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Morris EJ, Gray K, Gibbons PJ, Grayson J, Sullivan J, Amorim AB, Burns J, McKay MJ. Evaluating the Use of PROMs in Paediatric Orthopaedic Registries. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1552. [PMID: 37761513 PMCID: PMC10528097 DOI: 10.3390/children10091552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023]
Abstract
Patient-reported outcome measures (PROMs) provide structured information on the patient's health experience and facilitate shared clinical decision-making. Registries that collect PROMs generate essential information about the clinical course and efficacy of interventions. Whilst PROMs are increasingly being used in adult orthopaedic registries, their use in paediatric orthopaedic registries is not well known. The purpose of this systematic review was to identify the frequency and scope of registries that collect PROMs in paediatric orthopaedic patient groups. In July 2023, six databases were systematically searched to identify studies that collected PROMs using a registry amongst patients aged under 18 years with orthopaedic diagnoses. Of 3190 identified articles, 128 unique registries were identified. Three were exclusively paediatric, 27 were majority paediatric, and the remainder included a minority of paediatric patients. One hundred and twenty-eight registries collected 72 different PROMs, and 58% of these PROMs were not validated for a paediatric population. The largest group of orthopaedic registries collected PROMs on knee ligament injuries (21%). There are few reported dedicated orthopaedic registries collecting PROMs in paediatric populations. The majority of PROMs collected amongst paediatric populations by orthopaedic registries are not validated for patients under the age of 18 years. The use of non-validated PROMs by registries greatly impedes their utility and impact. Dedicated orthopaedic registries collecting paediatric-validated PROMs are needed to increase health knowledge, improve decision-making between patients and healthcare providers, and optimise orthopaedic management.
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Affiliation(s)
- Eleanor J. Morris
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
- Sydney Children’s Hospitals Network, The Children’s Hospital at Westmead, Sydney 2145, Australia;
| | - Kelly Gray
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney 2109, Australia;
| | - Paul J. Gibbons
- Sydney Children’s Hospitals Network, The Children’s Hospital at Westmead, Sydney 2145, Australia;
| | - Jane Grayson
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
| | - Justin Sullivan
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
| | - Anita B. Amorim
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
| | - Joshua Burns
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
- Sydney Children’s Hospitals Network, Paediatric Gait Analysis Service of New South Wales, Sydney 2145, Australia
| | - Marnee J. McKay
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
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Rod derotation and translation techniques provide comparable functional outcomes for surgical correction of adolescent idiopathic scoliosis - A retrospective, cross-sectional study. Ann Med Surg (Lond) 2022; 73:103188. [PMID: 35070277 PMCID: PMC8767236 DOI: 10.1016/j.amsu.2021.103188] [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: 05/22/2021] [Revised: 12/17/2021] [Accepted: 12/19/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To compare the functional outcome of the two most commonly used methods of Adolescence Idiopathic Scoliosis (AIS) correction surgery using rod rotation and translation techniques from a single center in Indonesia. METHOD We performed retrospective, cross-sectional study of patients with AIS who underwent deformity correction surgery by either technique in Fatmawati General Hospital from January 2016 to March 2018. All patients were asked to complete scoliosis research society (SRS)-22 questionnaire. RESULT Both methods of surgical correction yielded similar functional outcome as recorded in SRS-22 score, 3.67 for rod derotation technique and 3.44 for translation technique (p = 0.235). CONCLUSION Both rod derotation and translation technique resulted in equally desirable quality of life for AIS patients, in line with what would be expected from the literatures. Neither technique can be judged superior to the other. Therefore, the decision to use rotation or translation technique, as well as to compliment it with additional correction methods, should be made by the surgeon according to personal preference, experience, and comfort.
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Beeckman M, Hughes S, Van der Kaap-Deeder J, Plasschaert F, Michielsen J, Moens P, Schelfaut S, Goubert L. Risk and Resilience Predictors of Recovery After Spinal Fusion Surgery in Adolescents. Clin J Pain 2021; 37:789-802. [PMID: 34419974 DOI: 10.1097/ajp.0000000000000971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 07/20/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This prospective study examined risk and resilience predictors of pain and functional recovery in the first 6 months after spinal fusion surgery in adolescents. METHODS Adolescents with adolescent idiopathic scoliosis undergoing spinal fusion surgery (n=100, aged 12 to 18 y, 77% girls) completed assessments before surgery and at 3 weeks, 6 weeks, and 6 months after surgery. Recovery trajectories in pain, health-related quality of life (HRQOL), and objectively registered physical activity were identified. Presurgical pain catastrophizing and pain intensity (risk), and psychological flexibility, and postsurgical pain acceptance (resilience) were examined as predictors of recovery. RESULTS Latent growth class analyses revealed 4 distinct pain recovery trajectories (ie, Severe-Moderate [11%, n=9], Mild-No [58%, n=49], Moderate-Mild [24%, n=20], and Moderate-Severe [7%, n=6] pain trajectory), 2 HRQOL recovery trajectories; 2 trajectories characterizing recovery in average daily physical activity at moderate-to-vigorous intensity (MVPA); and 3 trajectories characterizing recovery in total physical activity volume characterized by the average daily number of steps. Subsequent multivariate analyses of variance revealed that presurgical pain intensity (partial η2=0.21, P<0.001) and pain catastrophizing (partial η2=0.13, P<0.01) were both predictive of poorer recovery in HRQOL, and pain catastrophizing additionally predicted poorer pain recovery (partial η2=0.15, P<0.05). Psychological flexibility (partial η2=0.25, P<0.001) and postsurgical pain acceptance (partial η2=0.07, P<0.05) were predictive of more favorable recovery trajectories in HRQOL, and psychological flexibility additionally predicted more favorable recovery trajectories in postsurgical pain (partial η2=0.15, P<0.05). Daily MVPA trajectories were not significantly predicted by any of the hypothesized factors, while presurgical pain catastrophizing levels were predictive of a delayed recovery trajectory in the daily amount of steps (partial η2=0.17 P<0.01). CONCLUSIONS Presurgical screening could include assessment of pain intensity, pain catastrophizing, psychological flexibility, and pain acceptance to identify adolescents who are at risk for poorer recovery. These are potentially modifiable factors that can be targeted in presurgical interventions to prevent poor and foster adaptive outcomes after major surgery in adolescents.
