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Skatteboe S, Røe C, Heide M, Brox JI, Ignatius J, Bratsberg A, Wilhelmsen M, Bjørneboe J. Responsiveness and minimal important change of specific and generic patient-reported outcome measures for back patients: the Norwegian Neck and Back Register. 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 2024; 33:2960-2968. [PMID: 39007982 DOI: 10.1007/s00586-024-08394-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/17/2024] [Accepted: 06/30/2024] [Indexed: 07/16/2024]
Abstract
PURPOSE To evaluate responsiveness and minimal important change (MIC) of Oswestry Disability Index (ODI), pain during activity on a numeric rating scale (NRSa) and health related quality of life (EQ-5D) based on data from the Norwegian neck and back registry (NNRR). METHODS A total of 1617 patients who responded to NNRR follow-up after both 6 and 12 months were included in this study. Responsiveness was calculated using standardized response mean and area under the receiver operating characteristic (ROC) curve. We calculated MIC with both an anchor-based and distribution-based method. RESULTS The condition specific ODI had best responsiveness, the more generic NRSa and EQ-5D had lower responsiveness. We found that the MIC for ODI varied from 3.0 to 9.5, from 0.4 to 2.5 for NRSa while the EQ5D varied from 0.05 to 0.12 depending on the method for calculation. CONCLUSION In a register based back pain population, the condition specific ODI was more responsive to change than the more generic tools NRSa and EQ5D. The variations in responsiveness and MIC estimates also indicate that they should be regarded as indicative, rather than fixed estimates.
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Affiliation(s)
- Sigrid Skatteboe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.
| | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Marte Heide
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Jens Ivar Brox
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Janica Ignatius
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Andrea Bratsberg
- Oslo Centre for Biostatistics and Epidemiology, University of Oslo, Oslo, Norway
| | - Maja Wilhelmsen
- Department of Physical Medicine and Rehabilitation, University Hospital of North Norway, Tromsø, Norway
- Norwegian Neck and Back Registry, University Hospital of North Norway, Tromsø, Norway
| | - John Bjørneboe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
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Kearney A, Williamson PR, Dodd S. A review of core outcome sets (COS) developed for different settings finds there is a subset of outcomes relevant for both research and routine care. J Clin Epidemiol 2024; 173:111440. [PMID: 38936556 DOI: 10.1016/j.jclinepi.2024.111440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 06/06/2024] [Accepted: 06/19/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVES To compare the outcomes selected for the same condition in core outcome sets (COSs) for research with those in COS for the routine care setting. METHODS A sample of COS was created from the most frequent five health areas within previous systematic reviews of COS for research and COS for routine care. Outcomes were extracted and categorized using an outcome taxonomy. Frequency of outcome domains included within COS were analyzed in subgroups according to research or care setting, patient involvement in COS development and health area. Matched sets of COS were created, where at least one research COS and one routine care COS exist for the same health condition, to identify the outcomes that were recommended for both settings. A similar process was used for a subset of paired COS matched in scope for both intervention and population as well as health condition. RESULTS The sample of COS comprised: 246 COS for research only, 76 COS for routine care only and 55 COS for both research and routine care. Across the 18 sets matched by health condition the median number (range) of outcomes included in both research COS and routine care COS was 6 (3-15), with differences noted across health areas. For the 11 paired COS matched by scope and health condition, the corresponding figures were 2 (2-8). Across all settings, COS that did not include patients as participants were less likely to include life impact outcomes. CONCLUSION Within a given health condition, a small number of core outcomes were found to be relevant for both research and care, offering a meaningful starting point for linking research and real-world evaluation.
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Affiliation(s)
- Anna Kearney
- Health Data Science, University of Liverpool, Liverpool, UK.
| | | | - Susanna Dodd
- Health Data Science, University of Liverpool, Liverpool, UK
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3
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Young I, Dunning J, Butts R, Bliton P, Zacharko N, Garcia J, Mourad F, Charlebois C, Gorby P, Fernández-de-Las-Peñas C. Spinal manipulation and electrical dry needling as an adjunct to conventional physical therapy in patients with lumbar spinal stenosis: a multi-center randomized clinical trial. Spine J 2024; 24:590-600. [PMID: 38103739 DOI: 10.1016/j.spinee.2023.12.002] [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] [Received: 06/26/2023] [Revised: 11/10/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND CONTEXT Nonoperative management of lumbar spinal stenosis (LSS) includes activity modification, medication, injections, and physical therapy. Conventional physical therapy includes a multimodal approach of exercise, manual therapy, and electro-thermal modalities. There is a paucity of evidence supporting the use of spinal manipulation and dry needling as an adjunct to conventional physical therapy in patients with LSS. PURPOSE This study aimed to determine the effects of adding thrust spinal manipulation and electrical dry needling to conventional physical therapy in patients with LSS. STUDY DESIGN/SETTING Randomized, single-blinded, multi-center, parallel-group clinical trial. PATIENT SAMPLE One hundred twenty-eight (n=128) patients with LSS from 12 outpatient clinics in 8 states were recruited over a 34-month period. OUTCOME MEASURES The primary outcomes included the Numeric Pain Rating Scale (NPRS) and the Oswestry Disability Index (ODI). Secondary outcomes included the Roland Morris Disability Index (RMDI), Global Rating of Change (GROC), and medication intake. Follow-up assessments were taken at 2 weeks, 6 weeks, and 3 months. METHODS Patients were randomized to receive either spinal manipulation, electrical dry needling, and conventional physical therapy (MEDNCPT group, n=65) or conventional physical therapy alone (CPT group, n=63). RESULTS At 3 months, the MEDNCPT group experienced greater reductions in overall low back, buttock, and leg pain (NPRS: F=5.658; p=.002) and related-disability (ODI: F=9.921; p<.001; RMDI: F=7.263; p<.001) compared to the CPT group. Effect sizes were small at 2 and 6 weeks, and medium at 3 months for the NPRS, ODI, and RMDI. At 3 months, significantly (p=.003) more patients in the MEDNCPT group reported a successful outcome (GROC≥+5) than the CPT group. CONCLUSION Patients with LSS who received electrical dry needling and spinal manipulation in addition to impairment-based exercise, manual therapy and electro-thermal modalities experienced greater improvements in low back, buttock and leg pain and related-disability than those receiving exercise, manual therapy, and electro-thermal modalities alone at 3 months, but not at the 2 or 6 week follow-up.
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Affiliation(s)
- Ian Young
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, AL, USA; Tybee Wellness & Osteopractic, Tybee Island, GA, USA.
| | - James Dunning
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, AL, USA; Montgomery Osteopractic Physical Therapy & Acupuncture Clinic, Montgomery, AL, USA
| | | | - Paul Bliton
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, AL, USA; William S. Middleton Veterans Memorial Hospital, Madison, WI, USA
| | - Noah Zacharko
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, AL, USA; Osteopractic Physical Therapy of the Carolinas, Fort Mill, SC, USA
| | - Jodan Garcia
- Department of Physical Therapy, Georgia State University, Atlanta, GA, USA
| | - Firas Mourad
- Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, Differdange, Luxembourg
| | - Casey Charlebois
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, AL, USA
| | - Patrick Gorby
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, AL, USA; Gorby Osteopractic Physiotherapy, Colorado Springs, CO, USA
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain; Cátedra de Clínica, Investigación y Docencia en Fisioterapia: Terapia Manual, Punción Secay Ejercicio, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
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Bastiaens F, Wegener JT, Ostelo RWJG, van Roosendaal BKWP, Vissers KCP, van Hooff ML. Clinical Patient-Relevant Outcome Domains for Persistent Spinal Pain Syndrome-A Scoping Review and Expert Panels. J Clin Med 2024; 13:1975. [PMID: 38610739 PMCID: PMC11012536 DOI: 10.3390/jcm13071975] [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: 02/13/2024] [Revised: 03/14/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
Large variation exists in the monitoring of clinical outcome domains in patients with persistent spinal pain syndrome (PSPS). Furthermore, it is unclear which outcome domains are important from the PSPS patient's perspective. The study objectives were to identify patient-relevant outcome domains for PSPS and to establish a PSPS outcomes framework. PubMed, CINAHL, Cochrane, and EMBASE were searched to identify studies reporting views or preferences of PSPS patients on outcome domains. The Arksey and O'Malley framework was followed to identify outcome domains. An expert panel rated the domains based on the importance for PSPS patients they have treated. A framework of relevant outcome domains was established using the selected outcome domains by the expert panel. No studies were found for PSPS type 1. Five studies with 77 PSPS type 2 patients were included for further analysis. Fourteen outcome domains were identified. An expert panel, including 27 clinical experts, reached consensus on the domains pain, daily activities, perspective of life, social participation, mobility, mood, self-reliance, and sleep. Eleven domains were included in the PSPS type 2 outcomes framework. This framework is illustrative of a more holistic perspective and should be used to improve the evaluation of care for PSPS type 2 patients. Further research is needed on the prioritization of relevant outcome domains.
