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Bråten LCH, Grøvle L, Wigemyr M, Wilhelmsen M, Gjefsen E, Espeland A, Haugen AJ, Skouen JS, Brox JI, Zwart JA, Storheim K, Ostelo RW, Grotle M. Minimal important change was on the lower spectrum of previous estimates and responsiveness was sufficient for core outcomes in chronic low back pain. J Clin Epidemiol 2022; 151:75-87. [PMID: 35926821 DOI: 10.1016/j.jclinepi.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 07/13/2022] [Accepted: 07/21/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The objective of this study was to estimate the minimal important change (MIC) and responsiveness of core patient reported outcome measures for chronic low back pain (LBP) and Modic changes. STUDY DESIGN AND SETTING In the Antibiotics in Modic changes (AIM) trial we measured disability (RMDQ, ODI), LBP intensity (NRS) and health-related quality of life (EQ5D) electronically at baseline, three- and 12-month follow-up. MICs were estimated using Receiver Operating Curve (ROC) curve and Predictive modeling analyses against the global perceived effect. Credibility of the estimates was assessed by a standardized set of criteria. Responsiveness was assessed by a construct and criterion approach according to COSMIN guidelines. RESULTS The MIC estimates of RMDQ, ODI and NRS scores varied between a 15-40% reduction, depending on including "slightly improved" in the definition of MIC or not. The MIC estimates for EQ5D were lower. The credibility of the estimates was moderate. For responsiveness, five out of six hypotheses were confirmed and AUC was >0.7 for all PROMs. CONCLUSION When evaluated in a clinical trial of patients with chronic LBP and Modic changes, MIC thresholds for all PROMs were on the lower spectrum of previous estimates, varying depending on the definition of MIC. Responsiveness was sufficient.
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Affiliation(s)
- Lars Christian Haugli Bråten
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital HF, Ulleval, Bygg 37b, Postbox 4956, Nydalen, 0424, Oslo, Norway.
| | - Lars Grøvle
- Department of Rheumatology, Østfold Hospital Trust, PB 300, 1714, Grålum, Norway
| | - Monica Wigemyr
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital HF, Ulleval, Bygg 37b, Postbox 4956, Nydalen, 0424, Oslo, Norway
| | - Maja Wilhelmsen
- Department of Rehabilitation, University Hospital of North Norway, P.O. Box 100, 9038 Tromsø, Norway; Faculty of Health Sciences, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Elisabeth Gjefsen
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital HF, Ulleval, Bygg 37b, Postbox 4956, Nydalen, 0424, Oslo, Norway; Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, 0316, Oslo, Norway
| | - Ansgar Espeland
- Department of Radiology, Haukeland University Hospital, Jonas Liesvei 65, 5021 Bergen, Norway; Department of Clinical Medicine, University of Bergen, P.O. Box 7804, 5020, Bergen, Norway
| | - Anne Julsrud Haugen
- Department of Rheumatology, Østfold Hospital Trust, PB 300, 1714, Grålum, Norway
| | - Jan Sture Skouen
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Helse Bergen HF, Box 1, 5021 Bergen, Norway
| | - Jens Ivar Brox
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital HF, Ulleval, Postbox 4956, Nydalen, 0424, Oslo, Norway
| | - John-Anker Zwart
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital HF, Ulleval, Bygg 37b, Postbox 4956, Nydalen, 0424, Oslo, Norway; Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, 0316, Oslo, Norway
| | - Kjersti Storheim
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital HF, Ulleval, Bygg 37b, Postbox 4956, Nydalen, 0424, Oslo, Norway; Oslo Metropolitan University, Department of Physiotherapy, PO box 4 St. Olavs plass, NO-0130 Oslo, Norway
| | - Raymond Wjg Ostelo
- Department of Health Sciences, Faculty of Science, VU University Amsterdam, Amsterdam Movement Sciences Research Institute Amsterdam, Amsterdam, Netherlands; Department of Epidemiology and Data Science, Amsterdam University Medical Centre, Location VUmc, Amsterdam, Netherlands; Oslo Metropolitan University, Department of Physiotherapy, PO box 4 St. Olavs plass, NO-0130 Oslo, Norway
| | - Margreth Grotle
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital HF, Ulleval, Bygg 37b, Postbox 4956, Nydalen, 0424, Oslo, Norway; Oslo Metropolitan University, Department of Physiotherapy, PO box 4 St. Olavs plass, NO-0130 Oslo, Norway
