1
|
Li J, Song Y, Wu L, Su D, Wang LF. Effects of a new continuous nursing program on the short-term and long-term low back pain in patients after UBED: a retrospective study based on 282 patients. Front Surg 2024; 11:1443231. [PMID: 39268492 PMCID: PMC11390385 DOI: 10.3389/fsurg.2024.1443231] [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: 06/03/2024] [Accepted: 08/06/2024] [Indexed: 09/15/2024] Open
Abstract
Background Unilateral biportal endoscopic discectomy (UBED) is a widely accepted minimally invasive surgery for the treatment of lumbar degenerative diseases. However, some patients continue to have persistent low back pain (LBP) symptoms in the short and long term after surgery, which may be related to improper postoperative nursing and rehabilitation of patients. Further research is needed to determine whether continuous nursing can improve the symptoms of patients after UBED. Methods This study retrospectively enrolled 282 lumbar disc herniation (LDH) patients who underwent UBED in our hospital from January 2019 to January 2022. The patients were divided into two groups according to whether they accepted the continuous nursing program: 147 patients in the traditional nursing group and 135 patients in the continuous nursing group. Demographic characteristics, radiological parameters, and follow-up data of the patients were collected. Finally, the risk factors of LBP after UBED were analyzed. Results The visual analog scale (VAS) score of LBP in the continuous nursing group was 0.97 ± 1.159 at 3 months and 0.61 ± 0.954 at 12 months after operation, and VAS of leg pain was 0.23 ± 0.421 at 12 months after operation, which were better than those in the traditional nursing group (1.51 ± 1.313, 1.10 ± 1.076, 0.68 ± 0.788, respectively, p < 0.001) The Oswestry disability index (ODI) score of the continuous nursing group was lower than that of the traditional nursing group at 12 months after operation (7.36 ± 6.526 vs. 12.43 ± 6.942, p < 0.001). The rehabilitation completion (7.98 ± 1.857), efficacy satisfaction (9.13 ± 1.101), and re-herniation worry scores (1.97 ± 1.217) in the continuous nursing group were better than those in the traditional nursing group (4.14 ± 3.066, 8.28 ± 1.240, 2.79 ± 1.973, respectively, P < 0.001). The re-herniation rate within 1 year was similar between the two groups (3/135 vs. 2/147, p = 0.673). No incision infection occurred. Multivariate regression analysis showed that risk factors for persistent LBP at 3-month follow-up were degenerative disc [odds ratio (OR): 2.144, CI: 1.306-3.519, p = 0.03], Pfirrmann grade (OR: 3.073, CI: 1.427-6.614, p = 0.04), and surgical time (OR: 0.969, CI: 0.937-1.003, p = 0.74). At the 12-month follow-up, the risk factors for persistent LBP were preoperative VAS of the legs (OR: 1.261, CI: 1.000-1.591, p = 0.05) and Pfirrmann grade (OR: 3.309, CI: 1.460-7.496, p = 0.04). Conclusion Continuous nursing programs can improve the symptoms of short-term and long-term persistent LBP in patients after UBED, enhance the completion of rehabilitation training after UBED, alleviate patients' concerns about recurrence, and improve patients' satisfaction.
Collapse
Affiliation(s)
- Jucai Li
- Department of Spine Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yanli Song
- Department of Spine Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lumei Wu
- Department of Spine Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Dan Su
- Department of Spine Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lin-Feng Wang
- Department of Spine Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| |
Collapse
|
2
|
Zhang H, Zhao Y, Du Y, Yang Y, Zhang J, Wang S. Early mobilization can reduce the incidence of surgical site infections in patients undergoing spinal fusion surgery: A nested case-control study. Am J Infect Control 2024; 52:644-649. [PMID: 38232902 DOI: 10.1016/j.ajic.2024.01.007] [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: 09/22/2023] [Revised: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND To examine the influence of early mobilization on the risk of surgical site infections (SSI) in patients undergoing spinal fusion surgery. METHODS The retrospective cohort consisted of all consecutive patients who underwent spinal fusion surgery at our institution. For each case of SSI, 2 control patients without SSI at the corresponding index date were selected. Mobilization was predefined as "delayed" if it occurred more than 36 hours postoperatively. To account for potential confounding variables, we performed further adjustments using conditional logistic regression models. Subgroup analyses were conducted to evaluate the robustness of the statistical associations. RESULTS Following the predefined statistical protocol and matching criteria, we matched 236 control cases to the SSI cases. Upon adjustment for confounding factors, our findings revealed that the risk of SSI was 120% higher in the group beginning mobilization more than 36 hours after surgery compared to the group beginning mobilization within 36 hours postoperatively (odds ratio = 2.206, 95% confidence interval 1.169-4.166, P = .015). In subgroup analyses, this statistical trend remained consistent. CONCLUSIONS Early mobilization within 36 hours following spinal fusion surgery significantly reduces the risk of SSI. This pattern of reduced risk remains consistent among patients with degenerative diseases or spinal deformities.
Collapse
Affiliation(s)
- Haoran Zhang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yiwei Zhao
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - You Du
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yang Yang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jianguo Zhang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
| | - Shengru Wang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
| |
Collapse
|
3
|
Tieppo Francio V, Alm J, Leavitt L, Mok D, Yoon BV, Nazir N, Lam C, Latif U, Sowder T, Braun E, Sack A, Khan T, Sayed D. Variables associated with nonresponders to high-frequency (10 kHz) spinal cord stimulation. Pain Pract 2024; 24:584-599. [PMID: 38078593 DOI: 10.1111/papr.13328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
INTRODUCTION The use of spinal cord stimulation (SCS) therapy to treat chronic pain continues to rise. Optimal patient selection remains one of the most important factors for SCS success. However, despite increased utilization and the existence of general indications, predicting which patients will benefit from neuromodulation remains one of the main challenges for this therapy. Therefore, this study aims to identify the variables that may correlate with nonresponders to high-frequency (10 kHz) SCS to distinguish the subset of patients less likely to benefit from this intervention. MATERIALS AND METHODS This was a retrospective single-center observational study of patients who underwent 10 kHz SCS implant. Patients were divided into nonresponders and responders groups. Demographic data and clinical outcomes were collected at baseline and statistical analysis was performed for all continuous and categorical variables between the two groups to calculate statistically significant differences. RESULTS The study population comprised of 237 patients, of which 67.51% were responders and 32.49% were nonresponders. There was a statistically significant difference of high levels of kinesiophobia, high self-perceived disability, greater pain intensity, and clinically relevant pain catastrophizing at baseline in the nonresponders compared to the responders. A few variables deemed potentially relevant, such as age, gender, history of spinal surgery, diabetes, alcohol use, tobacco use, psychiatric illness, and opioid utilization at baseline were not statistically significant. CONCLUSION Our study is the first in the neuromodulation literature to raise awareness to the association of high levels of kinesiophobia preoperatively in nonresponders to 10 kHz SCS therapy. We also found statistically significant differences with greater pain intensity, higher self-perceived disability, and clinically relevant pain catastrophizing at baseline in the nonresponders relative to responders. It may be appropriate to screen for these factors preoperatively to identify patients who are less likely to respond to SCS. If these modifiable risk factors are present, it might be prudent to consider a pre-rehabilitation program with pain neuroscience education to address these factors prior to SCS therapy, to enhance successful outcomes in neuromodulation.
