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Samuel R, Bagdesar M, Brown TDG, Kong AC, Shetty S, George A, Ajwani S. Perceptions of patients towards oral health care in a spinal cord injury rehabilitation unit: A qualitative study. J Oral Rehabil 2024. [PMID: 38886619 DOI: 10.1111/joor.13762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 12/02/2023] [Accepted: 05/19/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Individuals with spinal cord injuries (SCIs) are at an increased risk of poor oral health compared to the general population. However, little is known about the related barriers and facilitators experienced by these individuals within the hospital setting. OBJECTIVES Understand the oral health knowledge, attitudes and practices of people with SCIs, barriers and facilitators to managing their oral health, and recommendations to improve oral care at acute/rehabilitation hospital settings. METHODS Semi-structured interviews were conducted with 11 participants, from a major metropolitan hospital in Sydney, Australia. The interviews were thematically analysed. RESULTS Three themes were constructed. Participants believed that the onus was on them to manage their oral health. Individuals also had limited knowledge of its importance to general health, and placed a lower priority on oral health compared to other aspects of health. All participants identified a combination of factors, such as cost, time, resources and prior negative experiences, that contributed to the neglect of their oral care. Participants also discussed the need of support from the multidisciplinary team and family/carers to facilitate oral care and identified various appropriate oral health education formats. CONCLUSION This study highlighted some areas where oral health knowledge among people with SCIs could be improved. It also identified the need for oral health training for the multidisciplinary team, as well as carers, to better integrate oral care during rehabilitation in the hospital. The development of oral health interventions would need to utilise a co-design approach to best support clients and their carers to facilitate oral care self-management.
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Affiliation(s)
- Rebecca Samuel
- Sydney Dental School, Faculty of Medicine and Health, University of Sydney, Surry Hills, New South Wales, Australia
| | - Mary Bagdesar
- Sydney Dental School, Faculty of Medicine and Health, University of Sydney, Surry Hills, New South Wales, Australia
| | - Travis D G Brown
- Sydney Dental School, Faculty of Medicine and Health, University of Sydney, Surry Hills, New South Wales, Australia
| | - Ariana C Kong
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing & Midwifery, Western Sydney University, Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Sachin Shetty
- Spinal Injuries Unit. Prince of Wales Hospital, Randwick, New South Wales, Australia
- Medicine and Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Ajesh George
- Sydney Dental School, Faculty of Medicine and Health, University of Sydney, Surry Hills, New South Wales, Australia
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing & Midwifery, Western Sydney University, Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Shilpi Ajwani
- Sydney Dental School, Faculty of Medicine and Health, University of Sydney, Surry Hills, New South Wales, Australia
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing & Midwifery, Western Sydney University, Liverpool, New South Wales, Australia
- Sydney Dental Hospital, Oral Health Services, Sydney Local Health District, Surry Hills, New South Wales, Australia
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Santos VS, Downie A, Kamper SJ, Yamato TP. A new version of a measurement for presence and impact of pain in children and adolescents - Presence and impact of pain in Kids (PIP-KIDS) questionnaire: Translation, cross-cultural adaptation and measurement properties into Brazilian-Portuguese. Musculoskelet Sci Pract 2023; 65:102772. [PMID: 37182390 DOI: 10.1016/j.msksp.2023.102772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/24/2023] [Accepted: 05/01/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Musculoskeletal pain in children and adolescents is prevalent and responsible for high levels of disability. Instruments to measure the presence and impact of pain in this population are needed. OBJECTIVE To translate, cross-culturally adapt, then test the measurement properties (structural validity, reliability and construct validity) of a questionnaire (Presence and Impact of Pain in Kids (PIP-Kids) questionnaire) to measure the presence and impact of pain in children and adolescents. DESIGN Measurement properties study. METHODS We conducted a measurement properties study. We translated and culturally adapted the PIP-Kids questionnaire into Brazilian Portuguese. The structural validity was measured by Confirmatory Factor Analysis. Reliability was measured by Kappa Coefficient. Measurement error was measured by the percentage of agreement. Construct validity was measured by Spearman Correlation. RESULTS/FINDINGS We included 656 children and adolescents from public and private schools. During the translation and cross-cultural adaptation no changes to wording were necessary. Structural validity confirmed two domains. Reliability by Kappa Coefficient ranges from 0.20 to 0.68. Measurement error by the percentage of agreement ranged from 60.2 to 92%. Construct validity was confirmed with 80.5% in accordance with prior hypotheses. CONCLUSION The PIP-Kids questionnaire translation and cross-cultural adaptation were adequate. The PIP-Kids questionnaire also has adequate structural validity with two dimensions (presence and impact), fair reliability, good agreement, and adequate construct validity.
