods according to their length: the number of short (4-9 seconds), moderate (10-89 seconds), and extended (≥90 seconds) continuous walking periods per day, and the number of steps per day. Results from the three groups were compared using negative binomial regression with lumbar spinal stenosis as the reference level. RESULTS Continuous walking periods of moderate length were observed 1.48 (95% CI 1.27, 1.72) times more often in individuals from the background population than in individuals with LSS. Continuous walking periods of extended length were observed 1.53 (95% CI 1.13, 2.06) times more often by individuals with low back pain and 1.60 (95% CI 1.29, 1.99) times more often by individuals from the background population. The number of steps per day was 1.22 (95% CI 1.03, 1.46) times larger in individuals with LBP and 1.35 (95% CI 1.20, 1.53) times larger in individuals from background population. CONCLUSIONS The impact of neurogenic claudication on walking ability in daily living seems possible to describe by continuous walking periods along with steps per day. The results support known-group validity of steps per day. This is the next step toward a clinically relevant and comprehensive assessment of walking in daily living in individuals with lumbar spinal stenosis.
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Affiliation(s)
- Malin Eleonora Av Kák Gustafsson
- Medical Research Unit, Spine Center of Southern Denmark, University Hospital of Southern Denmark, Østre Hougvej 55, 5500 Middelfart, Denmark; Department of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark.
| | - Berit Schiøttz-Christensen
- Research Unit of General Practice, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000 Odense C, Denmark
| | - Therese Lockenwitz Petersen
- Centre for Epidemiological Research, Nykøbing Falster Hospital, Strandboulevarden 64, 4800 Nykøbing Falster, Denmark
| | - Randi Jepsen
- Centre for Epidemiological Research, Nykøbing Falster Hospital, Strandboulevarden 64, 4800 Nykøbing Falster, Denmark
| | - Niels Wedderkopp
- Department of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark; Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
| | - Jan Christian Brønd
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
| | - Søren Francis Dyhrberg O'Neill
- Medical Research Unit, Spine Center of Southern Denmark, University Hospital of Southern Denmark, Østre Hougvej 55, 5500 Middelfart, Denmark; Department of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
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Fullwood D, Booker S, Fallon E, Means S, Asto-Flores E, Stickley ZL, Ellie-Turenne MC, Wilkie DJ. A descriptive study of physical function and performance in older black men with low back pain. Geriatr Nurs 2023; 53:78-84. [PMID: 37454422 PMCID: PMC10530352 DOI: 10.1016/j.gerinurse.2023.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023]
Abstract
The purpose of this paper is to describe physical function and performance scores and examine the relationships between measures of physical performance in older Black men with low back pain. The Mobility, Aging, Pain, and Disparities study used a cross-sectional, observational design to objectively measure physical performance on the Short Physical Performance Battery (SPPB), the Back Performance Scale (BPS), and the 400-meter Walk Test along with subjective ratings of pain intensity in the past 24 hours. Sixty community-based Black men aged 61-87 (x̄= 70 ± 6) years had an average BPS score of 7.0 ± 4 and total score on the SPPB 8.5 ± 2.1. Average 400-meter Walk time was 6.3 ± 3.1 minutes. Men's average pain intensity in the past 24 hours was 5.7 ± 2, indicating moderate pain. In conclusion, older Black men with low back pain demonstrated low physical function scores and a higher level of disability.
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Affiliation(s)
- Dottington Fullwood
- Mayo Clinic Florida, Cancer Health Equity Research Program, Jacksonville, Florida, USA.
| | - Staja Booker
- Department of Biobehavioral Nursing Science, University of Florida, Gainesville Florida, USA
| | - Elizabeth Fallon
- Mayo Clinic Florida, Cancer Health Equity Research Program, Jacksonville, Florida, USA
| | - Sydney Means
- Mayo Clinic Florida, Cancer Health Equity Research Program, Jacksonville, Florida, USA
| | - Emelina Asto-Flores
- Mayo Clinic Florida, Cancer Health Equity Research Program, Jacksonville, Florida, USA
| | - Zachary L Stickley
- Department of Educational Psychology, Leadership, & Counseling, Texas Tech University, Lubbock, Texas, USA
| | - Marie-Carmelle Ellie-Turenne
- Department of Emergency Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Diana J Wilkie
- Department of Biobehavioral Nursing Science, University of Florida, Gainesville Florida, USA
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Kim M, Bak J, Goh D, Bae J, Shin K, Son HJ, Huh J, Kang SS, Hwang B. Changes in pain scores and walking distance after transforaminal epidural steroid injection in patients with lumbar foraminal spinal stenosis. Medicine (Baltimore) 2023; 102:e34032. [PMID: 37352074 PMCID: PMC10289602 DOI: 10.1097/md.0000000000034032] [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: 03/03/2023] [Revised: 05/26/2023] [Accepted: 05/26/2023] [Indexed: 06/25/2023] Open
Abstract
Transforaminal epidural steroid injections (TFESI) are widely used in patients with lumbar foraminal spinal stenosis. Previous studies have evaluated the effects of TFESI on lumbar foraminal spinal stenosis using only pain scores. However, no study has evaluated the effect of TFESI on pain scores and walking distance in patients with lumbar foraminal spinal stenosis. This study aimed to assess the effect of TFESI on pain scores and walking distance in patients with lumbar foraminal spinal stenosis stratified according to disease severity. This retrospective study reviewed the medical records of patients who received TFESI for lumbar foraminal spinal stenosis. A total of 128 patients were divided into the moderate and severe groups based on the extent of fat obliteration and the presence of nerve root compression. A significant decrease in the numeric rating scale (NRS) scores was observed in the moderate and severe groups compared with the corresponding baseline values 4 weeks after TFESI; however, the NRS pain scores were lower in the moderate group than those in the severe group. In addition, the proportion of patients who experienced pain reduction (≥50%) was higher in the moderate group than that in the severe group. The moderate and severe groups showed a significant increase in walking distance compared with the baseline values 4 weeks after the treatment. However, the walking distance values did not differ significantly between the moderate and severe groups. Furthermore, the degree of satisfaction was higher in the moderate group than that in the severe group. Lumbar TFESI may reduce pain scores and increase walking distance in patients with moderate or severe lumbar foraminal spinal stenosis. Patients with moderate foraminal stenosis had better pain relief outcomes than those with severe foraminal stenosis.
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Affiliation(s)
- Minsoo Kim
- Department of Anesthesiology and Pain Medicine, Kangwon National University Hospital, School of Medicine, Kangwon National University, Chuncheon, Gangwon-do, Republic of Korea
| | - Jiwon Bak
- Department of Anesthesiology and Pain Medicine, Kangwon National University Hospital, School of Medicine, Kangwon National University, Chuncheon, Gangwon-do, Republic of Korea
| | - Daehun Goh
- Department of Anesthesiology and Pain Medicine, Kangwon National University Hospital, School of Medicine, Kangwon National University, Chuncheon, Gangwon-do, Republic of Korea
| | - Jangho Bae
- Department of Anesthesiology and Pain Medicine, Kangwon National University Hospital, School of Medicine, Kangwon National University, Chuncheon, Gangwon-do, Republic of Korea
| | - Kiyoung Shin
- Department of Anesthesiology and Pain Medicine, Kangwon National University Hospital, School of Medicine, Kangwon National University, Chuncheon, Gangwon-do, Republic of Korea
| | - Hee-Jeong Son
- Department of Anesthesiology and Pain Medicine, Kangwon National University Hospital, School of Medicine, Kangwon National University, Chuncheon, Gangwon-do, Republic of Korea
| | - Jin Huh
- Department of Anesthesiology and Pain Medicine, Kangwon National University Hospital, School of Medicine, Kangwon National University, Chuncheon, Gangwon-do, Republic of Korea
| | - Seong-Sik Kang
- Department of Anesthesiology and Pain Medicine, Kangwon National University Hospital, School of Medicine, Kangwon National University, Chuncheon, Gangwon-do, Republic of Korea
| | - Byeongmun Hwang
- Department of Anesthesiology and Pain Medicine, Kangwon National University Hospital, School of Medicine, Kangwon National University, Chuncheon, Gangwon-do, Republic of Korea
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Kirker K, Masaracchio MF, Loghmani P, Torres-Panchame RE, Mattia M, States R. Management of lumbar spinal stenosis: a systematic review and meta-analysis of rehabilitation, surgical, injection, and medication interventions. Physiother Theory Pract 2023; 39:241-286. [PMID: 34978252 DOI: 10.1080/09593985.2021.2012860] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Lumbar spinal stenosis (LSS) has a substantial impact on mobility, autonomy, and quality of life. Previous reviews have demonstrated inconsistent results and/or have not delineated between specific nonsurgical interventions. OBJECTIVE The purpose of this systematic review is to assess the effectiveness of interventions in the management of LSS. METHODS Eligible studies were randomized controlled trials (RCTs) or prospective studies, included patients with LSS, assessed the effectiveness of any interventions (rehabilitation, surgical, injection, medication), included at least two intervention groups, and included at least one measure of pain, disability, ambulation assessment, or LSS-specific symptoms. Eighty-five articles met inclusion criteria. Meta-analyses were conducted across outcomes. Effect sizes were calculated using Hedge's g and reported descriptively. Formal grading of evidence was conducted. RESULTS Meta-analysis comparing rehabilitation to no treatment/placebo demonstrated significant effects on pain favoring rehabilitation (mean difference, MD -1.63; 95% CI: -2.68, -0.57; I2 = 71%; p = .002). All other comparisons to no treatment/placebo revealed nonsignificant findings. The level of evidence ranged from very low to high for rehabilitation and medication versus no treatment/placebo for pain, disability, ambulation ability, and LSS symptoms. CONCLUSIONS Although the findings of this review are inconclusive regarding superiority of interventions, this accentuates the value of multimodal patient-centered care in the management of patients with LSS.