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Affiliation(s)
| | - Sean Hughes
- Experimental-Clinical and Health Psychology, Ghent University
| | | | - Frank Plasschaert
- Department of Orthopedics and Traumatology, Ghent University Hospital, Ghent
| | | | - Pierre Moens
- Department of Orthopedics, Leuven University Hospital, Leuven, Belgium
| | | | - Liesbet Goubert
- Experimental-Clinical and Health Psychology, Ghent University
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Charalampidis A, Möller H, Gerdhem P. Anterior versus posterior fusion surgery in idiopathic scoliosis: a comparison of health-related quality of life and radiographic outcomes in Lenke 5C curves - results from the Swedish spine registry. J Child Orthop 2021; 15:464-471. [PMID: 34858533 PMCID: PMC8582605 DOI: 10.1302/1863-2548.15.210049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 09/07/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To compare health-related quality of life and radiographic outcomes in patients treated with either anterior or posterior fusion surgery for Lenke 5C type idiopathic scoliosis. METHODS We used data from the Swedish spine registry and identified 59 patients with idiopathic scoliosis treated with fusion for Lenke 5C type curves; 27 patients underwent anterior surgery and 32 underwent posterior surgery. All patients had pre- and postoperative radiographic data and postoperative clinical data at a minimum of two years after surgery. Patient-reported outcomes measures included the Scoliosis Research Society (SRS)-22r, EuroQoL 5 dimensions 3 levels (EQ-5D-3L), EQ-visual analogue scale (VAS) and VAS for back pain. Radiographic assessment included measurement of the angle of the major curve, disc angulation below the lowest instrumented vertebra, curve flexibility, rate of curve correction, differences in sagittal parameters, number of fused vertebrae and length of fusion. RESULTS The mean age at surgery was 16 years in both groups. The mean follow-up time was 3.8 years. There were no significant differences in the SRS-22r score and EQ-5D-3L index at follow-up (all p ≥ 0.2). Postoperatively, both the anterior and posterior fusion group demonstrated a significant correction of the major curve (p ≤ 0.001) with no significant difference of the correction rate between the groups (p = 0.4). The posterior fusion group had shorter operative time (p < 0.001) and higher perioperative blood loss (p = 0.004) while the anterior group had lower number of fused vertebrae ( p< 0.001). CONCLUSION The type of surgical approach for Lenke 5C curves is not associated with differences in health-related quality of life, despite the lower number of fused vertebrae after anterior surgery. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Anastasios Charalampidis
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet,Department of Reconstructive Orthopaedics, Karolinska University Hospital, Stockholm, Sweden,Correspondence should be sent to Anastasios Charalampidis, MD, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska University Hospital, 141 86 Stockholm, Sweden. E-mail:
| | - Hans Möller
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet,Stockholm Center for Spine Surgery, Stockholm, Sweden
| | - Paul Gerdhem
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet,Department of Reconstructive Orthopaedics, Karolinska University Hospital, Stockholm, Sweden
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Charalampidis A, Rundberg L, Möller H, Gerdhem P. Predictors of persistent postoperative pain after surgery for idiopathic scoliosis. J Child Orthop 2021; 15:458-463. [PMID: 34858532 PMCID: PMC8582608 DOI: 10.1302/1863-2548.15.210090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/11/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To identify factors contributing to persistent postoperative pain in patients treated surgically for idiopathic scoliosis. METHODS In total, 280 patients aged ten through 25 years at surgery, were identified in the Swedish Spine registry; all having preoperative and postoperative visual analogue scale (VAS) for back pain scores. The patients were divided into a high and low postoperative pain group based on the reported postoperative VAS for back pain scores (by using 45 mm on the 0 mm to 100 mm VAS scale as a cut-off). The patient-reported questionnaire included VAS for back pain, the 3-level version of EuroQol 5-dimensional (EQ-5D-3L) instrument, the EuroQol VAS (EQ-VAS) and the Scoliosis Research Society 22r instrument (SRS-22r). Predictors of postoperative back pain were searched in the preoperative data. RESULTS The 67 (24%) patients that reported high postoperative VAS back pain (> 45 mm) also reported lower postoperative EQ-5D-3L, EQ-VAS and SRS-22r than patients with low postoperative VAS back pain (all p < 0.001). Two preoperative variables were independently associated with postoperative pain; each millimetre increase in preoperative VAS back pain (on the 0 mm to 100 mm scale) was associated with a higher risk of being in the high postoperative back pain group (odds ratio (OR) 1.03; 95% confidence interval (CI) 1.02 to 1.05) and each 1 point decrease on the preoperative SRS-22r mental health (scale from 1 to 5) was associated with a higher risk of being in the high postoperative back pain group (OR 1.68; 95% CI 1.03 to 2.73). CONCLUSION High preoperative back pain and low preoperative mental health are independent predictors of back pain after surgery for idiopathic scoliosis. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Anastasios Charalampidis
- Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Sweden,Department of Reconstructive Orthopaedics, Karolinska University Hospital, Stockholm, Sweden,Correspondence should be sent to Anastasios Charalampidis, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska University Hospital, 141 86 Stockholm, Sweden. E-mail:
| | - Lina Rundberg
- Department of Surgery, Danderyd Hospital, Stockholm, Sweden
| | - Hans Möller
- Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Sweden,Stockholm Center for Spine Surgery, Stockholm, Sweden
| | - Paul Gerdhem
- Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Sweden,Department of Reconstructive Orthopaedics, Karolinska University Hospital, Stockholm, Sweden
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Lin JL, Tawfik DS, Gupta R, Imrie M, Bendavid E, Owens DK. Health and Economic Outcomes of Posterior Spinal Fusion for Children With Neuromuscular Scoliosis. Hosp Pediatr 2021; 10:257-265. [PMID: 32079619 DOI: 10.1542/hpeds.2019-0153] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Neuromuscular scoliosis (NMS) can result in severe disability. Nonoperative management minimally slows scoliosis progression, but operative management with posterior spinal fusion (PSF) carries high risks of morbidity and mortality. In this study, we compare health and economic outcomes of PSF to nonoperative management for children with NMS to identify opportunities to improve care. METHODS We performed a cost-effectiveness analysis. Our decision analytic model included patients aged 5 to 20 years with NMS and a Cobb angle ≥50°, with a base case of 15-year-old patients. We estimated costs, life expectancy, quality-adjusted life-years (QALYs), and incremental cost-effectiveness from published literature and conducted sensitivity analyses on all model inputs. RESULTS We estimated that PSF resulted in modestly decreased discounted life expectancy (10.8 years) but longer quality-adjusted life expectancy (4.84 QALYs) than nonoperative management (11.2 years; 3.21 QALYs). PSF costs $75 400 per patient. Under base-case assumptions, PSF costs $50 100 per QALY gained. Our findings were sensitive to quality of life (QoL) and life expectancy, with PSF favored if it significantly increased QoL. CONCLUSIONS In patients with NMS, whether PSF is cost-effective depends strongly on the degree to which QoL improved, with larger improvements when NMS is the primary cause of debility, but limited data on QoL and life expectancy preclude a definitive assessment. Improved patient-centered outcome assessments are essential to understanding the effectiveness of NMS treatment alternatives. Because the degree to which PSF influences QoL substantially impacts health outcomes and varies by patient, clinicians should consider shared decision-making during PSF-related consultations.
