1
|
Anwar FN, Roca AM, Khosla I, Loya AC, Medakkar SS, Kaul A, Wolf JC, Federico VP, Sayari AJ, Lopez GD, Singh K. Impact of preoperative back pain severity on PROMIS outcomes following minimally invasive lumbar decompression. 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/s00586-024-08275-w. [PMID: 39133294 DOI: 10.1007/s00586-024-08275-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 03/28/2024] [Accepted: 04/15/2024] [Indexed: 08/13/2024]
Abstract
PURPOSE To evaluate the effect of baseline back pain severity on PROMIS mental health outcomes following minimally invasive lumbar decompression (LD). METHODS Patients undergoing elective, primary, single-level LD were retrospectively reviewed from a prospective single spine surgeon registry. Perioperative characteristics, demographics, and the following patient-reported outcomes (PROs) were extracted: Oswestry Disability Index (ODI)/Patient-Health Questionnaire-9 /PROMIS-Physical Function/Anxiety/Pain Interference/Sleep Disturbance (PROMIS-PF/A/PI/SD). Two cohorts were created: preoperative VAS-B < 7 and VAS-B ≥ 7. Change in PROs (ΔPROs) from baseline to six weeks/final follow-up were determined. Average patient follow-up was 13.4 ± 8.8 months. Minimal clinically important difference (MCID) achievement rates were calculated and compared through multivariable logistic regression. Postoperative scores and ΔPROs, were compared with multivariable linear regression while all other data was compared between groups with inferential statistics. RESULTS Altogether, 347 patients were included, with 190 in the VAS-B < 7 group. VAS-B ≥ 7 reported worse outcomes preoperatively (p ≤ 0.013, all). At six weeks, VAS-B ≥ 7 reported worse VAS-B (p = 0.017), with no other significant differences. At final follow-up, patients with worse VAS-B reported worse ODI (p = 0.040) and VAS-B while all other PROs were similar (p ≥ 0.078, all). VAS-B ≥ 7 experienced greater 6-week improvements in VAS-B/ODI/PROMIS-PI/PROMIS-SD (p ≤ 0.009, all), greater VAS-B/ODI/PROMIS-SD improvement by final follow-up (p ≤ 0.009, all) and greater MCID achievement in ODI/VAS-B (p ≤ 0.027). CONCLUSION Patients with worse baseline back pain report inferior baseline scores that converge with those with milder preoperative back pain by 6 weeks after LD and reported greater 6-week improvements in disability, pain interference, and sleep disturbance by 6 weeks, and greater improvements in disability and sleep disturbance by final follow-up.
Collapse
Affiliation(s)
- Fatima N Anwar
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Andrea M Roca
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Ishan Khosla
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Alexandra C Loya
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Srinath S Medakkar
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Aayush Kaul
- Chicago Medical School at Rosalind Franklin University of Medicine and Science, 3333 N. Green Bay Rd., North Chicago, IL, 60064, USA
| | - Jacob C Wolf
- Chicago Medical School at Rosalind Franklin University of Medicine and Science, 3333 N. Green Bay Rd., North Chicago, IL, 60064, USA
| | - Vincent P Federico
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Arash J Sayari
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Gregory D Lopez
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA.
| |
Collapse
|
2
|
Antunez J, Malone ZC, Glaviano NR. Influence of self-perceived disability on squatting kinematics in individuals with patellofemoral pain. Clin Biomech (Bristol, Avon) 2023; 109:106089. [PMID: 37666039 DOI: 10.1016/j.clinbiomech.2023.106089] [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: 06/14/2023] [Revised: 08/15/2023] [Accepted: 08/29/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Individuals with patellofemoral pain have a heterogeneous presentation of symptoms during functional tasks; however, biomechanical data often negates self-reported disability. The single leg squat is common in patellofemoral pain literature but may not be a pain provoking task for all individuals. Therefore, our study examined the influence of self-perceived squatting disability in individuals with patellofemoral pain on lower extremity squatting kinematics. METHODS We analyzed two-dimensional hip frontal plane projection angle, knee frontal plane projection angle, lateral trunk movement, and pelvic drop in 100 participants, 82 with patellofemoral pain and 18 pain-free controls. Participants with patellofemoral pain were dichotomized based on the level of disability reported during squatting on the anterior knee pain scale. An analysis of variance with post hoc testing was used to compare differences in lower extremity and trunk kinematics between groups, p < 0.05. FINDINGS Participants who reported only being able to squat with partial weight bearing had greater hip frontal plane projection angles than those who reported squatting painful each time (p = 0.017). The partial weight bearing group had greater knee frontal plane projection angles compared those who reported pain with repeated squatting and the pain-free group, (p < 0.034). We found no significant differences in lateral trunk motion or pelvic drop between groups. INTERPRETATION Individuals with patellofemoral pain who self-reported worse squatting disability had greater hip and knee frontal plane motion compared to individuals with less disability and pain-free controls. Clinicians and researchers should consider specific pain provoking tasks when evaluating and treating patients with patellofemoral pain.