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Affiliation(s)
- Kaitlin Kirker
- Department of Physical Therapy, Long Island University, Brooklyn, NY, USA
| | | | - Parisa Loghmani
- Department of Physical Therapy, Long Island University, Brooklyn, NY, USA
| | | | - Michael Mattia
- Department of Allied Health, Kingsborough Community College, Brooklyn, NY, USA
| | - Rebecca States
- Department of Physical Therapy, Long Island University, Brooklyn, NY, USA
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Validation of a Model Predicting That Physical Activities Improve Health-Related Quality of Life in Older Japanese Adults with Pain, Dysesthesia, and Kinesiophobia after Lumbar Surgery: Structural Equation Modeling. Pain Res Manag 2022; 2022:4147497. [PMID: 35880113 PMCID: PMC9308535 DOI: 10.1155/2022/4147497] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/28/2022] [Accepted: 06/21/2022] [Indexed: 11/18/2022]
Abstract
Objectives. This study assessed the validity of a hypothesized model predicting that physical activity improves health-related quality of life (HRQOL) in older Japanese adults with pain, dysesthesia, and kinesiophobia following lumbar surgery. Methods. We included 431 elderly patients who underwent surgery for lumbar spinal stenosis at two hospitals. The frequency of physical activity, pain, dysesthesia, kinesiophobia (somatic focus and activity avoidance), and HRQOL were investigated using a questionnaire. Missing values were complemented by the stochastic regression imputation. We constructed the following model. (i) physical activity affects pain, dysesthesia, and kinesiophobia. (ii) pain, dysesthesia, and kinesiophobia separately affect HRQOL. This hypothetical model was tested by structural equation modeling. The model was improved based on a modified index. Results. Of the 431 respondents, 297 (median age 72 years, range 65–91 years; 158 men and 139 women) were analyzed (68.9%). The fit of the model improved based on the modification index and was acceptable comparative fit index, 0.948; Tucker–Lewis index, 0.919; root mean square error of approximation, 0.048 (90% confidence interval, 0.026–0.069), and standardized root mean square residual (0.046). The paths by which physical activities reduced pain or dysesthesia (standardized pass coefficients, −0.406) and somatic focus (−0.301) and consequently improved HRQOL were significant (pain/dysesthesia, −0.684; somatic focus, −0.218). Discussion. Our hypothesized model predicting that physical activity improves HRQOL in terms of pain, dysesthesia, and kinesiophobia in older Japanese adults after lumbar surgery was validated using cross-sectional data. Interventional studies on physical activity based on this model are required to establish the model.
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Kim M, Cho S, Noh Y, Goh D, Son HJ, Huh J, Kang SS, Hwang B. Changes in pain scores and walking distance after epidural steroid injection in patients with lumbar central spinal stenosis. Medicine (Baltimore) 2022; 101:e29302. [PMID: 35713433 PMCID: PMC9276438 DOI: 10.1097/md.0000000000029302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 04/27/2022] [Indexed: 11/25/2022] Open
Abstract
Lumbar spinal stenosis is a common degenerative disorder that is characterized by pain and neurogenic claudication. Previous studies have evaluated the effects of an epidural steroid injection (ESI) on spinal stenosis, based on changes to the spinal canal diameter.This study aimed to examine the impact of the ESI on pain scores and walking distance in patients with lumbar central spinal stenosis, stratified based on disease severity, which was graded according to the degree of cauda equina separation.We reviewed the medical records of patients who received the ESI for lumbar spinal central canal stenosis. A total of 128 patients were divided into moderate and severe groups, based on the degree of cauda equina separation.Relative to baseline values, 2 weeks after the ESI, the moderate group showed a significant decrease in the numeric rating scale (NRS) scores and an increase in walking distance. Meanwhile, the severe group showed a significant decrease in the NRS scores and no significant change in walking distance. The moderate group had lower NRS scores and a longer walking distance than did the severe group 2 weeks after the ESI. The proportion of patients with improved levels of satisfaction was higher in the moderate group than in the severe group.Lumbar interlaminar ESI may reduce pain scores and increase walking distance in patients with moderate lumbar spinal central canal stenosis. Patients with moderate spinal stenosis achieved better outcomes than did patients with severe stenosis.
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Carassiti M, Pascarella G, Strumia A, Russo F, Papalia GF, Cataldo R, Gargano F, Costa F, Pierri M, De Tommasi F, Massaroni C, Schena E, Agrò FE. Epidural Steroid Injections for Low Back Pain: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010231. [PMID: 35010492 PMCID: PMC8744824 DOI: 10.3390/ijerph19010231] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/19/2021] [Accepted: 12/22/2021] [Indexed: 05/03/2023]
Abstract
Low back pain represents a significant socioeconomic burden. Several nonsurgical medical treatments have been proposed for the treatment of this disabling condition. Epidural steroid injections (ESIs) are commonly used to treat lumbosacral radicular pain and to avoid surgery. Even though it is still not clear which type of conservative intervention is superior, several studies have proved that ESIs are able to increase patients' quality of life, relieve lumbosacral radicular pain and finally, reduce or delay more invasive interventions, such as spinal surgery. The aim of this narrative review is to analyze the mechanism of action of ESIs in patients affected by low back pain and investigate their current application in treating this widespread pathology.
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Affiliation(s)
- Massimiliano Carassiti
- Unit of Anaesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (G.P.); (A.S.); (R.C.); (F.G.); (F.C.); (F.E.A.)
- Correspondence:
| | - Giuseppe Pascarella
- Unit of Anaesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (G.P.); (A.S.); (R.C.); (F.G.); (F.C.); (F.E.A.)
| | - Alessandro Strumia
- Unit of Anaesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (G.P.); (A.S.); (R.C.); (F.G.); (F.C.); (F.E.A.)
| | - Fabrizio Russo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (F.R.); (G.F.P.)
| | - Giuseppe Francesco Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (F.R.); (G.F.P.)
| | - Rita Cataldo
- Unit of Anaesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (G.P.); (A.S.); (R.C.); (F.G.); (F.C.); (F.E.A.)
| | - Francesca Gargano
- Unit of Anaesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (G.P.); (A.S.); (R.C.); (F.G.); (F.C.); (F.E.A.)
| | - Fabio Costa
- Unit of Anaesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (G.P.); (A.S.); (R.C.); (F.G.); (F.C.); (F.E.A.)
| | - Michelangelo Pierri
- Integrated Sleep Surgery Team UCBM, Unit of Otolaryngology, Integrated Therapies in Otolaryngology, Campus Bio-Medico University of Rome, 00128 Rome, Italy;
| | - Francesca De Tommasi
- Unit of Measurements and Biomedical Instrumentation, Department of Engineering, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (F.D.T.); (C.M.); (E.S.)
| | - Carlo Massaroni
- Unit of Measurements and Biomedical Instrumentation, Department of Engineering, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (F.D.T.); (C.M.); (E.S.)
| | - Emiliano Schena
- Unit of Measurements and Biomedical Instrumentation, Department of Engineering, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (F.D.T.); (C.M.); (E.S.)
| | - Felice Eugenio Agrò
- Unit of Anaesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (G.P.); (A.S.); (R.C.); (F.G.); (F.C.); (F.E.A.)
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Stienen MN, Rezaii PG, Ho AL, Veeravagu A, Zygourakis CC, Tomkins-Lane C, Park J, Ratliff JK, Desai AM. Objective activity tracking in spine surgery: a prospective feasibility study with a low-cost consumer grade wearable accelerometer. Sci Rep 2020; 10:4939. [PMID: 32188895 PMCID: PMC7080733 DOI: 10.1038/s41598-020-61893-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 03/04/2020] [Indexed: 01/29/2023] Open
Abstract
Patient-reported outcome measures (PROMs) are commonly used to estimate disability of patients with spinal degenerative disease. Emerging technological advances present an opportunity to provide objective measurements of activity. In a prospective, observational study we utilized a low-cost consumer grade wearable accelerometer (LCA) to determine patient activity (steps per day) preoperatively (baseline) and up to one year (Y1) after cervical and lumbar spine surgery. We studied 30 patients (46.7% male; mean age 57 years; 70% Caucasian) with a baseline activity level of 5624 steps per day. The activity level decreased by 71% in the 1st postoperative week (p < 0.001) and remained 37% lower in the 2nd (p < 0.001) and 23% lower in the 4th week (p = 0.015). At no time point until Y1 did patients increase their activity level, compared to baseline. Activity was greater in patients with cervical, as compared to patients with lumbar spine disease. Age, sex, ethnic group, anesthesia risk score and fusion were variables associated with activity. There was no correlation between activity and PROMs, but a strong correlation with depression. Determining activity using LCAs provides real-time and longitudinal information about patient mobility and return of function. Recovery took place over the first eight postoperative weeks, with subtle improvement afterwards.