Collapse
Affiliation(s)
- Vinicius Tieppo Francio
- Department of Physical Medicine and Rehabilitation, The University of Kansas Medical Center, Kansas City, Kansas, USA
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - John Alm
- Department of Physical Medicine and Rehabilitation, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Logan Leavitt
- Department of Physical Medicine and Rehabilitation, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Daniel Mok
- Department of Physical Medicine and Rehabilitation, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - B Victor Yoon
- Department of Physical Medicine and Rehabilitation, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Niaman Nazir
- Department of Population Health, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Christopher Lam
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Usman Latif
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Timothy Sowder
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Edward Braun
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Andrew Sack
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Talal Khan
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Dawood Sayed
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| |
Collapse
|
4
|
Ege F. The relationship between kinesiophobia severity and clinical parameters in patients with mechanical low back pain. J Back Musculoskelet Rehabil 2024; 37:285-294. [PMID: 37482977 DOI: 10.3233/bmr-220365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
BACKGROUND Low back pain is an important widespread health problem that can occur at any age, causing serious socioeconomic losses. OBJECTIVE The objective of this study is to investigate the relationship between kinesiophobia severity and pain severity, depression, and quality of life in patients with mechanical low back pain. METHODS The study sample consisted of 155 patients, of whom 72 were female and 83 were male, aged between 18 and 75 years with mechanical low back pain. Quality of life was assessed with the 36-Item Short Form Health Survey (SF-36), pain intensity with the Visual Analogue Scale (VAS), kinesiophobia with the Tampa Kinesiophobia Scale (TKS), and depression with the Beck Depression Inventory (BDI). Patients were divided into the low (TKS ⩽ 37) and high kinesiophobia (TKS > 37) groups according to the scores they obtained from TKS. RESULTS VAS-pain severity and BDI scores were significantly higher in the high kinesiophobia group than in the low kinesiophobia group (p< 0.001). On the other hand, the SF-36 subscale scores were significantly higher in the low kinesiophobia group than in the high kinesiophobia group (p< 0.001). The TKS scores were moderately correlated with VAS-pain severity (r= 0.470; p< 0.001) and BDI scores (r= 0.584; p< 0.001) in the positive direction, and strongly correlated with all sub-parameters of quality of life in the negative direction (p< 0.001). CONCLUSION The results indicated that the severity of kinesiophobia in patients with non-inflammatory low back pain is associated with pain severity, depression, and poor quality of life.
Collapse
|
5
|
Taskin Gurel B, Vardar Yagli N, Calik Kutukcu E, Saglam M, Inal Ince D, Arikan H, Dogrul AB, Abbasoglu O. Long-Term Declines in Physical Fitness and Physical Activity for Individuals With Post-Liver Transplantation Compared to Healthy Controls. Percept Mot Skills 2023; 130:2450-2464. [PMID: 37643424 DOI: 10.1177/00315125231199662] [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] [Indexed: 08/31/2023]
Abstract
Functional changes are essential determinants of mortality and morbidity in individuals with chronic liver disease. However, there is limited information about whether these changes persist long-term after liver transplantation (LT). We aimed to compare physical fitness, physical activity, balance, kinesiophobia, and fatigue between patients with LT and healthy controls. All participants underwent evaluation with the Senior Fitness Test (SFT) for exercise capacity and physical fitness, the International Physical Activity Questionnaire (IPAQ) for physical activity, the Timed Up-and-Go Test (TUG) and the Berg Balance Scale (BBS) for balance, the Tampa Scale for Kinesiophobia (TSK) for kinesiophobia, and the Fatigue Severity Scale (FSS) and Fatigue Impact Scale (FIS) for fatigue. We studied 16 persons with LT (M age = 40.56, SD = 15.73 years; M time since LT = 66.81, SD = 72.05 months) and 16 control participants (M age = 39.87, SD = 13.98 years). Compared to controls, participants with LT showed significantly poorer performance on the SFT components assessing upper and lower body strength, aerobic endurance, agility, and dynamic balance (p < .001 for all), significantly lower IPAQ physical activity scores (p = .002) and BBS score (p = .017), and significantly higher TUG time (p < .001) and TSK, FSS, and FIS scores (p = .001, p = .001, and p = .004, respectively). Individuals with post-LT had lower exercise capacity, physical fitness, balance, and physical activity, and higher kinesiophobia and fatigue levels in the long-term compared to their peers. Future studies should focus on frailty in individuals in the long term after LT.
Collapse
Affiliation(s)
- Bilge Taskin Gurel
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Lokman Hekim University, Ankara, Turkey
| | - Naciye Vardar Yagli
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Ebru Calik Kutukcu
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Melda Saglam
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Deniz Inal Ince
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Hulya Arikan
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Ahmet Bulent Dogrul
- Department of General Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Osman Abbasoglu
- Department of General Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| |
Collapse
|
6
|
Akkaya H, Ayhan H. The effect of in-bed turning and mobilization training given to patients who undergo lumbar disk surgery on postoperative first mobility level: A single-blind, randomized controlled trial. Int J Orthop Trauma Nurs 2023; 50:101022. [PMID: 37441868 DOI: 10.1016/j.ijotn.2023.101022] [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: 01/02/2023] [Revised: 04/29/2023] [Accepted: 05/08/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVE This study was conducted to investigate the effects of mobilization and in-bed turning training given through the role-playing technique to patients to undergo lumbar disk surgery on the patient's pain, strain and dependence level during the first postoperative mobilization (turning, sitting, standing and walking). METHODS Patients who would undergo a lumbar disk hernia surgery were recruited from a neurosurgery clinic in Turkey. Patients who met inclusion criteria and agreed to participate (n = 40) in the study were randomly assigned to an intervention group (in-bed turning and mobilization training simulated with the role-playing technique, n = 19) and a control group (usual clinical care, n = 21). The outcome of the study was patient mobility and observer mobility scale scores. RESULTS Postoperative scores obtained from the patient mobility and observer mobility scale were lower in the intervention group than the scores of the control group, and the difference between the groups was found statistically significant (p < 0.05). The anxiety levels of the intervention group before (38.00 ± 6.59, p < 0.001) and after mobilization (31.63 ± 4.57, p = 0.032) were significantly lower. CONCLUSION The findings indicate training improves patient care outcomes for first postoperative mobility. It is recommended that structured training for in-bed turning and mobilization should be integrated into routine clinical care in the preoperative period for patients to undergo lumbar disk hernia surgery. PRACTICE IMPLICATIONS Preoperative training increases the patient's willingness to be mobilized and decreases the anxiety level and perceived pain and strain.
