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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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Pascucci S, Langella F, Franzò M, Tesse MG, Ciminello E, Biondi A, Carrani E, Sampaolo L, Zanoli G, Berjano P, Torre M. National spine surgery registries' characteristics and aims: globally accepted standards have yet to be met. Results of a scoping review and a complementary survey. J Orthop Traumatol 2023; 24:49. [PMID: 37715871 PMCID: PMC10505129 DOI: 10.1186/s10195-023-00732-4] [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: 07/11/2023] [Accepted: 08/15/2023] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND Surgery involving implantable devices is widely used to solve several health issues. National registries are essential tools for implantable device surveillance and vigilance. In 2017, the European Union encouraged Member States to establish "registries and databanks for specific types of devices" to evaluate device safety and performance and ensure their traceability. Spine-implantable devices significantly impact patient safety and public health; spine registries might help improve surgical outcomes. This study aimed to map existing national spine surgery registries and highlight their features and organisational standards to provide an essential reference for establishing other national registries. METHODS A scoping search was performed using the Embase, PubMed/Medline, Scopus, and Web of Science databases for the terms "registry", "register", "implantable", and all terms and synonyms related to spinal diseases and national registries in publications from January 2000 to December 2020. This search was later updated and finalised through a web search and an ad hoc survey to collect further detailed information. RESULTS Sixty-two peer-reviewed articles were included, which were related to seven national spine registries, six of which were currently active. Three additional active national registries were found through the web search. The nine selected national registries were set up between 1998 and 2021. They collect data on the procedure and use patient-reported outcome measures (PROMs) for the follow-up. CONCLUSION Our study identified nine currently active national spine surgery registries. However, globally accepted standards for developing a national registry of spine surgery are yet to be established. Therefore, an international effort to increase result comparability across registries is highly advisable. We hope the recent initiative from the Orthopaedic Data Evaluation Panel (ODEP) to establish an international collaboration will meet these needs.
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Affiliation(s)
- Simona Pascucci
- Scientific Secretariat of the President's Office, Italian National Institute of Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161, Rome, Italy
- Department of Mechanical and Aerospace Engineering, La Sapienza University of Rome, Rome, Italy
| | | | - Michela Franzò
- Department of Medico-Surgical Sciences and Biotechnologies, Rome, Italy
| | - Marco Giovanni Tesse
- Orthopaedics Section, Department of Neuroscience and Organs of Sense, Faculty of Medicine and Surgery, University of Bari, AOU Consorziale Policlinico, 70124, Bari, Italy
| | - Enrico Ciminello
- Scientific Secretariat of the President's Office, Italian National Institute of Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161, Rome, Italy
| | - Alessia Biondi
- Scientific Secretariat of the President's Office, Italian National Institute of Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161, Rome, Italy
| | - Eugenio Carrani
- Scientific Secretariat of the President's Office, Italian National Institute of Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161, Rome, Italy
| | - Letizia Sampaolo
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | | | | | - Marina Torre
- Scientific Secretariat of the President's Office, Italian National Institute of Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161, Rome, Italy.
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The Influence of Baseline Clinical Status and Surgical Strategy on Early Good to Excellent Result in Spinal Lumbar Arthrodesis: A Machine Learning Approach. J Pers Med 2021; 11:jpm11121377. [PMID: 34945849 PMCID: PMC8705358 DOI: 10.3390/jpm11121377] [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: 11/28/2021] [Revised: 12/10/2021] [Accepted: 12/13/2021] [Indexed: 12/23/2022] Open
Abstract
The study aims to create a preoperative model from baseline demographic and health-related quality of life scores (HRQOL) to predict a good to excellent early clinical outcome using a machine learning (ML) approach. A single spine surgery center retrospective review of prospectively collected data from January 2016 to December 2020 from the institutional registry (SpineREG) was performed. The inclusion criteria were age ≥ 18 years, both sexes, lumbar arthrodesis procedure, a complete follow up assessment (Oswestry Disability Index-ODI, SF-36 and COMI back) and the capability to read and understand the Italian language. A delta of improvement of the ODI higher than 12.7/100 was considered a "good early outcome". A combined target model of ODI (Δ ≥ 12.7/100), SF-36 PCS (Δ ≥ 6/100) and COMI back (Δ ≥ 2.2/10) was considered an "excellent early outcome". The performance of the ML models was evaluated in terms of sensitivity, i.e., True Positive Rate (TPR), specificity, i.e., True Negative Rate (TNR), accuracy and area under the receiver operating characteristic curve (AUC ROC). A total of 1243 patients were included in this study. The model for predicting ODI at 6 months' follow up showed a good balance between sensitivity (74.3%) and specificity (79.4%), while providing a good accuracy (75.8%) with ROC AUC = 0.842. The combined target model showed a sensitivity of 74.2% and specificity of 71.8%, with an accuracy of 72.8%, and an ROC AUC = 0.808. The results of our study suggest that a machine learning approach showed high performance in predicting early good to excellent clinical results.