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Affiliation(s)
- Jody L Lin
- Divisions of Pediatric Hospital Medicine and .,Clinical Excellence Research Center, Stanford University, Stanford, California.,Division of Inpatient Medicine, Department of Pediatrics, School of Medicine, The University of Utah, Salt Lake City, Utah; and
| | | | - Ribhav Gupta
- Division of Biomechanical Engineering, School of Engineering.,Divisions of Infectious Diseases and Geographic Medicine, and
| | | | - Eran Bendavid
- Primary Care and Population Health, Departments of Medicine and
| | - Douglas K Owens
- VA Palo Alto Health Care System, Palo Alto, California.,Stanford Health Policy, Freeman Spogli Institute for International Studies, School of Medicine, and
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Feasibility of Proxy-Reported EQ-5D-3L-Y and Its Agreement in Self-reported EQ-5D-3L-Y for Patients With Adolescent Idiopathic Scoliosis. Spine (Phila Pa 1976) 2020; 45:E799-E807. [PMID: 32539293 DOI: 10.1097/brs.0000000000003431] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVE To compare feasibility of self-reported and proxy-reported youth version of EuroQoL Five-Dimension Three-Level Questionnaire (EQ-5D-3L-Y), to estimate the agreement of health outcome between patients with adolescent idiopathic scoliosis (AIS) and their proxies, and to examine factors that may affect patient-proxy agreement. SUMMARY OF BACKGROUND DATA The EQ-5D-3L-Y questionnaire has both self-reported and proxy-reported versions. Despite previous studies have indicated that proxies tended to respond with higher or lower levels of severity in specific dimensions than patients report, the level of agreement between children with AIS and their proxies remained unknown. METHODS A consecutive sample of patients with AIS and their caregivers were recruited. Feasibility was tested according to the proportion of missing responses. Agreements between self-report and proxy EQ-5D-3L-Y were evaluated using percentage agreement, Gwet agreement coefficients and the intraclass correlation coefficients. Linear regressions and logistic regressions were conducted to assess the factors associated with the agreement in health outcome between self-reported and proxy-reported EQ-5D-3L-Y. RESULTS A total of 130 patient-proxy pairs were involved in the study. Agreement of EQ-5D-3L-Y responses between the self-report and proxy version was good for "Feeling worried/sad/unhappy" dimension, and very good for other dimensions. Poor agreement in visual analog scale score was observed between patient and proxy versions. Proxy's education level, patient's curvature type, and treatment modality were the significant determinants of the agreement in "Mobility," "usual activities," and "pain/discomfort" dimension, respectively. CONCLUSION Proxy-reported EQ-5D-3L-Y demonstrates good feasibility and satisfactory agreement with patient version. Proxy's education appears to have positive influence in agreement between patient-proxy dyads. LEVEL OF EVIDENCE 2.
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Ng BW, Chau WW, Illescas V. Correlation of curve flexibility analysis with patient health outcomes after scoliosis surgery using Scoliosis Research Society-22 Questionnaire. JOURNAL OF ORTHOPEDICS, TRAUMATOLOGY AND REHABILITATION 2020. [DOI: 10.4103/jotr.jotr_54_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Responsiveness of EQ-5D Youth version 5-level (EQ-5D-5L-Y) and 3-level (EQ-5D-3L-Y) in Patients With Idiopathic Scoliosis. Spine (Phila Pa 1976) 2019; 44:1507-1514. [PMID: 31634302 DOI: 10.1097/brs.0000000000003116] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective cohort study OBJECTIVE.: The aim of this study was to evaluate the responsiveness of EQ-5D Youth version (EQ-5D-Y) 5-level and 3-level in patients with idiopathic scoliosis SUMMARY OF BACKGROUND DATA.: A new version of EQ-5D-Y increasing the number of response levels from 3 (3LY) to 5 (5LY) has been recently introduced. Although the validity and reliability of 5LY and 3LY for use in idiopathic scoliosis patients are compared, responsiveness of two questionnaires among children and adolescents is unknown. METHODS A total of 129 children or adolescents attending the spine clinics of a tertiary hospital in Hong Kong, China, completed 3LY and 5LY. At 3-month follow-up, 110 (85.2%) patients completed two EQ-5D-Y questionnaires, and the single-item Global Rating on Change Scale determining "worsened,", "unchanged,", or "improved" global health. Among those indicating "unchanged" in global health from baseline to follow-up, agreement in responses to each 3LY and 5LY item was examined. Mean changes in EQ-5D-Y scores during the past 3 months in patients with "worsened," "unchanged," and "improved" health were calculated. RESULTS Most patients (82.7%) reported no change in global health, whereas about 12.7% and 4.5% of them felt better and worse, respectively, compared to baseline. Among those reporting "unchanged health," the "Looking after myself" item exhibited the largest proportion of agreement in responses (5LY: 96.36%; 3LY: 95.50%), followed by "Mobility" (5LY 90.91%; 3LY 90.99%), "Usual activities" (5LY 83.64%; 3LY 87.39%), "Pain/discomfort"(5LY 68.18%; 3LY 76.58%), and "Feeling worried/sad/unhappy" (5LY 66.36%; 3LY 72.07%). In the "improved" or "worsened" group, the 3-month follow-up 5LY and 3LY scores were higher or lower compared with baseline, respectively. CONCLUSION The 5LY is demonstrated as responsive as the 3LY for patients with idiopathic scoliosis. LEVEL OF EVIDENCE 2.
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Use of an Accelerated Discharge Pathway in Patients With Severe Cerebral Palsy Undergoing Posterior Spinal Fusion for Neuromuscular Scoliosis. Spine Deform 2019; 7:804-811. [PMID: 31495482 DOI: 10.1016/j.jspd.2019.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 12/22/2018] [Accepted: 02/05/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Implementation of a coordinated multidisciplinary postoperative pathway has been shown to reduce length of stay after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis. This study sought to compare the outcomes of nonambulatory cerebral palsy (CP) patients treated with PSF and cared for using an accelerated discharge (AD) pathway with those using a more traditional discharge (TD) pathway. METHODS A total of 74 patients with Gross Motor Function Classification System (GMFCS) class 4/5 CP undergoing PSF were reviewed. Thirty consecutive patients were cared for using a TD pathway, and 44 patients were subsequently treated using an AD pathway. The cohorts were then evaluated for postoperative complications and length of stay. RESULTS Length of stay (LOS) was 19% shorter in patients managed with the AD pathway (AD 4.0 days [95% CI 2.5-5.5] vs. TD 4.9 days [95% CI 3.5-6.3], p = .01). There was no difference between groups with respect to age at surgery, GMFCS class, preoperative curve magnitude, pelvic obliquity, kyphosis, postoperative curve correction, fusion to the pelvis, or length of fusion between groups. Length of stay remained significantly shorter in the AD group by 0.9 days when controlling for estimated blood loss (EBL) and length of surgery. Complication rates trended lower in the AD group (33% AD vs. 52% TD, p = .12), including pulmonary complications (21% AD vs. 38% TD, p = .13). There was no significant difference in wound complications, return to the operating room, or medical readmissions between groups. CONCLUSIONS Adoption of a standardized postoperative pathway reduced LOS by 19% in nonambulatory CP patients. Overall, complications, including pulmonary, trended lower in the AD group. Early discharge appears to be possible in this challenging patient population. Although the AD pathway may not be appropriate for all patients, the utility of the AD pathway in optimizing care for more routine PSF for this patient subset appears to be worthwhile. LEVEL OF EVIDENCE Level III, therapeutic.
