1
|
Fourney DR. Commentary: Predicting Spinal Surgery Candidacy From Imaging Data Using Machine Learning. Neurosurgery 2021; 89:E16-E17. [PMID: 33989412 DOI: 10.1093/neuros/nyab127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/13/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Daryl R Fourney
- Division of Neurosurgery, Royal University Hospital, University of Saskatchewan, Saskatoon, Canada
| |
Collapse
|
2
|
Abstract
STUDY DESIGN A retrospective cohort study. OBJECTIVE The aim of this study was to examine variation in spine surgery utilization between the province of Ontario and state of New York among all patients and pre-specified patient subgroups. SUMMARY OF BACKGROUND DATA Spine surgery is common and costly. Within-country variation in utilization is well studied, but there has been little exploration of variation in spine surgery utilization between countries. METHODS We used population-level administrative data from Ontario (years 2011-2015) and New York (2011-2014) to identify all adults who underwent inpatient spinal decompression or fusion surgery using relevant procedure codes. Patients were stratified according to age and surgical urgency (elective vs. emergent). We calculated standardized utilization rates (procedures per-10,000 population per year) for each jurisdiction. We compared Ontario and New York with respect to patient demographics and the percentage of hospitals performing spine surgery. We compared utilization rates of spinal decompression and fusion surgery in Ontario and New York among all patients and after stratifying by surgical urgency and patient age. RESULTS Patients in Ontario were older than patients in New York for both decompression (mean age 58.8 vs. 51.3 years; P < 0.001) and fusion (58.1 vs. 54.9; P < 0.001). A smaller percentage of hospitals in Ontario than New York performed decompression (26.1% vs. 54.9%; P < 0.001) or fusion (15.2% vs. 56.7%; P < 0.001). Overall, utilization of spine surgery (decompression plus fusion) in Ontario was 6.6 procedures per-10,000 population per-year and in New York was 16.5 per-10,000 per-year (P < 0.001). Ontario-New York differences in utilization were smaller for emergent cases (2.0 per 10,000 in Ontario vs. 2.5 in New York; P < 0.001), but larger for elective cases (4.6 vs. 13.9; P < 0.001). The lower utilization in Ontario was particularly large among younger patients (age <60 years). CONCLUSION We found significantly lower utilization of spine surgery in Ontario than in New York. These differences should inform policy reforms in both jurisdictions. LEVEL OF EVIDENCE 3.
Collapse
|
3
|
Gross DP, Emery DJ, Long A, Reese H, Whittaker JL. A descriptive study of physiotherapist use of publicly funded diagnostic imaging modalities in Alberta, Canada. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2019. [DOI: 10.1080/21679169.2018.1505947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Douglas P. Gross
- Department of Physical Therapy, University of Alberta, Edmonton, Canada
| | - Derek J. Emery
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada
| | - Audrey Long
- Bonavista Physiotherapy Clinic, Calgary, Canada
| | - Hilary Reese
- LifeMark at Academy Place Physiotherapy Clinic, Edmonton, Canada
| | - Jackie L. Whittaker
- Department of Physical Therapy, University of Alberta, Edmonton, Canada
- Glen Sather Sports Medicine Clinic, University of Alberta, Edmonton, Canada
| |
Collapse
|
4
|
Coyle MJ, Roffey DM, Phan P, Kingwell SP, Wai EK. The Use of a Self-Administered Questionnaire to Reduce Consultation Wait Times for Potential Elective Lumbar Spinal Surgical Candidates: A Prospective, Pragmatic, Blinded, Randomized Controlled Quality Improvement Study. J Bone Joint Surg Am 2018; 100:2125-2131. [PMID: 30562293 DOI: 10.2106/jbjs.18.00423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In a public health-care system, patients often experience lengthy wait times to see a spine surgeon for consultation, and most patients are found not to be surgical candidates, thereby prolonging the wait time for those who are. The aim of this study was to evaluate whether a self-administered 3-item questionnaire (3IQ) could reprioritize consultation appointments and reduce wait times for lumbar spinal surgical candidates. METHODS This prospective, pragmatic, blinded, randomized controlled quality improvement study was conducted at a single Canadian academic health-care center. This study enrolled 227 consecutive eligible participants with an elective lumbar condition who were referred for consultation with a spine surgeon. All participants were mailed the 3IQ after their referral was received. Patients were randomized into the intervention group, in which leg-dominant pain reported on the 3IQ resulted in an upgrade in priority to be seen, or into the control group, in which no change to wait-list priority occurred. The main outcome measured was time to consultation for participants who were deemed surgical candidates following consultation. RESULTS There were no significant differences between groups with regard to demographics, overall group wait times, proportion of surgical candidates, or disability. A total of 33 patients were deemed surgical candidates after consultation. The median wait from referral to consultation was shorter for the 16 surgical candidates in the intervention group (2.5 months; interquartile range [IQR]: 2.0 to 4.8 months) compared with the 17 surgical candidates in the control group (4.5 months; IQR: 3.4 to 6.9 months; p = 0.090). The odds of seeing a surgical candidate within the acceptable time frame of 3 months were 5.4 times greater (95% confidence interval: 1.2 to 24.5 times; p = 0.024) in the intervention group. CONCLUSIONS The use of a simple, self-administered questionnaire to reprioritize referrals resulted in shorter consultation wait times for patients who required a surgical procedure and significantly increased the number of surgical candidates seen within the acceptable time frame. It may be valuable to consider adding the 3IQ to clinical care practices to better triage these patients on waiting lists.