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Heino A, Laukkanen-Nevala P, Raatiniemi L, Tommila M, Nurmi J, Olkinuora A, Virkkunen I, Iirola T. Reliability of prehospital patient classification in helicopter emergency medical service missions. BMC Emerg Med 2020; 20:42. [PMID: 32450816 PMCID: PMC7249641 DOI: 10.1186/s12873-020-00338-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/19/2020] [Indexed: 11/10/2022] Open
Abstract
Background Several scores and codes are used in prehospital clinical quality registries but little is known of their reliability. The aim of this study is to evaluate the inter-rater reliability of the American Society of Anesthesiologists physical status (ASA-PS) classification system, HEMS benefit score (HBS), International Classification of Primary Care, second edition (ICPC-2) and Eastern Cooperative Oncology Group (ECOG) performance status in a helicopter emergency medical service (HEMS) clinical quality registry (CQR). Methods All physicians and paramedics working in HEMS in Finland and responsible for patient registration were asked to participate in this study. The participants entered data of six written fictional missions in the national CQR. The inter-rater reliability of the ASA-PS, HBS, ICPC-2 and ECOG were evaluated using an overall agreement and free-marginal multi-rater kappa (Κfree). Results All 59 Finnish HEMS physicians and paramedics were invited to participate in this study, of which 43 responded and 16 did not answer. One participant was excluded due to unfinished data entering. ASA-PS had an overall agreement of 40.2% and Κfree of 0.28 in this study. HBS had an overall agreement of 44.7% and Κfree of 0.39. ICPC-2 coding had an overall agreement of 51.5% and Κfree of 0.47. ECOG had an overall agreement of 49.6% and Κfree of 0.40. Conclusion This study suggests a marked inter-rater unreliability in prehospital patient scoring and coding even in a relatively uniform group of practitioners working in a highly focused environment. This indicates that the scores and codes should be specifically designed or adapted for prehospital use, and the users should be provided with clear and thorough instructions on how to use them.
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Affiliation(s)
- A Heino
- Research and Development Unit, FinnHEMS Ltd, Vantaa, Finland. .,Department of Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital and University of Turku, Turku, Finland.
