1
|
Lohmander LS, Peltonen M, Andersson-Assarsson JC, Sjöholm K, Taube M, Jacobson P, Svensson PA, Carlsson LMS, Ahlin S. Work-restricting musculoskeletal pain after bariatric surgery or usual obesity care in the Swedish Obese Subjects study. Obesity (Silver Spring) 2024; 32:1844-1856. [PMID: 39210593 DOI: 10.1002/oby.24128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 07/08/2024] [Accepted: 07/09/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE The objective of this study was to study the recovery from, and incidence of, work-restricting musculoskeletal pain after bariatric surgery compared with usual obesity care. METHODS Pain in different body regions was monitored using questionnaires in the nonrandomized, prospective, controlled Swedish Obese Subjects (SOS) study, which included 2007 participants treated with bariatric surgery and a matched control group of 2040 participants receiving usual obesity care at primary health care centers. Self-reported pain in the neck and shoulders, back, hips, knees, and ankles was captured from questionnaires administered at baseline and after 1, 2, 3, 4, 6, 8, 10, 15, and 20 years. RESULTS Compared with matched controls, bariatric surgery was associated with better recovery from baseline work-restricting knee and ankle pain in both the short (1-4 years) and long term (up to 20 years), as well as from back and hip pain in the short term. In participants without pain at baseline, bariatric surgery was associated with a lower incidence of developing new pain in the knee and ankle in the short and long term. CONCLUSIONS Bariatric surgery was associated with better recovery from pain, primarily in weight-bearing joints, as well as with prevention of pain development in the knee and ankle compared with matched controls receiving usual obesity care.
Collapse
Affiliation(s)
- L Stefan Lohmander
- Orthopaedics, Department of Clinical Sciences, Lund, Lund University, Lund, Sweden
| | - Markku Peltonen
- Finnish National Institute for Health and Welfare, Helsinki, Finland
| | | | - Kajsa Sjöholm
- Department of Molecular and Clinical Medicine, Institute of Medicine at the Sahlgrenska Academy, Gothenburg, Sweden
| | - Magdalena Taube
- Department of Molecular and Clinical Medicine, Institute of Medicine at the Sahlgrenska Academy, Gothenburg, Sweden
| | - Peter Jacobson
- Department of Molecular and Clinical Medicine, Institute of Medicine at the Sahlgrenska Academy, Gothenburg, Sweden
| | - Per-Arne Svensson
- Department of Molecular and Clinical Medicine, Institute of Medicine at the Sahlgrenska Academy, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lena M S Carlsson
- Department of Molecular and Clinical Medicine, Institute of Medicine at the Sahlgrenska Academy, Gothenburg, Sweden
| | - Sofie Ahlin
- Department of Molecular and Clinical Medicine, Institute of Medicine at the Sahlgrenska Academy, Gothenburg, Sweden
- Region of Västra Götaland, NU Hospital Group, Department of Clinical Physiology, Trollhättan, Sweden
| |
Collapse
|
2
|
Feng X, Blevins K, Tseng J, Sandhu K, Cunneen S, Burch M. 30-Day Postoperative Outcomes in Patients With Limited Mobility - A Propensity Score-Matched Comparative Analysis. Am Surg 2022; 88:2588-2595. [PMID: 35770827 DOI: 10.1177/00031348221109497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION There is limited data correlating preoperative mobility limitations with clinical outcomes in bariatric patients. This study uses propensity score matching (PSM) to compare 30-day outcomes between patients with preoperative limited mobility (LM) versus patients without (non-LM). METHODS Using the 2016-2018 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database, patients undergoing primary laparoscopic sleeve gastrectomy or gastric bypass were identified. Two cohorts were defined using preoperative LM status. To adjust for confounders, 1:1 PSM was performed using 25 preoperative characteristics, and balance was assessed with standardized mean difference. Preoperative patient demographics and postoperative 30-day outcomes were compared in both matched and unmatched cohorts. RESULTS 453,146 patients were identified, of which 6942 (1.47%) were LM and 464,555 were non-LM. 1:1 PSM matched 6624 LM to 6624 non-LM patients with good balance for all covariates. LM had higher rates of unplanned intubation (0.4% vs 0.7%, P < .01), unplanned admission to ICU (1.4% vs 2.5%, P < .01), readmissions (4.1% vs 4.9%, P = .036), unplanned reoperation (1.5% vs 2.0%, P = .02), and 30-day mortality (0.2% vs 0.5%, P = .02). Complications including acute renal failure, intra/postoperative myocardial infarction, venous thrombosis, and pulmonary embolism were not significantly different between the matched groups. CONCLUSION After adjusting for confounders, patients with preoperative limited mobility have higher rates of intubation, ICU admission, reoperation, readmission, and mortality. Prudent pre-operative candidate selection, counseling, and risk mitigation strategies are needed when a patient with limited mobility status is being considered for bariatric surgery.