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30-day Outcomes in Primary vs. Revision Posterior Spinal Fusion for Pediatric Spinal Deformity. Clin Neurol Neurosurg 2019; 180:106-110. [PMID: 30954807 DOI: 10.1016/j.clineuro.2019.03.023] [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: 01/12/2019] [Revised: 01/30/2019] [Accepted: 03/30/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Current evidence, with regard to primary vs. revision spinal fusions in pediatric spine deformities, is limited to inpatient outcomes only. The current study aims to analyze and compare 30-day outcomes in pediatric spine deformity patients undergoing a primary vs. a revision posterior spinal fusion. PATIENTS AND METHODS The 2012-2016 American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) Pediatric database was queried using Current Procedural Terminology (CPT) codes for patients undergoing posterior spinal fusions (22800, 22802 and 22804). Patients undergoing concurrent anterior fusion/combined fusion and anterior-only fusions were removed from the study. Revision spinal fusions were captured using CPT codes for re-insertion of spinal fixation device (22830), exploration of spinal fusions (22849), 22850 and 22852 (removal of posterior instrumentation). RESULTS Out of a total of 13,398 patients, 332 (2.5%) underwent a revision posterior spinal fusion and the remained underwent primary spinal fusion. Following adjustment for baseline clinical characteristics, patients undergoing revision posterior spinal fusions were at a higher risk of deep surgical site infections (OR 2.43 [95% CI 1.10-5.35]; p = 0.028), organ/space surgical site infections (OR 4.09 [1.19-14.04]; p = 0.025) and 30-day unplanned re-operations (OR 1.87 [95% CI 1.17-3.00]. CONCLUSIONS Pediatric spine deformity patients undergoing revision spinal fusions are at a higher risk of experiencing wound-complications and subsequent unplanned re-operations within 30-days of surgery. Providers should promote careful wound-care and/or awareness among care-givers to minimize the risks and costs associated with these specific adverse outcomes.
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Cuka C, McDevitt AW, Porter-Hoke A, Karas S. Spinal manipulation after multiple fusions in an adult with scoliosis: a case report. J Man Manip Ther 2019; 27:115-124. [PMID: 30935333 DOI: 10.1080/10669817.2018.1560523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Spinal fusion (SF)is a common surgical intervention for individuals with idiopathic scoliosis. However, individuals may experience continued pain and disability from suspected mechanical dysfunction. CASE DESCRIPTION The purpose of this case report was to describe how specific thrust manipulation (TM) was used to treat a patient with scoliosis after multilevel SF. The 25-year-old female patient presented with left-sided pain in the rib, thoracic, and lumbar and sacroiliac joint regions that had been aggravated by trail running. After clearance from her surgeon, physical therapy examination and subsequent diagnosis were consistent with mechanical dysfunction of the ribs, lumbar spine, and sacroiliac joint causing decreased ability to participate in high-level activities, such as running. OUTCOMES The patient was treated for eight visits her 4 months with specific TM, movement analysis, and physiotherapeutic scoliosis-specific exercises. Pain and function were assessed with the Trunk Appearance Perception scale (TAPS), Scoliosis Research Society questionnaire (SRS-22), Numeric Pain Rating Scale (NPRS), Oswestry Disability Index (ODI), and spirometry. Pain and function improved during treatment, but outcomes for the ODI and spirometry remained the same. DISCUSSION The current case report suggests specific TM to areas outside of the fused spinal segments may be beneficial for decreasing pain and improving functional activities and participation levels. However, more research is needed to verify the efficacy of this treatment in clinical practice.
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Affiliation(s)
- Christina Cuka
- a True Physical Therapy , Lakewood , CO , USA.,b North American Institute of Orthopedic Manual Therapy , Eugene , OR , USA.,c Department of Physical Therapy , Andrews University , Berrien Springs , MI , USA.,d Department of Physical Therapy , A.T. Still University , Mesa , AZ , USA
| | - Amy W McDevitt
- e School of Medicine, Physical Therapy Program , University of Colorado , Aurora , CO , USA
| | - Ann Porter-Hoke
- b North American Institute of Orthopedic Manual Therapy , Eugene , OR , USA
| | - Steve Karas
- b North American Institute of Orthopedic Manual Therapy , Eugene , OR , USA.,f Physical Therapy Program , Chatham University , Pittsburgh , PA , USA
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Health-related Quality of Life and Body Image Disturbance of Adolescents With Severe Untreated Idiopathic Early-onset Scoliosis in a Developing Country. Spine (Phila Pa 1976) 2018; 43:1566-1571. [PMID: 29664812 DOI: 10.1097/brs.0000000000002686] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A cross-sectional study. OBJECTIVE This study aimed to investigate the health-related quality of life (HRQOL) and body image disturbance of adolescents with untreated severe idiopathic early-onset scoliosis (IEOS) in a developing country. SUMMARY OF BACKGROUND DATA IEOS has the potential to progress rapidly and may lead to significant disability if left untreated. Moreover, it can lead to significant body image changes that may lead to social and psychological stresses on developing adolescents. In developing countries, untreated severe IEOS among adolescents is common. METHODS The Scoliosis Research Society 22 revision (SRS-22r) Arabic version questionnaire and Body Image Disturbance Questionnaire-Scoliosis version (BIDQ-S) were used to investigate the HRQOL and body image disturbance of these patients. RESULTS A total of 137 patients with untreated severe IEOS (mean age, 15.5 years; range, 12-21 years) were included: group 1 (76 patients) with major curve angles of 90° to 120°, group 2 (61 patients) with major curve angles above 120°, and group 3 comprising 50 healthy controls were used for comparison. No significant differences were found regarding age, sex, and body mass index among the groups. Group 1 had significantly lower scores than group 3 in all SRS-22r domains (P < 0.001). Group 2 had significantly lower scores than group 1 in all SRS-22r domains, except for satisfaction (P < 0.005); the satisfaction domain had 100% worst answers in groups 1 and 2. Group 2 had worse scores than group 1 in all BIDQ-S questions (P < 0.001). No significant differences were found between males and females in all SRS-22r domains and BIDQ-S questions (P > 0.05). Further, 13% to 100% and 25% to 71% of the patients provided the worst answers to the SRS-22r and BIDQ-S questions, respectively. CONCLUSION The HRQOL and body image of the adolescents with untreated severe IEOS in a developing country were severely impaired. LEVEL OF EVIDENCE 3.
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Pasha S, Flynn J. Data-driven Classification of the 3D Spinal Curve in Adolescent Idiopathic Scoliosis with an Applications in Surgical Outcome Prediction. Sci Rep 2018; 8:16296. [PMID: 30389972 PMCID: PMC6214965 DOI: 10.1038/s41598-018-34261-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 10/15/2018] [Indexed: 11/20/2022] Open
Abstract
Adolescent idiopathic scoliosis (AIS) is a three-dimensional (3D) deformity of the spinal column. For progressive deformities in AIS, the spinal fusion surgery aims to correct and stabilize the deformity; however, common surgical planning approaches based on the 2D X-rays and subjective surgical decision-making have been challenged by poor clinical outcomes. As the suboptimal surgical outcomes can significantly impact the cost, risk of revision surgery, and long-term rehabilitation of adolescent patients, objective patient-specific models that predict the outcome of different treatment scenarios are in high demand. 3D classification of the spinal curvature and identifying the key surgical parameters influencing the outcomes are required for such models. Here, we show that K-means clustering of the isotropically scaled 3D spinal curves provides an effective, data-driven method for classification of patients. We further propose, and evaluate in 67 right thoracic AIS patients, that by knowing the patients’ pre-operative and early post-operation clusters and the vertebral levels which were instrumented during the surgery, the two-year outcome cluster can be determined. This framework, once applied to a larger heterogeneous patient dataset, can further isolate the key surgeon-modifiable parameters and eventually lead to a patient-specific predictive model based on a limited number of factors determinable prior to surgery.