Collapse
Affiliation(s)
- Joaquin Antunez
- Department of Kinesiology, University of Connecticut, Storrs, CT, United States of America
| | - Zachary C Malone
- Department of Kinesiology, University of Connecticut, Storrs, CT, United States of America
| | - Neal R Glaviano
- Department of Kinesiology, University of Connecticut, Storrs, CT, United States of America.
| |
Collapse
|
3
|
Martin P, Keppler AM, Alberton P, Neuerburg C, Drey M, Böcker W, Kammerlander C, Saller MM. Self-Assessment of Mobility of People over 65 Years of Age. MEDICINA-LITHUANIA 2021; 57:medicina57090980. [PMID: 34577903 PMCID: PMC8469271 DOI: 10.3390/medicina57090980] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/23/2021] [Accepted: 09/14/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Nowadays, various clinical scoring systems are used in the medical care of the elderly to assess the quality of mobility. However, people often tend to under- or overestimate themselves in many aspects. Since this can have serious consequences in their treatment and care, the aim of this study was to identify differences in the self and external assessment of mobility of persons over 65 years of age. MATERIALS AND METHODS 222 participants over 65 years of age and one external, closely-related relative or professional caregiver were interviewed by a unique study assistant using a standardized questionnaire. Participants were divided into people living in nursing homes and independent people living at home, where either the caregivers or the relatives provided the external assessment of mobility, respectively. The questionnaire included demographics, cognitive abilities (Mini Mental Status Test); fall risk (Hendrich 2 Fall Risk Model); as well as the Parker Mobility Score, Barthel Index, and EQ-5D-5L to measure mobility, activities of daily life and quality of life. In each case, the participant and the external person were asked for their assessment to the participants' mobility situation. Statistical significance of the difference between self and external assessment was calculated with a Wilcoxon rank-sum test and assumed with a p-value of ≤ 0.05. RESULTS Self-assessment indicated a significantly higher value, when compared to an external assessment for the Parker Mobility Score for females in nursing homes (p ≤ 0.01), as well as for the Barthel Index for females (p ≤ 0.01) and males (p ≤ 0.01) in nursing homes. The EQ-5D-5L received a significantly higher self-assessment value for females (p ≤ 0.01) and males (p ≤ 0.01) living at home and females (p ≤ 0.01) and males (p ≤ 0.05) in nursing homes. CONCLUSIONS Persons over 65 years of age tend to overestimate their level of mobility, quality of life and activities of daily life. Especially for people living in nursing homes, these scoring systems should be treated with caution due to the differences between the verbal statements. It is important to properly assess the mobility situation of elderly patients to ensure correct medical treatment and prevention of falls.
Collapse
Affiliation(s)
- Pascal Martin
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 80336 Munich, Germany; (P.M.); (A.M.K.); (P.A.); (C.N.); (W.B.); (C.K.)
| | - Alexander Martin Keppler
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 80336 Munich, Germany; (P.M.); (A.M.K.); (P.A.); (C.N.); (W.B.); (C.K.)
| | - Paolo Alberton
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 80336 Munich, Germany; (P.M.); (A.M.K.); (P.A.); (C.N.); (W.B.); (C.K.)
| | - Carl Neuerburg
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 80336 Munich, Germany; (P.M.); (A.M.K.); (P.A.); (C.N.); (W.B.); (C.K.)
| | - Michael Drey
- Department of Medicine IV, Geriatrics, University Hospital, LMU Munich, 80336 Munich, Germany;
| | - Wolfgang Böcker
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 80336 Munich, Germany; (P.M.); (A.M.K.); (P.A.); (C.N.); (W.B.); (C.K.)
| | - Christian Kammerlander
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 80336 Munich, Germany; (P.M.); (A.M.K.); (P.A.); (C.N.); (W.B.); (C.K.)
- Traumahospital Styria, Graz & Kalwang, Austria
| | - Maximilian Michael Saller
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 80336 Munich, Germany; (P.M.); (A.M.K.); (P.A.); (C.N.); (W.B.); (C.K.)
- Correspondence:
| |
Collapse
|