Collapse
Affiliation(s)
- Matthew J Coyle
- Division of Orthopaedic Surgery (M.J.C., P.P., S.P.K, and E.K.W.), Department of Surgery, and the Combined Adult Spinal Surgery Program (D.M.R., P.P., S.P.K., and E.K.W.), The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Darren M Roffey
- Division of Orthopaedic Surgery (M.J.C., P.P., S.P.K, and E.K.W.), Department of Surgery, and the Combined Adult Spinal Surgery Program (D.M.R., P.P., S.P.K., and E.K.W.), The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Philippe Phan
- Division of Orthopaedic Surgery (M.J.C., P.P., S.P.K, and E.K.W.), Department of Surgery, and the Combined Adult Spinal Surgery Program (D.M.R., P.P., S.P.K., and E.K.W.), The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Stephen P Kingwell
- Division of Orthopaedic Surgery (M.J.C., P.P., S.P.K, and E.K.W.), Department of Surgery, and the Combined Adult Spinal Surgery Program (D.M.R., P.P., S.P.K., and E.K.W.), The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Eugene K Wai
- Division of Orthopaedic Surgery (M.J.C., P.P., S.P.K, and E.K.W.), Department of Surgery, and the Combined Adult Spinal Surgery Program (D.M.R., P.P., S.P.K., and E.K.W.), The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| |
Collapse
|
5
|
Zarrabian M, Bidos A, Fanti C, Young B, Drew B, Puskas D, Rampersaud R. Improving spine surgical access, appropriateness and efficiency in metropolitan, urban and rural settings. Can J Surg 2018. [PMID: 30246685 DOI: 10.1503/cjs.016116] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The Inter-professional Spine Assessment and Education Clinics (ISAEC) were developed to improve primary care assessment, education and management of patients with persistent or recurrent low back pain-related symptoms. This study aims to determine the effect of ISAEC on access for surgical assessment, referral appropriateness and efficiency for patients meeting a priori referral criteria in rural, urban and metropolitan settings. METHODS We conducted a retrospective review of prospective data from networked ISAEC clinics in Thunder Bay, Hamilton and Toronto, Ontario. For patients meeting surgical referral criteria, wait times for surgical assessment, surgical referral-related magnetic resonance imaging (MRI) scans and appropriateness of referral were recorded. RESULTS Overall 422 patients, representing 10% of all ISAEC patients in the study period, were referred for surgical assessment. The average wait times for surgical assessment were 5.4, 4.3 and 2.2 weeks at the metropolitan, urban and rural centres, respectively. Referral MRI usage for the group decreased by 31%. Of the patients referred for formal surgical assessment, 80% had leg-dominant pain and 96% were deemed appropriate surgical referrals. CONCLUSION Contrary to geographic concentration of health care resources in metropolitan settings, the greatest decrease in wait times was achieved in the rural setting. A networked, shared-cared model of care for patients with low back pain-related symptoms significantly improved access for surgical assessment despite varying geographic practice settings and barriers. The greatest reductions were noted in the rural setting. In addition, significant improvements in referral appropriateness and efficiency were achieved compared with historical reports across all sites.