Collapse
Affiliation(s)
| | - Katherine Blevins
- Department of Surgery, 22494Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Joshua Tseng
- Department of Surgery, 22494Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kulmeet Sandhu
- Department of Surgery, 22494Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Scott Cunneen
- Department of Surgery, 22494Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Miguel Burch
- Department of Surgery, 22494Cedars-Sinai Medical Center, Los Angeles, CA, USA
| |
Collapse
|
3
|
Chen LH, Weber K, Mehrabkhani S, Baskaran S, Abbass T, Macedo LG. The effectiveness of weight loss programs for low back pain: a systematic review. BMC Musculoskelet Disord 2022; 23:488. [PMID: 35606809 PMCID: PMC9125929 DOI: 10.1186/s12891-022-05391-w] [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: 08/26/2021] [Accepted: 04/26/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Low back pain has been associated with obesity or with being overweight. However, there are no high-quality systematic reviews that have been conducted on the effect of all types of weight loss programs focused on individuals with low back pain. Therefore, the present systematic review aims to evaluate the effectiveness of weight loss programs in reducing back pain and disability or increasing quality of life for individuals experiencing low back pain. MATERIALS AND METHODS Searches for relevant studies were conducted on CINAHL, Web of Science, Ovid Medline, Ovid Embase and AMED. Studies were included if they were randomized controlled trials, non-randomized studies of intervention or quasi-experimental designs evaluating a weight loss program for persons with low back pain aimed at decreasing back pain and disability. The Effective Public Health Practice Project (EPHPP) Quality Assessment Tool was used to evaluate individual studies and GRADE was used to summarize the quality of the evidence. The review was prospectively registered; PROSPERO#: CRD42020196099. RESULTS Eleven studies (n = 689 participants) including one randomized controlled trial, two non-randomized studies of intervention and eight single-arm studies were included (seven of which evaluated bariatric surgery). There was low-quality evidence that a lifestyle intervention was no better than waitlist for improving back pain and very low-quality evidence from single-arm studies that back pain improved from baseline after bariatric surgery. Most studies included were of poor quality, primarily due to selection bias, uncontrolled confounders, and lack of blinding, limiting the quality of evidence. CONCLUSION There is very low-quality evidence that weight loss programs may improve back pain, disability, and quality of life in patients with LBP, although adherence and maintenance are potential barriers to implementation.
Collapse
Affiliation(s)
- Lu Hsi Chen
- School of Rehabilitation Sciences, Faculty of Health Sciences, Institute of Applied Health Sciences, McMaster University, 1400 Main St. W. Hamilton, Hamilton, ON, L8S 1C7, Canada
| | - Kirsten Weber
- School of Rehabilitation Sciences, Faculty of Health Sciences, Institute of Applied Health Sciences, McMaster University, 1400 Main St. W. Hamilton, Hamilton, ON, L8S 1C7, Canada
| | - Saba Mehrabkhani
- School of Rehabilitation Sciences, Faculty of Health Sciences, Institute of Applied Health Sciences, McMaster University, 1400 Main St. W. Hamilton, Hamilton, ON, L8S 1C7, Canada
| | - Sarmina Baskaran
- School of Rehabilitation Sciences, Faculty of Health Sciences, Institute of Applied Health Sciences, McMaster University, 1400 Main St. W. Hamilton, Hamilton, ON, L8S 1C7, Canada
| | - Thomas Abbass
- School of Rehabilitation Sciences, Faculty of Health Sciences, Institute of Applied Health Sciences, McMaster University, 1400 Main St. W. Hamilton, Hamilton, ON, L8S 1C7, Canada
| | - Luciana Gazzi Macedo
- School of Rehabilitation Sciences, Faculty of Health Sciences, Institute of Applied Health Sciences, McMaster University, 1400 Main St. W. Hamilton, Hamilton, ON, L8S 1C7, Canada.