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Affiliation(s)
- Ferdinand Bastiaens
- Department of Research, Sint Maartenskliniek, 9500 GM Nijmegen, The Netherlands
- Department of Anesthesiology, Pain, and Palliative Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
- Department of Anesthesiology and Pain Medicine, Sint Maartenskliniek, 9500 GM Nijmegen, The Netherlands
| | - Jessica T. Wegener
- Department of Anesthesiology and Pain Medicine, Sint Maartenskliniek, 9500 GM Nijmegen, The Netherlands
| | - Raymond W. J. G. Ostelo
- Department of Health Sciences, Faculty of Science and Amsterdam Movement Science Research Institute, Vrije Universiteit, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Department of Epidemiology and Data Science, Amsterdam University Medical Centre, Vrije Universiteit, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Bert-Kristian W. P. van Roosendaal
- Department of Anesthesiology, Pain, and Palliative Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Kris C. P. Vissers
- Department of Anesthesiology, Pain, and Palliative Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
- Department of Anesthesiology and Pain Medicine, Sint Maartenskliniek, 9500 GM Nijmegen, The Netherlands
| | - Miranda L. van Hooff
- Department of Research, Sint Maartenskliniek, 9500 GM Nijmegen, The Netherlands
- Department of Orthopedics, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
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Danielsen E, Ingebrigtsen T, Gulati S, Salvesen Ø, Johansen TO, Nygaard ØP, Solberg TK. Patient Characteristics Associated With Worsening of Neck Pain-Related Disability After Surgery for Degenerative Cervical Myelopathy: A Nationwide Study of 1508 Patients. Neurosurgery 2024:00006123-990000000-01043. [PMID: 38323820 DOI: 10.1227/neu.0000000000002852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/17/2023] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Functional status, pain, and quality of life usually improve after surgery for degenerative cervical myelopathy (DCM), but a subset of patients report worsening. The objective was to define cutoff values for worsening on the Neck Disability Index (NDI) and identify prognostic factors associated with worsening of pain-related disability 12 months after DCM surgery. METHODS In this prognostic study based on prospectively collected data from the Norwegian Registry for Spine Surgery, the NDI was the primary outcome. Receiver operating characteristics curve analyses were used to obtain cutoff values, using the global perceived effect scale as an external anchor. Univariable and multivariable analyses were performed using mixed logistic regression to evaluate the relationship between potential prognostic factors and the NDI. RESULTS Among the 1508 patients undergoing surgery for myelopathy, 1248 (82.7%) were followed for either 3 or 12 months. Of these, 317 (25.4%) were classified to belong to the worsening group according to the mean NDI percentage change cutoff of 3.3. Multivariable analyses showed that smoking (odds ratio [OR] 3.4: 95% CI 1.2-9.5: P < .001), low educational level (OR 2.5: 95% CI 1.0-6.5: P < .001), and American Society of Anesthesiologists grade >II (OR 2.2: 95% CI 0.7-5.6: P = .004) were associated with worsening. Patients with more severe neck pain (OR 0.8: 95% CI 0.7-1.0: P = .003) and arm pain (OR 0.8: 95% CI 0.7-1.0; P = .007) at baseline were less likely to report worsening. CONCLUSION We defined a cutoff value of 3.3 for worsening after DCM surgery using the mean NDI percentage change. The independent prognostic factors associated with worsening of pain-related disability were smoking, low educational level, and American Society of Anesthesiologists grade >II. Patients with more severe neck and arm pain at baseline were less likely to report worsening at 12 months.
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Affiliation(s)
- Elisabet Danielsen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tor Ingebrigtsen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Neurosurgery and the Norwegian Registry for Spine Surgery (NORspine), University Hospital of North Norway, Tromsø, Norway
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Sasha Gulati
- Department of Neurosurgery, St. Olavs Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- National Advisory Unit on Spinal Surgery, St. Olavs Hospital, Trondheim, Norway
| | - Øyvind Salvesen
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Tonje O Johansen
- Department of Neurosurgery, St. Olavs Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Øystein P Nygaard
- Department of Neurosurgery, St. Olavs Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- National Advisory Unit on Spinal Surgery, St. Olavs Hospital, Trondheim, Norway
| | - Tore K Solberg
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Neurosurgery and the Norwegian Registry for Spine Surgery (NORspine), University Hospital of North Norway, Tromsø, Norway
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Kjærgaard C, Schmidt AM, Larsen JB, Laurberg TB, Mechlenburg I. Which patients with chronic low back pain respond favorably to multidisciplinary rehabilitation? A secondary analysis of a randomized controlled trial. Scand J Pain 2024; 24:sjpain-2023-0139. [PMID: 38733320 DOI: 10.1515/sjpain-2023-0139] [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: 11/27/2023] [Accepted: 04/22/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVES The aim of this study was to identify prognostic variables at baseline associated with being responding favorably to multidisciplinary rehabilitation in patients with chronic low back pain (CLBP). METHODS A responder analysis was conducted based on data from a randomized controlled trial with 26-week follow-up including 165 patients with CLBP treated at a Danish multidisciplinary rehabilitation center. Patients were dichotomized into responders and non-responders based on the outcome of a minimal clinically important difference of six points on the Oswestry Disability Index. The associations between prognostic variables and responders were analyzed using logistic regression. RESULTS A total of 139 patients completed the study, of which 42% were classified as responders. Sex and employment status were statistically significant, with a decreased odds ratio (OR) of being a responder found for males compared to females (OR = 0.09, 95% CI = 0.02-0.48) and for being on temporary or permanent social benefits (OR = 0.28, 95% CI = 0.10-0.75) compared to being self-supporting or receiving retirement benefits. Statistically significant interaction (OR = 8.84, 95% CI = 1.11-70.12) was found between males and being on temporary or permanent social benefits. CONCLUSIONS In patients with CLBP, female patients as well as patients who were self-supporting or receiving retirement benefits were significantly more likely than male patients or patients on temporary or permanent social benefits to be a responder to multidisciplinary rehabilitation.
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Affiliation(s)
- Claus Kjærgaard
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Aarhus, Denmark
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
| | - Anne Mette Schmidt
- Medical Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Josefine Beck Larsen
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Aarhus, Denmark
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
| | - Trine Bay Laurberg
- Department of Rheumatology, Aarhus University Hospital, Sano Aarhus, Aarhus, Denmark
| | - Inger Mechlenburg
- Department of Orthopedic Surgery, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Hofstetter L, Mikhail J, Lalji R, Kurmann A, Rabold L, Côté P, Tricco AC, Pagé I, Hincapié CA. Minimal clinical datasets for spine-related musculoskeletal disorders in primary and outpatient care settings: a scoping review. J Clin Epidemiol 2024; 165:111217. [PMID: 37952699 DOI: 10.1016/j.jclinepi.2023.11.007] [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: 08/03/2023] [Revised: 11/02/2023] [Accepted: 11/07/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVES Effective measurement and monitoring of health status in patients with spine-related musculoskeletal (MSK) disorders are essential for providing appropriate care and improving outcomes. Minimal clinical datasets are standardized sets of key data elements and patient-centered outcomes that can be measured and recorded during routine clinical care. Our scoping review aimed to identify and map current evidence on minimal clinical datasets for measuring and monitoring health status in patients with spine-related MSK disorders in primary and outpatient healthcare settings. STUDY DESIGN AND SETTING We followed the JBI (formerly Joanna Briggs Institute) methodology for scoping reviews. MEDLINE, CINAHL, Cochrane Library, Index to Chiropractic Literature, MANTIS, ProQuest Dissertations and Theses Global, and medRxiv preprint repository were searched from database inception to August 1, 2021. Two reviewers independently screened titles and abstracts, full-text articles, and charted the evidence. Findings were synthesized and summarized descriptively. RESULTS After screening 5,583 citations and 301 full-text articles, 104 studies about 32 individual minimal clinical datasets were included. Most minimal clinical datasets were developed for patient populations with spine-involving inflammatory arthritis, nonspecific or degenerative spinal pain, and MSK disorders in general. The minimal clinical datasets varied substantially in terms of the author-reported time-to-complete (1-48 minutes) and the number of items (5-100 items). Fifty percent of the datasets involved healthcare professionals in their development process, and only 28% involved patients. Health domain items were most frequently linked to the components of activities and participation (43.9%) and body functions (28.6%), according to the International Classification of Functioning, Disability, and Health. There is no standardized definition of minimal clinical datasets to measure and monitor health status of patients with spine-related MSK disorders in routine clinical practice. Common core elements identified were practicality, feasibility in a busy routine practice, time efficiency, and the capability to be used across different healthcare settings. CONCLUSION Due to the absence of a standard definition for minimal clinical datasets for patients with spine-related MSK disorders, there is a lack of consistency in the selection of key data elements and patient-centered outcomes that should be included. More research on the implementation and feasibility of minimal clinical datasets in routine care settings is warranted and needed. It is essential to involve all relevant partners in the development process of minimal clinical datasets to ensure successful implementation and adoption in routine primary care.
