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Klukowska AM, Vandertop WP, Schröder ML, Staartjes VE. Calculation of the minimum clinically important difference (MCID) using different methodologies: case study and practical guide. 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 2024:10.1007/s00586-024-08369-5. [PMID: 38940854 DOI: 10.1007/s00586-024-08369-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 05/17/2024] [Accepted: 06/10/2024] [Indexed: 06/29/2024]
Abstract
INTRODUCTION Establishing thresholds of change that are actually meaningful for the patient in an outcome measurement instrument is paramount. This concept is called the minimum clinically important difference (MCID). We summarize available MCID calculation methods relevant to spine surgery, and outline key considerations, followed by a step-by-step working example of how MCID can be calculated, using publicly available data, to enable the readers to follow the calculations themselves. METHODS Thirteen MCID calculations methods were summarized, including anchor-based methods, distribution-based methods, Reliable Change Index, 30% Reduction from Baseline, Social Comparison Approach and the Delphi method. All methods, except the latter two, were used to calculate MCID for improvement of Zurich Claudication Questionnaire (ZCQ) Symptom Severity of patients with lumbar spinal stenosis. Numeric Rating Scale for Leg Pain and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire Walking Ability domain were used as anchors. RESULTS The MCID for improvement of ZCQ Symptom Severity ranged from 0.8 to 5.1. On average, distribution-based methods yielded lower MCID values, than anchor-based methods. The percentage of patients who achieved the calculated MCID threshold ranged from 9.5% to 61.9%. CONCLUSIONS MCID calculations are encouraged in spinal research to evaluate treatment success. Anchor-based methods, relying on scales assessing patient preferences, continue to be the "gold-standard" with receiver operating characteristic curve approach being optimal. In their absence, the minimum detectable change approach is acceptable. The provided explanation and step-by-step example of MCID calculations with statistical code and publicly available data can act as guidance in planning future MCID calculation studies.
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Affiliation(s)
- Anita M Klukowska
- Department of Neurosurgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Department of Neurosurgery, University Clinical Hospital of Bialystok, Bialystok, Poland
| | - W Peter Vandertop
- Department of Neurosurgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Marc L Schröder
- Department of Neurosurgery, Park Medical Center, Rotterdam, The Netherlands
| | - Victor E Staartjes
- Machine Intelligence in Clinical Neuroscience and Microsurgical Neuroanatomy (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
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Hiyama A, Sakai D, Katoh H, Sato M, Watanabe M. Comprehensive Assessment of Indirect Decompression Through Lateral Lumbar Interbody Fusion for Degenerative Lumbar Spinal Stenosis: A Japanese Orthopedic Association Back Pain Evaluation Questionnaire-Based Analysis. Global Spine J 2023:21925682231204254. [PMID: 37750358 DOI: 10.1177/21925682231204254] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2023] Open
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE This study aimed to comprehensively evaluate the clinical outcomes of lateral lumbar interbody fusion (LLIF) as an indirect decompression technique for degenerative spondylolisthesis (DS) and concomitant degenerative lumbar spinal stenosis (DLSS) patients. We utilized the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) to assess treatment success and its impact on patient's quality of life (QOL). METHODS We included 124 patients who underwent LLIF. Pre- and postoperative JOABPEQ evaluations indicated treatment success. Subgroup analysis categorized patients' perceptions of surgery as beneficial or non-beneficial. RESULTS 89% of patients (110/124) reported satisfaction with LLIF. Lateral lumbar interbody fusion achieved successful indirect decompression, increasing canal diameter and central canal area. Significant improvements occurred across all JOABPEQ domains, notably for low back pain, lumbar function, walking ability, social life function, and mental health. Patients who perceived the surgery as beneficial experienced fewer postoperative complications, lower numeric rating scale scores for pain relief, and greater functional outcome improvements compared to non-beneficial patients. CONCLUSIONS Our findings highlight the utility of JOABPEQ as a valuable and sensitive tool for assessing treatment effectiveness and patient-reported outcomes in DS and concomitant DLSS patients. Patients undergoing LLIF. The results affirm the favorable outcomes of LLIF as a surgical option for DLSS patients and emphasize the importance of considering patient perspectives when evaluating overall treatment success. The study provides valuable insights into the impact of indirect decompression on patients' QOL, supporting the effectiveness of LLIF as a minimally invasive technique for DLSS and DS management.
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Affiliation(s)
- Akihiko Hiyama
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Japan
| | - Daisuke Sakai
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Japan
| | - Hiroyuki Katoh
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Japan
| | - Masato Sato
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Japan
| | - Masahiko Watanabe
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Japan
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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.
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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.