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Affiliation(s)
- Martin N Stienen
- Department of Neurosurgery, Stanford University Hospitals and Clinics, Stanford, California, USA. .,Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland. .,Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland.
| | - Paymon G Rezaii
- Department of Neurosurgery, Stanford University Hospitals and Clinics, Stanford, California, USA
| | - Allen L Ho
- Department of Neurosurgery, Stanford University Hospitals and Clinics, Stanford, California, USA
| | - Anand Veeravagu
- Department of Neurosurgery, Stanford University Hospitals and Clinics, Stanford, California, USA
| | - Corinna C Zygourakis
- Department of Neurosurgery, Stanford University Hospitals and Clinics, Stanford, California, USA
| | - Christy Tomkins-Lane
- Wearable Health Lab, Department of Physical Medicine and Rehabilitation, Stanford University Hospitals and Clinics, Stanford, California, USA.,Department of Health and Physical Education, Mount Royal University, Calgary, Alberta, Canada
| | - Jon Park
- Department of Neurosurgery, Stanford University Hospitals and Clinics, Stanford, California, USA
| | - John K Ratliff
- Department of Neurosurgery, Stanford University Hospitals and Clinics, Stanford, California, USA
| | - Atman M Desai
- Department of Neurosurgery, Stanford University Hospitals and Clinics, Stanford, California, USA
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Objective measures of functional impairment for degenerative diseases of the lumbar spine: a systematic review of the literature. Spine J 2019; 19:1276-1293. [PMID: 30831316 DOI: 10.1016/j.spinee.2019.02.014] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 02/24/2019] [Accepted: 02/24/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND CONTEXT The accurate determination of a patient's functional status is necessary for therapeutic decision-making and to critically appraise treatment efficacy. Current subjective patient-reported outcome measure (PROM)-based assessments have limitations and can be complimented by objective measures of function. PURPOSE To systematically review the literature and provide an overview on the available objective measures of function for patients with degenerative diseases of the lumbar spine. STUDY DESIGN/SETTING Systematic review of the literature. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Two reviewers independently searched the PubMed, Web of Science, EMBASE, and SCOPUS databases for permutations of the words "objective," "assessment," "function," "lumbar," and "spine" including articles on human subjects with degenerative diseases of the lumbar spine that reported on objective measures of function, published until September 2018. Risk of bias was not assessed. No funding was received. The authors report no conflicts of interest. RESULTS Of 2,389 identified articles, 82 were included in the final analysis. There was a significant increase of 0.12 per year in the number of publications dealing with objective measures of function since 1989 (95% CI 0.08-0.16, p<.001). Some publications studied multiple diagnoses and objective measures. The United States was the leading nation in terms of scientific output for objective outcome measures (n=21; 25.6%), followed by Switzerland (n=17; 20.7%), Canada, Germany, and the United Kingdom (each n=6; 7.3%). Our search revealed 21 different types of objective measures, predominantly applied to patients with lumbar spinal stenosis (n=67 publications; 81.7%), chronic/unspecific low back pain (n=28; 34.2%) and lumbar disc herniation (n=22; 26.8%). The Timed-Up-and-Go test was the most frequently applied measure (n=26 publications; 31.7%; cumulative number of reported subjects: 5,181), followed by the Motorized Treadmill Test (n=25 publications; 30.5%, 1,499 subjects) and with each n=9 publications (11.0%) the Five-Repetition Sit-To-Stand test (955 subjects), as well as accelerometry analyses (336 subjects). The reliability and validity of many of the less-applied objective measures was uncertain. There was profound heterogeneity in their application and interpretation of results. CONCLUSIONS Clinical studies on patients with lumbar degenerative diseases increasingly employ objective measures of function, which offer high potential for improving the quality of outcome measurement in patient-care and research. This review provides an overview on available options. Our findings call for an agreement and standardization in terms of test selection, conduction and analysis to facilitate comparison of results across cohorts. PROSPERO REGISTRATION NUMBER CRD42019122622.
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Seo J, Lee JW, Kang Y, Lee E, Ahn JM, Kim DH, Kang HS. Evaluation of the responsiveness of outcome measures after spine injection: A retrospective study. PLoS One 2019; 14:e0211763. [PMID: 30811428 PMCID: PMC6392275 DOI: 10.1371/journal.pone.0211763] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 01/21/2019] [Indexed: 11/25/2022] Open
Abstract
Discrepancies in patients’ responses to various outcome measures challenge clinicians’ evaluation of treatment outcomes. Therefore, we aimed to 1) evaluate the concordance of outcome measures after spine injection, 2) determine the patient variables that lead to discordant responses, and 3) suggest practical outcome measure for spine injections with good responsiveness. From October 2014 to November 2014, 164 patients with neck or low back pain who visited our outpatient clinics and had spine injections on the previous visit were enrolled. We asked patients to report changes in their symptom in the form of outcome measures: numeric rating scale, Oswestry disability index, neck disability index, residual symptom percentage and global perceived effect. The responses were categorized into three groups according to the degree of change; not improved, minimally improved, and significantly improved. The concordances of these categorized answers were evaluated. When “significantly improved” was considered as true improvement, 46 (28%) of the 164 patients had discordant responses to the four measures. There was no significant patients’ variable that affects discordance in the outcome measures. Good agreement was shown between the global perceived effect and residual symptom percentage, while the Oswestry disability index had poor agreement with the other measurements. The calculated numeric rating scale and residual symptom percentage also had low levels of agreement. However, patients with severe pre-treatment pain tended to have better agreement. In conclusion, this result suggest that the residual symptom percentage may be a more practical for clinicians and better represent patients’ improvements after spine injection.
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Affiliation(s)
- Jiwoon Seo
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Joon Woo Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
- * E-mail:
| | - Yusuhn Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Eugene Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Joong Mo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Dong Hyun Kim
- Department of Radiology, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Heung Sik Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
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Przkora R, Kinsky MP, Fisher SR, Babl C, Heyde CE, Vasilopoulos T, Kaye AD, Volpi E. Functional Improvements Utilizing the Short Physical Performance Battery (SPPB) in the Elderly after Epidural Steroid Injections. Curr Pain Headache Rep 2019; 23:14. [PMID: 30796532 DOI: 10.1007/s11916-019-0748-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE OF REVIEW The treatment of debilitating pain and loss of function secondary to lumbar stenosis is in high demand with the aging patient population. Options, including epidural steroid injections (ESIs) and medication therapy, are limited and it is unclear if they provide any functional improvements. In this prospective study, we evaluate functional outcomes in older adults with symptomatic lumbar stenosis treated with ESIs compared to those managed with medications by introducing the Short Physical Performance Battery (SPPB). Our study was IRB-approved and included 16 patients, 68 to 83 years old, with symptomatic back and radicular leg pain secondary to lumbar stenosis. Patients could elect to undergo a lumbar ESI (n = 11) or be treated via medication management (n = 5). Numeric pain score, SPPB score, and adverse events were measured and compared at baseline and a 1-month follow-up visit. RECENT FINDINGS Statistically significant improvements were observed from baseline compared to the 1-month follow-up for total SPPB score in the injection group. Similar improvements in the injection group were observed for pain scores and the SPPB subcomponents such as the 4-m walk test, chair stand time, and balance score. Comparatively, no statistically significant improvements were observed in the medication group. Lumbar ESIs improved objective physical capacity parameters and pain scores in elderly patients with symptomatic lumbar stenosis compared to medication management. In addition, the SPPB is an easy-to-use tool to measure changes in physical function in older adults and could easily be integrated into an outpatient pain clinic.