Collapse
Affiliation(s)
- Hatice Akkaya
- Kutahya Vocational School, Kutahya University of Health Sciences, Kutahya, Turkey
| | - Hatice Ayhan
- Department of Surgical Nursing, Gulhane Faculty of Nursing, University of Health Sciences Turkey, Ankara, Turkey.
| |
Collapse
|
7
|
Huysmans E, Goudman L, Van Bogaert W, Nijs J, Putman K, Moens M, Buyl R, Ickmans K, Garcia Barajas G, Fernández-Carnero J, Coppieters I. Experimental Pain Measurements Do Not Relate to Pain Intensity and Pain Cognitions in People Scheduled for Surgery for Lumbar Radiculopathy. PAIN MEDICINE 2023; 24:139-149. [PMID: 36053220 DOI: 10.1093/pm/pnac133] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 06/03/2022] [Accepted: 08/05/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The present cross-sectional study aims to unravel associations of pain intensity and cognitions with quantitative sensory testing in people scheduled for surgery for lumbar radiculopathy. Additionally, insight will be provided into the presence of dysfunctional nociceptive processing and maladaptive pain cognitions in this population. DESIGN Cross-sectional study. SETTING Data from three hospitals in Belgium. SUBJECTS The final sample comprised 120 participants with lumbar radiculopathy scheduled for surgery, included between March 2016 and April 2019. METHODS Self-reported pain intensity was assessed on a visual analog scale, and pain cognitions were assessed with self-reported questionnaires (Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, and Pain Vigilance and Awareness Questionnaire). Quantitative sensory testing (detection thresholds, pain thresholds, temporal summation, and conditioned pain modulation) was evaluated, as well. RESULTS Evidence was found for the presence of an impaired inhibitory response to nociceptive stimuli and maladaptive pain cognitions in this population. Kinesiophobia was found to be present to a maladaptive degree in the majority of the patients (n = 106 [88%]). Significant, but weak, associations between electrical pain thresholds at the sural nerves and leg pain intensity (sural nerve symptomatic side: r = -0.23; P = 0.01; non-symptomatic side: r = -0.22; P = 0.02) and kinesiophobia levels (sural nerve non-symptomatic side: r = -0.26; P = 0.006) were identified. CONCLUSIONS Electrical detection thresholds and correlates for endogenous nociceptive facilitation and inhibition were not found to be related to any of the pain cognitions or to pain intensity in people scheduled to undergo surgery for lumbar radiculopathy.
Collapse
Affiliation(s)
- Eva Huysmans
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Interuniversity Centre for Health Economics Research (I-CHER), Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- Research Foundation Flanders (FWO), Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Lisa Goudman
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Research Foundation Flanders (FWO), Brussels, Belgium
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium
- STIMULUS research group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Wouter Van Bogaert
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Interuniversity Centre for Health Economics Research (I-CHER), Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- Research Foundation Flanders (FWO), Brussels, Belgium
| | - Jo Nijs
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Koen Putman
- Interuniversity Centre for Health Economics Research (I-CHER), Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Maarten Moens
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium
- STIMULUS research group, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Ronald Buyl
- Department of Biostatistics and Medical Informatics, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Kelly Ickmans
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Research Foundation Flanders (FWO), Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Guillermo Garcia Barajas
- Department of Physical and Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Josue Fernández-Carnero
- Department of Physical and Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
- La Paz Hospital Institute for Health Research, IdiPAZ, Madrid, Spain
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Iris Coppieters
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| |
Collapse
|
8
|
Rushton A, Elena B, Jadhakhan F, Masson A, Staal JB, Verra ML, Emms A, Reddington M, Cole A, Willems PC, Benneker L, Heneghan NR, Soundy A. Immediate patient perceptions following lumbar spinal fusion surgery: semi-structured multi-centre interviews exploring the patient journey and experiences of lumbar fusion surgery (FuJourn). 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 2022; 31:3590-3602. [PMID: 36114890 DOI: 10.1007/s00586-022-07381-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 08/28/2022] [Accepted: 09/04/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE To understand the patient journey to Lumbar Spinal Fusion Surgery (LSFS) and patients' experiences of surgery. METHODS Qualitative study using interpretive phenomenological analysis. Adult participants following LSFS were recruited from 4 UK clinical sites using purposive sampling to ensure representation of key features (e.g. age). Semi-structured interviews informed by a piloted topic guide developed from the literature were audio-recorded and transcribed verbatim. Framework analysis for individual interviews and then across participants (deductive and inductive) identified emerging themes. Trustworthiness of data analyses was enhanced using multiple strategies (e.g. attention to negative cases). RESULTS Four emerging themes from n = 31 patients' narratives were identified: decision for surgery, coping strategies, barriers to recovery and recovery after surgery. Decision for surgery and recovery after surgery themes are distinguished by the point of surgery. However, barriers to recovery and coping strategies are key to the whole patient journey encompassing long journeys to surgery and their initial journey after surgery. The themes of coping strategies and barriers to recovery were inter-related and perceived by participants as parallel concepts. The 4 multifactorial themes interacted with each other and shaped the process of an individual patient's recovery. Factors such as sporadic interventions prior to surgery, time-consuming wait for diagnosis and surgery and lack of information regarding recovery strongly influenced perceptions of outcome. CONCLUSION Patient driven data enables insights to inform research regarding surgery/rehabilitation through depth of understanding of the patient journey. Awareness of factors important to patients is important; ensuring that patient-driven data informs research and patient care.
Collapse
Affiliation(s)
- Alison Rushton
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada. .,Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, UK.
| | - Bini Elena
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Feroz Jadhakhan
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Annabel Masson
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - J Bart Staal
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Martin L Verra
- Department of Physiotherapy, Bern University Hospital, Insel Group, Bern, Switzerland
| | - Andrew Emms
- Department of Physiotherapy, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Michael Reddington
- Department of Physiotherapy, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, UK
| | - Ashley Cole
- Department of Orthopaedics & Trauma, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Paul C Willems
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Lorin Benneker
- Department of Orthopaedic Surgery Inselspital, University of Bern, Bern, Switzerland
| | - Nicola R Heneghan
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Andrew Soundy
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| |
Collapse
|
9
|
Impact of Active Physiotherapy Rehabilitation on Pain and Global and Functional Improvement 1-2 Months after Lumbar Disk Surgery: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2022; 10:healthcare10101943. [PMID: 36292390 PMCID: PMC9601491 DOI: 10.3390/healthcare10101943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/09/2022] [Accepted: 09/28/2022] [Indexed: 11/04/2022] Open
Abstract
Introduction: Lumbar disc surgery is a common procedure for patients with lower back pain associated with lumbar disc herniation. This study aims to evaluate the impact of active physiotherapeutic rehabilitation on global/functional improvement and subjective pain score reduction among patients 1–2 months following lumbar disc surgery. The outcomes of this study are to assess the impact of active physiotherapeutic rehabilitation on functional improvement and subjective improvement in pain behavior post active rehabilitation. The outcomes are measured as pain assessed using the visual analog scale, global measurement of improvement, back pain functional status, and return to work. Methods: Databases, including MEDLINE/PubMed (10 June 1996, 2022), Web of Science (10 June 1997, 2022), Scopus (15 March, 10 June 2004, 2022), CINAHL Plus (10 June 1961, 2022), and Cochrane (10 June 1993, 2022) were reviewed without any language restrictions. All studies were systematically screened; however, only randomized controlled trials were eligible against the inclusion/exclusion criteria. All statistical tests were conducted in Review Manager (RevMan) 5.4. The quality of studies was appraised using the grading of recommendations assessment, development, and evaluation (GRADE) approach and the risk-of-bias 2 (RoB 2) tool. Results: Fifteen articles were identified, enrolling a total of 2188 patients, where the majority of active rehabilitation interventions continued for 3 months. All these interventions began 1–2 months postoperatively, and quantitative findings were presented as mean scores. The subjective pain scores were significantly lower in the interventional group, with a mean difference (MD) of −7.01 (p = 0.004). The pain disability score was considerably lower in the interventional group, with an MD of −3.94 (p = 0.002). Global improvement was higher in the interventional group (OR = 1.94, p = 0.0001). Conclusions: This study presents significant improvement in all parameters concerning pain and functionality. Postoperative rehabilitation requires optimization concerning timing, duration, intensity, and associated components to benefit patients post lumbar disc surgery.