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Sudo H, Miyakoshi T, Watanabe Y, Ito YM, Kahata K, Tha KK, Yokota N, Kato H, Terada T, Iwasaki N, Arato T, Sato N, Isoe T. Protocol for treating lumbar spinal canal stenosis with a combination of ultrapurified, allogenic bone marrow-derived mesenchymal stem cells and in situ-forming gel: a multicentre, prospective, double-blind randomised controlled trial. BMJ Open 2023; 13:e065476. [PMID: 36731929 PMCID: PMC9896178 DOI: 10.1136/bmjopen-2022-065476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION In patients with combined lumbar spinal canal stenosis (LSCS), a herniated intervertebral disc (IVD) that compresses the dura mater and nerve roots is surgically treated with discectomy after laminoplasty. However, defects in the IVD after discectomy may lead to inadequate tissue healing and predispose patients to the development of IVD degeneration. Ultrapurified stem cells (rapidly expanding clones (RECs)), combined with an in situ-forming bioresorbable gel (dMD-001), have been developed to fill IVD defects and prevent IVD degeneration after discectomy. We aim to investigate the safety and efficacy of a new treatment method in which a combination of REC and dMD-001 is implanted into the IVD of patients with combined LSCS. METHODS AND ANALYSIS This is a multicentre, prospective, double-blind randomised controlled trial. Forty-five participants aged 20-75 years diagnosed with combined LSCS will be assessed for eligibility. After performing laminoplasty and discectomy, participants will be randomised 1:1:1 into the combination of REC and dMD-001 (REC-dMD-001) group, the dMD-001 group or the laminoplasty and discectomy alone (control) group. The primary outcomes of the trial will be the safety and effectiveness of the procedure. The effectiveness will be assessed using visual analogue scale scores of back pain and leg pain as well as MRI-based estimations of morphological and compositional quality of the IVD tissue. Secondary outcomes will include self-assessed clinical scores and other MRI-based estimations of compositional quality of the IVD tissue. All evaluations will be performed at baseline and at 1, 4, 12, 24 and 48 weeks after surgery. ETHICS AND DISSEMINATION This study was approved by the ethics committees of the institutions involved. We plan to conduct dissemination of the outcome data by presenting our data at national and international conferences, as well as through formal publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER jRCT2013210076.
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Affiliation(s)
- Hideki Sudo
- Department of Orthopaedic Surgery, Hokkaido University Hospital, Sapporo, Japan
| | - Takashi Miyakoshi
- Clinical Research and Medical Innovation Center, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Yudai Watanabe
- Clinical Research and Medical Innovation Center, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Yoichi M Ito
- Data Science Center, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Kaoru Kahata
- Clinical Research and Medical Innovation Center, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Khin Khin Tha
- Global Center for Biomedical Science and Engineering, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Nozomi Yokota
- Clinical Research and Medical Innovation Center, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Hiroe Kato
- Clinical Research and Medical Innovation Center, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Tomoko Terada
- Clinical Research and Medical Innovation Center, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Hokkaido University Hospital, Sapporo, Japan
| | - Teruyo Arato
- Clinical Research and Medical Innovation Center, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Norihiro Sato
- Clinical Research and Medical Innovation Center, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Toshiyuki Isoe
- Clinical Research and Medical Innovation Center, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
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Jawad ZY, Hamdan FB, Nema IS. Neurophysiologic evaluation of patients with cervical spondylotic myelopathy. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022. [DOI: 10.1186/s41983-022-00595-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
Background
Cervical spondylotic myelopathy (CSM) is a neurodegenerative disease caused by repetitive spinal cord damage that has resulted in significant clinical morbidity. The clinical evaluation of signs and symptoms, as well as neuroimaging and several neurophysiological tests, are used to make the diagnosis.
Objectives
To investigate changes in the cutaneous silent period (CuSP), cortical silent period (CoSP), and H-reflex in CSM patients, and to correlate these tests with the Japanese Orthopedic Association (JOA) score and Nurick’s grading, as well as to determine the diagnostic value of each of them.
Methods
Twenty patients (14 males and 6 females) with CSM were clinically diagnosed and documented by magnetic resonance imaging (MRI), and they were paired with another 20 healthy volunteers (13 males and 7 females) as a control group. CuSP, CoSP, and H-reflex tests were performed on both groups.
Results
In CSM patients, CuSP latency and duration are substantially longer and shorter in CSM patients, respectively. The degree of changes in CuSP latency is well correlated with the severity of the disease. Further, CoSP duration is significantly shortened. The H-reflex parameters did not differ significantly between the patient and control groups.
Conclusion
The shortened CoSP’s duration and the prolonged CuSP's latency suggest malfunction of the inhibitory and excitatory circuits in the spinal cord. The CuSP is more sensitive and specific than the CoSP in the diagnosis of a patient with CSM.
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Takahashi N, Takatsuki K, Kasahara S, Yabuki S. Characteristics of patients who dropped out after multidisciplinary pain management in Japan: A prospective cohort study. J Back Musculoskelet Rehabil 2022; 35:793-802. [PMID: 34957984 PMCID: PMC9398070 DOI: 10.3233/bmr-200292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Because regular visits to distant hospitals may be a burden to patients, both in terms of time and cost, some patients with chronic musculoskeletal pain may discontinue multidisciplinary pain treatment, unable to maintain motivation to attend. OBJECTIVE To evaluate and compare the pre-program characteristics of patients who dropped out and patients who continued treatment, thereby clarifying the characteristics of patients at risk of dropping out. METHODS A multidisciplinary pain management treatment program was implemented for patients at the Pain Management Center, Hoshi General Hospital. From April 2015 to March 2018, 23 patients participated in the program. Twelve of the 23 patients lived outside the prefecture where the hospital is located. Of these 12 patients, five completed the program, while seven did not. We compared the dropout and continuation groups in terms of patient characteristics, pain severity, pain-related psychosocial factors, and quality of life. RESULTS We found significant differences (p< 0.05) in median age, Japanese Orthopaedic Association Back Pain Evaluation Questionnaire walking ability dysfunction score, and Roland-Morris Disability Questionnaire score. CONCLUSIONS The characteristics of patients who dropped out were older age, walking ability dysfunction, and low quality of life associated with low back pain.