Collapse
Affiliation(s)
- Mohammad Zarrabian
- From the Division of Orthopedic Surgery, University of Manitoba, Winnipeg, Man. (Zarrabian); the Toronto Western Hospital University Health Network, Toronto, Ont. (Bidos); the Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ont. (Fanti, Puskas); Absolute Chiropractic, Hamilton, Ont. (Young); the Division of Orthopedic Surgery, McMaster University, Hamilton, Ont. (Drew); the Arthritis Program, Toronto Western Hospital, University of Toronto, Toronto, Ont. (Rampersaud); and the Division of Orthopaedic Surgery and Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ont. (Rampersaud)
| | - Andrew Bidos
- From the Division of Orthopedic Surgery, University of Manitoba, Winnipeg, Man. (Zarrabian); the Toronto Western Hospital University Health Network, Toronto, Ont. (Bidos); the Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ont. (Fanti, Puskas); Absolute Chiropractic, Hamilton, Ont. (Young); the Division of Orthopedic Surgery, McMaster University, Hamilton, Ont. (Drew); the Arthritis Program, Toronto Western Hospital, University of Toronto, Toronto, Ont. (Rampersaud); and the Division of Orthopaedic Surgery and Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ont. (Rampersaud)
| | - Caroline Fanti
- From the Division of Orthopedic Surgery, University of Manitoba, Winnipeg, Man. (Zarrabian); the Toronto Western Hospital University Health Network, Toronto, Ont. (Bidos); the Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ont. (Fanti, Puskas); Absolute Chiropractic, Hamilton, Ont. (Young); the Division of Orthopedic Surgery, McMaster University, Hamilton, Ont. (Drew); the Arthritis Program, Toronto Western Hospital, University of Toronto, Toronto, Ont. (Rampersaud); and the Division of Orthopaedic Surgery and Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ont. (Rampersaud)
| | - Barry Young
- From the Division of Orthopedic Surgery, University of Manitoba, Winnipeg, Man. (Zarrabian); the Toronto Western Hospital University Health Network, Toronto, Ont. (Bidos); the Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ont. (Fanti, Puskas); Absolute Chiropractic, Hamilton, Ont. (Young); the Division of Orthopedic Surgery, McMaster University, Hamilton, Ont. (Drew); the Arthritis Program, Toronto Western Hospital, University of Toronto, Toronto, Ont. (Rampersaud); and the Division of Orthopaedic Surgery and Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ont. (Rampersaud)
| | - Brian Drew
- From the Division of Orthopedic Surgery, University of Manitoba, Winnipeg, Man. (Zarrabian); the Toronto Western Hospital University Health Network, Toronto, Ont. (Bidos); the Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ont. (Fanti, Puskas); Absolute Chiropractic, Hamilton, Ont. (Young); the Division of Orthopedic Surgery, McMaster University, Hamilton, Ont. (Drew); the Arthritis Program, Toronto Western Hospital, University of Toronto, Toronto, Ont. (Rampersaud); and the Division of Orthopaedic Surgery and Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ont. (Rampersaud)
| | - David Puskas
- From the Division of Orthopedic Surgery, University of Manitoba, Winnipeg, Man. (Zarrabian); the Toronto Western Hospital University Health Network, Toronto, Ont. (Bidos); the Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ont. (Fanti, Puskas); Absolute Chiropractic, Hamilton, Ont. (Young); the Division of Orthopedic Surgery, McMaster University, Hamilton, Ont. (Drew); the Arthritis Program, Toronto Western Hospital, University of Toronto, Toronto, Ont. (Rampersaud); and the Division of Orthopaedic Surgery and Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ont. (Rampersaud)
| | - Raja Rampersaud
- From the Division of Orthopedic Surgery, University of Manitoba, Winnipeg, Man. (Zarrabian); the Toronto Western Hospital University Health Network, Toronto, Ont. (Bidos); the Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ont. (Fanti, Puskas); Absolute Chiropractic, Hamilton, Ont. (Young); the Division of Orthopedic Surgery, McMaster University, Hamilton, Ont. (Drew); the Arthritis Program, Toronto Western Hospital, University of Toronto, Toronto, Ont. (Rampersaud); and the Division of Orthopaedic Surgery and Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ont. (Rampersaud)
| |
Collapse
|
6
|
Robarts S, Stratford P, Kennedy D, Malcolm B, Finkelstein J. Evaluation of an advanced-practice physiotherapist in triaging patients with lumbar spine pain: surgeon-physiotherapist level of agreement and patient satisfaction. Can J Surg 2017; 60:266-272. [PMID: 28730987 DOI: 10.1503/cjs.013416] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Surgery for lumbar spine pain is indicated for specific etiologies. Given the majority of individuals referred to spine surgeons are not surgical candidates, care delivery is inefficient, with consultations being of limited value for most. Using specially trained physiotherapists in triage is a human resource strategy that may optimize surgeons' time and the patient experience. METHODS An advanced-practice physiotherapist (APP) and a surgeon assessed consecutive patients with lumbar spine pain presenting at an academic health centre's spine surgery clinic. The second assessor was blinded to the outcome of the first. We used the κ statistic to evaluate surgeon-APP level of chance-corrected agreement concerning patients' need for a surgical consultation. To assess satisfaction with the APP, patients completed a modified version of the validated Visit-specific Questionnaire. RESULTS The sample included 102 participants (54 women) with a mean age of 54.3 ± 14.3 years and a mean Oswestry Disability Index score of 35.4 ± 16.6. The assessors' overall agreement was 86%. The κ coefficient for the need for a surgical consultation was 0.69 (95% confidence interval 0.54-0.84). The APP identified that 77% of patients did not require a surgical consultation. Twenty-one patients underwent surgery. Satisfaction scores for the APP were very high (mean score 92 out of 100). CONCLUSION In triaging patients with lumbar spine pain, the APP and surgeon had a high level of agreement. An APP performing triage at a surgical centre can effectively reduce wait lists by 70%, reserving surgical consultations for those patients in whom they are indicated.