Collapse
|
10
|
Lim S, Bazydlo M, Macki M, Haider S, Hamilton T, Hunt R, Chaker A, Kantak P, Schultz L, Nerenz D, Schwalb JM, Abdulhak M, Park P, Aleem I, Easton R, Khalil JG, Perez-Cruet MJ, Chang V. Validation of the Benefits of Ambulation Within 8 Hours of Elective Cervical and Lumbar Surgery: A Michigan Spine Surgery Improvement Collaborative Study. Neurosurgery 2022; 91:505-512. [PMID: 35550477 DOI: 10.1227/neu.0000000000002032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/10/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Early ambulation is considered a key element to Enhanced Recovery After Surgery protocol after spine surgery. OBJECTIVE To investigate whether ambulation less than 8 hours after elective spine surgery is associated with improved outcome. METHODS The Michigan Spine Surgery Improvement Collaborative database was queried to track all elective cervical and lumbar spine surgery between July 2018 and April 2021. In total, 7647 cervical and 17 616 lumbar cases were divided into 3 cohorts based on time to ambulate after surgery: (1) <8 hours, (2) 8 to 24 hours, and (3) >24 hours. RESULTS For cervical cases, patients who ambulated 8 to 24 hours (adjusted odds ratio [aOR] 1.38; 95% CI 1.11-1.70; P = .003) and >24 hours (aOR 2.20; 95% CI 1.20-4.03; P = .011) after surgery had higher complication rate than those who ambulated within 8 hours of surgery. Similar findings were noted for lumbar cases with patients who ambulated 8 to 24 hours (aOR 1.31; 95% CI 1.12-1.54; P < .001) and >24 hours (aOR 1.96; 95% CI 1.50-2.56; P < .001) after surgery having significantly higher complication rate than those ambulated <8 hours after surgery. Analysis of secondary outcomes for cervical cases demonstrated that <8-hour ambulation was associated with home discharge, shorter hospital stay, lower 90-day readmission, and lower urinary retention rate. For lumbar cases, <8-hour ambulation was associated with shorter hospital stay, satisfaction with surgery, lower 30-day readmission, home discharge, and lower urinary retention rate. CONCLUSION Ambulation within 8 hours after surgery is associated with significant improved outcome after elective cervical and lumbar spine surgery.
Collapse
Affiliation(s)
- Seokchun Lim
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Michael Bazydlo
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mohamed Macki
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Sameah Haider
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Travis Hamilton
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Rachel Hunt
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Anisse Chaker
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Pranish Kantak
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Lonni Schultz
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.,Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan, USA
| | - David Nerenz
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.,Center for Health Services Research, Henry Ford Hospital, Detroit, Michigan, USA
| | - Jason M Schwalb
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.,Center for Health Services Research, Henry Ford Hospital, Detroit, Michigan, USA
| | - Muwaffak Abdulhak
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Paul Park
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Ilyas Aleem
- Department of Orthopedics, University of Michigan, Ann Arbor, Michigan, USA
| | - Richard Easton
- Department of Orthopedics, William Beaumont Hospital, Troy, Michigan, USA
| | - Jad G Khalil
- Department of Orthopedics, William Beaumont Hospital, Royal Oak, Michigan, USA
| | | | - Victor Chang
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| |
Collapse
|
11
|
Belova AN, Shabanova MA, Sushin VO, Rezenova AM, Kuznetsov AN, Gerasimov SA, Sheiko GE. [Kinesiophobia in patients requiring hip and knee endoprosthetics: severity and provoking factors]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOI FIZICHESKOI KULTURY 2022; 99:34-41. [PMID: 36538402 DOI: 10.17116/kurort20229906134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
UNLABELLED Kinesiophobia (KP), or an irrational fear of physical activity, significantly hinders the active rehabilitation of patients with joint pathology. PURPOSE OF THE STUDY To study the severity and risk factors of KP in patients requiring total hip and knee endoprosthetics (EP). MATERIAL AND METHODS We examined 50 patients requiring total EP of the hip and knee joints. Pain syndrome was assessed in the preoperative and early postoperative periods in all patients using a visual analog scale, as well as the levels of kinesiophobia, anxiety, and depression using the Hospital Anxiety and Depression Scale and the Tampa Scale for Kinesiophobia (TSK). Quality of patients life was studied in the preoperative period (RAND SF36 questionnaire). RESULTS In the majority of cases, both before and after EP, the level of KP corresponded to an average degree of severity. Both in the preoperative and in the early postoperative periods, not a single case of the absence of KP was detected (≤17 points according to the TSK); at the same time, a very high level of KP (≥55 points according to TSK) was also rarely recorded - in 3 patients in the postoperative period after EP of the hip joint. KP level significantly correlated with the duration of the pain syndrome, while the mental component of the KP, in addition to the duration of the pain syndrome, was influenced by the social status: in patients who had a steady job, the psychological component of the KP was expressed in a less degree. KP level was negatively correlated with such indicators of quality of life as vitality and physical functioning. In addition, the physical component of the KP significantly correlated with the pain intensity, the mental component - with role-playing behavior. CONCLUSION Early detection of KP and timely correction of distorted ideas about physical activity are necessary for successful rehabilitation of patients requiring total joint endoprosthetics of the lower limb.
Collapse
Affiliation(s)
- A N Belova
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - M A Shabanova
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - V O Sushin
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - A M Rezenova
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - A N Kuznetsov
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - S A Gerasimov
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - G E Sheiko
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| |
Collapse
|
12
|
Damar HT, Bilik Ö, Baksi A, Akyil Ş. Examining the relationship between elderly patients' fear of falling after spinal surgery and pain, kinesiophobia, anxiety, depression and the associated factors. Geriatr Nurs 2021; 42:1006-1011. [PMID: 34256148 DOI: 10.1016/j.gerinurse.2021.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/06/2021] [Accepted: 06/09/2021] [Indexed: 01/08/2023]
Abstract
This study aimed to examine the relationship between fear of falling in elderly patients who underwent spinal surgery and pain, kinesiophobia, anxiety, depression, and associated factors. The study was a descriptive, cross-sectional design. The research sample consisted of 211 elderly patients who had undergone spinal surgery. The average age of the patients was 66.68 ± 5.57. Of the sample, 83.4% were afraid of falling, and 21.3% were severely afraid of falling. In the study, age (β = 0.115, p = 0.005), being a woman (β = -0.182, p < 0.001), pain (β = 0.269, p < 0.001), risk of falling (β = 0.084, p = 0.49), Hospital Anxiety and Depression Scale-Anxiety (HADS-A) (β = 0.135, p = 0.044), Hospital Anxiety and Depression Scale Anxiety-Depression (HADS-D) (β = 0.382, p < 0.001), and kinesiophobia (β = 0.722, p < 0.001) were statistically significant predictors of fear of falling. This study provided important information about the variables that surgical nurses should pay attention to while evaluating the fear of falling in elderly patients who underwent spinal surgery.