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Affiliation(s)
- Saba Pasha
- Division of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, 19141, USA. .,Department of Surgery, University of Pennsylvania, Philadelphia, PA, 19141, USA.
| | - John Flynn
- Division of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, 19141, USA.,Department of Surgery, University of Pennsylvania, Philadelphia, PA, 19141, USA
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Health-related Quality of Life of Adolescents With Severe Untreated Congenital Kyphosis and Kyphoscoliosis in a Developing Country. Spine (Phila Pa 1976) 2018; 43:E942-E948. [PMID: 29462064 DOI: 10.1097/brs.0000000000002598] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A cross-sectional study OBJECTIVE.: The aim of this study was to study the health-related quality of life (HRQOL) of adolescents with severe untreated congenital kyphosis (CK) and congenital kyphoscoliosis (CKS) in a developing country. SUMMARY OF BACKGROUND DATA Surgical intervention is generally indicated early in patients with progressive CK or CKS to prevent the progression of deformity and to improve the quality of life of the patients. HRQOL of adolescents with untreated CK and CKS in developing countries has never been investigated. METHODS Arabic version of the Scoliosis Research Society 22 revision (SRS-22r) questionnaire used to study HRQOL of adolescents with severe untreated CK or CKS in a dev eloping country. RESULTS A total of 134 adolescent (mean age 17.1 years) completed SRS-22r questionnaire: 38 patients with CK from 80° to 110° (group 1), 24 patients with CK > 110° (group 2), 27 patients with CKS (group 3), and 45 healthy controls (group 4). Group 1 had significant lower scores than group 4 in all SRS 22r domains (P < 0.001). Scores of all domains except pain showed significant (P < 0.001) decrease with increase of the severity of CK. Group 3 had significant lower scores than group 2 in all SRS-22r domains except mental health. Satisfaction domain had significant lower scores than all other SRS-22r domains for group 1, 2, and 3. All patients of groups 2 and 3 gave the minimum answers for satisfaction domain questions. A total of 69%, 84% and 94% of group 1, 2, and 3, respectively, gave the minimum answer when asked whether their back condition affects their personal relationships. Female patients of group 1, 2, and 3 had significant lower scores for self-image domain. CONCLUSION HRQOL is severely affected in adolescents with untreated severe CK and CKS in a developing country. LEVEL OF EVIDENCE 3.
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Charalampidis A, Möller A, Wretling ML, Brismar T, Gerdhem P. Implant density is not related to patient-reported outcome in the surgical treatment of patients with idiopathic scoliosis. Bone Joint J 2018; 100-B:1080-1086. [DOI: 10.1302/0301-620x.100b8.bjj-2017-1114.r1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims There is little information about the optimum number of implants to be used in the surgical treatment of idiopathic scoliosis. Retrospective analysis of prospectively collected data from the Swedish spine register was undertaken to discover whether more implants per operated vertebra (implant density) leads to a better outcome in the treatment of idiopathic scoliosis. The hypothesis was that implant density is not associated with patient-reported outcomes, the correction of the curve or the rate of reoperation. Patients and Methods A total of 328 patients with idiopathic scoliosis, aged between ten and 20 years at the time of surgery, were identified in the Swedish spine register (Swespine) and had patient reported outcomes including the Scoliosis Research Society 22r instrument (SRS-22r) score, EuroQol 5 dimensions quality of life, 3 level (EQ-5D-3L) score and a Viual Analogue Score (VAS) for back pain, at a mean follow-up of 3.1 years and reoperation data at a mean follow-up of 5.5 years. Implant data and the correction of the curve were assessed from radiographs, preoperatively and a mean of 1.9 years postoperatively. The patients were divided into tertiles based on implant density. Data were analyzed with analysis of variance, logistic regression or log-rank test. Some analyses were adjusted for gender, age at the time of surgery, the flexibility of the major curve and follow-up. Results The mean number of implants per operated vertebra in the low, medium and high-density groups were 1.36 (1.00 to 1.54), 1.65 (1.55 to 1.75) and 1.91 (1.77 to 2.00), respectively. There were no statistically significant differences in the correction of the curve, the SRS-22r total score, EQ-5D-3L index or number of reoperations between the groups (all p > 0.34). In the SRS-22r domains, self-image was marginally higher in the medium implant density group (p = 0.029) and satisfaction marginally higher in the high implant density group (p = 0.034). Conclusion These findings suggest that there is no clear advantage in using a high number of implants per operated vertebra in the surgical treatment of patients with idiopathic scoliosis. Cite this article: Bone Joint J 2018;100-B:1080–6.
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Affiliation(s)
- A. Charalampidis
- Department of Clinical Sciences, Intervention
and Technology (CLINTEC), Karolinska, Sweden and Institutet and
Department of Orthopaedics, Karolinska University Hospital, Stockholm,
Sweden and Division of Radiology, Department of Clinical Science, Intervention
and Technology, Karolinska Institutet, Karolinska University
Hospital, Stockholm, Sweden
| | - A. Möller
- Department of Clinical Sciences, Intervention
and Technology (CLINTEC), Karolinska, Sweden and Institutet and
Department of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden
| | - M-L. Wretling
- Division of Radiology, Department of Clinical
Science, Intervention and Technology, Karolinska Institutet, Karolinska University
Hospital
| | - T. Brismar
- Division of Radiology, Department of Clinical
Science, Intervention and Technology, Karolinska Institutet, Karolinska University
Hospital
| | - P. Gerdhem
- Department of Clinical Sciences, Intervention
and Technology (CLINTEC), Karolinska, Sweden and Institutet and
Department of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden
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von Heideken J, Iversen MD, Gerdhem P. Rapidly increasing incidence in scoliosis surgery over 14 years in a nationwide sample. 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 2017; 27:286-292. [PMID: 29052036 DOI: 10.1007/s00586-017-5346-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 08/13/2017] [Accepted: 10/10/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Severe scoliosis is primarily managed with surgery. This cohort study describes the incidence of surgically treated scoliosis among Swedish youth and young adults, stratified by age, sex, scoliosis type, and surgical approach and identifies changes in incidence rate and hospital length of stay (LOS), infections requiring re-surgery and mortality within 90 days. METHODS Swedish youth, 0-21 years, (n = 3062) with a diagnostic code for scoliosis and spine surgery between 2000 and 2013 were selected from the National Patient Register. Incidence was computed by comparing individuals with surgically treated scoliosis to the total at risk population. Linear regression models and Spearman correlation coefficients analyzed trends over time. RESULTS Overall annual incidence per 100,000 individuals was 9.1 (5.9 males/12.5 females). Annual incidence increased over 14 years from 5.1 to 9.8; an average 4.6% per year (p < 0.001). Adolescent idiopathic scoliosis was most common (4.5 per 100,000; n = 1516) followed by neuromuscular 2.7 (n = 913) and congenital 0.7 (n = 236). Average LOS decreased among scoliosis types except infantile and neuromuscular scoliosis. Posterior fusion was the most common surgical approach (75%) followed by anterior (18%) and anteroposterior fusion (7%). Posterior fusions significantly increased with a resultant decrease in anterior and anteroposterior fusion over time. Individuals with neuromuscular scoliosis exhibited the highest mortality (n = 12; 1.3%) and (n = 59; 6%) of individuals with neuromuscular scoliosis and (n = 12; 15%) with scoliosis related to MMC required revision surgery due to post-op infection. CONCLUSIONS Surgical management of scoliosis is increasing with a concurrent decrease in hospital LOS. Surgical management of neuromuscular scoliosis is associated with high 90-day post-operative infections and mortality rate.