Collapse
Affiliation(s)
- Susan Robarts
- From the Department of Rehabilitation, Sunnybrook Holland Orthopaedic and Arthritic Centre, Toronto, Ont. (Robarts, Kennedy); the School of Rehabilitation Science, McMaster University, Hamilton, Ont. (Stratford, Kennedy); the Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ont. (Malcom, Finkelstein); and the Department of Surgery, Faculty of Medicine, University of Toronto, Ont. (Finkelstein)
| | - Paul Stratford
- From the Department of Rehabilitation, Sunnybrook Holland Orthopaedic and Arthritic Centre, Toronto, Ont. (Robarts, Kennedy); the School of Rehabilitation Science, McMaster University, Hamilton, Ont. (Stratford, Kennedy); the Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ont. (Malcom, Finkelstein); and the Department of Surgery, Faculty of Medicine, University of Toronto, Ont. (Finkelstein)
| | - Deborah Kennedy
- From the Department of Rehabilitation, Sunnybrook Holland Orthopaedic and Arthritic Centre, Toronto, Ont. (Robarts, Kennedy); the School of Rehabilitation Science, McMaster University, Hamilton, Ont. (Stratford, Kennedy); the Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ont. (Malcom, Finkelstein); and the Department of Surgery, Faculty of Medicine, University of Toronto, Ont. (Finkelstein)
| | - Barry Malcolm
- From the Department of Rehabilitation, Sunnybrook Holland Orthopaedic and Arthritic Centre, Toronto, Ont. (Robarts, Kennedy); the School of Rehabilitation Science, McMaster University, Hamilton, Ont. (Stratford, Kennedy); the Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ont. (Malcom, Finkelstein); and the Department of Surgery, Faculty of Medicine, University of Toronto, Ont. (Finkelstein)
| | - Joel Finkelstein
- From the Department of Rehabilitation, Sunnybrook Holland Orthopaedic and Arthritic Centre, Toronto, Ont. (Robarts, Kennedy); the School of Rehabilitation Science, McMaster University, Hamilton, Ont. (Stratford, Kennedy); the Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ont. (Malcom, Finkelstein); and the Department of Surgery, Faculty of Medicine, University of Toronto, Ont. (Finkelstein)
| |
Collapse
|
7
|
Rempel J, Busse JW, Drew B, Reddy K, Cenic A, Kachur E, Murty N, Candelaria H, Moore AE, Riva JJ. Patients' Attitudes Toward Nonphysician Screening of Low Back and Low Back Related Leg Pain Complaints Referred for Surgical Assessment. Spine (Phila Pa 1976) 2017; 42:E288-E293. [PMID: 28244969 DOI: 10.1097/brs.0000000000001764] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A questionnaire survey. OBJECTIVE The aim of this study was to explore patient attitudes toward screening to assess suitability for low back surgery by nonphysician health care providers. SUMMARY OF BACKGROUND DATA Canadian spine surgeons have shown support for nonphysician screening to assess and triage patients with low back pain and low back related leg pain. However, patients' attitudes toward this proposed model are largely unknown. METHODS We administered a 19-item cross-sectional survey to adults with low back and/or low back related leg pain who were referred for elective surgical assessment at one of five spine surgeons' clinics in Hamilton, Ontario, Canada. The survey inquired about demographics, expectations regarding wait time for surgical consultation, as well as willingness to pay, travel, and be screened by nonphysician health care providers. RESULTS Eighty low back patients completed our survey, for a response rate of 86.0% (80 of 93). Most respondents (72.5%; 58 of 80) expected to be seen by a surgeon within 3 months of referral, and 88.8% (71 of 80) indicated willingness to undergo screening with a nonphysician health care provider to establish whether they were potentially a surgical candidate. Half of respondents (40 of 80) were willing to travel >50 km for assessment by a nonphysician health care provider, and 46.2% were willing to pay out-of-pocket (25.6% were unsure). However, most respondents (70.0%; 56 of 80) would still want to see a surgeon if they were ruled out as a surgical candidate, and written comments from respondents revealed concern regarding agreement between surgeons' and nonphysicians' determination of surgical candidates. CONCLUSION Patients referred for surgical consultation for low back or low back related leg pain are largely willing to accept screening by nonphysician health care providers. Future research should explore the concordance of screening results between surgeon and nonphysician health care providers. LEVEL OF EVIDENCE 3.