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Shanbehzadeh S, ShahAli S, Hides J, Ebrahimi-Takamjani I, Rasouli O. Effect of Motor Control Training on Trunk Muscle Morphometry, Pain, and Disability in People With Chronic Low Back Pain: A Systematic Review and Meta-Analysis. J Manipulative Physiol Ther 2022; 45:202-215. [PMID: 35879124 DOI: 10.1016/j.jmpt.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/12/2022] [Accepted: 06/09/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The aim of this systematic review and meta-analysis was to study the effects of motor control training (MCT) on trunk muscle morphometry measured by ultrasound imaging and pain and disability in individuals with chronic low back pain. METHODS PubMed, Web of Science, Scopus, and Cochrane Library databases were searched from study inception until January 2021. Randomized control trials evaluating both muscle morphometry and pain or disability in individuals with chronic low back pain were included. Study selection, data extraction, and quality assessment were performed by 2 reviewers independently. Modified Downs and Black tool and the Grading of Recommendations Assessment, Development and Evaluation approach were used to assess the risk of bias and quality of evidence, respectively. A meta-analysis was performed using a random effects model with mean difference or standardized mean difference (SMD). RESULTS Of 3459 studies initially identified, 15 studies were included, and 13 studies were selected for meta-analysis. The results revealed no differences in the resting thickness of the transversus abdominis, internal and external oblique, and lumbar multifidus muscles in studies that compared MCT with other interventions. The transversus abdominis muscles contraction ratio was greater (SMD = 0.93; 95% confidence interval [CI], -0.0 to 1.85) and lower pain (weighted mean difference: -1.07 cm; 95% CI, -1.91 to -0.22 cm; P = .01) and disability (SMD = -0.86; 95% CI, -1.42 to -0. 29; P < .01) scores were found in the groups who underwent MCT compared with other interventions. CONCLUSION This systematic review and meta-analysis found that motor control exercise training increased the transverse abdominis contraction ratio (muscle activation) and improved the level of pain and disability compared to other interventions in people with chronic low back pain. However, motor control exercise training was not superior to other interventions in increasing the resting thickness of deep abdominal and lumbar multifidus muscles in intervention times less than 12 weeks.
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Affiliation(s)
- Sanaz Shanbehzadeh
- Rehabilitation Research Center, Iran University of Medical Sciences, Tehran, Iran; Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Shabnam ShahAli
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Julie Hides
- School of Health Sciences and Social Work, Griffith University, Nathan Campus, Brisbane, Queensland, Australia
| | - Ismail Ebrahimi-Takamjani
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Omid Rasouli
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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Roland-Morris Disability Questionnaire, Oswestry Disability Index, and Quebec Back Pain Disability Scale: Which Has Superior Measurement Properties in Older Adults With Low Back Pain? J Orthop Sports Phys Ther 2022; 52:457-469. [PMID: 35584027 DOI: 10.2519/jospt.2022.10802] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To examine the validity, reliability, and responsiveness of 3 commonly used questionnaires for assessing physical function (ie, Oswestry Disability Index [ODI], Quebec Back Pain Disability Scale [QBPDS], and Roland-Morris Disability Questionnaire [RMDQ]) in older patients undergoing chiropractic care for low back pain (LBP). DESIGN Head-to-head clinimetric comparison. METHODS Patients completed the ODI, QBPDS, and RMDQ at baseline and after 2 weeks of treatment. Reliability was evaluated for internal consistency (Cronbach α), test-retest reliability (interclass correlation coefficient [ICC]), and measurement error (standard error of measurement and smallest detectable change [SDC]). Structural validity was evaluated through unidimensional confirmatory factor analysis, and construct validity was investigated by a priori hypotheses with other measures. Responsiveness was evaluated by testing a priori hypotheses using data at baseline and at 2-week follow-up. RESULTS Two hundred fourteen patients (53% males and 47% females) with a mean age of 66.2 years (standard deviation = 7.8 years) were included, of which 193 patients completed the 2-week follow-up for our responsiveness analysis. The RMDQ, ODI, and QBPDS showed sufficient internal consistency (Cronbach α of .89, .86, and .94, respectively) and test-retest reliability (ICC[2,1] of 0.85, 0.89, and 0.84, respectively). The SDC for the RMDQ was 6.9, for the ODI was 19.1, and for the QBPDS was 23.6, which are values larger than the minimal important change. None of the measures met all criteria for sufficient structural validity, but the RMDQ and ODI exhibited a partial unidimensional fit. The questionnaires had sufficient construct validity and responsiveness. CONCLUSION The ODI, QBPDS, and RMDQ have similar measurement properties in older adults with LBP. J Orthop Sports Phys Ther 2022;52(7):457-469. Epub: 18 May 2022. doi:10.2519/jospt.2022.10802.