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Affiliation(s)
- Veronica Souza Santos
- Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, Sao Paulo, Brazil
| | - Aron Downie
- Faculty of Medicine and Health, Sydney School of Public Health, Institute for Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Steven J Kamper
- Center for Pain, Health, and Lifestyle (CPHL), Australia; School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Nepean Blue Mountains Local Health District, NSW, Australia
| | - Tie P Yamato
- Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, Sao Paulo, Brazil; Center for Pain, Health, and Lifestyle (CPHL), Australia; School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Nepean Blue Mountains Local Health District, NSW, Australia.
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Fioratti I, Santos VS, Fernandes LG, Rodrigues KA, Soares RJ, Saragiotto BT. Translation, cross-cultural adaptation and measurement properties of three implementation measures into Brazilian-Portuguese. Arch Physiother 2023; 13:7. [PMID: 36967380 PMCID: PMC10041794 DOI: 10.1186/s40945-023-00160-x] [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: 09/22/2022] [Accepted: 02/21/2023] [Indexed: 03/28/2023] Open
Abstract
BACKGROUND To translate and cross-culturally adapt into Brazilian-Portuguese, and to test the measurement properties of the following items of implementation outcome measures: Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM) and Feasibility of Intervention Measure (FIM). METHODS This was a measurement properties study in accordance with the Consensus-based Standards for the selection of health status Measurement Instruments (COSMIN). We conducted a translation and cross-cultural adaptation of three implementation measures according to guidelines for translation and cross-cultural adaptation, then we collected information from patients who had participated in remotely delivered physical therapy treatment for musculoskeletal condition. The patients answered the translated versions of the implementation outcome measures. The measurement properties of the three implementation outcome measures were collected in a test-retest assessment, with an interval of 7 to 14 days.. The measurement properties evaluated in this study were interpretability, measured using Ceiling and Floor Effects, reliability in test-retest evaluation, measured using Cronbach's Alpha Coefficient, internal consistency, measured using Intraclass Correlation Coefficient and construct validity, measured using Pearson Correlation. RESULTS We included 104 participants (76 female). The average age of the sample was 56.8 (SD 14.8) years old. The items of implementation outcome measures (AIM, IAM, and FIM) showed 66.39%, 63.11%, and 63.93% of ceiling effects. The items of implementation outcome measures showed adequate internal consistency measured using Cronbach's Alpha Coefficient (AIM: 0.89, IAM: 0.91, FIM: 0.93) and values of Standard Error of Measurement between 5 and 10%, showing good measurement error. The results of AIM and IAM was classified as moderate reliability and the FIM as substantial reliability. In a total 96 correlations, > 75% of correlations met our prior hypothesis. CONCLUSION The three Brazilian-Portuguese versions of items of implementation outcome measures had adequate internal consistency, measurement error and construct validity. The three implementation outcome measures showed moderate to substantial reliability values. The Ceiling Effect was observed in the three measures, showing maximum values in more than 15% of the evaluations.