| | | | - L Raatiniemi
- Centre for Pre-Hospital Emergency Care, Oulu University Hospital, Oulu, Finland.,Anaesthesia Research Group, MRC, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - M Tommila
- Department of Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital and University of Turku, Turku, Finland
| | - J Nurmi
- Emergency Medicine Services, Helsinki University Hospital, Helsinki, Finland.,Department of Emergency Medicine, University of Helsinki, Helsinki, Finland
| | - A Olkinuora
- Research and Development Unit, FinnHEMS Ltd, Vantaa, Finland
| | - I Virkkunen
- Research and Development Unit, FinnHEMS Ltd, Vantaa, Finland
| | - T Iirola
- Emergency Medical Services, Turku University Hospital and University of Turku, Turku, Finland
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Heino A, Iirola T, Raatiniemi L, Nurmi J, Olkinuora A, Laukkanen-Nevala P, Virkkunen I, Tommila M. The reliability and accuracy of operational system data in a nationwide helicopter emergency medical services mission database. BMC Emerg Med 2019; 19:53. [PMID: 31615407 PMCID: PMC6792230 DOI: 10.1186/s12873-019-0265-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 09/12/2019] [Accepted: 09/12/2019] [Indexed: 11/10/2022] Open
Abstract
AIM The aim of this study was to evaluate the reliability and accuracy of documentation in FinnHEMS database, which is a nationwide helicopter emergency service (HEMS) clinical quality registry. METHODS This is a nationwide study based on written fictional clinical scenarios. Study subjects were HEMS physicians and paramedics, who filled in the clinical quality registry based on the clinical scenarios. The inter-rater -reliability of the collected data was analyzed with percent agreement and free-marginal multi-rater kappa. RESULTS Dispatch coding had a percent agreement of 91% and free-marginal multi-rater kappa value of 0.83. Coding for transportation or mission cancellation resulted in an agreement of 84% and free-marginal kappa value of 0.68. An agreement of 82% and a kappa value of 0.73 for dispatcher coding was found. Mission end, arrival at hospital and HEMS unit dispatch -times had agreements from 80 to 85% and kappa values from 0.61 to 0.73. The emergency call to dispatch centre time had an agreement of 71% and kappa value of 0.56. The documentation of pain had an agreement of 73% on both the first and second measurements. All other vital parameters had less than 70% agreement and 0.40 kappa value in the first measurement. The documentation of secondary vital parameter measurements resulted in agreements from 72 to 91% and kappa values from 0.43 to 0.64. CONCLUSION Data from HEMS operations can be gathered reliably in a national clinical quality registry. This study revealed some inaccuracies in data registration and data quality, which are important to detect to improve the overall reliability and validity of the HEMS clinical quality register.
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Affiliation(s)
- A Heino
- FinnHEMS Research and Development Unit, Vantaa, Finland. .,Department of Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital and University of Turku, Turku, Finland.
| | - T Iirola
- Emergency Medical Services, Turku University Hospital and University of Turku, Turku, Finland
| | - L Raatiniemi
- Centre for Pre-Hospital Emergency Medicine, Oulu University Hospital, Oulu, Finland
| | - J Nurmi
- Emergency Medicine Services, Helsinki University Hospital and Department of Emergency Medicine, University of Helsinki, Helsinki, Finland
| | - A Olkinuora
- FinnHEMS Research and Development Unit, Vantaa, Finland
| | | | - I Virkkunen
- FinnHEMS Research and Development Unit, Vantaa, Finland
| | - M Tommila
- Department of Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital and University of Turku, Turku, Finland
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Staartjes VE, Schröder ML. Effectiveness of a Decision-Making Protocol for the Surgical Treatment of Lumbar Stenosis with Grade 1 Degenerative Spondylolisthesis. World Neurosurg 2017; 110:e355-e361. [PMID: 29133000 DOI: 10.1016/j.wneu.2017.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 11/01/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Addition of fusion to decompression for stenosis with grade 1 degenerative spondylolisthesis is a controversial topic, and the question remains if fusion provides any benefit to the patient that warrants the increased health care utilization and perioperative morbidity. There is no consensus on indications for use of fusion over decompression alone. METHODS Patients received fusion or decompression according to a decision-making protocol based on their pattern of complaints, location of the compression, and facet angles and effusion as proven predictors of postoperative instability. Propensity score matching of patients was done for baseline data. RESULTS The study comprised 102 patients in 2 equally sized groups. No intergroup differences in numeric rating scale and Oswestry Disability Index were detected at any follow-up point (all P > 0.05). Duration of surgery, length of stay, estimated blood loss, and radiation doses were higher in the fusion group (all P < 0.001). Cumulative reoperation rate was similar with 6% for fusion and 8% for decompression (P > 0.05), as was the complication rate (8% vs. 6%, P > 0.05). Postoperative iatrogenic progression of spondylolisthesis requiring fusion surgery was seen in only 2% in the decompression group. CONCLUSIONS Use of a decision-making protocol led to a low rate of iatrogenically increased spondylolisthesis after decompression, while retaining outcomes. These data suggest that a decision-making protocol based on clinical history, location of nerve root compression, and proven radiologic predictors of postoperative instability assigns patients to fusion or decompression in a safe and effective manner.