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Affiliation(s)
- Naoto Takahashi
- Department of Pain Medicine, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan,Pain Management Center, Hoshi General Hospital, Koriyama City, Fukushima, Japan,Corresponding author: Naoto Takahashi, Department of Pain Medicine, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima City, Fukushima 9601295, Japan. Tel.: +81 24 581 5547; Fax: +81 24 581 5547; E-mail:
| | - Kozue Takatsuki
- Department of Pain Medicine, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan
| | - Satoshi Kasahara
- Department of Pain Medicine, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan,Pain Management Center, Hoshi General Hospital, Koriyama City, Fukushima, Japan
| | - Shoji Yabuki
- Department of Pain Medicine, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan,Pain Management Center, Hoshi General Hospital, Koriyama City, Fukushima, Japan
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Minetama M, Kawakami M, Teraguchi M, Enyo Y, Nakagawa M, Yamamoto Y, Matsuo S, Nakatani T, Sakon N, Nakagawa Y. Supervised physical therapy versus surgery for patients with lumbar spinal stenosis: a propensity score-matched analysis. BMC Musculoskelet Disord 2022; 23:658. [PMID: 35820887 PMCID: PMC9275154 DOI: 10.1186/s12891-022-05632-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background Previous studies comparing surgical with nonsurgical treatment for lumbar spinal stenosis (LSS) reported that surgery is superior to nonsurgical treatments, but intensive and adequate volume of physical therapy were rarely performed. The purpose of this study was to compare the 1-year follow-up outcomes of patients with LSS treated with supervised physical therapy or surgery using propensity score-matched analysis. Methods A total of 224 patients with LSS who received supervised physical therapy (n = 38) or surgery (n = 186) were included, of which 66 were matched on baseline demographics, radiological findings, and patient-reported outcomes. The physical therapy group received supervised physical therapy twice weekly for 6 weeks. The physical therapy sessions included manual therapy, individually tailored exercises, cycling, and body-weight supported treadmill walking. The surgery group underwent decompression surgery with or without spinal fusion. A propensity score analysis was performed using a one-to-one nearest neighbor approach. Results The surgery group showed greater improvements in Zurich claudication questionnaire symptom severity and physical function, SF-36 physical functioning, bodily pain, and mental health, but had more severe stenosis and symptoms and mental health problems than the physical therapy group at baseline (P < 0.05). After propensity score matching, there were no significant differences in baseline characteristics, and all clinical outcomes at 1 year, except for a higher percentage of responders achieving minimum clinically important difference in the role-emotional subscale of SF-36 in the surgery group (P < 0.05). Conclusions When baseline characteristics were considered, supervised physical therapy yielded similar effects to lumbar surgery. These results suggest that supervised physical therapy is preferred over surgery as first-choice treatment, to prevent complications and to minimize health care costs, especially in mild to moderate cases of LSS.
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Affiliation(s)
- Masakazu Minetama
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama, 649-7113, Japan.
| | - Mamoru Kawakami
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama, 649-7113, Japan.,Department of Orthopaedic Surgery, Saiseikai Wakayama Hospital, 45 Jyunibancho, Wakayama city, Wakayama, 640-8158, Japan
| | - Masatoshi Teraguchi
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama, 649-7113, Japan
| | - Yoshio Enyo
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama, 649-7113, Japan
| | - Masafumi Nakagawa
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama, 649-7113, Japan
| | - Yoshio Yamamoto
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama, 649-7113, Japan
| | - Sachika Matsuo
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama, 649-7113, Japan
| | - Tomohiro Nakatani
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama, 649-7113, Japan
| | - Nana Sakon
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama, 649-7113, Japan
| | - Yukihiro Nakagawa
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama, 649-7113, Japan
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Aihara T, Kojima A, Urushibara M, Endo K, Sawaji Y, Suzuki H, Matsuoka Y, Nishimura H, Murata K, Konishi T, Yamamoto K. In Reply to the Letter to the Editor Regarding "Long-Term Outcomes Following Lumbar Microendoscopic Decompression for Lumbar Spinal Stenosis with and without Degenerative Spondylolisthesis: Minimum 10-Year Follow-Up". World Neurosurg 2021; 151:326-328. [PMID: 34243658 DOI: 10.1016/j.wneu.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Takato Aihara
- Department of Orthopedic Surgery, Funabashi Orthopedic Hospital, Chiba; Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan.