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Affiliation(s)
- Iuri Fioratti
- grid.412268.b0000 0001 0298 4494Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Verônica S. Santos
- grid.412268.b0000 0001 0298 4494Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Lívia G. Fernandes
- grid.412268.b0000 0001 0298 4494Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Karina A. Rodrigues
- grid.412286.b0000 0001 1395 7782Department of Physical Therapy, Universidade de Taubaté, São Paulo, Brazil
| | - Renato J. Soares
- grid.412286.b0000 0001 1395 7782Department of Physical Therapy, Universidade de Taubaté, São Paulo, Brazil
| | - Bruno T. Saragiotto
- grid.412268.b0000 0001 0298 4494Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
- grid.117476.20000 0004 1936 7611Discipline of Physiotherapy, University of Technology Sydney, Sydney, Australia
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EROL E, APAYDIN U, YILDIZ R, YILDIZ A, ERTURAN S, GÖKMEN D, AKKOYUN SERT Ö, ÜNÜVAR BS, GERÇEK H, ELBASAN B. Rasch analysis, reliability, and validity of the Turkish version of the Lumbar Spine Instability Questionnaire. Turk J Med Sci 2023; 53:1120-1126. [PMID: 38813025 PMCID: PMC10763753 DOI: 10.55730/1300-0144.5677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 10/26/2023] [Accepted: 03/23/2023] [Indexed: 05/31/2024] Open
Abstract
Background/aim Lumbar instability is an important condition that can be seen frequently in people with low back pain, affecting both the progression and the choice of appropriate exercise. The Lumbar Spine Instability Questionnaire (LSIQ) is a simple and low-cost tool for evaluating disturbed back stability in people with low back pain. The aim of this study is to develop the Turkish version of the LSIQ (LSIQ-T) and to evaluate its psychometric properties using the Rasch model. Materials and methods One hundred participants with chronic low back pain completed the LSIQ-T. The LSIQ-T was repeated for 30 participants after 1 week to establish its test-retest reliability. While internal and external construct validity were investigated using Rasch analysis and the Spearman correlation coefficient, respectively, reliability was evaluated in terms of internal consistency by Cronbach's alpha and the Person Separation Index (PSI). Results All items of the LSIQ-T were found to fit the Rasch model (chi-square: 34.07 (df = 15), p = 0.0033). The internal construct validity was good, the overall mean item fit residual was 0 (SD: 0.765), and the mean person fit residual was 0.322 (SD: 1.123). Internal consistency reliability was low with a PSI of 0.63 although Cronbach's alpha was acceptable (0.68). When the test-retest reliability was examined via differential item functioning (DIF) by time, none of the items showed DIF. Conclusion The LSIQ-T is a valid unidimensional scale for the Turkish population. Although the LSIQ-T had low internal consistency, it demonstrated unidimensionality and is appropriate for use. Therefore, the LSIQ-T can be used in clinical practice and scientific research.
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Affiliation(s)
- Erkan EROL
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Tokat Gaziosmanpaşa University, Tokat,
Turkiye
| | - Umut APAYDIN
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Karadeniz Technical University, Trabzon,
Turkiye
| | - Ramazan YILDIZ
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Erzurum Technical University, Erzurum,
Turkiye
| | - Ayşe YILDIZ
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Erzurum Technical University, Erzurum,
Turkiye
| | - Sinem ERTURAN
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara,
Turkiye
| | - Derya GÖKMEN
- Department of Biostatistics, Ankara University Faculty of Medicine, Ankara,
Turkiye
| | - Özlem AKKOYUN SERT
- Department of Physiotherapy and Rehabilitation, School of Health Sciences, KTO Karatay University, Konya,
Turkiye
| | - Bayram Sönmez ÜNÜVAR