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Määttä J, Takatalo J, Leinonen T, Pienimäki T, Ylinen J, Häkkinen A. Lower thoracic spine extension mobility is associated with higher intensity of thoracic spine pain. J Man Manip Ther 2022; 30:300-308. [PMID: 35257630 PMCID: PMC9487940 DOI: 10.1080/10669817.2022.2047270] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objectives To evaluate the association of thoracic spine (TS) posture and mobility with TS pain. Methods Participants with TS pain reported maximum, average, and night pain in TS area, and pain summary score was calculated. Upright and sitting TS postures were evaluated by inspection. TS posture and mobility (flexion and extension) were recorded using an inclinometer and a tape measure, respectively. Correlations between posture and mobility assessments were calculated using Spearman rank correlation, the association of TS posture and mobility with TS pain by logistic regression analysis. Results The participants’ (n = 73, 52 females, age range 22–56) TS pain duration was 12 weeks on average. The correlations for measurements of TS posture and flexion mobility were higher than correlations of other TS measurements being between 0.53 and 0.82. Decreased extension mobility of the upper (from 1st to 6th TS segments; Th1–Th6) TS was associated with higher worst pain (OR 1.04, 95% CI 1.00–1.07) and whole TS with pain sum score (OR 1.05, 95% CI 1.01–1.08). Less kyphotic whole TS was associated with lower pain sum score (OR 0.96, 95% CI 0.92–1.00). Greater flexion mobility of upper and lower (Th6–Th12) TS were associated with lower pain sum score (OR 0.96, 95% CI 0.91–1.00, and OR 0.96, 95% CI 0.91–1.00, respectively). Conclusions Reduced thoracic extension mobility was associated with higher pain scores and the greater flexion mobility with lower pain scores. Future research is warranted to evaluate if treatments geared toward TS extension mobility improvements would result in lower TS pain.
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Affiliation(s)
- Juhani Määttä
- Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Loisto Terveys, Oulu, Finland
| | - Jani Takatalo
- Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Loisto Terveys, Oulu, Finland.,Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Tero Leinonen
- Loisto Terveys, Oulu, Finland.,Fysios Oulu, Oulu, Finland
| | - Tuomo Pienimäki
- Department of Physical and Rehabilitation Medicine, University of Oulu, Oulu, Finland
| | - Jari Ylinen
- Central Hospital of Central Finland, Jyväskylä, Finland
| | - Arja Häkkinen
- Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.,Central Hospital of Central Finland, Jyväskylä, Finland
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Chala MB, Donnelly C, Wondie Y, Ghahari S, Miller J. Cross-cultural adaptation and validation of the Amharic version of Roland Morris Disability Questionnaire in people with low back pain in Ethiopia. Disabil Rehabil 2021; 44:5638-5648. [PMID: 34167417 DOI: 10.1080/09638288.2021.1939798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Cross-culturally translate, adapt, and validate Roland Morris Disability Questionnaire (RMDQ) in Amharic language in Ethiopia. METHODS The English version RMDQ was translated into Amharic and back-translated into English. An expert review committee reviewed the translations and created Amharic version of the RMDQ (RMDQ-Am). Pilot testing and cognitive debriefing of the RMDQ-Am were conducted with a sample of 20 individuals with LBP. The RMDQ-Am was administered to 240 individuals with LBP from three rehabilitation centers to determine its psychometric properties. Internal consistency of the tool was determined by Cronbach's alpha. Test-retest reliability was determined by the Intraclass correlation coefficient. The Standard Error of Measurement (SEM), Minimum Detectable Change (MDC), and the Bland Altman Limit of Agreement (LOA) was also determined. The Short-Form Health Survey (SF-36) Bodily Pain and Physical Functioning subscales were used to assess convergent validity. Exploratory Factor Analysis (EFA) was used to determine the dimensionality of the tool. RESULTS RMDQ-Am demonstrated good internal consistency (α = 0.88), excellent test-retest reliability (ICC = 0.91), SEM (1.64), MDC (3.55), and good LOA. There is a significant moderate correlation between RMDQ-Am and the Physical Functioning (Rho = -0.62, p < 0.01) and Bodily Pain (BP) (Rho = -0.41, p < 0.01) subscales of the SF-36. Exploratory Factor Analysis demonstrates that the Amharic version of RMDQ is a primary one and secondary four-factor model [The Kaiser Meyer Olkin = 0.877, X2 (df) =1413.278/190, p < 0.001]. CONCLUSION RMDQ-Am is a reliable and valid tool that can be used in both clinical practice and research with the Ethiopian LBP population.IMPLICATION FOR REHABILITATIONDespite LBP being a concern in Ethiopia, the magnitude of disability related to this phenomenon is not studied in the country, mainly due to the absence of validated LBP specific patient-reported outcome measures such as the Roland Morris Disability Questionnaire (RMDQ).The RMDQ was successfully translated, adapted, and validated into the Amharic language and the Ethiopian context (RMDQ-Am).The RMDQ-Am is a reliable outcome measure among the Ethiopian population with LBP, as demonstrated by the good internal consistency (α = 0.88) and excellent test-retest reliability (ICC = 0.91).There is a moderate negative correlation between the RMDQ-Am and the Physical Functioning (Rho = -0.62, p < 0.01) and Bodily Pain (Rho = -0.41, p < 0.01) subscales of the SF-36.The RMDQ-Am can be used in clinical and research settings to measure LBP-related disability and its impact among individuals living with LBP in Ethiopia.