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Affiliation(s)
- Rene Przkora
- Department of Anesthesiology, University of Florida College of Medicine, SW Archer Road, PO Box 100254, Gainesville, FL, 32610, USA.
| | - Michael P Kinsky
- Departments of Anesthesiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Steve R Fisher
- Departments of Physical Therapy, University of Texas Medical Branch, Galveston, TX, USA
| | - Christopher Babl
- Department of Anesthesiology, University of Florida College of Medicine, SW Archer Road, PO Box 100254, Gainesville, FL, 32610, USA
| | - Christoph E Heyde
- Department of Orthopaedic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Terrie Vasilopoulos
- Department of Anesthesiology, University of Florida College of Medicine, SW Archer Road, PO Box 100254, Gainesville, FL, 32610, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, LA, USA
| | - Elena Volpi
- Internal Medicine-Geriatrics, University of Texas Medical Branch, Galveston, TX, USA
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Tomkins-Lane C, Norden J, Sinha A, Hu R, Smuck M. Digital biomarkers of spine and musculoskeletal disease from accelerometers: Defining phenotypes of free-living physical activity in knee osteoarthritis and lumbar spinal stenosis. Spine J 2019; 19:15-23. [PMID: 30025995 DOI: 10.1016/j.spinee.2018.07.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 07/03/2018] [Accepted: 07/05/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Lumbar spinal stenosis (LSS) and knee osteoarthritis (OA) are 2 of the leading causes of disability worldwide. In order to provide disease-specific prescriptions for physical activity, there is a clear need to better understand physical activity in daily life (performance) in these populations. PURPOSE To discover performance phenotypes for LSS and OA by applying novel analytical methods to accelerometry data. Specific objectives include the following: (1) to identify characteristic features (phenotypes) of free-living physical activity unique to individuals with LSS and OA, and (2) to determine which features can best differentiate between these conditions. STUDY DESIGN AND SETTING Leveraging data from 3 existing cross-sectional cohorts, accelerometry signal feature characterization and selection were performed in a computational laboratory. PATIENT SAMPLE Data from a total of 4,028 individuals were analyzed from the following 3 datasets: LSS Accelerometry Database (n=75); OA Initiative (n=1950); and the 2003 to 2004 National Health and Nutrition Examination Survey (pain-free controls, n=2003). METHODS In order to characterize the accelerometry signals, data were examined using (1) standard intervals for counts/minute from Freedson et al. and (2) the physical performance intervals for mobility-limited pain populations. From this, 42 novel accelerometry features were defined and evaluated for significance in discriminating between the groups (LSS, OA, and controls) in order to then determine which sparse set of features best differentiates between the groups. These sparse sets of features defined the performance phenotypes. OUTCOME MEASURES Accelerometry features and their ability to differentiate between individuals with LSS, OA, and controls. RESULTS Given age and gender, classification rates were at least 80% accurate (pairwise) between diseased and pain-free populations (LSS vs. controls and OA vs. controls). The most important features to distinguish between disease groups corresponded to measures in the light and sedentary activity intervals. The more subtle classification between diseased populations (LSS vs. OA) was 72% accurate, with light and moderate activity providing the prominent distinguishing features. CONCLUSIONS We describe the discovery of performance phenotypes of LSS and OA from accelerometry data, revealed through a novel set of features that characterize daily patterns of movement in people with LSS and OA. These performance phenotypes provide a new method for analyzing free-living physical activity (performance) in LSS and OA, and provide the groundwork for more personalized approaches to measuring and improving function.
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Affiliation(s)
- Christy Tomkins-Lane
- Department of Health and Physical Education, Mount Royal University, 4825 Mount Royal Gate SW, Calgary, AB T3E 6K6, Canada.
| | - Justin Norden
- Stanford University School of Medicine, 291 Campus Drive, Li Ka Shing Building, Stanford, CA 94305, USA
| | - Aman Sinha
- Department of Electrical Engineering, Stanford University, 350 Serra Mall, Stanford, CA 94305, USA
| | - Richard Hu
- Department of Surgery, University of Calgary, 1403 29 St NW, Calgary, AB T2N 2T9, Canada
| | - Matthew Smuck
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway, Redwood City, CA 94063, USA
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Chuan Yen T, Mohler J, Dohm M, Laksari K, Najafi B, Toosizadeh N. The Effect of Pain Relief on Daily Physical Activity: In-Home Objective Physical Activity Assessment in Chronic Low Back Pain Patients after Paravertebral Spinal Block. SENSORS 2018; 18:s18093048. [PMID: 30213036 PMCID: PMC6163962 DOI: 10.3390/s18093048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 09/09/2018] [Accepted: 09/10/2018] [Indexed: 11/16/2022]
Abstract
This study evaluates the effect of paravertebral spinal injection (PSI), utilizing both subjective and objective assessments in chronic low back pain (LBP) associated with facet joint arthrosis over a one-month duration. Subjective questionnaires included the visual analogue scale (VAS) for pain, the Oswestry Disability Index, the Health Survey SF-12, and the short Falls Efficacy Scale International (FES-I). Objective assessments included in-clinic gait and Timed Up and Go (TUG) tests using wearable sensors, as well as 48 h daily physical activity (DPA) monitored using a chest-worn triaxial accelerometer. Subjective and objective measures were performed prior to treatment, immediately after the treatment, and one month after the treatment. Eight LBP patients were recruited for this study (mean age = 54 ± 13 years, body mass index = 31.41 ± 6.52 kg/m², 50% males). Results show significant decrease in pain (~55%, p < 0.05) and disability (Oswestry scores, ~21%, p < 0.05). In-clinic gait and TUG were also significantly improved (~16% and ~18% faster walking and shorter TUG, p < 0.05); however, DPA, including the percentage of physical activities (walking and standing) and the number of steps, showed no significant change after PSI (p > 0.25; effect size ≤ 0.44). We hypothesize that DPA may continue to be truncated to an extent by conditioned fear-avoidance, a psychological state that may prevent increase in daily physical activity to avoid pain.
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Affiliation(s)
- Tzu Chuan Yen
- Arizona Center on Aging, Department of Medicine, University of Arizona, Tucson, AZ 85719, USA.
- Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA.
| | - Jane Mohler
- Arizona Center on Aging, Department of Medicine, University of Arizona, Tucson, AZ 85719, USA.
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ 85719, USA.
- Division of Geriatrics, General Internal Medicine and Palliative Medicine, Department of Medicine, University of Arizona, Tucson, AZ 85719, USA.
| | - Michael Dohm
- Department of Orthopaedic Surgery, University of Arizona, Tucson, AZ 85719, USA.
| | - Kaveh Laksari
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ 85719, USA.
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance, Division of Vascular Surgery and Endovascular Therapy, Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
| | - Nima Toosizadeh
- Arizona Center on Aging, Department of Medicine, University of Arizona, Tucson, AZ 85719, USA.
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ 85719, USA.
- Division of Geriatrics, General Internal Medicine and Palliative Medicine, Department of Medicine, University of Arizona, Tucson, AZ 85719, USA.
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Fishchenko IV, Kravchuk LD, Perepechay OA. Lumbar spinal stenosis: symptoms, diagnosis and treatment (meta-analysis of literature data). PAIN MEDICINE 2018. [DOI: 10.31636/pmjua.v3i1.83] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Lumbar spinal stenosis is a disease in which degenerated discs, ligamentum flavum, facet joints, while aging, lead to a narrowing of the space around the neurovascular structures of the spine. This article presents a meta-analysis of literature data on epidemiology, causes, pathogenesis, diagnosis and various types of treatment of lumbar spinal stenosis.
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Correlation between the Oswestry Disability Index and objective measurements of walking capacity and performance in patients with lumbar spinal stenosis: a systematic literature review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:1604-1613. [PMID: 29508075 DOI: 10.1007/s00586-018-5520-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 01/31/2018] [Accepted: 02/10/2018] [Indexed: 01/19/2023]
Abstract
PURPOSE The Oswestry Disability Index (ODI) plays a significant role in lumbar spinal stenosis research and is used to assess patient's walking limitations. The World Health Organisation describes the constructs of walking capacity and performance and recommend measuring both to fully describe patient's walking ability. Objective methods to assess walking capacity and performance is being investigated and used alongside the traditional use of PROs. This review of the literature was made to provide an overview of relations between the ODI and outcome measures of walking capacity and performance in spinal stenosis research, and to provide a strategy for improving such measures in future research. METHODS The review was conducted according to the Prisma Statement. In February 2017, a search was performed in Pubmed, Embase and Cochrane database. Authors independently screened articles by title, abstract, and full text, and studies were included if both authors agreed. Articles with correlation analysis between the ODI, walking capacity and performance measures by accelerometer or GPS were included. RESULTS The results support a correlation between the ODI and walking capacity measures. The available studies using ODI and accelerometers were too few to reach a conclusion regarding correlation between ODI and walking performance. No articles with GPS measure were identified. CONCLUSIONS The ODI should not stand alone when evaluating walking limitations in patients with lumbar spinal stenosis. To enable a comprehensive assessment of walking ability, a walking test should be used to assess walking capacity and accelerometers should be investigated and standardized in measuring walking performance. These slides can be retrieved under Electronic Supplementary Material.