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Affiliation(s)
- Johan von Heideken
- Department of Women's and Children's Health, Karolinska Institutet, Karolinska Universitetssjukhuset Solna, 171 76, Stockholm, Sweden
| | - Maura D Iversen
- Department of Women's and Children's Health, Karolinska Institutet, Karolinska Universitetssjukhuset Solna, 171 76, Stockholm, Sweden.,Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, 360 Huntington Avenue, Rm 301c Robinson Hall, Boston, MA, 02115, USA.,Section of Clinical Sciences, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Paul Gerdhem
- Department of Clinical Science, Intervention and Technology, Division of Orthopedics and Biotechnology, Karolinska Institutet, Karolinska University Hospital, Huddinge, K54, 141 86, Stockholm, Sweden. .,Department of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden.
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Theis JC, Grauers A, Diarbakerli E, Savvides P, Abbott A, Gerdhem P. An observational study on surgically treated adult idiopathic scoliosis patients' quality of life outcomes at 1- and 2-year follow-ups and comparison to controls. SCOLIOSIS AND SPINAL DISORDERS 2017; 12:11. [PMID: 28413830 PMCID: PMC5389187 DOI: 10.1186/s13013-017-0118-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 03/28/2017] [Indexed: 12/05/2022]
Abstract
Background Prospective data on health-related quality of life in patients with idiopathic scoliosis treated surgically as adults is needed. We compared preoperative and 1- and 2-year follow-up data in surgically treated adults with idiopathic scoliosis with juvenile or adolescent onset. Results were compared to untreated adults with scoliosis and population normative data. Methods A comparison of preoperative and 1- and 2-year follow-up data of 75 adults surgically treated for idiopathic scoliosis at a mean age of 28 years (range 18 to 69) from a prospective national register study, as well as a comparison with age- and sex-matched data from 75 untreated adults with less severe scoliosis and 75 adults without scoliosis, was made. Outcome measures were EuroQol-5 dimensions (EQ-5D) and Scoliosis Research Society (SRS)-22r questionnaire. Results In the surgically treated, EQ-5D and SRS-22r scores had statistically significant improvements at both 1- and 2-year follow-ups (all p
< 0.015). The effect size of surgery on EQ-5D at 1-year follow-up was large (r = −0.54) and small-medium (r = −0.20) at 2-year follow-up. The effect size of surgery on SRS-22r outcomes was medium-large at 1- and 2-year follow-ups (r = −0.43 and r = −0.42 respectively). At the 2-year follow-up, the EQ-5D score and the SRS-22r subscore were similar to the untreated scoliosis group (p = 0.56 and p = 0.91 respectively), but lower than those in the adults without scoliosis (p < 0.001 for both comparisons). Conclusions Adults with idiopathic scoliosis experience an increase in health-related quality of life following surgery at 2-year follow-up, approaching the health-related quality of life of untreated individuals with less severe scoliosis, but remain lower than normative population data.
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Affiliation(s)
- Jennifer C Theis
- Faculty of Health Science and Medicine, Bond Institute of Health and Sport, Bond University, 2 Promethean Way, Robina, Queensland 4226 Australia.,Department of Orthopaedics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
| | - Anna Grauers
- Department of Orthopaedics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, SE-141 86 Stockholm, Sweden.,Department of Orthopaedics, Sundsvall and Härnösand County Hospital, 85186 Sundsvall, Sweden
| | - Elias Diarbakerli
- Department of Orthopaedics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
| | - Panayiotis Savvides
- Department of Orthopaedics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
| | - Allan Abbott
- Faculty of Health Science and Medicine, Bond Institute of Health and Sport, Bond University, 2 Promethean Way, Robina, Queensland 4226 Australia.,Department of Physical Therapy, Karolinska University Hospital, SE-141 86 Stockholm, Sweden.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, SE-141 86 Stockholm, Sweden.,Department of Medical and Health Sciences, Division of Physiotherapy, Faculty of Health Sciences, Linköping University, SE-58183 Linköping, Sweden
| | - Paul Gerdhem
- Department of Orthopaedics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
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Borges PA, de Carvalho Neto JT, Letaif OB, Marcon RM, Cristante AF. The influence of body image on surgical decisions in adolescent idiopathic scoliosis patients. Clinics (Sao Paulo) 2017; 72:130-133. [PMID: 28355357 PMCID: PMC5348583 DOI: 10.6061/clinics/2017(03)01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 11/04/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES: The objective of this study was to evaluate whether the severity of deformities in patients with adolescent idiopathic scoliosis contributes to patients' decision regarding whether to undergo an operation. METHODS: We evaluated body image factors in adolescent idiopathic scoliosis patients. We evaluated the magnitude of the main scoliotic curve, gibbosity (magnitude and location), shoulder height asymmetry and patient's age. We analyzed the correlation of these data with the number of years the patient was willing to trade for surgery, as measured by the time-trade-off method. RESULTS: A total of 52 patients were studied. We did not find a correlation between any of the parameters that were studied and the number of years that the patient would trade for the surgery. CONCLUSIONS: The magnitude of body deformities in patients with adolescent idiopathic scoliosis does not interfere with the decision to undertake surgical treatment.
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Affiliation(s)
- Paulo Alvim Borges
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (IOT-HCFMUSP), Instituto de Ortopedia e Traumatologia, Laboratório de Investigação Médica, Divisão de Cirurgia da Coluna, São Paulo/SP, Brazil
| | - José Thomé de Carvalho Neto
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (IOT-HCFMUSP), Instituto de Ortopedia e Traumatologia, Laboratório de Investigação Médica, Divisão de Cirurgia da Coluna, São Paulo/SP, Brazil
| | - Olavo Biraghi Letaif
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (IOT-HCFMUSP), Instituto de Ortopedia e Traumatologia, Laboratório de Investigação Médica, Divisão de Cirurgia da Coluna, São Paulo/SP, Brazil
| | - Raphael Martus Marcon
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (IOT-HCFMUSP), Instituto de Ortopedia e Traumatologia, Laboratório de Investigação Médica, Divisão de Cirurgia da Coluna, São Paulo/SP, Brazil
| | - Alexandre Fogaça Cristante
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (IOT-HCFMUSP), Instituto de Ortopedia e Traumatologia, Laboratório de Investigação Médica, Divisão de Cirurgia da Coluna, São Paulo/SP, Brazil
- *Corresponding author. E-mail:
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Roberts SB, Tsirikos AI. Factors influencing the evaluation and management of neuromuscular scoliosis: A review of the literature. J Back Musculoskelet Rehabil 2016; 29:613-623. [PMID: 26966821 DOI: 10.3233/bmr-160675] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Neuromuscular scoliosis (NMS) is the second most prevalent spinal deformity (after idiopathic scoliosis) and is usually first identified during early childhood. Cerebral palsy (CP) is the most common cause of NMS, followed by Duchenne muscular dystrophy (DMD). Progressive spinal deformity causes difficulty with daily care, walking and sitting, and can lead to back and rib pain, cardiac and pulmonary complications, altered seizure thresholds, and skin compromise. Early referral to specialist spinal services and early diagnosis of NMS is essential to ensure appropriate multidisciplinary patient management. The most important goals for patients are preservation of function, facilitation of daily care, and alleviation of pain. Non-operative management includes observation or bracing for less severe and flexible deformity in young patients as a temporising measure to provide postural support. Surgical correction and stabilisation of NMS is considered for patients with a deformity >40-50°, but may be performed for less severe deformity in patients with DMD. Post-operative intensive care, early mobilisation and nutritional supplementation aim to minimise the rate of post-surgical complications, which are relatively common in this patient group. However, surgical management of NMS is associated with good long-term outcomes and high satisfaction rates for patients, their relatives and carers.