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Affiliation(s)
| | | | - Yemataw Wondie
- Department of Psychology, University of Gondar, Gondar, Ethiopia
| | - Setareh Ghahari
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Jordan Miller
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
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Fawkes C, Carnes D. Patient reported outcomes in a large cohort of patients receiving osteopathic care in the United Kingdom. PLoS One 2021; 16:e0249719. [PMID: 33861778 PMCID: PMC8051759 DOI: 10.1371/journal.pone.0249719] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 03/23/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The use of Patient Reported Outcome Measures (PROMs) to evaluate care is being advocated increasingly in clinical settings. Electronic data capture is both resource and environmentally friendly and convenient. This purpose of this study was to test and implement a nationwide system to collect routine PROM data from osteopathic patients using a web and mobile app. METHODS A prospective study design was used to monitor outcomes of care for patients attending osteopathic clinics. Demographic and service data were collected, the primary outcomes were the Bournemouth Questionnaire and a Global Rating of Change score. Data concerning patients' satisfaction and experience of care were collected also. Data were collected at baseline, one week, and six weeks post-treatment. RESULTS A total of 1721 patients completed the PROM app questionnaire. The majority (65.8%) of patients who used the PROM app were between 40 and 69 years old with 11% being 70 years and over. At baseline 39.8% of patients reported they'd had their symptoms for 13 weeks or more. Low back pain was the most common symptom (55.8%). Patients reported high scores for both satisfaction and experience of osteopathic care: 88.1% were very satisfied at six weeks post-baseline and 93.5% reported very good experience at six weeks post-baseline. Data from the Global Rating of Change scale indicated that at one week post-baseline 89.1% of patients reported some measure of improvement, and at six weeks this figure rose to 92.8%. The mean sum score for the Bournemouth Questionnaire went from 30.8 at baseline to 13.3 at six weeks post-baseline. This represented a significant and clinically meaningful positive change score of 56.8%. CONCLUSION The app was well-completed and the data very encouraging. These data will help to form the basis for standards of care for patients attending osteopathic practices.
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Affiliation(s)
- Carol Fawkes
- Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- * E-mail:
| | - Dawn Carnes
- Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- University College of Osteopathy, London, United Kingdom
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Haase I, Kladny B. Clinical Relevance of Changes in Pain Intensity in Patients with Specific Back Pain. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2021; 160:213-221. [PMID: 33461231 DOI: 10.1055/a-1304-3677] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Pain intensity is frequently measured on the 11-point numerical pain rating scale (NRS-PI), ranging from 0 (no pain) to 10 points (worst imaginable pain). However, it is difficult to interpret the clinical importance of changes from baseline to endpoint on this instrument. OBJECTIVES To estimate the minimal detectable change (MDC) and the minimal clinically important difference (MCID) for average pain intensity in patients with specific back pain. MATERIALS AND METHODS Data on 1232 subjects with specific back pain from a German hospital were included in this study. A score combining the patient's (PGIC) and the physician's global impression of change (CGIC) over the in-patient length of stay was used as an external criterion. A priori, we considered the score value "slightly improved" as the MCID. MDC was calculated using the standard error of measurement (SEM) and the standard deviation (SD) of the sample. MCID was estimated by the mean value of PI-NRS change in patients who self-assess as "slightly improved", and by sensitivity/specificity analyses, computed by the receiver operating characteristic method (ROC). RESULTS MDC was 1.77. The MCS and ROC methods consistently showed an MCID of 2 for the total sample. Both methods showed the dependence of the MCID on the initial pain: 1 for mild to moderate pain at baseline (1 - 4 NRS points), 2 for moderate to severe pain (5 - 7) and 3 - 4 for very severe to extreme pain (8 - 10). For patients with lumbosacral intervertebral disc disorders and patients in the acute phase (duration of pain < 6 weeks), the ROC method resulted in a higher limit than the MCS method. CONCLUSIONS In order to facilitate the interpretation of changes and to take into account the patient's perspective, the global assessment of the success of treatment should be used as an anchor criterion. In addition to dealing with pain measurement, function-related and psychosocial aspects of pain symptoms should be kept in mind.