- Department of Physiotherapy and Rehabilitation, Vocational School of Health Services, KTO Karatay University, Konya,
Turkiye
| | - Hasan GERÇEK
- Department of Physiotherapy and Rehabilitation, Vocational School of Health Services, KTO Karatay University, Konya,
Turkiye
| | - Bülent ELBASAN
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara,
Turkiye
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Krantz R, Rasmussen-Barr E. The Swedish version of the Lumbar Spine Instability Questionnaire: A clinimetric study of validity and reliability. Physiother Theory Pract 2023; 39:154-162. [PMID: 34724863 DOI: 10.1080/09593985.2021.1999353] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The Lumbar Spine Instability Questionnaire (LSIQ) is a patient-reported outcome measure (PROM) suggested to measure clinical instability of the spine. OBJECTIVE The aim was to translate and cross-culturally adapt the LSIQ into Swedish and to test its measurement properties. METHODS We included people with low back pain (LBP) seeking primary care (n = 101). The LSIQ was translated using international recommendations. Construct validity was investigated via the Roland Morris Disability Questionnaire (RM) and the Numeric Pain Rating Scale (NPRS). Reliability was tested via test-retest (Intra Class Correlation, ICC2.1) (n = 50) and by analyzing internal consistency (Cronbach Alpha). A suggested cutoff score was used to study discriminative ability. RESULTS The LSIQ was successfully translated into Swedish. For construct validity, a moderate correlation was shown with the RM (rho 0.58) and the NPRS (rho 0.47). Test-retest demonstrated high reliability for the total score (ICC2.1 0.94, 95% CI 0.86-0.96). Internal consistency reached a Cronbach Alpha of 0.64. Participants scoring higher on the LSIQ (≥9) showed significantly higher pain and lower disability levels, were of higher age and less physically active. CONCLUSION The Swedish LSIQ shows acceptable measurement properties regarding test-retest reliability and validity. To further study the usefulness of the LSIQ and the suggested cutoff score, the dimensionality needs to be investigated.
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Affiliation(s)
- Rasmus Krantz
- Department of Health Sciences, Division of Health and Rehabilitation, Luleå University of Technology, Luleå, Sweden
| | - Eva Rasmussen-Barr
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
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Prevalence of Lumbar Segmental Instability in Young Individuals with the Different Types of Lumbar Disc Herniation-Preliminary Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159378. [PMID: 35954735 PMCID: PMC9368739 DOI: 10.3390/ijerph19159378] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 11/17/2022]
Abstract
Lumbar segmental instability (LSI) can cause pain and disability, and its background can be related to lumbar disc herniation (LDH). This retrospective study was conducted to analyze the prevalence of lumbar segmental instability (LSI) in young patients with different types of lumbar disc herniation (LDH). The study evaluated 133 individuals (18−25 years old) who suffered from LDH and underwent MRI and flexion-extension X-rays. Two groups were created: protrusion (PRO) and extrusion (EXT). LSI was scored positive when translatory motion was greater than 4 mm anteriorly or 2 mm posteriorly at the level of herniation. Statistica 13 was used to perform statistics. The LSI overall prevalence was 18.33% in PRO and 21.92% in EXT (p > 0.05). Out of all LSI positives, higher LSI incidence was observed in females compared to males; in PRO: 63.64%; in EXT: 68.75% (p > 0.05). LSI correlated positively with the passive lumbar extension test (PLE) (R = 0.32; p = 0.01) in the PRO group only. In summary, the results showed that the overall incidence of LSI was higher with severer disc damage. In addition, females were more prone to this pathology. However, the different types of LDH do not significantly affect the prevalence of LSI in young individuals.