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Affiliation(s)
- Victor E Staartjes
- Department of Neurosurgery, Bergman Clinics, Amsterdam, The Netherlands; Faculty of Medicine, University of Zurich, Zurich, Switzerland.
| | - Marc L Schröder
- Department of Neurosurgery, Bergman Clinics, Amsterdam, The Netherlands
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An Approach to Lumbar Revision Spine Surgery in Adults. J Am Acad Orthop Surg 2017; 25:e20-e22. [PMID: 27906772 DOI: 10.5435/jaaos-d-16-00530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Stynes S, Konstantinou K, Dunn KM. Classification of patients with low back-related leg pain: a systematic review. BMC Musculoskelet Disord 2016; 17:226. [PMID: 27215590 PMCID: PMC4877814 DOI: 10.1186/s12891-016-1074-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 05/11/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The identification of clinically relevant subgroups of low back pain (LBP) is considered the number one LBP research priority in primary care. One subgroup of LBP patients are those with back related leg pain. Leg pain frequently accompanies LBP and is associated with increased levels of disability and higher health costs than simple low back pain. Distinguishing between different types of low back-related leg pain (LBLP) is important for clinical management and research applications, but there is currently no clear agreement on how to define and identify LBLP due to nerve root involvement. The aim of this systematic review was to identify, describe and appraise papers that classify or subgroup populations with LBLP, and summarise how leg pain due to nerve root involvement is described and diagnosed in the various systems. METHODS The search strategy involved nine electronic databases including Medline and Embase, reference lists of eligible studies and relevant reviews. Selected papers were appraised independently by two reviewers using a standardised scoring tool. RESULTS Of 13,358 initial potential eligible citations, 50 relevant papers were identified that reported on 22 classification systems. Papers were grouped according to purpose and criteria of the classification systems. Five themes emerged: (i) clinical features (ii) pathoanatomy (iii) treatment-based approach (iv) screening tools and prediction rules and (v) pain mechanisms. Three of the twenty two systems focused specifically on LBLP populations. Systems that scored highest following quality appraisal were ones where authors generally included statistical methods to develop their classifications, and supporting work had been published on the systems' validity, reliability and generalisability. There was lack of consistency in how LBLP due to nerve root involvement was described and diagnosed within the systems. CONCLUSION Numerous classification systems exist that include patients with leg pain, a minority of them focus specifically on distinguishing between different presentations of leg pain. Further work is needed to identify clinically meaningful subgroups of LBLP patients, ideally based on large primary care cohort populations and using recommended methods for classification system development.
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Affiliation(s)
- Siobhán Stynes
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.
| | - Kika Konstantinou
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Kate M Dunn
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
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Clement RC, Welander A, Stowell C, Cha TD, Chen JL, Davies M, Fairbank JC, Foley KT, Gehrchen M, Hagg O, Jacobs WC, Kahler R, Khan SN, Lieberman IH, Morisson B, Ohnmeiss DD, Peul WC, Shonnard NH, Smuck MW, Solberg TK, Stromqvist BH, Hooff MLV, Wasan AD, Willems PC, Yeo W, Fritzell P. A proposed set of metrics for standardized outcome reporting in the management of low back pain. Acta Orthop 2015; 86:523-33. [PMID: 25828191 PMCID: PMC4564773 DOI: 10.3109/17453674.2015.1036696] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Outcome measurement has been shown to improve performance in several fields of healthcare. This understanding has driven a growing interest in value-based healthcare, where value is defined as outcomes achieved per money spent. While low back pain (LBP) constitutes an enormous burden of disease, no universal set of metrics has yet been accepted to measure and compare outcomes. Here, we aim to define such a set. PATIENTS AND METHODS An international group of 22 specialists in several disciplines of spine care was assembled to review literature and select LBP outcome metrics through a 6-round modified Delphi process. The scope of the outcome set was degenerative lumbar conditions. RESULTS Patient-reported metrics include numerical pain scales, lumbar-related function using the Oswestry disability index, health-related quality of life using the EQ-5D-3L questionnaire, and questions assessing work status and analgesic use. Specific common and serious complications are included. Recommended follow-up intervals include 6, 12, and 24 months after initiating treatment, with optional follow-up at 3 months and 5 years. Metrics for risk stratification are selected based on pre-existing tools. INTERPRETATION The outcome measures recommended here are structured around specific etiologies of LBP, span a patient's entire cycle of care, and allow for risk adjustment. Thus, when implemented, this set can be expected to facilitate meaningful comparisons and ultimately provide a continuous feedback loop, enabling ongoing improvements in quality of care. Much work lies ahead in implementation, revision, and validation of this set, but it is an essential first step toward establishing a community of LBP providers focused on maximizing the value of the care we deliver.