Collapse
Affiliation(s)
- Joshua Rempel
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jason W Busse
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
| | - Brian Drew
- Department of Surgery, Division of Orthopedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Kesava Reddy
- Department of Surgery, Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
| | - Aleksa Cenic
- Department of Surgery, Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
| | - Edward Kachur
- Department of Surgery, Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
| | - Naresh Murty
- Department of Surgery, Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
| | - Henry Candelaria
- University Health Network, Toronto, Ontario, Canada
- Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada
| | - Ainsley E Moore
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - John J Riva
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
8
|
Della Mora LS, Perruccio AV, Badley EM, Rampersaud YR. Differences among primary care patients with different mechanical patterns of low back pain: a cross-sectional investigation. BMJ Open 2016; 6:e013060. [PMID: 27927661 PMCID: PMC5168682 DOI: 10.1136/bmjopen-2016-013060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To characterise and compare a persistent low back pain (LBP) population based on 4 clinical pain patterns. DESIGN Cross-sectional analysis of patient-reported data. SETTING Patients from 220 primary care practitioners in 3 cities in Ontario, Canada. PARTICIPANTS 1020 individuals seeking LBP care. INCLUSION CRITERIA LBP symptoms lasting 1½-12 months, or unmanageable recurrent symptoms; ages 18+years. EXCLUSION CRITERIA pregnant/1-year postpartum; involved in active litigation or motor vehicle injury; emergent spinal presentations; pain disorder diagnosis; work injury claim; or constant symptoms persisting >12 months postonset. MAIN OUTCOME MEASURE Hall pain pattern subgroups: back dominant pain aggravated by flexion (P1) or extension (P2), or leg dominant constant (P3) or intermittent (P4) pain (multinomial logistic outcome; referent: P1). RESULTS Groups P1 and P2 had the highest proportion of women. P2 and P4 had higher mean ages and comorbidity counts. P3 and P4 had higher proportions of overweight/obese individuals and lower general health scores. Adjusted models: being male and overweight/obese was associated with increased odds of being in P3 (OR 1.64 (95% CI 1.10 to 2.46), and OR 1.74 (1.13 to 2.68), respectively) and P4 (OR 1.87 (1.11 to 3.15) and OR 1.91 (1.06 to 3.42), respectively), and increasing age with increased odds of being in P2 (OR 1.02 (1.01 to 1.03)) and P4 (OR 1.06 (1.04 to 1.08)). Increasing comorbidity count was associated with increased odds of being in P2 (OR 1.14 (1.0 to 1.3)), and better general health scores with decreased odds of being in P3 (OR 0.40 (0.18 to 0.93)). CONCLUSIONS This is the first study to examine the 'Hall system' in a non-rehab primary care population. Subgroups classified according to this system appear to have distinct profiles. Further research is needed to better characterise and determine the prognostic implication of these clinically derived subgroups.
Collapse
Affiliation(s)
- Lauren S Della Mora
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Anthony V Perruccio
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Health Care and Outcomes Research, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Arthritis Program, University Health Network, Toronto, Ontario, Canada
- Faculty of Medicine, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth M Badley
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Health Care and Outcomes Research, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Arthritis Program, University Health Network, Toronto, Ontario, Canada
| | - Y Raja Rampersaud
- Arthritis Program, University Health Network, Toronto, Ontario, Canada
- Faculty of Medicine, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
9
|
Uribe JS, Deukmedjian AR. Visceral, vascular, and wound complications following over 13,000 lateral interbody fusions: a survey study and literature review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 24 Suppl 3:386-96. [DOI: 10.1007/s00586-015-3806-4] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 02/08/2015] [Accepted: 02/08/2015] [Indexed: 11/29/2022]
|