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Cultural adaptation and psychometric assessment of the Persian version of the lumbar spine instability questionnaire. BMC Sports Sci Med Rehabil 2022; 14:90. [PMID: 35590342 PMCID: PMC9119383 DOI: 10.1186/s13102-022-00486-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/17/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND The Lumbar Spine Instability Questionnaire (LSIQ) is a self-reported measure of clinical instability of the lumbar spine. This study aimed to translate and culturally adapt the LSIQ into Persian language (LSIQ-P) and to evaluate its reliability and validity in a sample of patients with chronic non-specific low back pain (LBP). METHODS In a cross-sectional study, the LSIQ was translated using guidelines. Participants with chronic non-specific LBP, aged ≥ 18 years old, answered an online survey consisting of LSIQ-P, the Persian Functional Rating Index (FRI), and the pain Numeric Rating Scale (NRS). Construct validity, internal consistency reliability, test-retest reliability, standard error of measurement (SEM), smallest detectable change (SDC), discriminant validity, and factor analysis were evaluated. RESULTS The LSIQ was successfully adapted into Persian. A sample of 100 participants with LBP and 100 healthy subjects completed the survey. Floor and ceiling effects were not observed. Cronbach's alpha = 0.767 and ICCagreement = 0.78 indicated good internal consistency and test-retest reliability. The SEM and SDC were 1.53 and 4.24, respectively. Construct validity of LSIQ-P was confirmed with significant correlation with Persian FRI (r = 0.44, p < 0.001) and pain NRS (r = 0.30, p = 0.003). An evidence of discriminant validity was demonstrated by significant difference in LSIQ-P total scores between the patients with LBP and healthy subjects, and between the patients with high total score ≥ 9 and those with low total score < 9 on the LSIQ-P. The LSIQ-P was found a multidimensional instrument with eight items appeared being redundant. CONCLUSIONS The Persian LSIQ showed satisfactory metric characteristics of reliability and validity. Further studies are required to elucidate the internal structure of the LSIQ-P.
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Chatprem T, Puntumetakul R, Kanpittaya J, Selfe J, Yeowell G. A diagnostic tool for people with lumbar instability: a criterion-related validity study. BMC Musculoskelet Disord 2021; 22:976. [PMID: 34814879 PMCID: PMC8609735 DOI: 10.1186/s12891-021-04854-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 11/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several clinical tests used to identify patients with lumbar instability have reported diagnostic accuracy in separate studies with conflicting results. To augment the diagnostic process, tests that are better able to identify lumbar instability suitable for use in the clinical setting are required. The aim of this study was to identify the probability to diagnose patients with lumbar instability, using x-ray imaging as the reference standard. METHODS This study was a cross-sectional, diagnostic validity study. One hundred forty participants with chronic low back pain underwent an x-ray assessment and 14 clinical examinations. Data were analysed using multivariate regression methods to determine which clinical tests were most diagnostic for lumbar instability when they were applied together. RESULTS Eighteen (12.85%) participants had radiological lumbar instability. Three clinical tests i) interspinous gap change during flexion-extension, ii) passive accessory intervertebral movement tests, iii) posterior shear test demonstrated an ability to diagnose lumbar instability of 67% when they were all positive. At this probability threshold, sensitivity, specificity, positive likelihood ratio (+LR), and negative likelihood ratio (-LR) were 5.56, 99.18%, 6.78, and 0.95. CONCLUSIONS These 3 clinical tests could be useful in identifying patients with lumbar instability in the general community. These three tests are simple to perform by physical therapists, reliable to use in a clinical setting, and safe for patients. We recommend physical therapists use these three tests to assess patients who are suspected of having lumbar instability, in the absence of an x-ray assessment, to receive appropriate targeted intervention or referral for further investigation. TRIAL REGISTRATION Thai Clinial Trial Registry (TCTR 20180820001; 19th August 2018).
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Affiliation(s)
- Thiwaphon Chatprem
- Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
- Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, 40002, Thailand
- The Thailand Research Fund (TRF), Bangkok, Thailand
| | - Rungthip Puntumetakul
- Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, 40002, Thailand.