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Affiliation(s)
- R Carter Clement
- Department of Orthopaedic Surgery, University of North Carolina Hospitals, Chapel Hill, NC, USA
| | | | - Caleb Stowell
- International Consortium for Health Outcomes Measurement, Boston, MA, USA
| | - Thomas D Cha
- Department of Orthopaedics, Massachusetts General Hospital, Boston, MA, USA
| | - John L Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | | | | | - Kevin T Foley
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Martin Gehrchen
- Department of Orthopaedic Surgery, Spine Section, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Olle Hagg
- Spine Center Göteborg, Gothenburg, Sweden
| | - Wilco C Jacobs
- Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Safdar N Khan
- Department of Orthopaedics, Division of Spine, Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | | | | | | | - Wilco C Peul
- Department of Neurosurgery, Leiden University Medical Center and Medical Center Haaglanden, Leiden and The Hague, the Netherlands
| | - Neal H Shonnard
- Director, Spine SCOAP Collaborative, Rainier Orthopedic Institute, Puyallup, WA, US
| | - Matthew W Smuck
- Department of Orthopaedic Surgery, PM&R Section, Stanford University, Palo Alto, CA, USA
| | - Tore K Solberg
- Department of Ophthalmology and Neurosurgery, University Hospital of Northern Norway, Tromsø, Norway,The Norwegian Registry for Spine Surgery (NORspine), Northern Norway Regional Health Authority, Tromsø, Norway
| | - Bjorn H Stromqvist
- Department of Orthopedics, Clinical Sciences Lund, Lund University Hospital, Lund, Sweden
| | | | - Ajay D Wasan
- Department of Anesthesiology, University of Pittsburgh Medical Center Pittsburgh, PA, USA
| | - Paul C Willems
- Maastricht University Medical Center, Maastricht, the Netherlands
| | - William Yeo
- Orthopaedic Diagnostic Centre, Singapore General Hospital, Singapore
| | - Peter Fritzell
- Department of Orthopaedic Surgery, Ryhov Hospital, Jönköping, Sweden,Registry Manager, Swespine
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van Hooff ML, van Loon J, van Limbeek J, de Kleuver M. The Nijmegen decision tool for chronic low back pain. Development of a clinical decision tool for secondary or tertiary spine care specialists. PLoS One 2014; 9:e104226. [PMID: 25133645 PMCID: PMC4136789 DOI: 10.1371/journal.pone.0104226] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 07/09/2014] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND In Western Europe, low back pain has the greatest burden of all diseases. When back pain persists, different medical specialists are involved and a lack of consensus exists among these specialists for medical decision-making in Chronic Low Back Pain (CLBP). OBJECTIVE To develop a decision tool for secondary or tertiary spine care specialists to decide which patients with CLBP should be seen by a spine surgeon or by other non-surgical medical specialists. METHODS A Delphi study was performed to identify indicators predicting the outcome of interventions. In the preparatory stage evidence from international guidelines and literature were summarized. Eligible studies were reviews and longitudinal studies. Inclusion criteria: surgical or non-surgical interventions and persistence of complaints, CLBP-patients aged 18-65 years, reported baseline measures of predictive indicators, and one or more reported outcomes had to assess functional status, quality of life, pain intensity, employment status or a composite score. Subsequently, a three-round Delphi procedure, to reach consensus on candidate indicators, was performed among a multidisciplinary panel of 29 CLBP-professionals (>five years CLBP-experience). The pre-set threshold for general agreement was ≥70%. The final indicator set was used to develop a clinical decision tool. RESULTS A draft list with 53 candidate indicators (38 with conclusive evidence and 15 with inconclusive evidence) was included for the Delphi study. Consensus was reached to include 47 indicators. A first version of the decision tool was developed, consisting of a web-based screening questionnaire and a provisional decision algorithm. CONCLUSIONS This is the first clinical decision tool based on current scientific evidence and formal multidisciplinary consensus that helps referring the patient for consultation to a spine surgeon or a non-surgical spine care specialist. We expect that this tool considerably helps in clinical decision-making spine care, thereby improving efficient use of scarce sources and the outcomes of spinal interventions.