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Affiliation(s)
- Léonie Hofstetter
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland; Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland; University Spine Centre Zurich (UWZH), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jérémie Mikhail
- Department of Chiropractic, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Rahim Lalji
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland; Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland; University Spine Centre Zurich (UWZH), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Astrid Kurmann
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland
| | - Lorene Rabold
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland
| | - Pierre Côté
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada; Division of Epidemiology and Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Andrea C Tricco
- Division of Epidemiology and Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Queen's Collaboration for Health Care Quality Joanna Briggs Institute Centre of Excellence, School of Nursing, Queen's University, Kingston, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Isabelle Pagé
- Department of Chiropractic, Université du Québec à Trois-Rivières, Trois-Rivières, Canada; Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS) - Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec City, Canada
| | - Cesar A Hincapié
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland; Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland; University Spine Centre Zurich (UWZH), Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
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8
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Larsson H, Strömbäck E, Schau M, Johansson S, Berglund L. Lumbopelvic movement control in powerlifters with and without low back pain. Phys Ther Sport 2024; 65:74-82. [PMID: 38070289 DOI: 10.1016/j.ptsp.2023.11.006] [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: 09/07/2023] [Revised: 11/25/2023] [Accepted: 11/27/2023] [Indexed: 01/23/2024]
Abstract
OBJECTIVES To measure lumbopelvic movement control in powerlifters with and without low back pain (LBP). DESIGN Quantitative Cross-sectional. PARTICIPANTS Twelve powerlifters with LBP and 28 powerlifters without LBP. SETTING Powerlifters were recruited in nine different cities and filmed while performing a movement control test battery. MAIN OUTCOME MEASURES Lumbopelvic movement control test battery consisting of seven tests, with a possible score between 0 and 13. The tests were rated by a physical therapist blinded to the group allocation and comparisons of the frequency of current/incorrect tests between groups were calculated. RESULTS There was no statistically significant difference in the movement control test battery between the powerlifters with LBP (Median = 7.0, (2-11)) and powerlifters without LBP (Median = 6.0, (1-10)) (P = 0.59). There were no statistically significant differences between groups when the individual movement control tests were analyzed separately. CONCLUSIONS The lack of significant differences between groups indicates that performance in lumbopelvic movement control test might not be associated with LBP in powerlifters. More studies on associations between LBP and movement control and other body functions are needed to guide assessment and treatment of powerlifters with LBP and for investigation of possible risk factors for LBP in powerlifters.
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Affiliation(s)
- Hampus Larsson
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Edit Strömbäck
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Mikael Schau
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Susanna Johansson
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Lars Berglund
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden.
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Geere JH, Hunter PR, Swamy GN, Cook AJ, Rai AS. Development and temporal validation of clinical prediction models for 1-year disability and pain after lumbar decompressive surgery. The Norwich Lumbar Surgery Predictor (development version). 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 2023; 32:4210-4219. [PMID: 37740114 DOI: 10.1007/s00586-023-07931-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/21/2023] [Accepted: 08/28/2023] [Indexed: 09/24/2023]
Abstract
PURPOSE To identify clinical predictors and build prediction models for 1-year patient-reported outcomes measures (PROMs) after lumbar decompressive surgery for disc herniation or spinal stenosis. METHODS The study included 1835 cases, with or without additional single-level fusion, from a single centre from 2008 through 2020. General linear models imputed with 37 clinical variables identified 18 significant 1-year PROM predictors for retention in development models. Interaction of surgical indication with each predictor was tested. Temporal validation was conducted at the same centre on cases through 2021. R2 was used to measure goodness-of-fit, and area under curve (AUC) used to measure classification to a satisfactory symptom state (Oswestry Disability Index (ODI) ≤ 22; back or leg pain ≤ 30 out of 100). RESULTS A total 1228 (67%) had complete data for inclusion in model development. Predictors of ODI were baseline PROMs (ODI, back pain, leg pain), work status, condition duration, previous lumbar operation, multiple-joint osteoarthritis, female, diabetes, current smoker, rheumatic disorder, lower limb arthroplasty, mobility aided, provider status, facet cyst, scoliosis, and age, with BMI significantly associated with stenosis. Temporal validation (n = 188) found the ODI model R2 was 0.29 (95% confidence intervals (CI) 0.18-0.40) and AUC was 0.74 (95% CI 0.67-0.81). Back and leg pain models had lower R2 (0.12-0.14) and AUC (0.68-0.69) values. CONCLUSION Important PROM predictors are baseline PROMs, specific co-morbidities, work status, condition duration, previous lumbar operation, female, and smoking status. The ODI model predicted the likelihood of achieving a satisfactory state of both disability and pain.
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Affiliation(s)
- Jonathan H Geere
- Physiotherapy Department, Spire Norwich Hospital, Old Watton Road, Colney, Norwich, NR4 7TD, UK.
| | - Paul R Hunter
- Norwich Medical School, University of East Anglia, Norwich, UK
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10
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Mikkelsen E, Ingebrigtsen T, Thyrhaug AM, Olsen LR, Nygaard ØP, Austevoll I, Brox JI, Hellum C, Kolstad F, Lønne G, Solberg TK. The Norwegian registry for spine surgery (NORspine): cohort profile. 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 2023; 32:3713-3730. [PMID: 37718341 DOI: 10.1007/s00586-023-07929-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/28/2023] [Accepted: 08/28/2023] [Indexed: 09/19/2023]
Abstract
PURPOSE To review and describe the development, methods and cohort of the lumbosacral part of the Norwegian registry for spine surgery (NORspine). METHODS NORspine was established in 2007. It is government funded, covers all providers and captures consecutive cases undergoing operations for degenerative disorders. Patients' participation is voluntary and requires informed consent. A set of baseline-, process- and outcome-variables (3 and 12 months) recommended by the International Consortium for Health Outcome Measurement is reported by surgeons and patients. The main outcome is the Oswestry disability index (ODI) at 12 months. RESULTS We show satisfactory data quality assessed by completeness, timeliness, accuracy, relevance and comparability. The coverage rate has been 100% since 2016 and the capture rate has increased to 74% in 2021. The cohort consists of 60,647 (47.6% women) cases with mean age 55.7 years, registered during the years 2007 through 2021. The proportions > 70 years and with an American Society of Anaesthesiologists' Physical Classification System (ASA) score > II has increased gradually to 26.1% and 19.3%, respectively. Mean ODI at baseline was 43.0 (standard deviation 17.3). Most cases were operated with decompression for disc herniation (n = 26,557, 43.8%) or spinal stenosis (n = 26,545, 43.8%), and 7417 (12.2%) with additional or primary fusion. The response rate at 12 months follow-up was 71.6%. CONCLUSION NORspine is a well-designed population-based comprehensive national clinical quality registry. The register's methods ensure appropriate data for quality surveillance and improvement, and research.
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Affiliation(s)
- Eirik Mikkelsen
- Department of Neurosurgery, Ophthalmology and Otorhinolaryngology, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tor Ingebrigtsen
- Department of Neurosurgery, Ophthalmology and Otorhinolaryngology, University Hospital of North Norway, Tromsø, Norway.
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
- The Norwegian Registry for Spine Surgery, University Hospital of North Norway, Tromsø, Norway.
| | - Anette M Thyrhaug
- The Norwegian Registry for Spine Surgery, University Hospital of North Norway, Tromsø, Norway
| | - Lena Ringstad Olsen
- Centre for Clinical Documentation and Evaluation, Northern Norway Regional Health Authority, Tromsø, Norway
| | - Øystein P Nygaard
- The Norwegian Registry for Spine Surgery, University Hospital of North Norway, Tromsø, Norway
- Department of Neuromedicine and Movement Science, The Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neurosurgery, St. Olav's University Hospital, Trondheim, Norway
| | - Ivar Austevoll
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Jens Ivar Brox
- Department of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Christian Hellum
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Frode Kolstad
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Greger Lønne
- Department of Neuromedicine and Movement Science, The Norwegian University of Science and Technology, Trondheim, Norway
- Department of Orthopaedic Surgery, Innlandet Hospital Trust, Lillehammer, Norway
| | - Tore K Solberg
- Department of Neurosurgery, Ophthalmology and Otorhinolaryngology, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- The Norwegian Registry for Spine Surgery, University Hospital of North Norway, Tromsø, Norway
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11
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Leopold VJ, Warminski N, Löchel J, Labbus K, Pumberger M, Zahn RK. Validation of the Subjective Spine Value: A new single item score for the assessment of spine-specific function. Arch Orthop Trauma Surg 2023; 143:6497-6501. [PMID: 37318631 PMCID: PMC10541823 DOI: 10.1007/s00402-023-04941-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/02/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Spinal function can be assessed through different patient reported outcome measures (PROMs). PURPOSE The aim of the present study was to evaluate a novel single-item score for the assessment of spinal function: The Subjective Spine Value (SSpV). It was hypothesized that the SSpV correlates with the established scores Oswestry disability index (ODI) and Core Outcome Measures Index (COMI). METHODS Between 08/2020 and 11/2021 151 consecutive patients were prospectively enrolled and completed a questionnaire with the ODI, COMI as well as the SSpV. Patients were divided into 4 groups depending on their specific pathology (Group 1: Degenerative pathologies, Group 2: Tumor, Group 3: Inflammatory / Infection, Group 4: Trauma). Pearson correlation coefficient was used to evaluate correlation between the SSpV and the ODI and COMI separately. Floor and ceiling effects were evaluated. RESULTS Overall, the SSpV correlated significantly with both ODI (p = < 0.001; r = - 0.640) and COMI (p = < 0.001; r = - 0.640). This was also observed across all investigated groups (range - 0.420-0.736). No relevant floor or ceiling effects were noticed. CONCLUSIONS The SSpV is a valid single-item score for the assessment of spinal function. The SSpV offers a useful tool to efficiently assess spinal function in a variety of spinal pathologies. LEVEL OF EVIDENCE I, prospective cohort study.