| | - Jaturat Kanpittaya
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - James Selfe
- Department of Health Professions, Faculty of Health and Education, Manchester Metropolitan University, Manchester, UK
| | - Gillian Yeowell
- Department of Health Professions, Faculty of Health and Education, Manchester Metropolitan University, Manchester, UK
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Leungbootnak A, Puntumetakul R, Kanpittaya J, Chatprem T, Boucaut R. Validity of a Screening Tool for Patients with a Sub-Threshold Level of Lumbar Instability: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12151. [PMID: 34831906 PMCID: PMC8622495 DOI: 10.3390/ijerph182212151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/14/2021] [Accepted: 11/15/2021] [Indexed: 11/26/2022]
Abstract
Lumbar instability (LI) comprises one subgroup of those with chronic low back pain (CLBP); it indicates the impairment of at least one of the spinal stabilizing systems, and radiographic criteria of translation and rotation are used for its diagnosis. Previous studies have developed and tested a screening tool for LI where patients with sub-threshold lumbar instability (STLI) were detected in the initial stage of lumbar pathology using radiographs as a gold standard for diagnosis. The radiographic measurement in STLI lies between the range of translation and rotation of the LI and asymptomatic lumbar motion. However, there are no studies indicating the validity and cut-off points of the screening tool for STLI. The current study aimed to determine the validity of an LI screening tool to support the diagnostic process in patients with STLI. This study design was cross-sectional in nature. A total of 135 participants with CLBP, aged between 20 and 60 years, who had undergone flexion and extension radiographs, answered a screening tool with 14 questions. The cut-off score for identifying STLI using the screening tool was at least 6/14 positive responses to the LI questions. The findings suggested that the LI screening tool we tested is effective for the detection of STLI. The tool can be used in outpatient settings.
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Affiliation(s)
- Arisa Leungbootnak
- Research Center of Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Department of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand; (A.L.); (T.C.)
| | - Rungthip Puntumetakul
- Research Center of Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Department of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand; (A.L.); (T.C.)
| | - Jaturat Kanpittaya
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand;
| | - Thiwaphon Chatprem
- Research Center of Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Department of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand; (A.L.); (T.C.)
| | - Rose Boucaut
- International Centre for Allied Health Evidence (iCAHE), School of Health Sciences (Physiotherapy), University of South Australia, Adelaide, SA 5001, Australia;
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Macedo LG, Hodges PW, Bostick G, Hancock M, Laberge M, Hanna S, Spadoni G, Gross A, Schneider J. Which Exercise for Low Back Pain? (WELBack) trial predicting response to exercise treatments for patients with low back pain: a validation randomised controlled trial protocol. BMJ Open 2021; 11:e042792. [PMID: 33472786 PMCID: PMC7818834 DOI: 10.1136/bmjopen-2020-042792] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Exercise therapy is the most recommended treatment for chronic low back pain (LBP). Effect sizes for exercises are usually small to moderate and could be due to the heterogeneity of people presenting with LBP. Thus, if patients could be better matched to exercise based on individual factors, then the effects of treatment could be greater. A recently published study provided evidence of better outcomes when patients are matched to the appropriate exercise type. The study demonstrated that a 15-item questionnaire, the Lumbar Spine Instability Questionnaire (LSIQ), could identify patients who responded best to one of the two exercise approaches for LBP (motor control and graded activity). The primary aim of the current study isill be to evaluate whether preidentified baseline characteristics, including the LSIQ, can modify the response to two of the most common exercise therapies for non-specific LBP. Secondary aims include an economic evaluations with a cost-effectiveness analysis. METHODS AND ANALYSIS Participants (n=414) will be recruited by primary care professionals and randomised (1:1) to receive motor control exercises or graded activity. Participants will undergo 12 sessions of exercise therapy over an 8-week period. The primary outcome will be physical function at 2 months using the Oswestry Disability Index. Secondary outcomes will be pain intensity, function and quality of life measured at 2, 6 and 12 months. Potential effect modifiers will be the LSIQ, self-efficacy, coping strategies, kinesiophobia and measures of nociceptive pain and central sensitisation. We will construct linear mixed models with terms for participants (fixed), treatment group, predictor (potential effect modifier), treatment group×predictor (potential effect modifier), physiotherapists, treatment group×physiotherapists and baseline score for the dependent variable. ETHICS AND DISSEMINATION This study received ethics approval from the Hamilton Integrate Research Ethics Board. Results will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04283409.