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Affiliation(s)
| | - Jan van Loon
- Sint Maartenskliniek, Department of Orthopedics, Nijmegen, The Netherlands
| | | | - Marinus de Kleuver
- Sint Maartenskliniek, Department of Orthopedics, Nijmegen, The Netherlands
- VU University Medical Center, Department of Orthopedics, Amsterdam, The Netherlands
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Similar outcome despite slight clinical differences between lumbar radiculopathy induced by lateral versus medial disc herniations in patients without previous foraminal stenosis: a prospective cohort study with 1-year follow-up. Spine J 2014; 14:1526-31. [PMID: 24291407 DOI: 10.1016/j.spinee.2013.09.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 07/30/2013] [Accepted: 09/19/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT It has been claimed that lumbar radiculopathy induced by foraminal disc herniations had poorer outcome and different clinical features, including: 1-more progressive onset, but shorter duration between the first sign and request of medical care; 2-more severe radiculopathy; 3-less frequent/severe back pain; 4-less limitation of straight leg raising (SLR); 5-more frequent neurologic deficiencies; 6-poorer outcome. PURPOSE To check whether this still holds true when including only patients without other reasons for foraminal stenosis, that is, whether patients with medial disc herniations had different features and outcome than those with more lateral disc herniations. STUDY DESIGN All patients hospitalized to treat a lumbar radiculopathy within a 6-month period in two French rheumatology units in 2012 were included in this prospective study each time computed tomography scan or magnetic resonance imaging had already been performed and showed clear disc bulging/herniation but no features of medial or lateral spinal stenosis. PATIENT SAMPLE Fifty-nine patients (31 males, 49 with sciatica only) were included: 31 (53%) had medial disc herniations and 28 (47%) had more lateral herniations (posterolateral in 3, foraminal in 20, and far lateral in 5). OUTCOME MEASURES Outcome was assessed by a phone call 1 year after the baseline assessment using a standardized questionnaire. Patients were asked whether they experienced a relapse of their radiculopathy after discharge from the hospital; whether they had been operated or not; whether they felt it had improved or not; whether they felt cured or not; to assess their level of pain radiating in the leg when standing on a 0 to 10 verbal scale; and how long they could walk. METHODS Features of patients with medial disc herniations were compared with patients with more lateral herniations. RESULTS No significant differences according to the location of herniations were noticed for the speed of radiculopathy onset, time elapsed since onset, back pain (both lying or standing), and leg pain (both lying or standing), but slight significant differences (t test<0.05) were observed for other items: the 28 patients with lateral herniations were 8 years older (53.4 ±15.8 vs. 45.2±12.6), their herniations involved discs from upper levels of the lumbar spine (above L4-L5: 7/28 vs. 3/31), motor weakness was more frequent (25% vs. 3%), SLR was less restricted (65.0°±24.5° vs. 51.1°±25.7°), DN4 score of neuropathic pain was higher (4.4±2.1 vs. 3.2±1.8), anxiety level was higher (10.3±4.1 vs. 7.9±3.2), length of hospital stay was longer (5.7±2.4 days vs. 4.5±1.4 days), and physician's prognosis of a good outcome was poorer (6.6±2.2 vs. 8.0±1.6). However, at the end of follow-up (12.2±3.3 months), outcome was similar: 37% (vs. 41% for medial herniations) had transiently relapsed, 66% felt finally improved (vs. 63%), and walking capacity was nearly identical despite the fact that only 18% had to be operated (vs. 32% of those with medial herniations). CONCLUSIONS Despite differences in clinical presentation, the outcome of radiculopathy induced by the more lateral lumbar disc herniations was not worse than the outcome of patients with only medial disc herniations. Previous claims of poorer outcome in foraminal herniations might be explained by the inclusion of patients with associated foraminal stenosis.