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Affiliation(s)
- Ingo Haase
- Research, Development, Quality Assurance, m&i Hospital Group Enzensberg, Hopfen am See, Germany
| | - Bernd Kladny
- Department of Orthopaedics and Trauma Surgery, Fachklinik Herzogenaurach, Germany
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Carnes D, Bright P, Brownhill K, Carroll K, Engel R, Grace S, Vogel S, Vaucher P. Crying Unsettled and disTressed Infants Effectiveness Study of osteopathic care (CUTIES trial): Pragmatic randomised superiority trial protocol. INT J OSTEOPATH MED 2020. [DOI: 10.1016/j.ijosm.2020.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Gallo L, Gallo M, Murphy J, Waltho D, Baxter C, Karpinski M, Mowakket S, Copeland A, Thoma A. Reporting Outcomes and Outcome Measures in Cubital Tunnel Syndrome: A Systematic Review. J Hand Surg Am 2020; 45:707-728.e9. [PMID: 32591175 DOI: 10.1016/j.jhsa.2020.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 02/29/2020] [Accepted: 04/03/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE Comparison between studies assessing outcomes after surgical treatment of cubital tunnel syndrome (CuTS) has proven to be difficult owing to variations in outcome reporting. This study aimed to identify outcomes and outcome measures used to evaluate postoperative results for CuTS. METHODS We performed computerized database searches of MEDLINE and EMBASE. Studies with 20 or more patients aged 18 and older who were undergoing medial epicondylectomy, endoscopic decompression, open simple decompression, or decompression with subcutaneous, submuscular, or intramuscular transposition for ulnar neuropathy at the elbow were included. Outcomes and outcome measures were extracted and tabulated. RESULTS Of the 101 studies included, 45 unique outcomes and 31 postoperative outcome measures were identified. These included 7 condition-specific, clinician-reported instruments; 4 condition-specific, clinician-reported instruments; 8 patient-reported, generic instruments; 11 clinician-generated instruments; and one utility measure. Outcome measures were divided into 6 unique domains. Overall, 60% of studies used condition-specific outcome measures. The frequency of any condition-specific outcome measure ranged from 1% to 37% of included studies. CONCLUSIONS There is marked heterogeneity in outcomes and outcome measures used to assess CuTS. A standardized core outcome set is needed to compare results of various techniques of cubital tunnel decompression. CLINICAL RELEVANCE This study builds on the existing literature to support the notion that there is marked heterogeneity in outcomes and outcome measures used to assess CuTS. The authors believe that a future standardized set of core outcomes is needed to limit heterogeneity among studies assessing postoperative outcomes in CuTS to compare these interventions more easily and pool results in the form of systematic reviews and meta-analyses.
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Affiliation(s)
- Lucas Gallo
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Matteo Gallo
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jessica Murphy
- Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Daniel Waltho
- Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Charmaine Baxter
- Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Marta Karpinski
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Sadek Mowakket
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Andrea Copeland
- Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Achilleas Thoma
- Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
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Is There Equivalence Between the Electronic and Paper Version of the Questionnaires for Assessment of Patients With Chronic Low Back Pain? Spine (Phila Pa 1976) 2020; 45:E329-E335. [PMID: 31593061 DOI: 10.1097/brs.0000000000003281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVE To investigate the equivalence of electronic and paper version of self-report questionnaires for the assessment of disability, pain, fear of movement, depression, and physical activity of patients with chronic low back pain (LBP). SUMMARY OF BACKGROUND DATA Paper and electronic versions of self-report questionnaires are commonly used for assessment of patients with LBP. However, the equivalence of self-report questionnaires commonly used for assessment of patients with chronic LBP remains unclear. METHODS Seventy-nine individuals with chronic LBP seeking physiotherapy care were recruited. Participants attended the clinic twice with an interval of 1 week and completed the self-reported questionnaires in a random order. The following questionnaires were administered: Roland Morris Disability Questionnaire (RMDQ); 11-point numerical rating scale (NRS); Tampa Scale for Kinesiophobia (TSK); Center for Epidemiological Studies-Depression (CES-D), and Baecke Habitual Physical Activity Questionnaire (BPAQ). To investigate the equivalence between the two questionnaire versions, intraclass correlation coefficient with 95% confidence interval and Bland-Altman plotting was used. RESULTS The paper and electronic versions of the RMDQ, TSK, and CES-D showed good reliability and the showed moderate reliability. In contrast, the NRS showed poor reliability between the electronic and paper versions. CONCLUSION Our findings support that the electronic version of the RMDQ, TSK, CES-D, and BPAQ can be administered in clinical and research settings for assessment of patients with chronic LBP. Nevertheless, electronic version of the NRS for assessment of pain intensity should not be used interchangeably in clinical practice in patients with chronic LBP. LEVEL OF EVIDENCE 3.