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Affiliation(s)
- Vincent J. Leopold
- Department of Orthopaedic Surgery and Traumatology, Charité Berlin, University Hospital, Chariteplatz 1, 10117 Berlin, Germany
| | - Nikolas Warminski
- Department of Orthopaedic Surgery and Traumatology, Charité Berlin, University Hospital, Chariteplatz 1, 10117 Berlin, Germany
| | - Jannis Löchel
- Department of Orthopaedic Surgery and Traumatology, Charité Berlin, University Hospital, Chariteplatz 1, 10117 Berlin, Germany
| | - Kirsten Labbus
- Department of Orthopaedic Surgery and Traumatology, Charité Berlin, University Hospital, Chariteplatz 1, 10117 Berlin, Germany
| | - Matthias Pumberger
- Department of Orthopaedic Surgery and Traumatology, Charité Berlin, University Hospital, Chariteplatz 1, 10117 Berlin, Germany
| | - Robert K. Zahn
- Department of Orthopaedic Surgery and Traumatology, Charité Berlin, University Hospital, Chariteplatz 1, 10117 Berlin, Germany
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12
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Sun YN, An Y, Weng ZW, Zhou YJ, Wang XY, Yu CH. Development of CORE-CM core outcome domain sets for trials of Chinese medicine for lumbar spinal stenosis. BMJ Open 2023; 13:e075856. [PMID: 37844991 PMCID: PMC10582923 DOI: 10.1136/bmjopen-2023-075856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 09/22/2023] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVES Most Asian countries have employed Chinese medicine (CM) and Western medicine to treat lumbar spinal stenosis (LSS). Evidence synthesis and comparison of effectiveness are difficult since outcomes examined and presented through trials possess heterogeneity. This study aimed to solve the outcome problems for CM clinical trials in LSS by building a core outcome set (COS). METHODS To achieve an agreement on a set of core outcome domains, a four-phase study was carried out. First, we identified candidate outcome domains by systematically reviewing trials. In addition, we identified outcome domains associated with patients by conducting semistructured interviews with patients. Next, outcome domains were processed through a national two-round Delphi survey, in which 18 patients and 21 experts were recruited. Finally, the above domains were converted as a core outcome domain set based on a consensus meeting, in which 24 stakeholders were recruited. RESULTS Seventeen outcome subdomains were identified by the systematic review and interviews. The Delphi survey assigned a priority to four outcome domains in the first round and four outcomes additionally in the second round. The core outcome domains were determined through discussion and redefinition of outcomes in the consensus meeting: pain and discomfort, health-related quality of life, lumbar function, activities of daily living, measures of walking, patient global assessment, adverse events and CM-specific outcomes. CONCLUSION COS-CM-LSS is likely to enhance the consistency of outcomes reported in clinical trials. In-depth research should be conducted for the exploration of the best methods to examine the above outcomes.
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Affiliation(s)
- Ya-Nan Sun
- Traditional Chinese Medicine Department, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yi An
- First Clinical College, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, China
- Health Management Department, Aerospace Central Hospital, Beijing, China
| | - Zhi-Wen Weng
- Tuina and Pain Management Department, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, China
| | - Yan-Ji Zhou
- First Clinical College, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, China
- Health Management Department, Aerospace Central Hospital, Beijing, China
| | - Xi-You Wang
- Tuina and Pain Management Department, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, China
| | - Chang-He Yu
- Tuina and Pain Management Department, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, China
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13
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Joelson A, Szigethy L, Wildeman P, Sigmundsson FG, Karlsson J. Associations between future health expectations and patient satisfaction after lumbar spine surgery: a longitudinal observational study of 9929 lumbar spine surgery procedures. BMJ Open 2023; 13:e074072. [PMID: 37748852 PMCID: PMC10533696 DOI: 10.1136/bmjopen-2023-074072] [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] [Received: 03/26/2023] [Accepted: 09/08/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVE This study aimed to investigate the associations between general health expectations and patient satisfaction with treatment for the two common spine surgery procedures diskectomy for lumbar disk herniation (LDH) and decompression for lumbar spinal stenosis (LSS). DESIGN Register study with prospectively collected preoperative and 1-year postoperative data. SETTING National outcome data from Swespine, the national Swedish spine register. PARTICIPANTS A total of 9929 patients, aged between 20 and 85 years, who were self-reported non-smokers, and were operated between 2007 and 2016 for one-level LSS without degenerative spondylolisthesis, or one-level LDH, were identified in the national Swedish spine register (Swespine). We used SF-36 items 11c and 11d to assess future health expectations and present health perceptions. Satisfaction with treatment was assessed using the Swespine satisfaction item. INTERVENTIONS One-level diskectomy for LDH or one-level decompression for LSS. PRIMARY OUTCOME MEASURES Satisfaction with treatment. RESULTS For LSS, the year 1 satisfaction ratio among patients with negative future health expectations preoperatively was 60% (95% CI 58% to 63%), while it was 75% (95% CI 73% to 76%) for patients with positive future health expectations preoperatively. The corresponding numbers for LDH were 73% (95% CI 71% to 75%) and 84% (95% CI 83% to 85%), respectively. CONCLUSIONS Patients operated for the common lumbar spine diseases LSS or LDH, with negative future general health expectations, were significantly less satisfied with treatment than patients with positive expectations with regard to future general health. These findings are important for patients, and for the surgeons who counsel them, when surgery is a treatment option for LSS or LDH.
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Affiliation(s)
- Anders Joelson
- School of Medical Sciences, Orebro University, Orebro, Sweden
- Department of Orthopaedics, Orebro University Hospital, Orebro, Sweden
| | - Lilla Szigethy
- Department of Orthopaedics, Orebro University Hospital, Orebro, Sweden
| | - Peter Wildeman
- School of Medical Sciences, Orebro University, Orebro, Sweden
- Department of Orthopaedics, Orebro University Hospital, Orebro, Sweden
| | - Freyr Gauti Sigmundsson
- School of Medical Sciences, Orebro University, Orebro, Sweden
- Department of Orthopaedics, Orebro University Hospital, Orebro, Sweden
| | - Jan Karlsson
- Faculty of Medicine and Health, Orebro University, Orebro, Sweden
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14
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Raymer M, Window P, Cottrell M, Comans T, O'Leary S. Revised service metrics partially explain variation in outcomes across facilities in a state-wide advanced practice public musculoskeletal service. Musculoskeletal Care 2023; 21:562-570. [PMID: 36437478 DOI: 10.1002/msc.1717] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 11/13/2022] [Accepted: 11/14/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Maree Raymer
- Royal Brisbane and Women's Hospital, Department of Physiotherapy, Metro North Hospital Health Service, Brisbane, Queensland, Australia
| | - Peter Window
- Royal Brisbane and Women's Hospital, Department of Physiotherapy, Metro North Hospital Health Service, Brisbane, Queensland, Australia
| | - Michelle Cottrell
- Royal Brisbane and Women's Hospital, Department of Physiotherapy, Metro North Hospital Health Service, Brisbane, Queensland, Australia
| | - Tracy Comans
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Shaun O'Leary
- Royal Brisbane and Women's Hospital, Department of Physiotherapy, Metro North Hospital Health Service, Brisbane, Queensland, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
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15
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van de Wijgert IH, de Groot JC, Rood A, Spruit M, Vissers KCP, Fenten MG, van Hooff ML. Scoping review of early pain-related outcome domains and measurement instruments after degenerative lumbar spine surgery. Reg Anesth Pain Med 2023; 48:134-140. [PMID: 36396300 DOI: 10.1136/rapm-2022-103929] [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: 07/15/2022] [Accepted: 11/09/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Optimization of perioperative pain interventions in lumbar spine surgery could reduce the incidence of acute and persistent postoperative pain and opioid consumption. Standardization in early outcome measurement provides a solid foundation for future clinical and research practices and should be integrated in core outcome sets for long-term treatment outcome evaluations. This scoping review provides an overview of outcomes used when evaluating early perioperative pain interventions after lumbar spine surgery. OBJECTIVES To create an overview of outcome domains and measurement instruments previously used in research on perioperative pain management for degenerative lumbar spine surgery. EVIDENCE REVIEW A scoping review was performed to identify articles comprising outcome evaluations in adult patients who undergo degenerative lumbar spine surgery, mentioning perioperative pain interventions. 75 articles were included for review. Data on study characteristics, outcome domains and measurement instruments were extracted and structured using the three-tiered hierarchy of Porter. FINDINGS 12 outcome domains were identified: pain intensity (93.3%), adverse events (76%), analgesic consumption (70.7%), length of stay (52%), patient satisfaction (24%), daily functioning (22.7%), (early) mobilization (22.7%), quality of life (12%), mortality (9.3%), quality of recovery (6.7%), physical function (4%), and quality of sleep (2.7%). 63 corresponding measurement instruments were found. CONCLUSIONS This review portrays an extensive overview of outcome measurements used in perioperative pain management in lumbar spine surgery. A lack of consensus on the set of indicators exists. This scoping review is a call for action to create consensus on how to evaluate perioperative pain interventions in degenerative lumbar spine surgery.