| | - Atsushi Kojima
- Department of Orthopedic Surgery, Funabashi Orthopedic Hospital, Chiba
| | - Makoto Urushibara
- Department of Orthopedic Surgery, Funabashi Orthopedic Hospital, Chiba
| | - Kenji Endo
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yasunobu Sawaji
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hidekazu Suzuki
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yuji Matsuoka
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hirosuke Nishimura
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kazuma Murata
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Takamitsu Konishi
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kengo Yamamoto
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
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Yamada K, Kenichiro M, Ito YM, Inage F, Isoe T, Yokota N, Sugita O, Sato N, Tha KK, Iwasaki N, Arato T, Sudo H. Exploratory clinical trial on the safety and capability of dMD-001 in lumbar disc herniation: Study protocol for a first-in-human pilot study. Contemp Clin Trials Commun 2021; 23:100805. [PMID: 34278043 PMCID: PMC8261539 DOI: 10.1016/j.conctc.2021.100805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 06/08/2021] [Accepted: 06/12/2021] [Indexed: 01/08/2023] Open
Abstract
Herniated nucleus pulposus (NP), one of the most common diseases of the spine, is surgically treated by removing the sequestered NP. However, intervertebral disc (IVD) defects may remain after discectomy, leading to inadequate tissue healing and predisposing patients to IVD degeneration. An acellular, bioresorbable, ultra-purified alginate (UPAL) gel (dMD-001) implantation system can be used to fill any IVD defects in order to prevent IVD degeneration after discectomy. This first-in-human pilot study aims to determine the feasibility, safety, and perceived patient response to a combined treatment involving discectomy and UPAL gel implantation for herniated NP. We designed a one-arm, double-centre, open-label, pilot trial. The study started in November 2018 and will run until a sample of 40 suitable participants is established. Patients aged 20-49 years, diagnosed with isolated lumbar IVD herniation and scheduled for discectomy represent suitable candidates. All eligible participants who provide informed consent undergo standard discectomy followed by UPAL gel implantation. The primary outcomes of the trial will be the feasibility and safety of the procedure. Secondary outcomes will include self-assessed clinical scores and magnetic resonance imaging-based measures of morphological and compositional quality of the IVD tissue. Initial outcomes will be published at 24 weeks. Analysis of feasibility and safety will be performed using descriptive statistics. Both intention-to-treat and per-protocol analyses of treatment trends of effectiveness will be conducted.
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Affiliation(s)
- Katsuhisa Yamada
- Department of Orthopaedic Surgery, Hokkaido University Hospital, N14W5, Sapporo, Japan.,Department of Orthopaedic Surgery, Faculty of Medicine, and Graduate School of Medicine, Hokkaido University, N15W7, Sapporo, Hokkaido, 060-8638, Japan
| | - Maeda Kenichiro
- Clinical Research and Medical Innovation Center, Hokkaido University Hospital, N14W5, Sapporo, Japan
| | - Yoichi M Ito
- Department of Biostatistics, Hokkaido University Graduate School of Medicine, N14W5, Sapporo, Hokkaido, Japan
| | - Fujio Inage
- Clinical Research and Medical Innovation Center, Hokkaido University Hospital, N14W5, Sapporo, Japan
| | - Toshiyuki Isoe
- Clinical Research and Medical Innovation Center, Hokkaido University Hospital, N14W5, Sapporo, Japan
| | - Nozomi Yokota
- Clinical Research and Medical Innovation Center, Hokkaido University Hospital, N14W5, Sapporo, Japan
| | - Osamu Sugita
- Clinical Research and Medical Innovation Center, Hokkaido University Hospital, N14W5, Sapporo, Japan
| | - Norihiro Sato
- Clinical Research and Medical Innovation Center, Hokkaido University Hospital, N14W5, Sapporo, Japan
| | - Khin Khin Tha
- Department of Diagnostic Imaging, Hokkaido University Hospital, N14W5, Sapporo, Hokkaido, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Hokkaido University Hospital, N14W5, Sapporo, Japan.,Department of Orthopaedic Surgery, Faculty of Medicine, and Graduate School of Medicine, Hokkaido University, N15W7, Sapporo, Hokkaido, 060-8638, Japan
| | - Teruyo Arato
- Clinical Research and Medical Innovation Center, Hokkaido University Hospital, N14W5, Sapporo, Japan
| | - Hideki Sudo
- Department of Orthopaedic Surgery, Hokkaido University Hospital, N14W5, Sapporo, Japan.,Department of Advanced Medicine for Spine and Spinal Cord Disorders, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
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10
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Inose H, Hirai T, Yoshii T, Kimura A, Takeshita K, Inoue H, Maekawa A, Endo K, Miyamoto T, Furuya T, Nakamura A, Mori K, Kanbara S, Imagama S, Seki S, Matsunaga S, Okawa A. Predictors for quality of life improvement after surgery for degenerative cervical myelopathy: a prospective multi-center study. Health Qual Life Outcomes 2021; 19:150. [PMID: 34011361 PMCID: PMC8132343 DOI: 10.1186/s12955-021-01789-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 05/11/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Degenerative cervical myelopathy (DCM) can significantly impair a patient's quality of life (QOL). In this study, we aimed to identify predictors associated with QOL improvement after surgery for DCM. METHODS This study included 148 patients who underwent surgery for DCM. The European QOL-5 Dimension (EQ-5D) score, the Japanese Orthopedic Association for the assessment of cervical myelopathy (C-JOA) score, and the Nurick grade were used as outcome measures. Radiographic examinations were performed at enrollment. The associations of baseline variables with changes in EQ-5D scores from preoperative to 1-year postoperative assessment were investigated using a multivariable linear regression model. RESULTS The EQ-5D and C-JOA scores and the Nurick grade improved after surgery (P < 0.001, P < 0.001, and P < 0.001, respectively). Univariable analysis revealed that preoperative EQ-5D and C-JOA scores were significantly associated with increased EQ-5D scores from preoperative assessment to 1 year after surgery (P < 0.0001 and P = 0.045). Multivariable regression analysis showed that the independent preoperative predictors of change in QOL were lumbar lordosis (LL), sacral slope (SS), and T1 pelvic angle (TPA). According to the prediction model, the increased EQ-5D score from preoperatively to 1 year after surgery = 0.308 - 0.493 × EQ-5D + 0.006 × LL - 0.008 × SS + 0.004 × TPA. CONCLUSIONS Preoperative LL, SS, and TPA significantly impacted the QOL of patients who underwent surgery for DCM. Less improvement in QOL after surgery was achieved in patients with smaller LL and TPA and larger SS values. Patients with these risk factors may therefore require additional support to experience adequate improvement in QOL.