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Heritability of spinal curvature and its relationship to disc degeneration and bone mineral density in female adult twins. 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 2014; 24:2387-94. [DOI: 10.1007/s00586-014-3477-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 06/15/2014] [Accepted: 07/18/2014] [Indexed: 11/27/2022]
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Bourigua I, Simoneau EM, Leteneur S, Gillet C, Ido G, Barbier F. Chronic low back pain sufferers exhibit freezing-like behaviors when asked to move their trunk as fast as possible. Spine J 2014; 14:1291-9. [PMID: 24333457 DOI: 10.1016/j.spinee.2013.11.051] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 11/14/2013] [Accepted: 11/26/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The effect of chronic low back pain (CLBP) on the kinematic parameters of trunk motion has received much more interest in this last decade. However, there are no descriptions of the motor strategies that occur when patients perform trunk movements in the three anatomical planes at different pace conditions. PURPOSE To investigate motor strategies used by CLBP patients and asymptomatic people while performing different go and back trunk movements in an upright standing position. STUDY DESIGN A comparative study. PATIENT SAMPLE The control group (CG, n=33) included 14 men and 19 women with no history of low back pain, and the chronic low back pain group (CLBPG, n=49) included 21 men and 28 women. OUTCOME MEASURES Kinematic data were analyzed during six trunk movements: flexion, extension, left and right lateral bendings, and rotations under two pace conditions (preferred and fast paces). METHODS A three-dimensional optoelectronic motion analysis system was used to assess static (trunk inclinations and base of support) and dynamic (range of motion [ROM] and mean angular velocity of the trunk) parameters during the go and back phases of trunk movements. RESULTS In the initial position, CLBPG showed a more forward-tilted trunk inclination (2.1°±1.1°, p=.013) compared with CG. The base of support was significantly higher in CG (+22.7 cm2, p=.009) during the fast pace when compared with the preferred pace. Regardless of the pace condition, ROM and mean angular velocity of the trunk were significantly lower in CLBPG for all examined movements and the pace condition did not significantly alter ROM. At the preferred pace, both groups displayed the same motor strategy: they all went faster during the second phase of movement than during the first phase. However, at the fast pace, while CG was going faster during the first phase than during the second, CLBPG maintained the same motor strategy as at the preferred pace. CONCLUSIONS Contrary to CG who changed its motor behavior from a preferred pace to a fast pace, CLBPG exhibited freezing-like behaviors. This original result highlights the importance of studying the velocity. The use of this parameter may improve the diagnosis of CLBP patients and could be a key indicator for treatment progress and long-term monitoring.
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Affiliation(s)
- Imen Bourigua
- Univ Lille Nord de France, F-59000 Lille, France; UVHC, LAMIH, F-59313 Valenciennes, France; CNRS, UMR 8201, F-59313 Valenciennes, France; Centre de Rééducation Fonctionnelle La Rougeville, 59880 Saint-Saulve, France.
| | - Emilie M Simoneau
- Univ Lille Nord de France, F-59000 Lille, France; UVHC, LAMIH, F-59313 Valenciennes, France; CNRS, UMR 8201, F-59313 Valenciennes, France
| | - Sébastien Leteneur
- Univ Lille Nord de France, F-59000 Lille, France; UVHC, LAMIH, F-59313 Valenciennes, France; CNRS, UMR 8201, F-59313 Valenciennes, France; Centre de Rééducation Fonctionnelle La Rougeville, 59880 Saint-Saulve, France
| | - Christophe Gillet
- Univ Lille Nord de France, F-59000 Lille, France; UVHC, LAMIH, F-59313 Valenciennes, France; CNRS, UMR 8201, F-59313 Valenciennes, France
| | - Ghassan Ido
- Centre de Rééducation Fonctionnelle La Rougeville, 59880 Saint-Saulve, France
| | - Franck Barbier
- Univ Lille Nord de France, F-59000 Lille, France; UVHC, LAMIH, F-59313 Valenciennes, France; CNRS, UMR 8201, F-59313 Valenciennes, France
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