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Affiliation(s)
- Ilse H van de Wijgert
- Department of Anesthesiology, Sint Maartenskliniek, Nijmegen, The Netherlands .,Department of Anesthesiology, Pain and Palliative Medicine, Radboudumc, Nijmegen, The Netherlands.,Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Jantina C de Groot
- Department of Anesthesiology, Sint Maartenskliniek, Nijmegen, The Netherlands.,Department of Anesthesiology, Pain and Palliative Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Akkie Rood
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Maarten Spruit
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Kris C P Vissers
- Department of Anesthesiology, Sint Maartenskliniek, Nijmegen, The Netherlands.,Department of Anesthesiology, Pain and Palliative Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Maaike Ge Fenten
- Department of Anesthesiology, Sint Maartenskliniek, Nijmegen, The Netherlands.,Department of Anesthesiology, Pain and Palliative Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Miranda L van Hooff
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands.,Department of Orthopaedic Surgery, Radboudumc, Nijmegen, The Netherlands
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16
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Schepens MHJ, van Hooff ML, van Erkelens JA, Bartels R, Hoebink E, Smits M, Kuijpens JLP, van Limbeek J. Outcomes After Lumbar Disk Herniation Surgery in the Dutch Population. Global Spine J 2023; 13:60-66. [PMID: 33576274 PMCID: PMC9837512 DOI: 10.1177/2192568221991124] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE There is only limited data on the outcome of primary surgery of lumbar disk herniation (LDH) in Dutch patients. The objective of this study is to describe undesirable outcomes after primary LDH. METHODS The National Claims Database (Vektis) was searched for primary LDH operations performed from July 2015 until June 2016, for reoperations within 18 months, prescription of opioids between 6 to 12 months and nerve root block within 1 year. A combined outcome measure was also made. Group comparisons were analyzed with the Student's t-test. RESULTS Primary LDH surgery was performed in 6895 patients in 70 hospitals. Weighted mean of reoperations was 7.3%, nerve root block 6.7% and opioid use 15.6%. In total, 23.0% of patients had one or more undesirable outcomes after surgery. The 95% CI interval exceeded the 50% incidence line for 14 out of 26 hospitals with less than 50 surgical interventions per year. Although the data suggested a volume effect on undesired outcomes, the t-tests between hospitals with volume thresholds of 100, 150 and 200 interventions per year did not support this (P values 0.078, 0.129, 0.114). CONCLUSION This unique nationwide claims-based study provides insight into patient-relevant undesirable outcomes such as reoperation, nerve root block and opioid use after LDH surgery. About a quarter of the patients had a serious complication in the first follow up year that prompted further medical treatment. There is a wide variation in complication rates between hospitals with a trend that supports concentration of LDH care.
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Affiliation(s)
- Maike H. J. Schepens
- Department Strategy and Quality of Care, Dutch
Association of Health Insurers (ZN), Zeist, Netherlands
| | - Miranda L. van Hooff
- Department Research, Sint Maartenskliniek,
Ubbergen, Netherlands,Department Orthopedics, Radboud University
Medical Center, Nijmegen, Netherlands,Miranda L. van Hooff, Department Research, Sint
Maartenskliniek, Ubbergen, Netherlands; Department Orthopedics, Radboud University Medical
Center, Nijmegen, Netherlands.
| | | | - Ronald Bartels
- Department Neurosurgery, Radboud University
Medical Center, Nijmegen, Netherlands
| | - Eric Hoebink
- Department Orthopedics, Amphia Hospital,
Breda, Netherlands
| | - Margot Smits
- Department Medical Advice, Zilveren Kruis
Health Insurance Company, Leusden, Netherlands
| | | | - Jacques van Limbeek
- Department Medical Advice, Zilveren Kruis
Health Insurance Company, Leusden, Netherlands
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17
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Danielsen E, Gulati S, Salvesen Ø, Ingebrigtsen T, Nygaard ØP, Solberg TK. Clinical outcomes after surgery for cervical radiculopathy performed in public and private hospitals : a nationwide relative effectiveness study. Bone Joint J 2023; 105-B:64-71. [PMID: 36587250 PMCID: PMC9948431 DOI: 10.1302/0301-620x.105b1.bjj-2022-0591.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
AIMS The number of patients undergoing surgery for degenerative cervical radiculopathy has increased. In many countries, public hospitals have limited capacity. This has resulted in long waiting times for elective treatment and a need for supplementary private healthcare. It is uncertain whether the management of patients and the outcome of treatment are equivalent in public and private hospitals. The aim of this study was to compare the management and patient-reported outcomes among patients who underwent surgery for degenerative cervical radiculopathy in public and private hospitals in Norway, and to assess whether the effectiveness of the treatment was equivalent. METHODS This was a comparative study using prospectively collected data from the Norwegian Registry for Spine Surgery. A total of 4,750 consecutive patients who underwent surgery for degenerative cervical radiculopathy and were followed for 12 months were included. Case-mix adjustment between those managed in public and private hospitals was performed using propensity score matching. The primary outcome measure was the change in the Neck Disability Index (NDI) between baseline and 12 months postoperatively. A mean difference in improvement of the NDI score between public and private hospitals of ≤ 15 points was considered equivalent. Secondary outcome measures were a numerical rating scale for neck and arm pain and the EuroQol five-dimension three-level health questionnaire. The duration of surgery, length of hospital stay, and complications were also recorded. RESULTS The mean improvement from baseline to 12 months postoperatively of patients who underwent surgery in public and private hospitals was equivalent, both in the unmatched cohort (mean NDI difference between groups 3.9 points (95% confidence interval (CI) 2.2 to 5.6); p < 0.001) and in the matched cohort (4.0 points (95% CI 2.3 to 5.7); p < 0.001). Secondary outcomes showed similar results. The duration of surgery and length of hospital stay were significantly longer in public hospitals. Those treated in private hospitals reported significantly fewer complications in the unmatched cohort, but not in the matched cohort. CONCLUSION The clinical effectiveness of surgery for degenerative cervical radiculopathy performed in public and private hospitals was equivalent 12 months after surgery.Cite this article: Bone Joint J 2023;105-B(1):64-71.
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Affiliation(s)
- Elisabet Danielsen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway,Correspondence should be sent to Elisabet Danielsen. E-mail:
| | - Sasha Gulati
- Department of Neurosurgery, St. Olavs Hospital, Trondheim, Norway,Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway,National Advisory Unit on Spinal Surgery, St. Olavs Hospital, Trondheim, Norway
| | - Øyvind Salvesen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tor Ingebrigtsen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway,Department of Neurosurgery and the Norwegian Registry for Spine Surgery (NORspine), University Hospital of North Norway, Tromsø, Norway,Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Øystein P. Nygaard
- Department of Neurosurgery, St. Olavs Hospital, Trondheim, Norway,Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway,National Advisory Unit on Spinal Surgery, St. Olavs Hospital, Trondheim, Norway
| | - Tore K. Solberg
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway,Department of Neurosurgery and the Norwegian Registry for Spine Surgery (NORspine), University Hospital of North Norway, Tromsø, Norway
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18
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Olowe O, Sokunbi O, Salisu A, Okafor A. The effect of treadmill walk with abdominal bracing versus usual care on functional limitation and fear-avoidance behaviours in the management of non-specific low back pain—a randomized control study. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2022. [DOI: 10.1186/s43161-022-00084-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The use of a combined abdominal bracing technique concurrently with treadmill walking exercise seems not to have been widely investigated, The use of either abdominal bracing and treadmill walk as a single individual method of treatment has proven to be of immense benefit in athletic training and amelioration of pain and functional limitation among different age groups suffering from chronic low back pain. Thus, the need to investigate whether the combination of abdominal bracing and treadmill walking would produce greater benefits than when the exercises are carried out in isolation in the management of chronic low back pain patients.
Study design
The study was a randomized control.
Participants
Thirty-three participants who met the inclusion criteria with age from 18 to 65 participated in the study.
Aim
This study aimed to compare the effects of treadmill walk with and without abdominal bracing versus usual care on pain, functional limitation and fear-avoidance behaviours among patients with non-specific chronic low back pain.
Methods
Thirty-three non-specific chronic low back pain (NSCLBP) patients were randomized into three groups treadmill walk without abdominal bracing (TWW), treadmill walk with abdominal bracing (TWAB) and usual care (UC). Interventions were carried out for 6 weeks.
Outcome measure
Pre and post-intervention scores of pain intensity, functional limitation, and fear-avoidance belief were assessed with box numerical pain rating scales, Oswestry disability index and Fear-Avoidance Belief Questionnaire, respectively.
Results
Pre-intervention scores of pain intensity functional disability and fear-avoidance belief did not show significant differences among the groups (P >0.05). Within-group analysis with paired t-test showed that pain intensity and functional limitation were significantly reduced after 6 weeks of intervention among the 3 groups. Fear-avoidance belief recorded statistical reduction among the 2 treadmill procedures (TWAB and TWW) groups (P<0.05) but not in the usual care groups (P>0.05). Participants in the TWW group showed greater improvement than those in TWAB in terms of reduction in pain intensity (24.17±16.49), functional limitation (7.00±5.97, P = 0.001) and fear- avoidance (30.83±17.90, P = 0.003)
Conclusion
Treadmill walk with and without abdominal bracing as well as usual care could be effective in reducing pain. However, treadmill walk without abdominal bracing was more effective in improving back function in terms of reduction in pain intensity, functional limitation (as reported by the Oswestry scale) and reducing fear-avoidance behaviour (as reported by fear-avoidance belief scores).
Trial registration
PACTR, PACTR201910691645076. Registered on 22 October 2019.