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Affiliation(s)
- Hiroyuki Inose
- Department of Orthopaedic and Trauma Research, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan. .,Department of Orthopedic Surgery, Tokyo Medical and Dental University, Bunkyo-Ku, Japan.
| | - Takashi Hirai
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Bunkyo-Ku, Japan
| | - Toshitaka Yoshii
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Bunkyo-Ku, Japan
| | - Atsushi Kimura
- Department of Orthopaedics, Jichi Medical University, Shimotsuke, Japan
| | | | - Hirokazu Inoue
- Department of Orthopaedics, Jichi Medical University, Shimotsuke, Japan
| | - Asato Maekawa
- Department of Orthopaedic Surgery, Tokyo Medical University, Shinjuku-Ku, Japan
| | - Kenji Endo
- Department of Orthopaedic Surgery, Tokyo Medical University, Shinjuku-Ku, Japan
| | - Takuya Miyamoto
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba-shi, Japan
| | - Takeo Furuya
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba-shi, Japan
| | - Akira Nakamura
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Kanji Mori
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Shunsuke Kanbara
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shoji Seki
- Department of Orthopedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Shunji Matsunaga
- Department of Orthopedic Surgery, Imakiire General Hospital, Kagoshima-shi, Japan
| | - Atsushi Okawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Bunkyo-Ku, Japan
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Minetama M, Kawakami M, Teraguchi M, Kagotani R, Mera Y, Sumiya T, Nakagawa M, Yamamoto Y, Matsuo S, Sakon N, Nakatani T, Kitano T, Nakagawa Y. Supervised physical therapy versus unsupervised exercise for patients with lumbar spinal stenosis: 1-year follow-up of a randomized controlled trial. Clin Rehabil 2021; 35:964-975. [PMID: 33423549 DOI: 10.1177/0269215520986688] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare the 1-year outcomes of patients with lumbar spinal stenosis treated with supervised physical therapy or unsupervised exercise. DESIGN A single-center randomized controlled trial with concealed allocation, blinded assessor and intention-to-treat analysis. SETTING Spine care center. SUBJECTS A total of 86 patients presenting with symptoms of neurogenic claudication caused by lumbar spinal stenosis. INTERVENTIONS The physical therapy group received supervised physical therapy sessions twice a week for 6 weeks and home exercise program. The home exercise group received 6-week home exercise program only. MAIN MEASURES The primary outcome was symptom severity on the Zurich claudication questionnaire at 1 year. Secondary outcomes included physical function, pain, health-related quality of life and the surgery rate after 1 year. RESULTS At 1 year, more patients in the physical therapy group than in the home exercise group achieved minimum clinically important differences in Zurich claudication questionnaire symptom severity (60.5% vs 32.6%; adjusted odds ratio [AOR] 4.3, [95% CI [1.5-12.3], P = 0.01); Zurich claudication questionnaire physical function (55.8% vs 32.6%; AOR 3.0 [1.1-8.1], P = 0.03); SF-36 bodily pain (48.8% vs 25.6%; AOR 2.8 [1.1-7.3], P = 0.03), and SF-36 general health (20.9% vs 7.0%; AOR 6.1 [1.1-33.0], P = 0.04). The surgery rate at 1 year was lower in the physical therapy than in the home exercise group (7.0% vs 23.3%; AOR 0.2 [0.04-0.9] P = 0.04). CONCLUSIONS Supervised physical therapy produced greater improvements in symptom severity and physical function than unsupervised exercise and was associated with lower likelihood of receiving surgery within 1 year.
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Affiliation(s)
- Masakazu Minetama
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
| | - Mamoru Kawakami
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan.,Department of Orthopaedic Surgery, Saiseikai Wakayama Hospital, Wakayama, Japan
| | - Masatoshi Teraguchi
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
| | - Ryohei Kagotani
- Department of Orthopaedic Surgery, Wakayama Rosai Hospital, Wakayama, Japan
| | - Yoshimasa Mera
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
| | - Tadashi Sumiya
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
| | - Masafumi Nakagawa
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
| | - Yoshio Yamamoto
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
| | - Sachika Matsuo
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
| | - Nana Sakon
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
| | - Tomohiro Nakatani
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
| | - Tomoko Kitano
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
| | - Yukihiro Nakagawa
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
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12
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Aihara T, Endo K, Suzuki H, Kojima A, Sawaji Y, Urushibara M, Matsuoka Y, Takamatsu T, Murata K, Konishi T, Yamauchi H, Endo H, Yamamoto K. Long-Term Outcomes Following Lumbar Microendoscopic Decompression for Lumbar Spinal Stenosis with and without Degenerative Spondylolisthesis: Minimum 10-Year Follow-Up. World Neurosurg 2020; 146:e1219-e1225. [PMID: 33271376 DOI: 10.1016/j.wneu.2020.11.131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/21/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine whether preoperative presence of degenerative lumbar spondylolisthesis (DS) worsens the minimum 10-year outcome of patients undergoing microendoscopic decompression (MED) for lumbar spinal stenosis (SS). METHODS Eighty patients undergoing MED were classified into 2 groups: DS group (34 SS with DS patients) and SS group (46 SS without DS patients). The degrees of improvement (DOIs) by the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and intensities of improvement (IOIs) by Visual Analog Scale (VAS) at 120-159 (mean, 138.4) months after MED of the DS and SS groups were statistically compared. Patients with DS were classified into 2 groups based on the effectiveness by VAS or JOABPEQ: effective group (E group: IOI or DOI ≥20) and ineffective group (I group). All preoperative radiologic measurements were statistically compared between the E and I groups. RESULTS Significant decreases in low back pain, leg pain, and numbness, as measured by VAS, were noted at follow-up in the DS and SS groups. The effectiveness rates of pain-related disorders, lumbar spine dysfunction, and gait disturbance by JOABPEQ were almost equally high in the DS and SS groups. Statistical comparisons of the DOIs in all 5 functional scores and IOIs in low back pain, leg pain, and numbness showed no significant differences between the DS and SS groups. No significant differences were confirmed between the E and I groups concerning preoperative spondylolisthesis and instability. CONCLUSIONS Our study indicated that preoperative DS did not worsen the outcome of patients with SS undergoing MED.