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Diarbakerli E, Grauers A, Gerdhem P. Population-based normative data for the Scoliosis Research Society 22r questionnaire in adolescents and adults, including a comparison with EQ-5D. 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 2016; 26:1631-1637. [DOI: 10.1007/s00586-016-4854-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 09/20/2016] [Accepted: 10/28/2016] [Indexed: 01/19/2023]
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Cheung PWH, Wong CKH, Samartzis D, Luk KDK, Lam CLK, Cheung KMC, Cheung JPY. Psychometric validation of the EuroQoL 5-Dimension 5-Level (EQ-5D-5L) in Chinese patients with adolescent idiopathic scoliosis. SCOLIOSIS AND SPINAL DISORDERS 2016; 11:19. [PMID: 27525314 PMCID: PMC4973368 DOI: 10.1186/s13013-016-0083-x] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 07/21/2016] [Indexed: 01/08/2023]
Abstract
Background Scoliosis is a common spinal deformity that occurs often during adolescence. Previous studies suggested that adolescent idiopathic scoliosis (AIS) patients can have various aspects of their lives being affected, due to disease presentation and/or treatment received. It is important to define a reliable instrument based on which the affected patients’ health-related quality of life can be assessed. This study aims to assess the validity, reliability and sensitivity of the EuroQoL 5-dimension 5-level (EQ-5D-5L) in Chinese patients with AIS. Methods Adolescent idiopathic scoliosis patients of Chinese descent were prospectively recruited to complete both the traditional Chinese versions of the EQ-5D-5L and the refined Scoliosis Research Society-22 (SRS-22r) questionnaires. Patients’ demographic profiles and corresponding clinical parameters including treatment modalities, spinal curve pattern and magnitude, and duration of bracing were recorded. Telephone interviews were then conducted at least two weeks later for the assessment of test-retest reliability. Statistical analysis was performed: construct validity of the EQ-5D-5L domains were assessed using Spearman’s correlation test against the SRS-22r; whereas intra-class correlation coefficient (ICC) was used to assess the test-retest reliability, and agreement over the test-retest period was expressed in percentages. Also, the sensitivity of the EQ-5D-5L in differentiating various clinical known groups was determined by effect size, independent t-test and analysis of variance. Results A total of 227 AIS patients were recruited. Scores of domains of the EQ-5D-5L correlated significantly (r: 0.57-0.74) with the scores of the SRS-22r domains that were intended to measure similar constructs, supporting construct validity. The EQ-5D-5L domain responses and utility scores showed good test-retest reliability (ICC: 0.777; agreement: 76.4 -98.1 %). Internal consistency was good (Cronbach’s α: 0.78) for the EQ-5D-5L utility score. The EQ-5D-5L utility score was sensitive in detecting differences between subjects who had different treatment modalities and bracing duration, but not for curve pattern and its magnitude. Conclusions The EQ-5D-5L is found to be a valid, reliable and sensitive measure to assess the health-related quality of life in Chinese AIS patients. This potentiates the possibility of utilizing the EQ-5D-5L to estimate AIS patients’ health-related quality of life, based on which the outcome of various treatment options can eventually be evaluated. Electronic supplementary material The online version of this article (doi:10.1186/s13013-016-0083-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Prudence Wing Hang Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, 5/F, Professorial Block, Pokfulam, Hong Kong, SAR China
| | - Carlos King Ho Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, SAR China
| | - Dino Samartzis
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, 5/F, Professorial Block, Pokfulam, Hong Kong, SAR China
| | - Keith Dip Kei Luk
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, 5/F, Professorial Block, Pokfulam, Hong Kong, SAR China
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, SAR China
| | - Kenneth Man Chee Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, 5/F, Professorial Block, Pokfulam, Hong Kong, SAR China
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, 5/F, Professorial Block, Pokfulam, Hong Kong, SAR China
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Persson-Bunke M, Czuba T, Hägglund G, Rodby-Bousquet E. Psychometric evaluation of spinal assessment methods to screen for scoliosis in children and adolescents with cerebral palsy. BMC Musculoskelet Disord 2015; 16:351. [PMID: 26578150 PMCID: PMC4650493 DOI: 10.1186/s12891-015-0801-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 11/03/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In cerebral palsy (CP) there is an increased risk of scoliosis. It is important to identify a progressive scoliosis early-on because the results of surgery depend on the magnitude of the curve. The Swedish follow-up program for cerebral palsy (CPUP) includes clinical examinations of the spine. The reliability and validity of the assessment method have not been studied. In this study we evaluate the interrater reliability of the clinical spinal examination used in CPUP and scoliometer measurement in children with CP and we evaluate their validity compared to radiographic examination. METHODS Twenty-eight children (6-16 years) with CP in Gross Motor Function Classification System levels II-V were included. Clinical spinal examinations and scoliometer measurements in sitting position were performed by three independent examiners. The results were compared to the Cobb angle as determined by radiographic measurement. Interrater reliability was calculated using weighted kappa. Concurrent validity was analyzed using the Cobb angle as gold standard. Sensitivity, specificity, area under receiver operating characteristic curves (AUC) and likelihood ratios (LR) were calculated. Cut-off values for scoliosis were set to ≥ 20° Cobb angle and ≥ 7° scoliometer angle. RESULTS There was an excellent interrater reliability for both clinical examination (weighted kappa = 0.96) and scoliometer measurement (weighted kappa = 0.86). The clinical examination showed a sensitivity of 75 % (95 % CI: 19.4-99.4 %), specificity of 95.8 % (95 % CI: 78.9-99.9 %) and an AUC of 0.85 (95 % CI: 0.61-1.00). The positive LR was 18 and the negative LR was 0.3. The scoliometer measurement showed a sensitivity of 50 % (95 % CI: 6.8-93.2 %), specificity of 91.7 % (95 % CI: 73.0-99.0 %) and AUC of 0.71 (95 % CI: 0.42-0.99). The positive LR was 6 and the negative LR was 0.5. CONCLUSION The psychometric evaluation of the clinical examination showed an excellent interrater reliability and a high concurrent validity compared to the Cobb angle. The findings should be interpreted cautiously until research with larger samples may further quantify the psychometric properties. Clinical spinal examinations seem appropriate as a screening tool to identify scoliosis in children with CP.