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Affiliation(s)
- Luciana G Macedo
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Paul W Hodges
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Geoff Bostick
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Mark Hancock
- Department of Health Professions, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Maude Laberge
- Faculty of Administration, Universite Laval, Quebec, Quebec, Canada
| | - Steven Hanna
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Greg Spadoni
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Anita Gross
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Julia Schneider
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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Nielsen J, Glissmann Nim C, O'Neill S, Boyle E, Hartvigsen J, Kawchuk GN. Self-reports vs. physical measures of spinal stiffness. PeerJ 2020; 8:e9598. [PMID: 33354411 PMCID: PMC7727369 DOI: 10.7717/peerj.9598] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 07/02/2020] [Indexed: 11/20/2022] Open
Abstract
Background Objectively measured reduction in lumbar posterior-to-anterior (PA) stiffness is associated with pain relief in some, but not all persons with low back pain. Unfortunately, these measurements can be time consuming to perform. In comparison, the Lumbar Spine Instability Questionnaire (LSIQ) is intended to measure spinal instability and the Lumbar Spine Disability Index (LSDI) is created for self-reporting functional disability due to increased spinal stiffness. Given the above, the aim of this study is to compare measures of the LSIQ and LSDI with objective measures of lumbar PA stiffness as measured by a mechanical device, Vertetrack (VT), in patients with persistent non-specific low back pain (nsLBP). Methods Twenty-nine patients with nsLBP completed the LSIQ and LSDI at baseline and after two weeks. On these same occasions, PA spinal stiffness was measured using the VT. Between measurements, patients received four sessions of spinal manipulation. The resulting data was analyzed to determine the correlation between the self-report and objective measures of stiffness at both time points. Further, the patients were categorized into responders and non-responders based on pre-established cut points depending on values from the VT and compared those to self-report measures in order to determine whether the LSIQ and the LSDI were sensitive to change. Results Twenty-nine participants completed the study. Measures from the LSIQ and LSDI correlated poorly with objectively measured lumbar PA stiffness at baseline and also with the change scores. The change in objectively measured lumbar PA stiffness following spinal manipulation did not differ between those who improved, and those who did not improve according to the pre-specified cut-points. Finally, a reduction in lumbar PA stiffness following intervention was not associated with improvement in LSIQ and LSDI outcomes. Conclusions The current data indicate that the LSIQ and LSDI questionnaires do not correlate with measures obtained objectively by VT. Our results suggest that these objective and self- reported measures represent different domains and as such, cannot stand in place of one another.
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Affiliation(s)
- Jonas Nielsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Casper Glissmann Nim
- Spinecenter of Southern Denmark, Lillebaelt Hospital, Middelfart, Denmark.,Institute of Regional Health Science, University of Southern Denmark, Odense, Denmark
| | - Søren O'Neill
- Spinecenter of Southern Denmark, Lillebaelt Hospital, Middelfart, Denmark.,Institute of Regional Health Science, University of Southern Denmark, Odense, Denmark
| | - Eleanor Boyle
- Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
| | - Gregory N Kawchuk
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
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Areeudomwong P, Jirarattanaphochai K, Ruanjai T, Buttagat V. Clinical utility of a cluster of tests as a diagnostic support tool for clinical lumbar instability. Musculoskelet Sci Pract 2020; 50:102224. [PMID: 33099174 DOI: 10.1016/j.msksp.2020.102224] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/15/2020] [Accepted: 07/18/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Numerous clinical tests have been proposed for the diagnosis of clinical lumbar instability (CLI), but a cluster of clinical tests is still needed to increase the accuracy of CLI diagnosis. OBJECTIVE To evaluate a diagnostic support tool intended to identify the presence of CLI using a cluster of clinical tests. DESIGN Analytical cross-sectional study. METHODS Two hundred participants with chronic low back pain (LBP) were diagnosed with or without CLI by an orthopedic surgeon. The orthopedic surgeon made the diagnosis from classic clinical symptoms and signs. The diagnosis was used as the reference standard. An orthopedic physical therapist used four clinical tests to identify CLI in each participant, including the apprehension sign, the instability catch sign with/without the abdominal drawing-in maneuver (ADIM), the painful catch sign with/without the ADIM, and the prone instability test. RESULTS For an individual test, the apprehension sign showed a high specificity (92.6%) and a positive likelihood ratio (LR+; 2.4) but a very low sensitivity of 17.4%. A cluster of three of the four examined tests provided the most diagnostic accuracy for CLI, with a high LR+ (5.8) and a high specificity (91.7%) but low sensitivity (47.8%) and a negative likelihood ratio (LR-; 0.6). CONCLUSIONS A cluster of three of the four examined tests was determined to comprise a powerful clinical support tool for the identification of CLI patients as tested against a reference standard diagnosis. CLINICAL TRIAL REGISTRATION Name of the registry: Thai Clinical Trials Registry. Registration number: TCTR20190426002.