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Affiliation(s)
- Takato Aihara
- Department of Orthopedic Surgery, Funabashi Orthopedic Hospital, Chiba, Japan; Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan.
| | - Kenji Endo
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hidekazu Suzuki
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Atsushi Kojima
- Department of Orthopedic Surgery, Funabashi Orthopedic Hospital, Chiba, Japan
| | - Yasunobu Sawaji
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Makoto Urushibara
- Department of Orthopedic Surgery, Funabashi Orthopedic Hospital, Chiba, Japan
| | - Yuji Matsuoka
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Taichiro Takamatsu
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kazuma Murata
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Takamitsu Konishi
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hideya Yamauchi
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hiroo Endo
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kengo Yamamoto
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
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13
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Mochizuki T, Yano K, Ikari K, Hiroshima R, Fukagawa S, Nasu Y, Okazaki K. Association between low back pain and quality of life in patients with rheumatoid arthritis according to patient-reported outcomes using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ): A cross-sectional study. Mod Rheumatol 2020; 31:992-996. [PMID: 33084458 DOI: 10.1080/14397595.2020.1840047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To evaluate factors associated with low back pain (LBP) and effect on quality of life (QOL) using patient-reported outcome in patients with rheumatoid arthritis (RA). METHODS Overall, 414 patients with RA who answered the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) were included in this study. LBP-positive was defined a visual analog scale (VAS) of LBP (LBP VAS) of ≥ 30 mm. RESULTS The rate of LBP-positive group was 24.9%. Body mass index (BMI) (odds ratio [OR]: 1.116), tender joint count (TJC) (OR: 1.598), global VAS (OR: 1.016), and Health Assessment Questionnaire Disability Index (HAQ-DI) (OR: 2.392) were found as significant LBP-associated factors. When adjusted for sex and van der Heijde-modified total Sharp score, BMI (OR: 1.120), TJC (OR: 1.619), global VAS (OR: 1.016), pain VAS (OR: 1.015), and HAQ-DI (OR: 2.312) were found to be the significant factors associated with LBP. Moreover, LBP VAS had relatively high correlations in all domains of the JOABPEQ scores (correlation coefficient: LBP, -0.601; lumbar function, -0.624; walking ability, -0.548; social life function, -0.479; and mental health, -0.463). CONCLUSIONS This study investigated the effect of LBP in patients with RA. The results of this study indicate that LBP is associated with the physical function and QOL in patients with RA. We believe that our results will be useful for physical function and QOL assessments in patients with RA with LBP.
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Affiliation(s)
- Takeshi Mochizuki
- Department of Orthopedic Surgery, Kamagaya General Hospital, Chiba, Japan
| | - Koichiro Yano
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Katsunori Ikari
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Ryo Hiroshima
- Department of Orthopedic Surgery, Kamagaya General Hospital, Chiba, Japan
| | - Shingo Fukagawa
- Department of Orthopedic Surgery, Kamagaya General Hospital, Chiba, Japan
| | - Yuki Nasu
- Department of Orthopedic Surgery, Kamagaya General Hospital, Chiba, Japan
| | - Ken Okazaki
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
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14
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Therapeutic Advantages of Frequent Physical Therapy Sessions for Patients With Lumbar Spinal Stenosis. Spine (Phila Pa 1976) 2020; 45:E639-E646. [PMID: 31842106 DOI: 10.1097/brs.0000000000003363] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective study of a randomized clinical trial and a prospective study of patients with lumbar spinal stenosis (LSS). OBJECTIVE The aim of this study was to identify the effects of the number of physical therapy (PT) sessions on clinical outcomes of patients with LSS. SUMMARY OF BACKGROUND DATA Supervised PT for patients with LSS has been reported to lead to better short-term outcomes in terms of disability and leg pain than unsupervised exercise. However, no studies have investigated the relationship between the number of PT sessions and the therapeutic effects in patients with LSS. METHODS All patients received exercise therapy for 6 weeks. Included were 43 patients receiving supervised PT twice a week (P2 group), 38 patients receiving supervised PT once a week (P1 group), and 43 patients receiving a home exercise program alone (HE group). Clinical outcomes were measured using the Zurich Claudication Questionnaire (ZCQ), a numerical rating scale (NRS) of back pain and leg pain, the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) at baseline and at 6 weeks. RESULTS At 6 weeks, the P2 group showed significant improvements in ZCQ physical function, back and leg pain on the NRS compared with the P1 group (P < 0.05). Compared with the HE group, the P2 group showed significant improvements in ZCQ symptom severity and physical function, back and leg pain on the NRS, and JOABPEQ gait disturbance (P < 0.05). There were no significant differences in mean changes after 6 weeks between the P1 and HE groups. CONCLUSION Six weeks of supervised PT twice a week resulted in significant short-term improvements in symptom severity, physical function, back and leg pain, and gait disturbance compared with once a week and/or home exercise alone. Patients with LSS should be treated with intensive and supervised exercise programs to obtain maximum benefit of exercise therapy. LEVEL OF EVIDENCE 3.