Collapse
Affiliation(s)
- Hale Turhan Damar
- Elderly Care Program, Health Services Vocational School, İzmir Demokrasi University, Izmir, Turkey.
| | - Özlem Bilik
- Department of Surgical Nursing, Faculty of Nursing, Dokuz Eylül University, Izmir, Turkey.
| | - Altun Baksi
- Department of Nursing, Faculty of Health Sciences, Suleyman Demirel University, Isparta, Turkey.
| | - Şirin Akyil
- Dokuz Eylül University Hospital, Izmır, Turkey.
| |
Collapse
|
13
|
Abstract
Adaption to changes of external environment or internal health, the body-mind connection, or autonomic nervous system must be flexible and healthy. Population health studies with wearable technology and remote monitoring will lead to paradigm shifts in how to approach the physiology of emotion. Heart rate variability as a whole health biomarker could emerge as a foundation for a process beginning with objective habits and skills of real-time modulation with focused breathing for healthier decision making and autonomic health trajectory change. Physical medicine and rehabilitation is uniquely poised to refine an autonomic rehabilitation process in an integrative manner to help individuals adapt.
Collapse
Affiliation(s)
- Raouf S Gharbo
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, 109 Elizabeth Meriwether, Williamsburg, VA 23185, USA.
| |
Collapse
|
14
|
Cruz-Montecinos C, Núñez-Cortés R, Guzmán-González B, Andersen LL, García-Massó X, Calatayud J. The Relevance of Dual Tasking for Improving Trunk Muscle Endurance After Back Surgery. Arch Phys Med Rehabil 2020; 102:463-469. [PMID: 32888906 DOI: 10.1016/j.apmr.2020.07.015] [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] [Received: 05/28/2020] [Revised: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the effect of dual tasking on trunk muscle endurance in patients after lumbar diskectomy. DESIGN Cross-sectional study. SETTING Rehabilitation hospital setting. PARTICIPANTS Individuals (N=14) undergoing primary lumbar diskectomy. INTERVENTION Using a randomized design on 2 separate days, muscle endurance was evaluated during prone bridging and Biering-Sorensen tests. Each test was randomly performed under 2 cognitive conditions: single task without cognitive condition and self-regulated dual task (ie, mathematical task). MAIN OUTCOME MEASURES The primary outcomes were time to failure and pain assessed by the visual analog scale from 0 to 100 mm. The secondary outcomes were kinesiophobia assessed by the Tampa Scale and disability assessed by the Oswestry Disability Index. Associations were tested using a repeated measures analysis of variance with relevant interaction test. RESULTS A significant interaction between condition, endurance tests, and kinesiophobia (P=.005) was found. The post hoc comparison showed positive effects between cognitive conditions in both endurance tests (prone bridging test: mean difference, 15.7s; 95% confidence interval [CI], 7.5-24s; P=.001; Biering-Sorensen test: mean difference, 7.9s; 95% CI, 1.9-14s; P=.014). The linear regression analysis between the Tampa Scale for Kinesiophobia and the difference of time to failure between cognitive conditions showed a positive correlation only during the Biering-Sorensen test (r=0.80; P=.001). CONCLUSIONS A self-regulated dual task increases trunk muscle endurance in patients after lumbar diskectomy. The results suggest that the difference observed in time to failure between the single task and dual task is associated with fear avoidance, especially during back extension. This strategy seems especially relevant for patients with high levels of fear avoidance and may be used to improve trunk muscle endurance.
Collapse
Affiliation(s)
- Carlos Cruz-Montecinos
- Laboratory of Clinical Biomechanics, Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile; Laboratory of Biomechanics and Kinesiology, San José Hospital, Santiago, Chile
| | - Rodrigo Núñez-Cortés
- Laboratory of Clinical Biomechanics, Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile; Service of Physical Therapy, Hospital Clínico La Florida, Santiago, Chile
| | - Benjamín Guzmán-González
- Laboratory of Clinical Biomechanics, Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Lars L Andersen
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Xavier García-Massó
- Department of Teaching of Musical, Visual and Corporal Expression, University of Valencia, Valencia, Spain; Human Movement Analysis Group, University of Valencia, Valencia, Spain
| | - Joaquín Calatayud
- National Research Centre for the Working Environment, Copenhagen, Denmark; Exercise Intervention for Health Research Group, Department of Physiotherapy, University of Valencia, Valencia, Spain.
| |
Collapse
|
15
|
The Relationship between Cognitive and Emotional Factors and Healthcare and Medication Use in People Experiencing Pain: A Systematic Review. J Clin Med 2020; 9:jcm9082486. [PMID: 32756298 PMCID: PMC7464293 DOI: 10.3390/jcm9082486] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/07/2020] [Accepted: 07/18/2020] [Indexed: 12/12/2022] Open
Abstract
Pain conditions are among the leading causes of global disability, impacting on global healthcare utilization (HCU). Health seeking behavior might be influenced by cognitive and emotional factors (CEF), which can be tackled by specific therapies. The purpose of this study was to systematically review the evidence concerning associations between CEF and HCU in people experiencing pain. Three databases were consulted: PubMed, Web of Science and EconLit. Risk of bias was assessed using the Downs and Black Checklist (modified). A total of 90 publications (total sample n = 59,719) was included after double-blind screening. In people experiencing pain, positive associations between general anxiety symptoms, depressive symptoms and catastrophizing and pain medication use were found. Additionally, there appears to be a relationship between general anxiety and depressive symptoms and opioid use. Symptom-related anxiety and psychological distress were found to be positively related with consulting behavior. Last, a positive association between use of complementary and alternative medicine and level of perceived symptom control was confirmed in people with pain. For other relationships no evidence or inconsistent findings were found, or they were insufficiently studied to draw firm conclusions, indicating that more research on this topic is needed.