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Affiliation(s)
- Måns Persson-Bunke
- Department of Clinical Sciences, Lund, Orthopaedics, Lund University, S-221 85, Lund, Sweden. .,Department of Orthopaedic, Skane University Hospital, SE 221 85, Lund, Sweden.
| | - Tomasz Czuba
- National Competence Center for Quality Registers, Lund University, University Hospital, S-221 85, Lund, Sweden.
| | - Gunnar Hägglund
- Department of Clinical Sciences, Lund, Orthopaedics, Lund University, S-221 85, Lund, Sweden.
| | - Elisabet Rodby-Bousquet
- Department of Clinical Sciences, Lund, Orthopaedics, Lund University, S-221 85, Lund, Sweden. .,Centre for Clinical Research, Uppsala University, County Hospital, S-721 89, Västerås, Sweden.
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Rabbitts JA, Palermo TM, Zhou C, Mangione-Smith R. Pain and Health-Related Quality of Life After Pediatric Inpatient Surgery. THE JOURNAL OF PAIN 2015; 16:1334-1341. [PMID: 26416163 DOI: 10.1016/j.jpain.2015.09.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 08/11/2015] [Accepted: 09/12/2015] [Indexed: 11/27/2022]
Abstract
UNLABELLED Around 4 million children undergo inpatient surgery in the United States each year, however little is known about the impact of surgery and postoperative pain on children's health-related quality of life (HRQOL) during the weeks and months after surgery. We measured pain and HRQOL in a large, heterogeneous pediatric postsurgical population from baseline to 1-month follow-up. Over a 20-month period, parents of 915 children age 2 to 18 years (mean = 9.6 years), 50% male, 56% white, admitted to surgical services at a children's hospital enrolled in the study. Parent participants reported on sociodemographics, child HRQOL, and pain characteristics at baseline and 1 month after discharge. Although most of the children recovered to baseline by 1 month after hospital discharge, 23% of children had a significant decline in HRQOL. Logistic regression analyses found that increasing child age (odds ratio = 2.1 for age 13-18 years) and the presence of moderate-severe postsurgical pain at 1 month (odds ratio = 5.7) were significantly associated with deterioration in HRQOL from baseline to 1-month follow-up (P < .05 for each variable). Although HRQOL returns to the baseline level for most children, a sizeable proportion have significant deterioration in HRQOL associated with continued postsurgical pain at 1 month after hospital discharge from surgery. PERSPECTIVE This study addresses an important gap in the literature, examining pain and health-related quality of life in a broad population of children undergoing a wide range of inpatient surgeries. Evaluation of inpatient health services from a patient and family perspective is essential in evaluating outcomes of surgical care.
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Affiliation(s)
- Jennifer A Rabbitts
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington; Seattle Children's Research Institute, Seattle, Washington.
| | - Tonya M Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington; Seattle Children's Research Institute, Seattle, Washington
| | - Chuan Zhou
- Department of Pediatrics, University of Washington, Seattle, Washington; Seattle Children's Research Institute, Seattle, Washington
| | - Rita Mangione-Smith
- Department of Pediatrics, University of Washington, Seattle, Washington; Seattle Children's Research Institute, Seattle, Washington
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25
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Schreiber S, Parent EC, Moez EK, Hedden DM, Hill D, Moreau MJ, Lou E, Watkins EM, Southon SC. The effect of Schroth exercises added to the standard of care on the quality of life and muscle endurance in adolescents with idiopathic scoliosis-an assessor and statistician blinded randomized controlled trial: "SOSORT 2015 Award Winner". SCOLIOSIS 2015; 10:24. [PMID: 26413145 PMCID: PMC4582716 DOI: 10.1186/s13013-015-0048-5] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 07/28/2015] [Indexed: 11/10/2022]
Abstract
Background In North America, care recommendations for adolescents with small idiopathic scoliosis (AIS) curves include observation or bracing. Schroth scoliosis-specific exercises have demonstrated promising results on various outcomes in uncontrolled studies. This randomized controlled trial (RCT) aimed to determine the effect of Schroth exercises combined with the standard of care on quality-of-life (QOL) outcomes and back muscle endurance (BME) compared to standard of care alone in patients with AIS. Material and Methods Fifty patients with AIS, aged 10–18 years, with curves 10–45 °, recruited from a scoliosis clinic were randomized to receive standard of care or supervised Schroth exercises plus standard of care for 6 months. Schroth exercises were taught over five sessions in the first two weeks. A daily home program was adjusted during weekly supervised sessions. The assessor and the statistician were blinded. Outcomes included the Biering-Sorensen (BME) test, Scoliosis Research Society (SRS-22r) and Spinal Appearance Questionnaires (SAQ) scores. Intention-to-treat (ITT) and per protocol (PP) linear mixed effects models were analyzed. Because ITT and PP analyses produced similar results, only ITT is reported. Results After 3 months, BME in the Schroth group improved by 32.3 s, and in the control by 4.8 s. This 27.5 s difference in change between groups was statically significant (95 % CI 1.1 to 53.8 s, p = 0.04). From 3 to 6 months, the self-image improved in the Schroth group by 0.13 and deteriorated in the control by 0.17 (0.3, 95 % CI 0.01 to 0.59, p = 0.049). A difference between groups for the change in the SRS-22r pain score transformed to its power of four was observed from 3 to 6 months (85.3, 95 % CI 8.1 to 162.5, p = 0.03), where (SRS-22 pain score)4 increased by 65.3 in the Schroth and decreased by 20.0 in the control group. Covariates: age, self-efficacy, brace-wear, Schroth classification, and height had significant main effects on some outcomes. Baseline ceiling effects were high: SRS-22r (pain = 18.4 %, function = 28.6 %), and SAQ (prominence = 26.5 %, waist = 29.2 %, chest = 46.9 %, trunk shift = 12.2 % and shoulders = 18.4 %). Conclusions Supervised Schroth exercises provided added benefit to the standard of care by improving SRS-22r pain, self-image scores and BME. Given the high prevalence of ceiling effects on SRS-22r and SAQ questionnaires’ domains, we hypothesize that in the AIS population receiving conservative treatments, different QOL questionnaires with adequate responsiveness are needed. Trial registration Schroth Exercise Trial for Scoliosis NCT01610908. Electronic supplementary material The online version of this article (doi:10.1186/s13013-015-0048-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | - Douglas M Hedden
- University of Alberta, Alberta Health Services, Edmonton, Canada
| | - Doug Hill
- University of Alberta, Alberta Health Services, Edmonton, Canada
| | - Marc J Moreau
- University of Alberta, Alberta Health Services, Edmonton, Canada
| | - Edmond Lou
- University of Alberta, Alberta Health Services, Edmonton, Canada
| | - Elise M Watkins
- University of Alberta, Alberta Health Services, Edmonton, Canada
| | - Sarah C Southon
- University of Alberta, Alberta Health Services, Edmonton, Canada
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