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Abstract
STUDY DESIGN Longitudinal cohort. OBJECTIVE To determine the cost per quality-adjusted life-year for lumbar epidural steroid injections (LESI). SUMMARY OF BACKGROUND DATA Despite being a widely performed procedure, there are few studies evaluating the cost-effectiveness of LESIs. METHODS Patients who had received LESI between June 2012 and July 2013 with EuroQOL-5D (EQ-5D) scores available before and after LESIs but before any surgical intervention were identified. Costs were calculated on the basis of the Medicare Fee Schedule multiplied by the number of LESIs received between the 2 clinic visits. Quality-adjusted life-years (QALYs) were calculated using the EQ-5D. RESULTS Of 421 patients who had pre-LESI EQ-5D data, 323 (77%) had post-LESI data available; 200 females, 123 males, mean age: 59.2 ± 14.2 years. Cost per LESI was $608, with most patients receiving 3 LESIs for more than 1 year (range: 1-6 yr). Mean QALY gained was 0.005. One hundred forty-five patients (45%) had a QALY gain (mean = 0.117) at a cost of $62,175 per QALY gained; 127 patients (40%) had a loss in QALY (mean = -0.120) and 51 patients (15%) had no change in QALY. Fourteen of the 145 patients who improved, and 29 of the 178 patients who did not, have medical comorbidities that precluded surgery. Thirty-two (22%) of 131 patients without medical comorbidities who improved and 57 (32%) of 149 patients without medical comorbidities who did not improve subsequently had undergone surgery (P = 0.015). CONCLUSION LESI may not be cost-effective in patients with lumbar degenerative disorders. For the 145 patients who improved, cost per QALY gained was acceptable at $62,175. However, for the 178 patients with no gain or a loss in QALY, the economics are not reportable with a cost per QALY gained being theoretically infinite. Further studies are needed to identify specific patient populations who will benefit from LESI because the economic viability of LESI requires improved patient selection. LEVEL OF EVIDENCE 2.
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Kim MS, Jeong TY, Cheong YS, Jeon YW, Lim SY, Kang SS, Kim IN, Chang TB, Seong HH, Hwang BM. Effect of epidural corticosteroid injection on magnetic resonance imaging findings. Korean J Pain 2017; 30:281-286. [PMID: 29123623 PMCID: PMC5665740 DOI: 10.3344/kjp.2017.30.4.281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 08/25/2017] [Accepted: 09/19/2017] [Indexed: 01/31/2023] Open
Abstract
Background Magnetic resonance imaging (MRI) of the spine is the preferred diagnostic tool for pathologic conditions affecting the spine. However, in patients receiving epidural corticosteroid injection (ESI) for treatment of spinal diseases, there is a possibility of misreading of MR images because of air or fluid in the epidural space after the injection. Therefore, we defined the characteristics of abnormal changes in MRI findings following an ESI in patients with low back pain. Methods We reviewed the medical records of 133 patients who underwent MRI of the lumbar spine within 7 days after ESI between 2006 and 2015.All patients were administered an ESI using a 22-gauge Tuohy needle at the lumbar spine through the interlaminar approach. The epidural space was identified by the loss of resistance technique with air. Results The incidences of abnormal changes in MRI findings because of ESI were 54%, 31%, and 25% in patients who underwent MRI at approximately 24 h, and 2 and 3 days after ESI, respectively. Abnormal MRI findings included epidural air or fluid, needle tracks, and soft tissue changes. Epidural air, the most frequent abnormal finding (82%), was observed in 41% of patients who underwent MRI within 3 days after injection. Abnormal findings due to an ESI were not observed in MR images acquired 4 days after ESI or later. Conclusions Pain physicians should consider the possibility of abnormal findings in MR images acquired after epidural injection using the interlaminar approach and the loss of resistance technique with air at the lumbar spine.
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Affiliation(s)
- Min Soo Kim
- Department of Anesthesiology and Pain Medicine, Institute of Medical Sciences, Kangwon National University Hospital, School of Medicine, Chuncheon, Korea
| | - Tae Yoon Jeong
- Department of Anesthesiology and Pain Medicine, Institute of Medical Sciences, Kangwon National University Hospital, School of Medicine, Chuncheon, Korea
| | - Yu Seon Cheong
- Department of Anesthesiology and Pain Medicine, Institute of Medical Sciences, Kangwon National University Hospital, School of Medicine, Chuncheon, Korea
| | - Young Wook Jeon
- Department of Radiology, Institute of Medical Sciences, Kangwon National University Hospital, School of Medicine, Chuncheon, Korea
| | - So Young Lim
- Department of Anesthesiology and Pain Medicine, Institute of Medical Sciences, Hallym University Hospital, School of Medicine, Chuncheon, Korea
| | - Seong Sik Kang
- Department of Anesthesiology and Pain Medicine, Institute of Medical Sciences, Kangwon National University Hospital, School of Medicine, Chuncheon, Korea
| | - In Nam Kim
- Department of Anesthesiology and Pain Medicine, Institute of Medical Sciences, Kangwon National University Hospital, School of Medicine, Chuncheon, Korea
| | - Tsong Bin Chang
- Department of Anesthesiology and Pain Medicine, Institute of Medical Sciences, Kangwon National University Hospital, School of Medicine, Chuncheon, Korea
| | - Hyun Ho Seong
- Department of Anesthesiology and Pain Medicine, Institute of Medical Sciences, Kangwon National University Hospital, School of Medicine, Chuncheon, Korea
| | - Byeong Mun Hwang
- Department of Anesthesiology and Pain Medicine, Institute of Medical Sciences, Kangwon National University Hospital, School of Medicine, Chuncheon, Korea
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Smuck M, Tomkins-Lane C, Ith MA, Jarosz R, Kao MCJ. Physical performance analysis: A new approach to assessing free-living physical activity in musculoskeletal pain and mobility-limited populations. PLoS One 2017; 12:e0172804. [PMID: 28235039 PMCID: PMC5325560 DOI: 10.1371/journal.pone.0172804] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 02/09/2017] [Indexed: 11/22/2022] Open
Abstract
Background Accurate measurement of physical performance in individuals with musculoskeletal pain is essential. Accelerometry is a powerful tool for this purpose, yet the current methods designed to evaluate energy expenditure are not optimized for this population. The goal of this study is to empirically derive a method of accelerometry analysis specifically for musculoskeletal pain populations. Methods We extracted data from 6,796 participants in the 2003–4 National Health and Nutrition Examination Survey (NHANES) including: 7-day accelerometry, health and pain questionnaires, and anthropomorphics. Custom macros were used for data processing, complex survey regression analyses, model selection, and statistical adjustment. After controlling for a multitude of variables that influence physical activity, we investigated whether distinct accelerometry profiles accompany pain in different locations of the body; and we identified the intensity intervals that best characterized these profiles. Results Unique accelerometry profiles were observed for pain in different body regions, logically clustering together based on proximity. Based on this, the following novel intervals (counts/minute) were identified and defined: Performance Sedentary (PSE) = 1–100, Performance Light 1 (PL1) = 101–350, Performance Light 2 (PL2) = 351–800, Performance Light 3 (PL3) = 801–2500, and Performance Moderate/Vigorous (PMV) = 2501–30000. The refinement of accelerometry signals into these new intervals, including 3 distinct ranges that fit inside the established light activity range, best captures alterations in real-life physical performance as a result of regional pain. Discussion and conclusions These new accelerometry intervals provide a model for objective measurement of real-life physical performance in people with pain and musculoskeletal disorders, with many potential uses. They may be used to better evaluate the relationship between pain and daily physical function, monitor musculoskeletal disease progression, gauge disease severity, inform exercise prescription, and quantify the functional impact of treatments. Based on these findings, we recommend that future studies of pain and musculoskeletal disorders analyze accelerometry output based on these new “physical performance” intervals.