Collapse
|
16
|
Jentoft ES, Kvåle A, Assmus J, Moen VP. Effect of information and exercise programmes after lumbar disc surgery: A randomized controlled trial. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2020; 25:e1864. [PMID: 32598090 DOI: 10.1002/pri.1864] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 03/24/2020] [Accepted: 05/23/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The aim of this study was to compare two physiotherapy interventions following lumber disc surgery regarding effect on pain, functioning and fear of movement. METHODS This study is a prospective randomized controlled study. When admitted to hospital for first time lumbar disc surgery, the participants were randomized to one of two post-operative intervention groups: one group received information only and the other exercise in combination with information. Outcomes were collected at baseline, 6-8 weeks and 12-months post-surgery. The primary outcome was to record changes in back/hip pain and leg pain. Secondary outcomes were evaluation of changes in function, fear-avoidance beliefs and kinesiophobia. RESULTS Seventy patients completed the study and were included in the analysis, of which 37 were randomized to the group receiving information only and the remaining 33 receiving both exercise and information. For primary outcomes, at 12 months postoperatively, the group receiving both exercise and information had significantly lower leg pain compared with those receiving only information (p < .033). For secondary outcomes, at 12 months postoperatively, a significant difference (p < .027) was detected for function, which favoured those that received both exercise and information. There was no significant difference in the results for the other secondary outcomes. Both groups showed clinically important changes in relation to pain and function from baseline to 12 months. The effect of treatment showed a statistically significant difference in favour of exercise and information, but the difference was not clinically relevant. CONCLUSION Exercise in combination with information reduced leg pain and improved function, which was statistically more evident over a period of time. Postoperative physiotherapy after lumbar disc surgery could include exercises in addition to information, but perhaps not for all patients, as both groups improved, and the difference between the two groups was not clinically relevant.
Collapse
Affiliation(s)
- Eva Saltskår Jentoft
- Orthopedic Clinic Kysthospitalet in Hagevik, Haukeland University Hospital, Bergen, Norway
| | - Alice Kvåle
- Western Norway University of Applied Sciences, Bergen, Norway
| | - Jörg Assmus
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Vegard Pihl Moen
- Western Norway University of Applied Sciences, Bergen, Norway.,Centre for Habilitation and Rehabilitation, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
17
|
Kemani MK, Hägg O, Jakobsson M, Lundberg M. Fear of Movement Is Related to Low Back Disability During a Two-Year Period in Patients Who Have Undergone Elective Lumbar Spine Surgery. World Neurosurg 2020; 137:e416-e424. [DOI: 10.1016/j.wneu.2020.01.218] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 10/25/2022]
|
18
|
Thomas KA, Sedney C, Gross R. Support for a Three-Item Questionnaire Prior to Spinal Surgery: A Health-Related Quality of Life Outcome Study. J Neurosci Rural Pract 2020; 11:100-105. [PMID: 32140011 PMCID: PMC7055628 DOI: 10.1055/s-0039-3400348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objective
Elective lumbar and cervical operations are becoming more common in the United States. Additionally, there is a movement in the literature and clinical practice to discover short versions of longer measures as a way to anticipate an outcome. This study aims to provide neurosurgeons in practice with a three-item questionnaire that can guide referrals to psychological services presurgery. Ultimately, results could lead to an improvement in health-related quality of life (HRQoL) postspinal surgery.
Methods
This quantitative-descriptive, survey-based design with a retrospective chart review component followed 47 patients at baseline (
N
= 47), 3 months (
N
= 20), 6 months (
N
= 31), and 1 year (
N
= 19). A single item from the Coping Strategies Questionnaire, the Survey of Pain Attitudes, and the Tampa Scale of Kinesiophobia were utilized in the three-item questionnaire as a baseline measure. Patient-Reported Outcomes Measurement Information System Global Health measured HRQoL outcome at all time points. A linear regression model was conducted to predict mental health QoL postspinal surgery.
Results
This measure can predict mental health QoL outcomes up to 3-month postsurgery. Six-month and 1-year follow-ups are statistically inconclusive.
Conclusion
Individuals who are undergoing spinal surgery show lower mental health QoL outcome at baseline and 3-month postsurgery when responses on a three-item questionnaire are elevated. Limitations and future directions are discussed.
Collapse
Affiliation(s)
- Kelly Anne Thomas
- Department of Counseling, Rehabilitation Counseling, and Counseling Psychology, West Virginia University, Morgantown, West Virginia, United States
| | - Cara Sedney
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia, United States
| | - Richard Gross
- Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, West Virginia, United States
| |
Collapse
|
19
|
Lotzke H, Gutke A, den Hollander M, Smeets R, Lundberg M. Developing an evidence-based prehabilitation programme designed to improve functional outcomes after lumbar fusion surgery - A feasibility study using the Medical Research Council framework. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2020. [DOI: 10.1080/21679169.2018.1553999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Hanna Lotzke
- Department of Orthopaedics at Sahlgrenska Academy, Institute of the Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Annelie Gutke
- Department of Health and Rehabilitation, Division of Physiotherapy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Marlies den Hollander
- Adelante Centre of Expertise in Rehabilitation, Hoensbroek, The Netherlands
- Department of Rehabilitation Medicine, Maastricht University, Maastricht, The Netherlands
| | - Rob Smeets
- Department of Rehabilitation Medicine, Maastricht University, Maastricht, The Netherlands
| | - Mari Lundberg
- Department of Health and Rehabilitation, Division of Physiotherapy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
20
|
Burgess LC, Wainwright TW. What Is the Evidence for Early Mobilisation in Elective Spine Surgery? A Narrative Review. Healthcare (Basel) 2019; 7:healthcare7030092. [PMID: 31323868 PMCID: PMC6787602 DOI: 10.3390/healthcare7030092] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 07/12/2019] [Accepted: 07/14/2019] [Indexed: 12/13/2022] Open
Abstract
Early mobilisation is a cornerstone of Enhanced Recovery after Surgery (ERAS) and is encouraged following spinal procedures. However, evidence of its implementation is limited and there are no formal guidelines on optimal prescription. This narrative review aimed to evaluate the evidence for the effect of early mobilisation following elective spinal surgery on length of stay, postoperative complications, performance-based function and patient-reported outcomes. Four trials (five articles) that compared a specific protocol of early in-hospital mobilisation to no structured mobilisation or bed rest were selected for inclusion. Nine studies that investigated the implementation of a multimodal intervention that was inclusive of an early mobilisation protocol were also included. Results suggest that goal-directed early mobilisation, delivered using an evidence-based algorithm with a clear, procedure-specific inclusion and exclusion criteria, may reduce length of stay and complication rate. In addition, there is evidence to suggest improved performance-based and patient-reported outcomes when compared to bed rest following elective spinal surgery. Whilst this review reveals a lack of evidence to determine the exact details of which early mobilisation protocols are most effective, mobilisation on the day of surgery and ambulation from the first postoperative day is possible and should be the goal. Future work should aim to establish consensus-based, best practice guidelines on the optimal type and timing of mobilisation, and how this should be modified for different spinal procedures.
Collapse
Affiliation(s)
- Louise C Burgess
- Orthopaedic Research Institute, Bournemouth University, Bournemouth BH8 8EB, UK
| | - Thomas W Wainwright
- Orthopaedic Research Institute, Bournemouth University, Bournemouth BH8 8EB, UK.