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Bernard S, Gentilcore-Saulnier E, Massé-Alarie H, Moffet H. Is adding pelvic floor muscle training to an exercise intervention more effective at improving pain in patients with non-specific low back pain? A systematic review of randomized controlled trials. Physiotherapy 2020; 110:15-25. [PMID: 32349867 DOI: 10.1016/j.physio.2020.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Pelvic floor muscles (PFM) contribute to optimal control of the lumbopelvic spine. PFM function appears altered in some people with nonspecific low back pain (LBP). OBJECTIVE To systematically review if adding PFM training (PFMT) to another exercise intervention can be more effective at improving pain and function in people with nonspecific LBP than without PFMT. DATA SOURCES The authors conducted a literature search on Medline, Embase, CINAHL, Cochrane Central and Web of Sciences up to October 2018. ELIGIBILITY CRITERIA: (1) Participants with nonspecific LBP; (2) additional PFMT to an exercise intervention; (3) comparison to the same intervention without PFMT; (4) included minimally one planned outcome; and (5) a randomized controlled trial. Two reviewers performed screening, data extraction (primary outcome; pain severity, secondary outcome; physical function) and risk of bias assessment. SYNTHESIS METHODS Meta-analysis was performed using mean difference and 95% confidence intervals. RESULTS Six studies were included (n=200 participants). Participants with PFMT had lower pain severity in comparison with the group without PFMT (mean difference: -0.61, 95%CI [-0.91, -0.31], P<0.0001 and low heterogeneity: I2=0%). Subgroup analysis shows significant effect for interventions lasting longer than 8-weeks. No difference was found for function. Overall risk of bias was unclear. LIMITATIONS Small groups and high heterogenicity limit our findings. CONCLUSION There is very low-quality evidence that there is a small benefit of adding PFMT to another exercise intervention on pain severity in nonspecific LBP. Longer duration for an integrated lumbopelvic exercise program including PFMT is likely to impact pain outcomes positively. PROSPERO REGISTRATION CRD42018114601.
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Affiliation(s)
- Stéphanie Bernard
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), 525 Wildrid-Hamel, Québec, Québec G1M 2S8, Canada; Université Laval, 1050 avenue de la Médecine, Pavillon Ferdinand-Vandry, Québec, Québec G1V 0A6, Canada
| | - Evelyne Gentilcore-Saulnier
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), 525 Wildrid-Hamel, Québec, Québec G1M 2S8, Canada; Université Laval, 1050 avenue de la Médecine, Pavillon Ferdinand-Vandry, Québec, Québec G1V 0A6, Canada; Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, 2915, avenue du Bourg-Royal, Québec, Québec G1C 3S2, Canada
| | - Hugo Massé-Alarie
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), 525 Wildrid-Hamel, Québec, Québec G1M 2S8, Canada; Université Laval, 1050 avenue de la Médecine, Pavillon Ferdinand-Vandry, Québec, Québec G1V 0A6, Canada
| | - Hélène Moffet
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), 525 Wildrid-Hamel, Québec, Québec G1M 2S8, Canada; Université Laval, 1050 avenue de la Médecine, Pavillon Ferdinand-Vandry, Québec, Québec G1V 0A6, Canada.
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Escalona-Marfil C, Coda A, Ruiz-Moreno J, Riu-Gispert LM, Gironès X. Validation of an Electronic Visual Analog Scale mHealth Tool for Acute Pain Assessment: Prospective Cross-Sectional Study. J Med Internet Res 2020; 22:e13468. [PMID: 32049063 PMCID: PMC7055746 DOI: 10.2196/13468] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 10/30/2019] [Accepted: 11/29/2019] [Indexed: 12/21/2022] Open
Abstract
Background Accurate measurement of pain is required to improve its management and in research. The visual analog scale (VAS) on paper format has been shown to be an accurate, valid, reliable, and reproducible way to measure pain intensity. However, some limitations should be considered, some of which can be implemented with the introduction of an electronic VAS version, suitable to be used both in a tablet and a smartphone. Objective This study aimed to validate a new method of recording pain level by comparing the traditional paper VAS with the pain level module on the newly designed Interactive Clinics app. Methods A prospective observational cross-sectional study was designed. The sample consisted of 102 participants aged 18 to 65 years. A Force Dial FDK 20 algometer (Wagner Instruments) was employed to induce mild pressure symptoms on the participants’ thumbs. Pain was measured using a paper VAS (10 cm line) and the app. Results Intermethod reliability estimated by ICC(3,1) was 0.86 with a 95% confidence interval of 0.81 to 0.90, indicating good reliability. Intramethod reliability estimated by ICCa(3,1) was 0.86 with a 95% confidence interval of 0.81 to 0.90, also indicating good reliability. Bland-Altman analysis showed a difference of 0.175 (0.49), and limits of agreement ranged from –0.79 to 1.14. Conclusions The pain level module on the app is highly reliable and interchangeable with the paper VAS version. This tool could potentially help clinicians and researchers precisely assess pain in a simple, economic way with the use of a ubiquitous technology.