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Affiliation(s)
- Matthew Smuck
- PM&R Section, Department of Orthopaedic Surgery, Stanford University, Redwood City, California, United States of America
- Wearable Health Lab, Department of Orthopaedic Surgery, Stanford University, Redwood City, California, United States of America
- * E-mail:
| | - Christy Tomkins-Lane
- Wearable Health Lab, Department of Orthopaedic Surgery, Stanford University, Redwood City, California, United States of America
- Department of Physical Education & Recreation, Mount Royal University, Calgary, Canada
| | - Ma Agnes Ith
- PM&R Section, Department of Orthopaedic Surgery, Stanford University, Redwood City, California, United States of America
- Wearable Health Lab, Department of Orthopaedic Surgery, Stanford University, Redwood City, California, United States of America
| | - Renata Jarosz
- PM&R Section, Department of Orthopaedic Surgery, Stanford University, Redwood City, California, United States of America
| | - Ming-Chih Jeffrey Kao
- Wearable Health Lab, Department of Orthopaedic Surgery, Stanford University, Redwood City, California, United States of America
- Department of Anesthesia and Pain Management, Stanford University, Redwood City, California, United States of America
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Norden J, Smuck M, Sinha A, Hu R, Tomkins-Lane C. Objective measurement of free-living physical activity (performance) in lumbar spinal stenosis: are physical activity guidelines being met? Spine J 2017; 17:26-33. [PMID: 27793759 PMCID: PMC5520978 DOI: 10.1016/j.spinee.2016.10.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 08/25/2016] [Accepted: 10/17/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND Research suggests that people with lumbar spinal stenosis (LSS) would benefit from increased physical activity. Yet, to date, we do not have disease-specific activity guidelines for LSS, and the nature of free-living physical activity (performance) in LSS remains unknown. LSS care providers could endorse the 2008 United States Physical Activity Guidelines; however, we do not know if this is realistic. The goal of the present study was to determine the proportion of individuals with LSS meeting the 2008 Guidelines. A secondary goal was to better understand the nature of physical performance in this population. STUDY DESIGN Retrospective study. PATIENT SAMPLE People from the Lumbar Spinal Stenosis Accelerometry Database, all of whom have both radiographic and clinical LSS and are seeking various treatments for their symptoms. OUTCOME MEASURES Seven-day accelerometry (functional outcome) and demographics (self-reported). METHODS For the present study, we analyzed only baseline data that were obtained before any new treatments. Patients with at least 4 valid days of baseline accelerometry data were included. We determined the proportion of individuals with LSS meeting the 2008 US Physical Activity Guidelines of at least 150 minutes of moderate-vigorous (MV) physical activity per week in bouts of 10 minutes or more. We also used the novel Physical Performance analysis designed by our group to determine time spent in varying intensities of activity. There are no conflicts of interest to disclose. RESULTS We analyzed data from 75 individuals with a mean age of 68 (SD 9), 37% of whom were male. Three people (4%) were considered Meeting Guidelines (at least 150 MV minutes/week), and 56 (75%) were considered Inactive with not even 1 MV minute/week. With the 10-minute bout requirement removed, 10 of 75 (13%) achieved the 150-minute threshold. The average time spent in sedentary activity was 82%, and of time spent in nonsedentary activity, 99.6% was in the light activity range. CONCLUSIONS In conclusion, the present study confirms that people with symptomatic LSS, neurogenic claudication, walking limitations, and LSS-related disability are extremely sedentary and are not meeting guidelines for physical activity. There is an urgent need for interventions aimed at reducing sedentary behavior and increasing the overall level of physical activity in LSS, not only to improve function but also to prevent diseases of inactivity. The present study suggests that reducing sedentary time, increasing time spent in light intensity activity, and increasing time spent in higher intensities of light activity may be appropriate as initial goals for exercise interventions in people with symptomatic LSS and neurogenic claudication, transitioning to moderate activity when appropriate. Results of the present study also demonstrate the importance of employing disease-specific measures for assessment of performance in LSS, and highlight the potential value of these methods for developing targeted and realistic goals for physical activity. Physical activity goals could be personalized using objective assessment of performance with accelerometry. The present study is one step toward a personalized medicine approach for people with LSS, focusing on increasing physical function.
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Affiliation(s)
- Justin Norden
- Stanford University School of Medicine, 291 Campus Dr, Li Ka Shing Building, Stanford, CA, 94305, USA,Department of Orthopaedic Surgery, Stanford University, 450 Broadway, Redwood City, CA 94063, USA
| | - Matthew Smuck
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway, Redwood City, CA 94063, USA
| | - Aman Sinha
- Department of Electrical Engineering, Stanford University, 350 Serra Mall, Stanford, CA 94305, USA
| | - Richard Hu
- Department of Surgery, University of Calgary, 1403 29 St NW, Calgary, AB T2N 2T9, Canada
| | - Christy Tomkins-Lane
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway, Redwood City, CA 94063, USA; Department of Health and Physical Education, Mount Royal University, 4825 Mount Royal Gate SW, Calgary, AB T3E 6K6, Canada.
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Paravertebral spinal injection for the treatment of patients with degenerative facet osteoarthropathy: Evidence of motor performance improvements based on objective assessments. Clin Biomech (Bristol, Avon) 2016; 39:100-108. [PMID: 27744005 PMCID: PMC5159257 DOI: 10.1016/j.clinbiomech.2016.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 10/06/2016] [Accepted: 10/07/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study examined short- and long-term improvements in motor performance, quantified using wearable sensors, in response to facet spine injection in degenerative facet osteoarthropathy patients. METHODS Adults with confirmed degenerative facet osteoarthropathy were recruited and were treated with medial or intermediate branch block injection. Self-report pain, health condition, and disability (Oswestry), as well as objective motor performance measures (gait, balance, and timed-up-and-go) were obtained in five sessions: pre-surgery (baseline), immediately after the injection, one-month, three-month, and 12-month follow-ups. Baseline motor performance parameters were compared with 10 healthy controls. FINDINGS Thirty patients (age=50 (14) years) and 10 controls (age=46 (15) years) were recruited. All motor performance parameters were significantly different between groups. Results showed that average pain and Oswestry scores improved by 51% and 24%, respectively among patients, only one month after injection. Similarly, improvement in motor performance was most noticeable in one-month post-injection measurements; most improvements were observed in gait speed (14% normal walking, P<0.02), hip sway within balance tests (63% eyes-open P<0.01), and turning velocity within the timed-up-and-go test (28%, P<0.02). Better baseline motor performance led to better outcomes in terms of pain relief; baseline turning velocity was 18% faster among the responsive compared to the non-responsive patients. INTERPRETATIONS Spinal injection can temporarily (one to three months) improve motor performance in degenerative facet osteoarthropathy patients. Successful pain relief in response to treatment is independent of demographic characteristics and initial pain but dependent on baseline motor performance. Immediate self-reported pain relief is unrelated to magnitude of gradual improvement in motor performance.
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Abstract
STUDY DESIGN A systematic review. OBJECTIVES The aim of this study is to evaluate the effectiveness of different types of surgery compared with different types of nonsurgical interventions in adults with symptomatic lumbar spinal stenosis (LSS). SUMMARY OF BACKGROUND DATA LSS is a debilitating condition associated with degeneration of the spine with aging. People with LSS experience a range of symptoms, including back pain, leg pain, numbness and tingling in the legs, and reduced physical function. Main treatment options are surgery, physical therapy, exercise, braces, and injections into the spine. METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, five other databases, and two trials registries up to February 2015, reference lists, and conference proceedings related to treatment of the spine. Randomized controlled trials (RCTs) compared surgical versus nonoperative treatments in participants with LSS.Outcomes included quality of life, disability, function, pain, complication rates, and side effects. RESULTS From the 12,966 citations screened, we included five RCTs (643 participants).Three studies compared spine surgery versus various types of nonsurgical treatment. It is difficult to draw conclusions from these studies because nonsurgical treatments were inadequately described. One study that compared surgery versus bracing and exercise found no differences in pain. Another study compared surgery versus spinal injections and found better physical function with injections, and better pain relief with surgery at six weeks. Still another trial compared surgery with an implanted device versus nonsurgical care. This study reported favorable outcomes of surgery for symptoms and physical function. CONCLUSION We cannot conclude on the basis of this review whether surgical or nonsurgical treatment is better for individuals with LSS. Nevertheless, we can report on the high rate of effects reported in three of five surgical groups, ranging from 10% to 24%. No side effects were reported for any of the conservative treatment options. LEVEL OF EVIDENCE 1.
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Lee SI, Park E, Huang A, Mortazavi B, Garst JH, Jahanforouz N, Espinal M, Siero T, Pollack S, Afridi M, Daneshvar M, Ghias S, Lu DC, Sarrafzadeh M. Objectively quantifying walking ability in degenerative spinal disorder patients using sensor equipped smart shoes. Med Eng Phys 2016; 38:442-9. [PMID: 26970892 DOI: 10.1016/j.medengphy.2016.02.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 11/27/2015] [Accepted: 02/07/2016] [Indexed: 02/04/2023]
Abstract
Lumbar spinal stenosis (LSS) is a condition associated with the degeneration of spinal disks in the lower back. A significant majority of the elderly population experiences LSS, and the number is expected to grow. The primary objective of medical treatment for LSS patients has focused on improving functional outcomes (e.g., walking ability) and thus, an accurate, objective, and inexpensive method to evaluate patients' functional levels is in great need. This paper aims to quantify the functional level of LSS patients by analyzing their clinical information and their walking ability from a 10 m self-paced walking test using a pair of sensorized shoes. Machine learning algorithms were used to estimate the Oswestry Disability Index, a clinically well-established functional outcome, from a total of 29 LSS patients. The estimated ODI scores showed a significant correlation to the reported ODI scores with a Pearson correlation coefficient (r) of 0.81 and p<3.5×10(-11). It was further shown that the data extracted from the sensorized shoes contribute most to the reported estimation results, and that the contribution of the clinical information was minimal. This study enables new research and clinical opportunities for monitoring the functional level of LSS patients in hospital and ambulatory settings.