- Physiotherapy Department, The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth BH7 7DW, UK.
| |
Collapse
|
21
|
Goudman L, Huysmans E, Ickmans K, Nijs J, Moens M, Putman K, Buyl R, Louw A, Logghe T, Coppieters I. A Modern Pain Neuroscience Approach in Patients Undergoing Surgery for Lumbar Radiculopathy: A Clinical Perspective. Phys Ther 2019; 99:933-945. [PMID: 30921465 DOI: 10.1093/ptj/pzz053] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 09/16/2018] [Indexed: 12/11/2022]
Abstract
Around 20% of patients undergoing surgery for lumbar radiculopathy develop chronic pain after surgery, leading to high socioeconomic burden. Current perioperative interventions, including education and rehabilitation, are not always effective in preventing prolonged or chronic postoperative pain and disability. Here, a shift in educational intervention from a biomedical towards a biopsychosocial approach for people scheduled for lumbar surgery is proposed. Pain neuroscience education (PNE) is a biopsychosocial approach that aims to decrease the threat value of pain by reconceptualizing pain and increasing the patient's knowledge about pain. This paper provides a clinical perspective for the provision of perioperative PNE, specifically developed for patients undergoing surgery for lumbar radiculopathy. Besides the general goals of PNE, perioperative PNE aims to prepare the patient for postsurgical pain and how to cope with it.
Collapse
Affiliation(s)
- Lisa Goudman
- Pain in Motion International Research Group; Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy (KIMA), Vrije Universiteit Brussel; and Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Eva Huysmans
- Pain in Motion International Research Group; Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy (KIMA), Vrije Universiteit Brussel, Building F-KIMA, Laarbeeklaan 103, BE-1090 Brussels, Belgium; I-CHER, Interuniversity Center for Health Economics Research; Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel; and Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel
| | - Kelly Ickmans
- Pain in Motion International Research Group; Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy (KIMA), Vrije Universiteit Brussel; and Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel
| | - Jo Nijs
- Pain in Motion International Research Group; Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy (KIMA), Vrije Universiteit Brussel; and Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel
| | - Maarten Moens
- Department of Neurosurgery, Universitair Ziekenhuis Brussel; Center for Neurosciences, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel; and Department of Manual Therapy (MANU), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel
| | - Koen Putman
- Interuniversity Center for Health Economics Research, Vrije Universiteit Brussel and Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel
| | - Ronald Buyl
- Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel and Department of Biostatistics and Medical Informatics, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel
| | - Adriaan Louw
- International Spine and Pain Institute, Story City, Iowa
| | - Tine Logghe
- Department of Physical Medicine and Revalidation, Sint-Dimpna Ziekenhuis Geel, Geel, Belgium
| | - Iris Coppieters
- Pain in Motion International Research Group and Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy (KIMA), Vrije Universiteit Brussel, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University
| |
Collapse
|
22
|
Schwartz S, Bazargan-Hejazi S, Pan D, Ruiz D, Shirazi A, Washington E. Association of Psychiatric Diagnostic Conditions with Hospital Care Outcomes of Patients with Orthopedic Injuries. Perm J 2018; 22:17-120. [PMID: 29702056 DOI: 10.7812/tpp/17-120] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
CONTEXT Psychiatric comorbidity is common in orthopedic injury, but the effects on hospital care outcomes have been identified only generally. OBJECTIVE To quantify psychiatric comorbidity and its outcome effects in a large, multicenter population of inpatients with orthopedic injuries. DESIGN Retrospective analysis of patient discharge data from 507 California hospitals from 2001 to 2010. Study sample included orthopedic diagnoses using International Classification of Diseases codes for major pelvic and lower extremity injuries in patients older than age 17 years. From the injury data, we extracted psychiatric diagnoses, alcoholism, substance abuse, and sociodemographic characteristics. MAIN OUTCOME MEASURES Length of stay, surgical complications, and inpatient deaths. RESULTS The entire injury admissions represented about 1.9% of all hospital admissions and were predominantly older than age 64 years, white, and women with conventional health care insurance. The most common comorbidity in the patients with injury was psychiatric illness (24.7%). The most common psychiatric diagnoses in orthopedic injury admissions were dementia (14.3%) and depression (6.9%) without association. Compared with the injury admissions with no psychiatric diagnosis, admissions with psychiatric diagnosis had higher odds of a hospital stay of 7 or more days, surgical treatment complications, and inhospital death. CONCLUSION Psychiatric comorbidity adversely affects several hospital outcomes in patients with orthopedic injuries: Length of stay, surgical complications, and inpatient mortality. In low-income populations, the adverse psychiatric effects are incrementally worse. The adverse effects of psychiatric comorbidity, particularly dementia and depression, on hospital outcomes should stimulate improved psychiatric care of many patients at risk of poor clinical outcomes.
Collapse
Affiliation(s)
- Steven Schwartz
- Assistant Professor of Orthopedic Surgery at the Charles R Drew University of Medicine and Science and at the David Geffen School of Medicine at the University of California, Los Angeles.
| | - Shahrzad Bazargan-Hejazi
- Professor at the Charles R Drew University of Medicine and Science and at the David Geffen School of Medicine at the University of California, Los Angeles.
| | - Deyu Pan
- is an Instructor at the Charles R Drew University of Medicine and Science in Los Angeles, CA.
| | - David Ruiz
- Interventional Radiologist at the Charles R Drew University of Medicine and Science and at the David Geffen School of Medicine at the University of California, Los Angeles.
| | - Anaheed Shirazi
- Research Intern at the Charles R Drew University of Medicine and Science in Los Angeles, CA.
| | - Eleby Washington
- Professor of Orthopedic Surgery at the Charles R Drew University of Medicine and Science and at the David Geffen School of Medicine at the University of California, Los Angeles, and an Orthopedic Surgeon at the Martin Luther King, Jr Outpatient Center and Community Hospital.
| |
Collapse
|
23
|
Kinesiophobia is associated with pain intensity but not pain sensitivity before and after exercise: an explorative analysis. Physiotherapy 2018; 104:187-193. [DOI: 10.1016/j.physio.2017.10.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 10/08/2017] [Indexed: 12/25/2022]
|
24
|
Biopsychosocial factors predict quality of life in thoracolumbar spine surgery. Qual Life Res 2017; 26:3099-3110. [DOI: 10.1007/s11136-017-1654-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2017] [Indexed: 12/15/2022]
|
25
|
Janssens L, Brumagne S, Claeys K, Pijnenburg M, Goossens N, Rummens S, Depreitere B. Proprioceptive use and sit-to-stand-to-sit after lumbar microdiscectomy: The effect of surgical approach and early physiotherapy. Clin Biomech (Bristol, Avon) 2016; 32:40-8. [PMID: 26795132 DOI: 10.1016/j.clinbiomech.2015.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 12/22/2015] [Accepted: 12/29/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Individuals with non-specific low back pain show decreased reliance on lumbosacral proprioceptive signals and slower sit-to-stand-to-sit performance. However, little is known in patients after lumbar microdiscectomy. METHODS Patients were randomly assigned into transmuscular (n=12) or paramedian lumbar surgery (n=13). After surgery, the same patients were randomly assigned into individualized active physiotherapy starting 2 weeks after surgery (n=12) or usual care (n=13). Primary outcomes were center of pressure displacement during ankle and back muscles vibration (to evaluate proprioceptive use), and the duration of five sit-to-stand-to-sit movements, evaluated at 2 (baseline), 8 and 24 weeks after surgery. FINDINGS Two weeks after surgery, all patients showed smaller responses to back compared to ankle muscles vibration (P<0.05). Patients that underwent a transmuscular surgical procedure and patients that received physiotherapy switched to larger responses to back muscles vibration at 24 weeks, compared to 2 weeks after surgery (P<0.005), although not seen in the paramedian group and usual care group (P>0.05). Already 8 weeks after surgery, the physiotherapy group needed significantly less time to perform five sit-to-stand-to-sit movements compared to the usual care group (P<0.05). INTERPRETATION Shortly after lumbar microdiscectomy, patients favor reliance on ankle proprioceptive signals over lumbosacral proprioceptive reliance to maintain posture, which resembles the behavior of patients with non-specific low back pain. However, early active physiotherapy after lumbar microdiscectomy facilitated higher reliance on lumbosacral proprioceptive signals and early improvement of sit-to-stand-to-sit performance. Transmuscular lumbar surgery favoured recovery of lumbosacral proprioception 6 months after surgery. CLINICAL TRIAL NUMBER NCT01505595.