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Affiliation(s)
- Carles Escalona-Marfil
- Facultat de Ciències de la Salut de Manresa, Universitat de Vic-Universitat Central de Catalunya, Manresa, Spain.,University School of Health and Sport, University of Girona, Salt (Girona), Spain
| | - Andrea Coda
- School of Health Sciences, Faculty of Health and Medicine, Priority Research Centre for Health Behaviour, Hunter Medical Research Institute, The University of Newcastle, Callaghan, Australia
| | | | - Lluís Miquel Riu-Gispert
- Facultat de Ciències de la Salut de Manresa, Universitat de Vic-Universitat Central de Catalunya, Manresa, Spain
| | - Xavier Gironès
- Facultat de Ciències de la Salut de Manresa, Universitat de Vic-Universitat Central de Catalunya, Manresa, Spain
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13
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Gomis-Pastor M, Roig E, Mirabet S, T De Pourcq J, Conejo I, Feliu A, Brossa V, Lopez L, Ferrero-Gregori A, Barata A, Mangues MA. A Mobile App (mHeart) to Detect Medication Nonadherence in the Heart Transplant Population: Validation Study. JMIR Mhealth Uhealth 2020; 8:e15957. [PMID: 32014839 PMCID: PMC7055830 DOI: 10.2196/15957] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/18/2019] [Accepted: 12/16/2019] [Indexed: 01/17/2023] Open
Abstract
Background Medication nonadherence in heart transplant recipients (HTxR) is related to graft loss and death. mHeart is a mobile app that uses electronic patient-reported outcome measures (ePROMs) to identify and manage medication nonadherence in the outpatient heart transplant (HTx) population. Objective The study primarily aimed to validate mHeart to measure medication nonadherence in early stage HTxR by assessing the psychometric properties of ePROMs. The secondary aims were to (1) measure patient satisfaction with the mHeart tool and its usability and (2) explore the impact of a theory-based treatment on medication nonadherence rates to determine its scalability to larger research. Methods A prospective study was conducted in the outpatient clinic of a tertiary hospital. All consecutive early stage HTxR (<1.5 years from HTx) were included. The ePROM psychometric properties assessed were validity, reliability, responsiveness, interpretability, and burden. ePROMs comprised the 4-item Morisky-Green-Levine questionnaire and an adapted version of the Haynes-Sackett questionnaire. The Simplified Medication Adherence Questionnaire (SMAQ) was also applied on-site. Three consecutive medication nonadherence assessments were performed by a transplant pharmacist. To improve medication nonadherence, theory-based interventions were delivered in a 1-month period. Patient satisfaction was assessed by a semiquantitative Web-based survey at the end of the study. Results We included 31 early stage HTxR (age: mean 54 years, SD 12 years), and 71% (22/31) of them were men. The HTxR were taking a mean 13 (SD 4; range 7-18) drugs per day. A total of 42% (13/31) of patients were unaware of the consequences of medication nonadherence, and 39% (12/31) of patients were nonadherent to immunosuppressive treatment. The content validity measure showed excellent levels of expert panel agreement for the Haynes-Sacket (14/14, 100%) and Morisky-Green-Levine (13/14, 93%) questionnaires. SMAQ and Morisky-Green-Levine ePROMs showed similar measurement domains (convergent validity, phi=0.6, P<.001), which, as expected, differed from Haynes-Sackett ePROMs (divergent validity, phi=0.3, P=.12). Reliability assessment revealed a very strong association between ePROM and on-site PROMs (phi>0.7, P<.001). Reproducibility was moderate (Haynes-Sackett κ=0.6, P<.002) or poor (Morisky-Green-Levine κ=0.3, P=.11) because of unexpected improved medication adherence rates during the test-retest period. According to responsiveness, the theory-based multifaceted intervention program improved medication nonadherence by 16% to 26% (P<.05). A burden analysis showed that ePROMs could potentially overcome traditional on-site limitations (eg, automatic recording of ePROM responses in the hospital information system). The mean score for overall patient satisfaction with the mHeart approach was 9 (SD 2; score range: 0-10). All 100% (29/29) of patients surveyed reported that they would recommend the mHeart platform to other HTxR. Conclusions ePROMs adhered to the quality standards and successfully identified medication nonadherence in the HTx population, supporting their widespread use. The theory-based intervention program showed a promising improvement in medication adherence rates and produced excellent patient satisfaction and usability scores in HTxR.