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Benning L, Das-Gupta Z, Sousa Fialho L, Wissig S, Tapela N, Gaunt S. Balancing adaptability and standardisation: insights from 27 routinely implemented ICHOM standard sets. BMC Health Serv Res 2022; 22:1424. [PMID: 36443786 PMCID: PMC9703690 DOI: 10.1186/s12913-022-08694-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 10/18/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Healthcare systems around the world experience increasing pressure to control future growth of healthcare expenditures. Among other initiatives, quality and value-based benchmarking has become an important field to inform clinical evaluation and reimbursement questions. The International Consortium for Health Outcomes Measurement (ICHOM) has become one of the driving forces to translate scientific evidence into standardized assessments that are routinely applicable in day-to-day care settings. These aim to provide a benchmarking tool that allows the comparison and competition of health care delivery on the basis of value-based health care principles. METHODS This work focuses on the consolidation of the ICHOM methodology and presents insights from 27 routinely implemented Standard Sets. The analysis is based on a literature review of the ICHOM literature repository, a process document review and key informant interviews with ICHOM's outcomes research and development team. RESULTS Key findings are that the scope of ICHOM Standard Sets shifted from a more static focus on burden of disease and poorly standardized care pathways to a more dynamic approach that also takes into account questions about the setting of care, feasibility of implementing a benchmarking tool and compatibility of different Standard Sets. Although certain overlaps exist with other initiatives in the field of patient reported outcomes (PRO), their scopes differ significantly and they hence rather complement each other. ICHOM pursues a pragmatic approach to enable the benchmarking and the analysis of healthcare delivery following the principles of value-based healthcare. CONCLUSION The ICHOM Standard Sets complement other initiatives in the field of patient-reported outcomes (PRO) and functional reporting by placing a particular focus on healthcare delivery, while other initiatives primarily focus on evaluation of academic endpoints. Although ICHOM promotes a pragmatic approach towards developing and devising its Standard Sets, the definition of standardized decision making processes emerged as one of the key challenges. Furthermore, the consolidation of core metrics across number of disease areas to enable the parallel implementation of different Standard Sets in the same care setting is an important goal that will enable the widespread implementation of patient-reported outcome measures (PROM).
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Affiliation(s)
- Leo Benning
- University Emergency Center, Medical Center - University of Freiburg, Freiburg, Germany.
- Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Zofia Das-Gupta
- International Consortium for Health Outcomes Measurement, London, UK
| | - Luz Sousa Fialho
- International Consortium for Health Outcomes Measurement, London, UK
| | - Stephanie Wissig
- International Consortium for Health Outcomes Measurement, Boston, USA
| | - Neo Tapela
- International Consortium for Health Outcomes Measurement, London, UK
| | - Suzanne Gaunt
- International Consortium for Health Outcomes Measurement, Boston, USA
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Langford DJ, Gewandter JS, Amtmann D, Reeve BB, Corneli A, McKenna K, Swezey T, McFatrich M, Jensen MP, Turk DC, Dworkin RH. Initial Content Validation and Roadmap for a New Patient-Reported Outcome Measure of Pain Intensity. THE JOURNAL OF PAIN 2022; 23:1945-1957. [PMID: 35868594 DOI: 10.1016/j.jpain.2022.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/09/2022] [Accepted: 07/11/2022] [Indexed: 06/15/2023]
Abstract
Measures of pain intensity (eg, numeric rating scales [NRS]) are widely used in clinical research and practice. While these measures have evidence for validity and reliability, poor standardization of instructions, and response options limits precision of pain assessment, allows for inconsistency in interpretation, and presents a challenge for comparison and aggregation of study results. Despite these pitfalls, the 0 to 10 NRS remains the most commonly used primary outcome measure in clinical trials of pain treatments and is the core measure recommended by regulatory agencies. The purpose of this study was to describe the first phase in the development of a pain intensity measure that is easily interpretable, psychometrically sound, and that adheres to FDA qualification processes. The Analgesic, Anesthetic, and Addiction Clinical Trial, Translations, Innovations, Opportunities, and Networks (ACTTION) public-private partnership conducted concept elicitation interviews (N = 44; 22 with acute pain; 22 with chronic pain) to understand the patient perspective on rating pain intensity and to identify actionable suggestions for improved clarity and meaningfulness of instructions, recall periods, and response options. This article summarizes interview findings, describes how patient input and FDA feedback informed preliminary candidate measures, and provides an overview of the FDA qualification process. PERSPECTIVE: Concept elicitation interviews informed the development of content-valid candidate measures of acute and chronic pain intensity for planned use in clinical trials of pain treatments, and comprise the initial stage in FDA clinical outcome assessment qualification. Measures will subsequently be evaluated through cognitive interviews and a series of psychometric studies.
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Affiliation(s)
- Dale J Langford
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, NY.
| | - Jennifer S Gewandter
- Department of Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, NY
| | - Dagmar Amtmann
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Bryce B Reeve
- Department of Population Health Sciences, Center for Health Measurement, Duke University, Durham, NC
| | - Amy Corneli
- Department of Population Health Sciences, Center for Health Measurement, Duke University, Durham, NC
| | - Kevin McKenna
- Department of Population Health Sciences, Center for Health Measurement, Duke University, Durham, NC
| | - Teresa Swezey
- Department of Population Health Sciences, Duke University, Durham, NC
| | - Molly McFatrich
- Department of Population Health Sciences, Center for Health Measurement, Duke University, Durham, NC
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Dennis C Turk
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA
| | - Robert H Dworkin
- Department of Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, NY
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Beighley A, Zhang A, Huang B, Carr C, Mathkour M, Werner C, Scullen T, Kilgore MD, Maulucci CM, Dallapiazza RF, Kalyvas J. Patient-reported outcome measures in spine surgery: A systematic review. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2022; 13:378-389. [PMID: 36777909 PMCID: PMC9910127 DOI: 10.4103/jcvjs.jcvjs_101_22] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/12/2022] [Indexed: 12/12/2022] Open
Abstract
Background Steadily increasing expenditure in the United States health-care system has led to a shift toward a value-based model that focuses on quality of care and cost-effectiveness. Operations involving the spine rank among some of the most common and expensive procedures performed in operating rooms nationwide. Patient-reported outcomes measures (PROMs) are a useful tool for reporting levels of outcome and analyzing patient recovery but are both under-utilized and nonstandardized in spine surgery. Methods We conducted a systematic review of the literature using the PubMed database, focusing on the most commonly utilized PROMs for spine disease as well as spinal deformity. The benefits and drawbacks of these PROMs were then summarized and compared. Results Spine-specific PROMs were based on the class of disease. The most frequently utilized PROMs were the Neck Disability Index and the modified Japanese Orthopaedic Association scale; the Oswestry Disability Index and the Roland-Morris Disability Questionnaire; and the Scoliosis Research Society 22-item questionnaire (SRS-22) for cervicothoracic spine disease, lumbar spine disease, and spinal deformity, respectively. Conclusion We found limited, though effective, use of PROMs targeting specific classes of disease within spine surgery. Therefore, we advocate for increased use of PROMs in spine surgery, in both the research and clinical settings. PROM usage can help physicians assess subjective outcomes in standard ways that can be compared across patients and institutions, more uniquely tailor treatment to individual patients, and engage patients in their own medical care.
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Affiliation(s)
- Adam Beighley
- Tulane University-Ochsner Clinic Foundation, Department of Neurosurgery, New Orleans, LA, USA
| | - Allen Zhang
- Tulane University-Ochsner Clinic Foundation, Department of Neurosurgery, New Orleans, LA, USA
| | - Brendan Huang
- Tulane University-Ochsner Clinic Foundation, Department of Neurosurgery, New Orleans, LA, USA
| | - Christopher Carr
- Tulane University-Ochsner Clinic Foundation, Department of Neurosurgery, New Orleans, LA, USA
| | - Mansour Mathkour
- Tulane University-Ochsner Clinic Foundation, Department of Neurosurgery, New Orleans, LA, USA
| | - Cassidy Werner
- Tulane University-Ochsner Clinic Foundation, Department of Neurosurgery, New Orleans, LA, USA
| | - Tyler Scullen
- Tulane University-Ochsner Clinic Foundation, Department of Neurosurgery, New Orleans, LA, USA
| | - Mitchell D. Kilgore
- Tulane University-Ochsner Clinic Foundation, Department of Neurosurgery, New Orleans, LA, USA
| | - Christopher M. Maulucci
- Tulane University-Ochsner Clinic Foundation, Department of Neurosurgery, New Orleans, LA, USA
| | - Robert F. Dallapiazza
- Tulane University-Ochsner Clinic Foundation, Department of Neurosurgery, New Orleans, LA, USA
| | - James Kalyvas
- Tulane University-Ochsner Clinic Foundation, Department of Neurosurgery, New Orleans, LA, USA
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Vraa M, Pascoe S, Maddox D, Rhon DI, Cleland JA, Young JL. Prevalence and extent of low back pain and low back-related disability in non-care-seeking working-age adults. Musculoskelet Sci Pract 2022; 60:102572. [PMID: 35512483 DOI: 10.1016/j.msksp.2022.102572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To explore the prevalence and extent of low back pain (LBP) and low back-related disability in working-age adults not seeking care. METHODS A convenience sample of 101 working-age adults not seeking care for LBP completed the Oswestry Disability Index (ODI) and Roland-Morris Disability Questionnaire (RMDQ) as measures of disability and completed questionnaires that collected information on various demographic and health-related variables. Those reporting current LBP also completed a Numeric Pain Rating Scale (NPRS). Prevalence was assessed based on a dichotomization of whether any disability or pain was reported and also as a continuous variable to assess the extent of pain and disability present for each participant. RESULTS Of the 101 participants, 72.3% reported some level of disability (ODI mean = 7.91%, RMDQ mean = 2.63) and 46.5% reported some level of pain (NRPS mean = 3.68). Previous care-seeking for LBP was associated with increased odds of reporting disability (ODI odds ratio [OR] 7.91, 95% confidence interval [CI], 2.43 to 31.18; RMDQ OR 2.69, 95% CI, 1.05 to 7.24), as was reporting any current LBP (ODI OR 9.45, 95% CI, 3.15 to 33.21; RMDQ OR 7.03, 95% CI, 2.82 to 18.89). No other demographic or health-related variables were associated with the presence or extent of pain or disability. CONCLUSION Many non-care-seeking individuals reported some level of LBP and/or disability, suggesting that some level of pain and disability may be considered normal, acceptable, or manageable. One-third of individuals with no pain reported some disability.