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Affiliation(s)
- Sunghoon Ivan Lee
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Charlestown, MA 02129, USA; Spaulding Rehabilitation Hospital, Charlestown, MA 02129, USA; Computer Science Department, UCLA, Los Angeles, CA 90095, USA; Wireless Health Institute, UCLA, Los Angeles, CA 90095, USA.
| | - Eunjeong Park
- Computer Science Department, UCLA, Los Angeles, CA 90095, USA; Wireless Health Institute, UCLA, Los Angeles, CA 90095, USA.
| | - Alex Huang
- Department of Neurosurgery, UCLA, Los Angeles, CA 90095, USA.
| | - Bobak Mortazavi
- Computer Science Department, UCLA, Los Angeles, CA 90095, USA; Wireless Health Institute, UCLA, Los Angeles, CA 90095, USA; Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT 06510, USA.
| | | | | | - Marie Espinal
- Department of Neurosurgery, UCLA, Los Angeles, CA 90095, USA
| | - Tiffany Siero
- Department of Neurosurgery, UCLA, Los Angeles, CA 90095, USA
| | - Sophie Pollack
- Department of Neurosurgery, UCLA, Los Angeles, CA 90095, USA
| | - Marwa Afridi
- Department of Neurosurgery, UCLA, Los Angeles, CA 90095, USA
| | | | - Saif Ghias
- Department of Neurosurgery, UCLA, Los Angeles, CA 90095, USA
| | - Daniel C Lu
- Department of Neurosurgery, UCLA, Los Angeles, CA 90095, USA; Neuroplasticity and Repair Laboratory, UCLA, Los Angeles, CA 90095, USA; Neuromotor Recovery and Rehabilitation Center, UCLA, Los Angeles, CA 90095, USA; Department of Orthopaedic Surgery, UCLA, Los Angeles, CA 90095, USA.
| | - Majid Sarrafzadeh
- Computer Science Department, UCLA, Los Angeles, CA 90095, USA; Wireless Health Institute, UCLA, Los Angeles, CA 90095, USA.
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Abstract
Lumbar spinal stenosis (LSS) affects more than 200,000 adults in the United States, resulting in substantial pain and disability. It is the most common reason for spinal surgery in patients over 65 years. Lumbar spinal stenosis is a clinical syndrome of pain in the buttocks or lower extremities, with or without back pain. It is associated with reduced space available for the neural and vascular elements of the lumbar spine. The condition is often exacerbated by standing, walking, or lumbar extension and relieved by forward flexion, sitting, or recumbency. Clinical care and research into lumbar spinal stenosis is complicated by the heterogeneity of the condition, the lack of standard criteria for diagnosis and inclusion in studies, and high rates of anatomic stenosis on imaging studies in older people who are completely asymptomatic. The options for non-surgical management include drugs, physiotherapy, spinal injections, lifestyle modification, and multidisciplinary rehabilitation. However, few high quality randomized trials have looked at conservative management. A systematic review concluded that there is insufficient evidence to recommend any specific type of non-surgical treatment. Several different surgical procedures are used to treat patients who do not improve with non-operative therapies. Given that rapid deterioration is rare and that symptoms often wax and wane or gradually improve, surgery is almost always elective and considered only if sufficiently bothersome symptoms persist despite trials of less invasive interventions. Outcomes (leg pain and disability) seem to be better for surgery than for non-operative treatment, but the evidence is heterogeneous and often of limited quality.
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Affiliation(s)
- Jon Lurie
- Department of Medicine, Dartmouth Medical School, Dartmouth Hitchock Medical Center, NH, USA
| | - Christy Tomkins-Lane
- Department of Health and Physical Education, Mount Royal University, Calgary, Canada
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Tomkins-Lane CC, Lafave LMZ, Parnell JA, Rempel J, Moriartey S, Andreas Y, Wilson PM, Hepler C, Ray HA, Hu R. The spinal stenosis pedometer and nutrition lifestyle intervention (SSPANLI): development and pilot. Spine J 2015; 15:577-86. [PMID: 25452012 DOI: 10.1016/j.spinee.2014.10.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 07/17/2014] [Accepted: 10/16/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Owing to mobility limitations, people with lumbar spinal stenosis (LSS) are at risk for diseases of inactivity, including obesity. Therefore, weight management in LSS is critical. Body mass index is the strongest predictor of function in LSS, suggesting that weight loss may promote physical activity and provide a unique treatment option. We propose a lifestyle modification approach of physical activity and nutrition education, delivered through an e-health platform. PURPOSE The purpose of this study was to develop and pilot an e-health intervention aimed at increasing physical activity and decreasing fat mass in people with LSS. STUDY DESIGN The study design was based on intervention development and pilot. PATIENT SAMPLE Ten overweight or obese individuals with LSS were confirmed clinically and on imaging. OUTCOME MEASURES Self-reported measures were food record, Short-Form 36 (SF-36), pain scales, Swiss Spinal Stenosis Symptom and Physical Function Scales, Oswestry Disability Index (ODI), Pain Catastrophizing Questionnaire, Tampa Scale for Kinesiophobia, Center for Epidemiologic Studies(Depression) Scale, Behavioral Regular in Exercise Questionnaire, and Regulation for Eating Behavior Scale and physiologic measures were dual-energy X-ray absorptiometry (DXA), blood draw, 7-day accelerometry, self-paced walking test, and balance test. METHODS The e-health platform was developed. INTERVENTION during Week 1, participants received a pedometer and a personalized consultation with a dietitian and an exercise physiologist. For 12 weeks, participants logged on to the e-health Web site to access personal step goals, nutrition education videos, and a discussion board. Follow-up occurred at Week 13. RESULTS Nine participants had a mean age of 67.5±6.7 years (60% women). Significant improvements were observed for fat mass (DXA), trunk fat mass, symptom severity (Swiss Symptom Scale), energy intake, maximum continuous activity (accelerometry), and mental health (SF-36) (p<.05). Nonsignificant improvements were observed for waist circumference, pain, ODI, and obesity biomarkers. Seventy percent lost weight, 50% increased walking capacity, and 60% increased quality of life. The mean increase in steps was 15%. CONCLUSIONS The spinal stenosis pedometer and nutrition lifestyle intervention was shown to be feasible, attractive to participants, and effective in this small sample. This intervention provides people with LSS the opportunity to participate in their own health management, potentially improving access to care. Efficacy is currently being assessed in a randomized trial.
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Affiliation(s)
- Christy C Tomkins-Lane
- Department of Physical Education and Recreation Studies, Mount Royal University, 4825 Mt Royal Gate SW, Calgary, Alberta, Canada T3E 6K6.
| | - Lynne M Z Lafave
- Department of Physical Education and Recreation Studies, Mount Royal University, 4825 Mt Royal Gate SW, Calgary, Alberta, Canada T3E 6K6
| | - Jill A Parnell
- Department of Physical Education and Recreation Studies, Mount Royal University, 4825 Mt Royal Gate SW, Calgary, Alberta, Canada T3E 6K6
| | - Jocelyn Rempel
- Department of Nursing, Mount Royal University, 4825 Mt Royal Gate SW, Calgary, Alberta, Canada T3E 6K6
| | - Stephanie Moriartey
- Southport Atrium-Cubicle #1510, Alberta Health Services, 10301 Southport Ln SW, Calgary, Alberta, Canada T2W 1S7
| | - Yvette Andreas
- Office of Research Services, Mount Royal University, 4825 Mt Royal Gate SW, Calgary, Alberta, Canada T3E 6K6
| | - Philip M Wilson
- Department of Kinesiology, Brock University, WC25, 500 Glenridge Ave., St Catharines, Ontario, Canada L2S 3A1
| | - Charles Hepler
- Department of Computer Science and Information Systems, Mount Royal University, 4825 Mt Royal Gate SW, Calgary, Alberta, Canada T3E 6K6
| | - Heather A Ray
- Department of Physical Education and Recreation Studies, Mount Royal University, 4825 Mt Royal Gate SW, Calgary, Alberta, Canada T3E 6K6
| | - Richard Hu
- Department of Surgery, University of Calgary, Foothills Medical Centre, Rm 0492, McCaig Tower, 3134 Hospital Dr NW, Calgary, Alberta, Canada T2N 5A1
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Manchikanti L, Kaye AD, Manchikanti K, Boswell M, Pampati V, Hirsch J. Efficacy of epidural injections in the treatment of lumbar central spinal stenosis: a systematic review. Anesth Pain Med 2015; 5:e23139. [PMID: 25789241 PMCID: PMC4350165 DOI: 10.5812/aapm.23139] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 09/12/2014] [Indexed: 12/13/2022] Open
Abstract
Context: Lumbar central spinal stenosis is common and often results in chronic persistent pain and disability, which can lead to multiple interventions. After the failure of conservative treatment, either surgical or nonsurgical modalities such as epidural injections are contemplated in the management of lumbar spinal stenosis. Evidence Acquisition: Recent randomized trials, systematic reviews and guidelines have reached varying conclusions about the efficacy of epidural injections in the management of central lumbar spinal stenosis. The aim of this systematic review was to determine the efficacy of all three anatomical epidural injection approaches (caudal, interlaminar, and transforaminal) in the treatment of lumbar central spinal stenosis. A systematic review was performed on randomized trials published from 1966 to July 2014 of all types of epidural injections used in the management of lumbar central spinal stenosis. Methodological quality assessment and grading of the evidence was performed. Results: The evidence in managing lumbar spinal stenosis is Level II for long-term improvement for caudal and lumbar interlaminar epidural injections. For transforaminal epidural injections, the evidence is Level III for short-term improvement only. The interlaminar approach appears to be superior to the caudal approach and the caudal approach appears to be superior to the transforaminal one. Conclusions: The available evidence suggests that epidural injections with local anesthetic alone or with local anesthetic with steroids offer short- and long-term relief of low back and lower extremity pain for patients with lumbar central spinal stenosis. However, the evidence is Level II for the long-term efficacy of caudal and interlaminar epidural injections, whereas it is Level III for short-term improvement only with transforaminal epidural injections.