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Affiliation(s)
- Mar Gomis-Pastor
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | - Eulalia Roig
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain.,Medicine Department, Autonomous University of Barcelona (UAB), Barcelona, Catalonia, Spain
| | - Sonia Mirabet
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | - Jan T De Pourcq
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | - Irene Conejo
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | - Anna Feliu
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | - Vicens Brossa
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | - Laura Lopez
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | - Andreu Ferrero-Gregori
- Institute of Biomedical Research IIB Sant Pau, Biomedical Research Networking Center on Cardiovascular Diseases (CIBERCV), Universitat Autonoma de Barcelona, Barcelona, Catalonia, Spain
| | - Anna Barata
- Moffitt Cancer Center, Florida, FL, United States
| | - M Antonia Mangues
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
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Lönnrot K, Taimela S, Toivonen P, Aronen P, Koski-Palken A, Frantzen J, Leinonen V, Silvasti-Lundell M, Förster J, Jarvinen T. Finnish Trial on Practices of Anterior Cervical Decompression and Fusion (FACADE): a protocol for a prospective randomised non-inferiority trial comparing outpatient versus inpatient care. BMJ Open 2019; 9:e032575. [PMID: 31772100 PMCID: PMC6886918 DOI: 10.1136/bmjopen-2019-032575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/22/2019] [Accepted: 10/29/2019] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Although a great majority of patients with cervical radiculopathy syndrome can successfully be treated non-operatively, a considerable proportion experience persistent symptoms, severe enough to require neurosurgical intervention. During the past decade, cervical spine procedures have increasingly been performed on an outpatient basis and retrospective database analyses have shown this to be feasible and safe. However, there are no randomised controlled studies comparing outpatient care with inpatient care, particularly with emphasis on the patients' perception of symptom relief and their ability to return to normal daily activities and work. METHODS AND ANALYSIS This is a prospective, randomised, controlled, parallel group non-inferiority trial comparing the traditional hospital surveillance (inpatient, patients staying in the hospital for 1-3 nights after surgery) with outpatient care (discharge on the day of the surgery, usually within 6-8 hours after procedure) in patients who have undergone anterior cervical decompression and fusion procedure. To determine whether early discharge (outpatient care) is non-inferior to inpatient care, we will randomise 104 patients to these two groups and follow them for 6 months using the Neck Disability Index (NDI) as the primary outcome. We expect that early discharge is not significantly worse than the current care in terms of change in NDI. Non-inferiority will be declared if the mean improvement for outpatient care is no worse than the mean improvement for inpatient care, by a margin of 17.3%. We hypothesise that a shorter hospital stay results in more rapid return to normal daily activities, shorter duration of sick leave and decreased secondary costs to healthcare system. Secondary outcomes in our study are arm pain and neck pain using the Numeric Rating Scale, operative success (Odom's criteria), patient's satisfaction to treatment, general quality of life (EQ-5D-5L), Work Ability Score, sickness absence days, return to previous leisure activities and complications. ETHICS AND DISSEMINATION The study was approved by the institutional review board of the Helsinki and Uusimaa Hospital District on 6 June 2019 (1540/2019) and duly registered at ClinicalTrials.gov. We will disseminate the findings of this study through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER NCT03979443.
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Affiliation(s)
- Kimmo Lönnrot
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Finnish Centre for Evidence-Based Orthopedics (FICEBO), University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Simo Taimela
- Finnish Centre for Evidence-Based Orthopedics (FICEBO), University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pirjo Toivonen
- Finnish Centre for Evidence-Based Orthopedics (FICEBO), University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pasi Aronen
- Finnish Centre for Evidence-Based Orthopedics (FICEBO), University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anniina Koski-Palken
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Janek Frantzen
- Division of Clinical neurosciences, Department of Neurosurgery, Turku University Hospital and University of Turku, Turku, Finland
| | - Ville Leinonen
- Department of Neurosurgery, Kuopio University Hospital and University of Eastern Finland, Kys, Finland
- Unit of Clinical Neuroscience, Neurosurgery, University of Oulu and Medical Research Center, Oulu, Finland
| | - Marja Silvasti-Lundell
- Division of Anaesthesiology, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital, Helsinki, Finland
| | - Johannes Förster
- Department of Anaesthesia, Orthopaedic Hospital Orton, Helsinki, Finland
| | - Teppo Jarvinen
- Finnish Centre for Evidence-Based Orthopedics (FICEBO), University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Measuring Stigma in Chronic Pain: Preliminary Investigation of Instrument Psychometrics, Correlates, and Magnitude of Change in a Prospective Cohort Attending Interdisciplinary Treatment. THE JOURNAL OF PAIN 2019; 20:1164-1175. [DOI: 10.1016/j.jpain.2019.03.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 02/08/2019] [Accepted: 03/13/2019] [Indexed: 01/16/2023]
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