| |
Collapse
|
4
|
Heuts EAF, de Jong LD, Hazebroek EJ, Wagener M, Somford MP. The influence of bariatric surgery on hip and knee joint pain: a systematic review. Surg Obes Relat Dis 2021; 17:1637-1653. [PMID: 34116961 DOI: 10.1016/j.soard.2021.04.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 02/02/2021] [Accepted: 04/21/2021] [Indexed: 12/26/2022]
Abstract
Obesity increases the risk of osteoarthritis and the chance of needing joint replacement arthroplasty to reduce lower limb joint pain. Although nonsurgical weight loss interventions can reduce hip and knee joint pain, bariatric surgery may be a more feasible treatment option for people with severe obesity. However, it is unclear whether weight loss through bariatric surgery can positively influence hip and knee joint pain. Our objective was to evaluate the influence of bariatric surgery on hip and knee joint pain in people with obesity by conducting a systematic review of the literature. The PubMed, EMBASE, and Cochrane bibliographic databases were searched for studies published between 1947 and September 2019. Risk of bias of the identified studies was independently assessed by 2 reviewers using JBI's Critical Appraisal Checklist for Case Series and the Newcastle-Ottawa Scale. This review included 23 studies, all of which evaluated knee pain and 9 of which also evaluated hip pain. Reported results regarding hip pain intensity and the proportion of participants with hip pain were too limited to draw useful conclusions. Reported results regarding knee pain suggest that weight loss after bariatric surgery reduced knee pain intensity, as well as the proportion of participants with knee pain. The overall risk of bias of the majority of included studies (83%; n = 19) was judged to be unclear to high. Four small studies were judged as having a low risk of bias. Results of this systematic review suggest that bariatric surgery can positively influence hip and knee joint pain, but conclusive evidence is lacking because most of the included studies were judged as having plausible bias overall and in their key domains. Well-designed randomized controlled trials evaluating the influence of bariatric surgery on hip and knee joint pain using standardized joint pain measures are needed.
Collapse
Affiliation(s)
- Elise A F Heuts
- Department of Orthopaedics, Rijnstate Hospital, Arnhem, The Netherlands
| | - Lex D de Jong
- Department of Orthopaedics, Rijnstate Hospital, Arnhem, The Netherlands
| | - Eric J Hazebroek
- Department of Bariatric Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| | - Marc Wagener
- Department of Orthopaedics, Rijnstate Hospital, Arnhem, The Netherlands
| | - Matthijs P Somford
- Department of Orthopaedics, Rijnstate Hospital, Arnhem, The Netherlands.
| |
Collapse
|
5
|
Koremans FW, Chen X, Das A, Diwan AD. Changes in Back Pain Scores after Bariatric Surgery in Obese Patients: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10071443. [PMID: 33916220 PMCID: PMC8036450 DOI: 10.3390/jcm10071443] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/15/2021] [Accepted: 03/22/2021] [Indexed: 01/22/2023] Open
Abstract
Bariatric surgery produces significant and quantifiable reductions in back pain. However, there is a lack of information on the association of weight changes after bariatric surgery with changes in pain score. We aim to evaluate the impact of bariatric surgery on back pain in obese patients and to address the association between changes in body mass index (BMI) and pain score. In obese patients eligible for bariatric surgery, the changes in pre- and post-operative pain scores, assessed by the Numeric Rating Pain Scale (NPS) or Visual Analogue Scale (VAS), were considered as primary outcomes. Mean difference (MD) and their 95% confidence intervals (CI) were evaluated. Eight cohort studies were included in the analysis of 298 obese patients undergoing bariatric surgery. All studies showed a reduction in back pain, with a mean change of -2.9 points in NPS and of -3.8 cm in VAS. There was a significant reduction in back pain (NPS: (MD = -3.49) (95% CI = -3.86, -3.12); VAS: MD = -3.75, (95% CI = -4.13, -3.37)) and BMI (MD = -12.93, (95% CI = -13.61, -12.24)) following bariatric surgery. No significant relationship between BMI change and decrease in clinical scores could be established. However, it was evident that bariatric surgery had a significant effect on back pain scores in severely obese patients. Ideally, a prospective study including spinal imaging, inflammatory markers, a longer follow-up period, and larger study groups with a randomized control group needs to be performed.
Collapse
Affiliation(s)
- Froukje W. Koremans
- Amsterdam UMC, Vrije Universiteit Amsterdam, Surgery, Amsterdam Trauma Surgery, De Boelelaan, 1117 Amsterdam, The Netherlands;
- Spine Labs, St. George and Sutherland Clinical School, University of New South Wales, Kogarah, NSW 2217, Australia; (X.C.); (A.D.D.)
| | - Xiaolong Chen
- Spine Labs, St. George and Sutherland Clinical School, University of New South Wales, Kogarah, NSW 2217, Australia; (X.C.); (A.D.D.)
| | - Abhirup Das
- Spine Labs, St. George and Sutherland Clinical School, University of New South Wales, Kogarah, NSW 2217, Australia; (X.C.); (A.D.D.)
- Spine Service, St. George Hospital, Kogarah, NSW 2217, Australia
- Correspondence:
| | - Ashish D. Diwan
- Spine Labs, St. George and Sutherland Clinical School, University of New South Wales, Kogarah, NSW 2217, Australia; (X.C.); (A.D.D.)
- Spine Service, St. George Hospital, Kogarah, NSW 2217, Australia
| |
Collapse
|