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15
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Nakagawa M, Kawakami M, Teraguchi M, Kagotani R, Mera Y, Sumiya T, Minetama M, Yamamoto Y, Matsuo S, Sakon N, Nakatani T, Kitano T, Nakagawa Y. Influence of Sarcopenia on the Effect of Exercise Therapy for Elderly Patients with Chronic Low Back Pain. Spine Surg Relat Res 2020; 4:247-255. [PMID: 32864492 PMCID: PMC7447336 DOI: 10.22603/ssrr.2019-0116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 01/09/2020] [Indexed: 01/06/2023] Open
Abstract
Introduction Sarcopenia, a condition characterized by decreased skeletal muscle mass, has increasingly been attracting attention in Japan, which has an aged society. The association between chronic low back pain (CLBP) and muscle mass is important. This study aimed to investigate the effect of exercise therapy for CLBP with or without sarcopenia. Methods This study was a prospective cohort study. Patients who were aged >65 years during 2017-2018 and had CLBP, with pain lasting >12 weeks and pain intensity being ≥3, were included in the study. The patients were divided into two groups: sarcopenia (S) and nonsarcopenia (NS) groups. The numerical rating scale (NRS) for pain intensity, Roland-Morris Disability Questionnaire (RMDQ), Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), Hospital Anxiety and Depression Scale (HADS), trunk muscle strength, a European Quality of Life instrument, and an NRS of treatment satisfaction were assessed. All patients underwent a high-intensity exercise therapy during 2 weeks of hospitalization and were followed up for 1 and 3 months. Results Twenty-eight patients with CLBP were included. The prevalence rate of sarcopenia was 42.9%. The NRS and RMDQ scores and gait function were clinically improved at the end points in all patients with or without sarcopenia. Moreover, high treatment satisfaction was achieved. The quality of life, treatment satisfaction, psychological disorder subscale score of the JOABPEQ, and HADS score tended to be lower in the S group than in the NS group. Conclusions Our short-term exercise therapy was effective for low back pain, disability, and gait disturbance in elderly patients with CLBP with or without sarcopenia. However, the prevalence of sarcopenia was high in elderly patients with CLBP. Although low back pain and disability in patients in the S group were improved by exercise therapy, their quality of life and treatment satisfaction might be lower than those of patients without sarcopenia.
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Affiliation(s)
- Masafumi Nakagawa
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
| | - Mamoru Kawakami
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
| | - Masatoshi Teraguchi
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
| | - Ryohei Kagotani
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
| | - Yoshimasa Mera
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
| | - Tadashi Sumiya
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
| | - Masakazu Minetama
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
| | - Yoshio Yamamoto
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
| | - Sachika Matsuo
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
| | - Nana Sakon
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
| | - Tomohiro Nakatani
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
| | - Tomoko Kitano
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
| | - Yukihiro Nakagawa
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
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Fujimori T, Miwa T, Oda T. Responsiveness of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire in lumbar surgery and its threshold for indicating clinically important differences. Spine J 2019; 19:95-103. [PMID: 29792993 DOI: 10.1016/j.spinee.2018.05.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 04/11/2018] [Accepted: 05/16/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Introduced in 2007, the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) has been widely used, but its psychometric properties have not been well studied. PURPOSE The objective of this study was to assess the responsiveness of the JOABPEQ in lumbar surgery and its threshold for indicating clinically important differences. STUDY DESIGN This is a prospective study. PATIENT SAMPLE Two hundred three consecutive patients underwent lumbar surgeries between July 2013 and November 2015 in a single hospital. Of the 203 patients, 181 patients who completed 1 year of follow-up were included. OUTCOME MEASURES Before and after surgery, the patients were asked to complete the questionnaire, including JOABPEQ, the 8-Item Short Form Health Survey (SF-8), and EuroQol-5D (EQ-5D). The participants were divided into five anchoring groups, ranging from "much better" to "much worse," according to reports from both physicians and patients. MATERIALS AND METHODS The responsiveness of measures was compared among five domains of the JOABPEQ ("low back pain," "walking ability," "lumbar function," "social function," and "mental health"), two domains of the SF-8 (the physical component summary [PCS] and the mental component summary [MCS]), and the EQ-5D. The responsiveness was assessed by the paired t test, the effect size, and the standardized response mean. The Spearman rank correlation coefficient and the receiver operating characteristic (ROC) curve were assessed using the five anchoring groups as external criteria. The clinically important differences, based on the ROC curve, were assessed. RESULTS Walking ability was most responsive, followed by low back pain and the PCS. The MCS was least responsive, followed by mental health and lumbar function. Social function and the EQ-5D had intermediate-level responsiveness. The substantial clinically important differences occurred at 20 points for low back pain and lumbar function, 23 points for walking ability, 14 points for social function, and 8 points for mental health. CONCLUSIONS The JOABPEQ domains are responsive measures in patients who undergo lumbar surgery. For physical function, the threshold for substantial clinically important differences was approximately 20 points for the JOABPEQ.