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Affiliation(s)
- Matthew Vraa
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, WI, USA; Doctor of Physical Therapy Program, Northwest University, Kirkland, WA, USA; Residency in Orthopaedic Physical Therapy, Evidence in Motion, San Antonio, TX, USA.
| | - Stephanie Pascoe
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, WI, USA; Residency in Orthopaedic Physical Therapy, Evidence in Motion, San Antonio, TX, USA; Department of Physical Therapy and Integrative Care, Wardenburg Student Health Center, Boulder, CO, USA
| | - Daniel Maddox
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, WI, USA; Department of Physical Therapy, Ivester College of Health Sciences, Brenau University, Gainesville, GA, USA; Fellowship in Orthopaedic Manual Physical Therapy, Upstream Rehab Institute, Smyrna, GA, USA
| | - Daniel I Rhon
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, WI, USA; Department of Rehabilitation Medicine, Uniformed Services University of Health Sciences, Bethesda, MD, USA
| | - Joshua A Cleland
- Doctor of Physical Therapy Program, School of Medicine, Tufts University, Boston, MA, USA
| | - Jodi L Young
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, WI, USA
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Outcome Domain and Measurement Instrument Reporting in Randomized Controlled Trials of Interventions for Lumbar Spinal Stenosis: A Systematic Review. J Orthop Sports Phys Ther 2022; 52:446-A2. [PMID: 35584024 DOI: 10.2519/jospt.2022.10879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To describe outcome measurement instruments and outcome domains in randomized controlled trials of any interventions for lumbar spinal stenosis (LSS). DESIGN Systematic review. LITERATURE SEARCH The Cochrane Central Register of Controlled Trials (CENTRAL) and PubMed were searched from inception to May 2020. STUDY SELECTION CRITERIA Trials were eligible if patients were diagnosed with LSS, with or without neurogenic claudication. Trials were eligible if they used at least 1 outcome measurement instrument. DATA SYNTHESIS Measurement instruments used in trials were extracted and then classified into outcome domains. We described the frequency of measurement instruments and outcome domains. RESULTS After study screening, 29 trials were included. In total, 54 different individual outcome measurement instruments were used. The Visual Analogue Scale (59%; n = 17) and the Oswestry Disability Index (52%; n = 15) were the most frequently used outcome measurement instruments in trials; function (90%; n = 26) and pain (62%; n = 18) were the most common outcome domains. CONCLUSION In total, 54 different measurement instruments were used in trials of interventions for LSS. This diverse range of observations contributes to outcome instrument heterogeneity between trials and impedes the analysis of data due to lack of comparability. The most common outcome domains assessed were pain and function, which will help inform a core outcome measure set for symptomatic LSS. J Orthop Sports Phys Ther 2022;52(7):446-456. Epub: 18 May 2022. doi:10.2519/jospt.2022.10879.
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Kowalski KL, Lukacs MJ, Mistry J, Goodman M, Rushton AB. Physical functioning outcome measures in the lumbar spinal surgery population and measurement properties of the physical outcome measures: protocol for a systematic review. BMJ Open 2022; 12:e060950. [PMID: 35667717 PMCID: PMC9171219 DOI: 10.1136/bmjopen-2022-060950] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Low back pain can lead to substantial decline in physical functioning. For disabling pain not responsive to conservative management, surgical intervention can enhance physical functioning. Measurements of physical functioning include patient-reported outcome measures and physical outcome measures using evaluations of impairments, performance on a standardised task or activity in a natural environment. Selecting outcome measures with adequate measurement properties is fundamental to evaluating effectiveness of interventions. The purpose of this systematic review is to identify outcome measures (patient reported and physical) used to evaluate physical functioning (stage 1) and assess the measurement properties of physical outcome measures of physical functioning (stage 2) in the lumbar spinal surgery population. METHODS AND ANALYSIS This protocol aligns with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines and Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Using a two-staged approach, searches will be performed in MEDLINE, EMBASE, Health and Psychosocial Instruments, CINAHL, Web of Science, Scopus, PEDro and the grey literature from inception until 15 December 2021. Stage 1 will identify studies evaluating physical functioning with patient-reported or physical outcome measures in the lumbar spinal surgery population. Stage 2 will search for studies evaluating measurement properties (validity, reliability, responsiveness) of the physical outcome measures identified in stage 1 in the lumbar spinal surgery population. Two independent reviewers will evaluate studies for inclusion, extract data, assess risk of bias (COSMIN risk of bias tool and checklist) and quality of evidence (modified Grading of Recommendations Assessment, Development and Evaluation approach). Results for each measurement property per physical outcome measure will be quantitatively pooled if there is adequate clinical and methodological homogeneity or qualitatively synthesised if there is high heterogeneity in studies. ETHICS AND DISSEMINATION Ethics approval is not required. Results will be disseminated through peer-reviewed journal publication and conference presentation. PROSPERO REGISTRATION NUMBER CRD42021293880.
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Affiliation(s)
- Katie L Kowalski
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Michael J Lukacs
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Jai Mistry
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
- Physiotherapy, St George's Hospital, London, UK
| | - Maren Goodman
- Western Libraries, Western University, London, Ontario, Canada
| | - Alison B Rushton
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
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Brasil AVB, Floriani MA, Sfreddo E, do Nascimento TL, Castro AA, Pedrotti LG, Bessel M, Maccari JG, Mutlaq MP, Nasi LA. Success and failure after surgery of degenerative disease of the lumbar spine: an operational definition based on satisfaction, pain, and disability from a prospective cohort. BMC Musculoskelet Disord 2022; 23:501. [PMID: 35624507 PMCID: PMC9137061 DOI: 10.1186/s12891-022-05460-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 05/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background To describe success and failure (S&F) after lumbar spine surgery in terms equally understandable across the entire health ecosystem. Methods Back and leg pain and disability were prospectively recorded before and up to 12 months after the procedure. Satisfaction was recorded using a Likert scale. Initially, patients were classified as satisfied or unsatisfied. Optimal satisfaction/unsatisfaction cutoff values for disability and pain were estimated with ROC curves. Satisfied and unsatisfied groups underwent a second subdivision into four subcategories: success (satisfied AND pain and disability concordant with cutoff values), incomplete success (satisfied AND pain and disability nonconformant with cutoff values), incomplete failure (unsatisfied AND pain and disability nonconformant with cutoff values), and failure (unsatisfied AND pain and disability concordant with cutoff values). Results A total of 486 consecutive patients were recruited from 2019–2021. The mean values of preoperative PROMs were ODI 42.2 (+ 16.4), NPRS back 6.6 (+ 2.6) and NPRS leg 6.2 points (+ 2.9). Of the total, 80.7% were classified as satisfied, and 19.3% were classified as unsatisfactory. The optimal disability and pain cutoff values for satisfaction/unsatisfaction (NPRS = 6, AND ODI = 27) defined a subdivision: 59.6% were classified as success, 20.4% as incomplete success, 7.1% as incomplete failure and 12.4% as failure. The descriptions of each group were translated to the following: success—all patients were satisfied and presented no or only mild to tolerable pain and no or borderline disability; incomplete success – all patients were satisfied despite levels of pain and/or disability worse than ideal for success; incomplete failure – all patients were not satisfied despite levels of pain and/or disability better than expected for failure; failure – all patients were unsatisfied and presented moderate to severe pain and disability. Conclusion It is possible to report S&F after surgery for DDL with precise and meaningful operational definitions focused on the experience of the patient.
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Affiliation(s)
- Albert V B Brasil
- Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil. .,Department of Neurosurgery, Grupo Hospitalar Conceição, Porto Alegre, Brazil.