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Affiliation(s)
- Laxmaiah Manchikanti
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, USA
- Pain Management Center of Paducah, Paducah, USA
- Corresponding author: Laxmaiah Manchikanti, Pain Management Center of Paducah, Paducah, USA. Tel: +1-2705548373, Fax: +1-2705548987, E-mail:
| | - Alan David Kaye
- Department of Anesthesia, LSU Health Science Center, New Orleans, USA
| | - Kavita Manchikanti
- University of Kentucky Medical School, University of Kentucky, Lexington, USA
| | - Mark Boswell
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, USA
| | - Vidyasagar Pampati
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, USA
| | - Joshua Hirsch
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Kao MCJ, Jarosz R, Goldin M, Patel A, Smuck M. Determinants of physical activity in America: a first characterization of physical activity profile using the National Health and Nutrition Examination Survey (NHANES). PM R 2014; 6:882-92. [PMID: 24631950 DOI: 10.1016/j.pmrj.2014.03.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Revised: 02/19/2014] [Accepted: 03/05/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To develop and implement methodologies for characterizing accelerometry-derived patterns of physical activity (PA) in the United States in relation to demographics, anthropometrics, behaviors, and comorbidities using the National Health and Nutrition Examination Survey (NHANES) dataset. DESIGN Retrospective analysis of nationally representative database. SETTING Computer-generated modeling in silico. PARTICIPANTS A total of 6329 adults in the United States from the NHANES 2003-2004 database. METHODS To discover subtle multivariate signal in the dynamic and noisy accelerometry data, we developed a novel approach, termed discretized multiple adaptive regression and implemented the algorithm in SAS 9.2 (SAS Institute, Cary, NC). MAIN OUTCOME MEASUREMENTS Demographic, anthropometric, comorbidity, and behavioral variables. RESULTS The intensity of PA decreased with both increased age and increased body mass index. Both greater education and greater income correlate with increased activity over short durations and reduced activity intensity over long durations. Numerous predictors demonstrated effects within activity ranges that may be masked by use of the standard activity intensity intervals. These include age, one of the most robust variables, where we discovered decreasing activities inside the moderate activity range. It also includes gender, where women compared with men have increased proportions of active times up to the center of light activity range, and income greater than $45,000, where a complex effect is seen with little correspondence to existing cut-points. CONCLUSIONS The results presented in this study suggest that the method of multiple regression and heat map visualization can generate insights otherwise hidden in large datasets such as NHANES. A review of the provided heat maps reveals the trends discussed previously involving demographic, anthropometric, comorbidity, and behavioral variables. It also demonstrates the power of accelerometry to expose alterations in PA. Ultimately, this study provides a US population-based norm to use in future studies of PA.
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Affiliation(s)
- Ming-Chih Jeffrey Kao
- Department of Orthopaedics, PM&R Section, Stanford University, Palo Alto, CA(∗)(†)(‡)(¶)
| | - Renata Jarosz
- Department of Orthopaedics, PM&R Section, Stanford University, Palo Alto, CA(∗)(†)(‡)(¶)
| | - Michael Goldin
- Department of Orthopaedics, PM&R Section, Stanford University, Palo Alto, CA(∗)(†)(‡)(¶)
| | - Amy Patel
- Michigan State University, East Lansing, MI(§)
| | - Matthew Smuck
- Department of Orthopaedics, PM&R Section, Stanford University, Palo Alto, CA(∗)(†)(‡)(¶).
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Tomkins-Lane CC, Lafave LMZ, Parnell JA, Krishnamurthy A, Rempel J, Macedo LG, Moriartey S, Stuber KJ, Wilson PM, Hu R, Andreas YM. The spinal stenosis pedometer and nutrition lifestyle intervention (SSPANLI) randomized controlled trial protocol. BMC Musculoskelet Disord 2013; 14:322. [PMID: 24228747 PMCID: PMC4225754 DOI: 10.1186/1471-2474-14-322] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 11/08/2013] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Because of symptoms, people with lumbar spinal stenosis (LSS) are often inactive, and this sedentary behaviour implies risk for diseases including obesity. Research has identified body mass index as the most powerful predictor of function in LSS. This suggests that function may be improved by targeting weight as a modifiable factor. An e-health lifestyle intervention was developed aimed at reducing fat mass and increasing physical activity in people with LSS. The main components of this intervention include pedometer-based physical activity promotion and nutrition education. METHODS/DESIGN The Spinal Stenosis Pedometer and Nutrition Lifestyle INTERVENTION (SSPANLI) was developed and piloted with 10 individuals. The protocol for a randomized controlled trail comparing the SSPANLI intervention to usual non-surgical care follows. One hundred six (106) overweight or obese individuals with LSS will be recruited. Baseline and follow-up testing includes dual energy x-ray absorptiometry, blood draw, 3-day food record, 7-day accelerometry, questionnaire, maximal oxygen consumption, neurological exam, balance testing and a Self-Paced Walking Test. INTERVENTION During Week 1, the intervention group will receive a pedometer, and a personalized consultation with both a Dietitian and an exercise specialist. For 12 weeks participants will log on to the e-health website to access personal step goals, walking maps, nutrition videos, and motivational quotes. Participants will also have access to in-person Coffee Talk meetings every 3 weeks, and meet with the Dietitian and exercise specialist at week 6. The control group will proceed with usual care for the 12-week period. Follow-up testing will occur at Weeks 13 and 24. DISCUSSION This lifestyle intervention has the potential to provide a unique, non-surgical management option for people with LSS. Through decreased fat mass and increased function, we may reduce risk for obesity, chronic diseases of inactivity, and pain. The use of e-health interventions provides an opportunity for patients to become more involved in managing their own health. Behaviour changes including increased physical activity, and improved dietary habits promote overall health and quality of life, and may decrease future health care needs in this population. TRIAL REGISTRATION Clinicaltrials.gov, NCT01902979.
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Affiliation(s)
- Christy C Tomkins-Lane
- Department of Physical Education and Recreation Studies, Mount Royal University, 4825 Mount Royal Gate SW, Calgary, AB T3E 6K6, Canada
| | - Lynne MZ Lafave
- Department of Physical Education and Recreation Studies, Mount Royal University, 4825 Mount Royal Gate SW, Calgary, AB T3E 6K6, Canada
| | - Jill A Parnell
- Department of Physical Education and Recreation Studies, Mount Royal University, 4825 Mount Royal Gate SW, Calgary, AB T3E 6K6, Canada
| | - Ashok Krishnamurthy
- Department of Physical Education and Recreation Studies, Mount Royal University, 4825 Mount Royal Gate SW, Calgary, AB T3E 6K6, Canada
| | - Jocelyn Rempel
- Department of Nursing, Mount Royal University, 4825 Mount Royal Gate SW, Calgary, AB T3E 6K6, Canada
| | - Luciana G Macedo
- Department of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Edmonton, AB T6G 2G4, Canada
| | - Stephanie Moriartey
- Southport Atrium - Cubicle #1510, Alberta Health Services, 10301 Southport Lane SW, Calgary, AB T2W 1S7, Canada
| | - Kent J Stuber
- Canadian Memorial Chiropractic College, 19-8 Weston Drive SW, Calgary, AB T3H 5P2, Canada
| | - Philip M Wilson
- Department of Kinesiology, Brock University, WC25, 500 Glenridge Ave, St. Catharines, ON L2S 3A1, Canada
| | - Richard Hu
- Department of Surgery, University of Calgary, Room 0492, McCaig Tower, Foothills Medical Centre, 3134 Hospital Drive NW, Calgary T2N 5A1, Canada
| | - Yvette M Andreas
- Office of Research Services, Mount Royal University, Mount Royal University, 4825 Mount Royal Gate SW, Calgary, AB T3E 6K6, Canada
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28
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Lumbar epidural injections for low back pain. Nurse Pract 2013; 38:11-2. [PMID: 23778175 DOI: 10.1097/01.npr.0000431186.02677.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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29
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Sawhney M. Lumbar epidural injections for low back pain. Nursing 2013; 43:66-67. [PMID: 23353918 DOI: 10.1097/01.nurse.0000426247.60577.ff] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Mona Sawhney
- Department of Anesthesia, North York General Hospital, Toronto, Ontario
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