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Affiliation(s)
- Takahito Fujimori
- Department of Orthopedic Surgery, Japan Community Healthcare Organization, Osaka Hospital, 4-2-78 Fukushimaku, Fukushima, Osaka 553-0003, Japan; Department of Orthopedic Surgery, Sumitomo Hospital, 5-3-20 Kitaku Nakanoshima, Osaka, Osaka 530-0005, Japan.
| | - Toshitada Miwa
- Department of Orthopedic Surgery, Sumitomo Hospital, 5-3-20 Kitaku Nakanoshima, Osaka, Osaka 530-0005, Japan
| | - Takenori Oda
- Department of Orthopedic Surgery, Sumitomo Hospital, 5-3-20 Kitaku Nakanoshima, Osaka, Osaka 530-0005, Japan; Department of Orthopedic Surgery, Osaka Minami Medical Center, 2-1 Kidohigashimachi, Kawachinagano, Osaka, Japan
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Tominaga R, Sekiguchi M, Yonemoto K, Kakuma T, Konno SI. Establishment of reference scores and interquartile ranges for the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) in patients with low back pain. J Orthop Sci 2018; 23:643-648. [PMID: 29728303 DOI: 10.1016/j.jos.2018.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 03/20/2018] [Accepted: 03/29/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) was developed in 2007, including the five domains of Pain-related disorder, Lumbar spine dysfunction, Gait disturbance, Social life disturbance, and Psychological disorder. It is used by physicians to evaluate treatment efficacy by comparing scores before and after treatment. However, the JOABPEQ does not allow evaluation of the severity of a patient's condition compared to the general population at a single time point. Given the unavailability of a standard measurement of back pain, we sought to establish reference scores and interquartile ranges using data obtained from a multicenter, cross-sectional survey taken in Japanese primary care settings. METHODS The Lumbar Spinal Stenosis Diagnosis Support Tool project was conducted from 2011 to 2012 in 1657 hospitals in Japan to investigate the establishment of reference scores using JOABPEQ. Patients aged ≥ 20 years undergoing medical examinations by either non-orthopaedic primary care physicians or general orthopedists were considered for enrollment. RESULTS A total of 10,651 consecutive low back pain patients (5331 men, 5320 women, 18 subjects with missing sex data) who had undergone a medical examination were included. Reference scores and interquartile ranges for each of the five domains of the JOABPEQ according to age and sex were recorded. The median score and interquartile range are the same in the domain of Pain-related disorder in all ages and sexes. The reference scores for Gait disturbance, Social life disturbance and Psychological disorder declined with increasing age in both age- and sex-stratified groups, while there was some different trend in Lumbar spine dysfunction between men and women. CONCLUSION Reference scores and interquartile ranges for JOABPEQ were generated based on the data from the examination data. These provide a measurement standard to assess patient perceptions of low back pain at any time point during evaluation or therapy.
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Affiliation(s)
- Ryoji Tominaga
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan
| | - Miho Sekiguchi
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan.
| | - Koji Yonemoto
- Advanced Medical Research Center, Faculty of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa, 903-0215, Japan
| | - Tatsuyuki Kakuma
- Biostatistics Center, Kurume University, 67 Asahimachi, Kurume, Japan
| | - Shin-Ichi Konno
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan
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Hirai T, Yoshii T, Inose H, Yamada T, Yuasa M, Ushio S, Egawa S, Hirai K, Okawa A. Revision Surgery for Short Segment Fusion Influences Postoperative Low Back Pain and Lower Extremity Pain: A Retrospective Single-Center Study of Patient-Based Evaluation. Spine Surg Relat Res 2018; 2:215-220. [PMID: 31440671 PMCID: PMC6698521 DOI: 10.22603/ssrr.2017-0048] [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: 06/26/2017] [Accepted: 10/30/2017] [Indexed: 11/29/2022] Open
Abstract
Introduction Patients treated with revision surgery after lumbar decompression with fusion typically have persistent low back pain and lower extremity numbness compared with patients treated with only primary surgery. No well-designed study has investigated the persistence and degree of pain after revision surgery following instrumented operation. The purpose of this study is to compare residual pain among patients who underwent reoperation and those who underwent only primary surgery for lumbar degenerative disorder using patient-based evaluation. Methods We reviewed 350 consecutive patients (143 men, 207 women, mean age 63 years) treated with primary lumbar instrumented surgery between October 2010 and February 2014 at our institution and followed up for ≥2 years postoperatively. Patients were categorized into three groups based on number of levels fused: 1-segment, 2-segment, and ≥3-segment fusion (1F, 2F, and ≥3F groups, respectively). We used the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and visual analog scales (VASs) for low back pain and lower extremity pain to evaluate pain intensity pre- and postoperatively. Results Salvage surgery for late-phase complications was required in 5 cases (2.4%), 6 cases (11.3%), and 11 cases (12.1%) in the 1F, 2F, and ≥3F groups, respectively. In the 1F and 2F groups, patients treated with revision surgery had unsatisfactory improvement in the pain domain of JOABPEQ and VASs for low back pain and lower extremity pain compared with patients with only primary short fusion surgery. The ≥3F group showed no significant differences between patients who underwent reoperation and those who underwent only primary surgery. Conclusion Low back pain and lower extremity pain often persist after revision surgery in patients treated with short fusion (≤2-segment) operation. We need to follow pain states in such patients.
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Affiliation(s)
- Takashi Hirai
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshitaka Yoshii
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroyuki Inose
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tsuyoshi Yamada
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masato Yuasa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shuta Ushio
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Satoru Egawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Keigo Hirai
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Atsushi Okawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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