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Affiliation(s)
- Pattanasin Areeudomwong
- Department of Physical Therapy, School of Integrative Medicine, Mae Fah Luang University, Chiang Rai, 57100, Thailand.
| | - Kitti Jirarattanaphochai
- Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Thapakorn Ruanjai
- Department of Public Health, School of Health Science, Mae Fah Luang University, Chiang Rai, 57100, Thailand
| | - Vitsarut Buttagat
- Department of Physical Therapy, School of Integrative Medicine, Mae Fah Luang University, Chiang Rai, 57100, Thailand
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Chatprem T, Puntumetakul R, Yodchaisarn W, Siritaratiwat W, Boucaut R, Sae-jung S. A Screening Tool for Patients With Lumbar Instability: A Content Validity and Rater Reliability of Thai Version. J Manipulative Physiol Ther 2020; 43:515-520. [DOI: 10.1016/j.jmpt.2019.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 02/11/2019] [Accepted: 04/07/2019] [Indexed: 12/01/2022]
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Enix DE, Mayer JM. Sacroiliac Joint Hypermobility Biomechanics and What it Means for Health Care Providers and Patients. PM R 2019; 11 Suppl 1:S32-S39. [DOI: 10.1002/pmrj.12176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 04/23/2019] [Indexed: 02/04/2023]
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Macedo LG, Kuspinar A, Roduta Roberts M, Maher CG. A Rasch analysis of the lumbar spine instability questionnaire. Physiother Theory Pract 2019; 37:844-851. [PMID: 31298078 DOI: 10.1080/09593985.2019.1642429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: A 2014 study found that the Lumbar Spine Instability questionnaire predicts response to two different types of exercise therapy. This is the first decision tool that has predicted response to exercise for chronic low back pain. The objective of this study was to evaluate the Lumbar Spine Instability questionnaire using Rasch analysis. Methods: Baseline data from patients included in a randomized controlled trial with chronic non-specific low back pain were included. Rasch Measurement Theory was used to assess the ordering of items along a common scale, data-to-model fit, Person Separation Index, unidimensionality and Differential Item Functioning. Results: Responses from 172 patients (102 females) underwent Rasch analysis. All Lumbar Spine Instability questionnaire items had fit residuals between ± 2.5 and Chi-Square values were non-significant with Bonferroni corrections. The Lumbar Spine Instability questionnaire demonstrated a Person Separation Index of 0.64, which is below the recommended cut-off of 0.7. Differential Item Functioning by different pain levels was identified for one item. Conclusion: The Lumbar Spine Instability questionnaire was found to be unidimensional, suggesting that the use of a summary score is appropriate. However, the low Person Separation Index value suggests that more items may be needed to increase the questionnaire's ability to discriminate among individuals with high and low clinical instability.
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Affiliation(s)
| | - Ayse Kuspinar
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Mary Roduta Roberts
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Chris G Maher
- Sydney School of Public Health, The University of Sydney and Institute for Musculoskeletal Health, Sydney Local Health District, Camperdown, NSW, Australia
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