Collapse
Affiliation(s)
- Lotte Janssens
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium; Hasselt University, Biomedical Research Institute, Diepenbeek, Belgium.
| | - Simon Brumagne
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium.
| | - Kurt Claeys
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium; KU Leuven Department of Rehabilitation Sciences, Campus Brugge, Bruges, Belgium.
| | | | - Nina Goossens
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium.
| | - Sofie Rummens
- Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium.
| | - Bart Depreitere
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium.
| |
Collapse
|
26
|
Does Kinesiophobia Modify the Effects of Physical Therapy on Outcomes in Patients With Sciatica in Primary Care? Subgroup Analysis From a Randomized Controlled Trial. Phys Ther 2015; 95:1217-23. [PMID: 25929529 DOI: 10.2522/ptj.20140458] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 04/22/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND A higher level of kinesiophobia appears to be associated with poor recovery in patients with sciatica. OBJECTIVE The aim of this study was to investigate whether kinesiophobia modifies the effect of physical therapy on outcomes in patients with sciatica. DESIGN This was a subgroup analysis from a randomized controlled trial. SETTING The study was conducted in a primary care setting. PATIENTS A total of 135 patients with acute sciatica participated. INTERVENTION Patients were randomly assigned to groups that received (1) physical therapy plus general practitioners' care (intervention group) or (2) general practitioners' care alone (control group). MEASUREMENTS Kinesiophobia at baseline was measured with the Tampa Scale for Kinesiophobia (TSK) and a single substitute question for kinesiophobia (SQK). Pain and recovery were assessed at 3- and 12-month follow-ups. Regression analysis was used to test for interaction between the level of kinesiophobia at baseline and treatment allocation. Subgroup results were calculated for patients classified with high fear of movement and for those classified with low fear of movement. RESULTS Kinesiophobia at baseline interacted with physical therapy in the analysis with leg pain intensity at 12-month follow-up. Kinesiophobia at baseline did not interact with physical therapy regarding any outcome at 3-month follow-up or recovery at 12-month follow-up. When comparing both treatment groups in the subgroup of patients with high fear of movement (n=73), the only significant result was found for leg pain intensity difference from baseline at 12-month follow-up (intervention group: X̅=-5.0, SD=2.6; control group: X̅=-3.6, SD=2.7). LIMITATIONS The post hoc study design and relatively small sample size were limitations of the study. CONCLUSIONS In 135 patients with sciatica, evidence shows that patients with a higher level of kinesiophobia at baseline may particularly benefit from physical therapy with regard to decreasing leg pain intensity at 12-month follow-up.
Collapse
|
27
|
Abstract
Orthopaedic surgery often requires many months of rehabilitation to achieve a successful outcome, regardless of subspecialty. Several important psychological factors strongly influence pain perceptions, rehabilitation compliance, and patient outcomes after common orthopaedic surgeries that require extensive rehabilitation, including total joint arthroplasty, anterior cruciate ligament reconstruction, and spine surgery for degenerative disease. Early recognition of patients exhibiting psychological distress, fear-avoidance behavior, or poor perceived self-efficacy or pessimistic personality traits can be used to improve preoperative risk stratification for poor rehabilitation or surgical outcomes. Several intervention strategies exist to address these psychological factors when they appear to contribute suboptimal postoperative rehabilitation or recovery.
Collapse
|
28
|
Haugen AJ, Brox JI, Grøvle L, Keller A, Natvig B, Soldal D, Grotle M. Prognostic factors for non-success in patients with sciatica and disc herniation. BMC Musculoskelet Disord 2012; 13:183. [PMID: 22999108 PMCID: PMC3495213 DOI: 10.1186/1471-2474-13-183] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 09/19/2012] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Few studies have investigated prognostic factors for patients with sciatica, especially for patients treated without surgery. The aim of this study was to identify factors associated with non-success after 1 and 2 years of follow-up and to test the prognostic value of surgical treatment for sciatica. METHODS The study was a prospective multicentre observational study including 466 patients with sciatica and lumbar disc herniation. Potential prognostic factors were sociodemographic characteristics, back pain history, kinesiophobia, emotional distress, pain, comorbidity and clinical examination findings. Study participation did not alter treatment considerations for the patients in the clinics. Patients reported on the questionnaires if surgery of the disc herniation had been performed. Uni- and multivariate logistic regression analyses were used to evaluate factors associated with non-success, defined as Maine-Seattle Back Questionnaire score of ≥5 (0-12) (primary outcome) and Sciatica Bothersomeness Index ≥7 (0-24) (secondary outcome). RESULTS Rates of non-success were at 1 and 2 years 44% and 39% for the main outcome and 47% and 42% for the secondary outcome. Approximately 1/3 of the patients were treated surgically. For the main outcome variable, in the final multivariate model non-success at 1 year was significantly associated with being male (OR 1.70 [95% CI; 1.06 - 2.73]), smoker (2.06 [1.31 - 3.25]), more back pain (1.0 [1.01 - 1.02]), more comorbid subjective health complaints (1.09 [1.03 - 1.15]), reduced tendon reflex (1.62 [1.03 - 2.56]), and not treated surgically (2.97 [1.75 - 5.04]). Further, factors significantly associated with non-success at 2 years were duration of back problems >; 1 year (1.92 [1.11 - 3.32]), duration of sciatica >; 3 months (2.30 [1.40 - 3.80]), more comorbid subjective health complaints (1.10 [1.03 - 1.17]) and kinesiophobia (1.04 [1.00 - 1.08]). For the secondary outcome variable, in the final multivariate model, more comorbid subjective health complaints, more back pain, muscular weakness at clinical examination, and not treated surgically, were independent prognostic factors for non-success at both 1 and 2 years. CONCLUSIONS The results indicate that the prognosis for sciatica referred to secondary care is not that good and only slightly better after surgery and that comorbidity should be assessed in patients with sciatica. This calls for a broader assessment of patients with sciatica than the traditional clinical assessment in which mainly the physical symptoms and signs are investigated.
Collapse
|