| | - Maiara Anschau Floriani
- Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil.,Value Management Office (VMO), Grupo Hospitalar Conceição, Porto Alegre, Brazil
| | - Ericson Sfreddo
- Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil.,Department of Neurosurgery, Grupo Hospitalar Conceição, Porto Alegre, Brazil
| | - Tobias Ludwig do Nascimento
- Department of Neurosurgery, Grupo Hospitalar Conceição, Porto Alegre, Brazil.,Hospital Cristo Redentor, Grupo Hospitalar Conceição, Porto Alegre, Brazil
| | - Andriele Abreu Castro
- Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil.,Value Management Office (VMO), Grupo Hospitalar Conceição, Porto Alegre, Brazil
| | | | - Marina Bessel
- Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | - Juçara Gasparetto Maccari
- Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil.,Value Management Office (VMO), Grupo Hospitalar Conceição, Porto Alegre, Brazil
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VAS and NRS, Same or Different? Are Visual Analog Scale Values and Numerical Rating Scale Equally Viable Tools for Assessing Patients after Microdiscectomy? Pain Res Manag 2022; 2022:5337483. [PMID: 35391853 PMCID: PMC8983264 DOI: 10.1155/2022/5337483] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 03/16/2022] [Indexed: 11/18/2022]
Abstract
Objectives To compare the viability of the numerical rating scale (NRS) and the visual analogue scale (VAS) as a pain assessment tools among a large cohort of patients who underwent microdiscectomy. Summary of Background Data. The pain intensity (PI) reduction is a parameter of surgical treatment efficacy. The two most commonly used scales of PI are NRS and VAS. Many studies have shown strong similarities between those two scales, but the direct interchange is difficult. Methods Patients, who underwent microdiscectomy, were prospectively enrolled into the study and assessed using VAS and NRS for the back (NRS-B) and the leg (NRS-L), Short Form of McGill Pain Questionnaire (SF-MPQ) included Pain Rating Index (PRI) and Oswestry Disability Index (ODI) 1 day before and 1 month and 3 months after the procedure. Results 131 patients were included in the study. NRS-L, NRS-B, VAS, and ODI were significantly lower (p < 0.001) 1 month after microdiscectomy. NRS-L and NRS-B ratings remained at a similar level while VAS and ODI decreased after 3 months. The rate of decline of PI measured by NRS-L correlated statistically significant (rs = 0.366; p < 0.001) with ODI 1 month after surgery. Before surgery, the most significant correlation was found between ODI and NRS-L (rs = 0.494; p < 0.001), the lowest with NRS-B (rs = 0.319; p < 0.001). 3 months after surgery, there was higher correlations between ODI and VAS (rs = 0.634) than NRS-L (rs = 0.265). PRI correlated significantly (p < 0.001) and more stronger with VAS than with NRS-L and NRS-B in every points of assessment. Conclusion The results showed that PI measurements by NRS-L/NRS-B and VAS mutually correlate and impair functionality evaluated by ODI (convergent validity) but in different modes (differential validity). NRS and VAS are not parallel scales and assess different aspects of pain. The measurement of NRS-L 1 month after microdiscectomy seems to give quick insight into the effectiveness of the procedure.
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Ho EKY, Chen L, Simic M, Ashton-James CE, Comachio J, Wang DXM, Hayden JA, Ferreira ML, Ferreira PH. Psychological interventions for chronic, non-specific low back pain: systematic review with network meta-analysis. BMJ 2022; 376:e067718. [PMID: 35354560 PMCID: PMC8965745 DOI: 10.1136/bmj-2021-067718] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To determine the comparative effectiveness and safety of psychological interventions for chronic low back pain. DESIGN Systematic review with network meta-analysis. DATA SOURCES Medline, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, SCOPUS, and CINAHL from database inception to 31 January 2021. ELIGIBILITY CRITERIA FOR STUDY SELECTION Randomised controlled trials comparing psychological interventions with any comparison intervention in adults with chronic, non-specific low back pain. Two reviewers independently screened studies, extracted data, and assessed risk of bias and confidence in the evidence. Primary outcomes were physical function and pain intensity. A random effects network meta-analysis using a frequentist approach was performed at post-intervention (from the end of treatment to <2 months post-intervention); and at short term (≥2 to <6 months post-intervention), mid-term (≥6 to <12 months post-intervention), and long term follow-up (≥12 months post-intervention). Physiotherapy care was the reference comparison intervention. The design-by-treatment interaction model was used to assess global inconsistency and the Bucher method was used to assess local inconsistency. RESULTS 97 randomised controlled trials involving 13 136 participants and 17 treatment nodes were included. Inconsistency was detected at short term and mid-term follow-up for physical function, and short term follow-up for pain intensity, and were resolved through sensitivity analyses. For physical function, cognitive behavioural therapy (standardised mean difference 1.01, 95% confidence interval 0.58 to 1.44), and pain education (0.62, 0.08 to 1.17), delivered with physiotherapy care, resulted in clinically important improvements at post-intervention (moderate quality evidence). The most sustainable effects of treatment for improving physical function were reported with pain education delivered with physiotherapy care, at least until mid-term follow-up (0.63, 0.25 to 1.00; low quality evidence). No studies investigated the long term effectiveness of pain education delivered with physiotherapy care. For pain intensity, behavioural therapy (1.08, 0.22 to 1.94), cognitive behavioural therapy (0.92, 0.43 to 1.42), and pain education (0.91, 0.37 to 1.45), delivered with physiotherapy care, resulted in clinically important effects at post-intervention (low to moderate quality evidence). Only behavioural therapy delivered with physiotherapy care maintained clinically important effects on reducing pain intensity until mid-term follow-up (1.01, 0.41 to 1.60; high quality evidence). CONCLUSIONS For people with chronic, non-specific low back pain, psychological interventions are most effective when delivered in conjunction with physiotherapy care (mainly structured exercise). Pain education programmes (low to moderate quality evidence) and behavioural therapy (low to high quality evidence) result in the most sustainable effects of treatment; however, uncertainty remains as to their long term effectiveness. Although inconsistency was detected, potential sources were identified and resolved. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019138074.
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Affiliation(s)
- Emma Kwan-Yee Ho
- Sydney Musculoskeletal Health, School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Sydney Musculoskeletal Health, The Kolling Institute, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Lingxiao Chen
- Sydney Musculoskeletal Health, The Kolling Institute, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Milena Simic
- Sydney Musculoskeletal Health, School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Claire Elizabeth Ashton-James
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Pain Management Research Institute, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Josielli Comachio
- Sydney Musculoskeletal Health, School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Daniel Xin Mo Wang
- Sydney Musculoskeletal Health, School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Jill Alison Hayden
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Manuela Loureiro Ferreira
- Sydney Musculoskeletal Health, The Kolling Institute, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Paulo Henrique Ferreira
- Sydney Musculoskeletal Health, School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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What does the patient with back pain want? A comparison of patient preferences and physician assumptions. Spine J 2022; 22:207-213. [PMID: 34551322 DOI: 10.1016/j.spinee.2021.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/30/2021] [Accepted: 09/14/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUD CONTEXT Low back pain can be difficult to diagnose, leaving patients frustrated and confused after medical visits. PURPOSE To evaluate the importance of reasons for seeking care in patients with back pain, and to compare this to physicians' assumptions about these patients' reasons. STUDY DESIGN/SETTING Prospective survey study carried out at two academic spine centers. PATIENT SAMPLE A sum of 419 patients with back pain upon initial presentation to a spine clinic, and 198 physicians; all volunteered to complete a survey. OUTCOME MEASURES Variance in mean values between patient and physician responders with significance determined by non-overlapping 95% confidence intervals. METHODS Patients were asked to "rate each of the following with regard to their importance to you" (answering between 0 "not important" to 4 "extremely important"): improvement in level of pain, improvement in ability to perform daily tasks, explanation of what is causing your problem, thorough physical examination, diagnostic testing, medication, physical therapy, surgery. Physicians were asked to rate each of these "with regard to their importance to your patients." RESULTS Patients indicated the following items were the most important (mean values): explanation of what is causing your problem (3.27), improvement in level of pain (3.48) and improvement in ability to perform daily tasks (3.31). Patients attributed the least importance and lowest scores to: surgery (1.07) and medication (1.89). Comparing the mean values to each item by patient and physician responders revealed statistically significant differences in certain items. Specifically, physicians underestimated the importance of an explanation of what is causing the problem (2.78±0.119 vs. 3.28±0.098, 95% CI) and overvalued diagnostic tests (2.64±0.120 vs. 2.30±0.147, 95% CI), medications (2.38±0.118 vs. 1.89± 0.143, 95% CI) and surgery (1.60±0.126 vs. 1.07±0.140, 95% CI). CONCLUSION Patients did not place as much importance on diagnostic tests, medications and surgery as the physicians assumed. Physicians understand that back pain patients want improvement in both pain and function, but they underestimate the importance of an explanation for the pain.
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Pellekooren S, Ben ÂJ, Bosmans JE, Ostelo RWJG, van Tulder MW, Maas ET, Huygen FJPM, Oosterhuis T, Apeldoorn AT, van Hooff ML, van Dongen JM. Can EQ-5D-3L utility values of low back pain patients be validly predicted by the Oswestry Disability Index for use in cost-effectiveness analyses? Qual Life Res 2022; 31:2153-2165. [PMID: 35040002 PMCID: PMC9188530 DOI: 10.1007/s11136-022-03082-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 11/26/2022]
Abstract
Purpose To assess whether regression modeling can be used to predict EQ-5D-3L utility values from the Oswestry Disability Index (ODI) in low back pain (LBP) patients for use in cost-effectiveness analysis. Methods EQ-5D-3L utility values of LBP patients were estimated using their ODI scores as independent variables using regression analyses, while adjusting for case-mix variables. Six different models were estimated: (1) Ordinary Least Squares (OLS) regression, with total ODI score, (2) OLS, with ODI item scores as continuous variables, (3) OLS, with ODI item scores as ordinal variables, (4) Tobit model, with total ODI score, (5) Tobit model, with ODI item scores as continuous variables, and (6) Tobit model, with ODI item scores as ordinal variables. The models’ performance was assessed using explained variance (R2) and root mean squared error (RMSE). The potential impact of using predicted instead of observed EQ-5D-3L utility values on cost-effectiveness outcomes was evaluated in two empirical cost-effectiveness analysis. Results Complete individual patient data of 18,692 low back pain patients were analyzed. All models had a more or less similar R2 (range 45–52%) and RMSE (range 0.21–0.22). The two best performing models produced similar probabilities of cost-effectiveness for a range of willingness-to-pay (WTP) values compared to those based on the observed EQ-5D-3L values. For example, the difference in probabilities ranged from 2 to 5% at a WTP of 50,000 €/QALY gained. Conclusion Results suggest that the ODI can be validly used to predict low back pain patients’ EQ-5D-3L utility values and QALYs for use in cost-effectiveness analyses. Supplementary Information The online version contains supplementary material available at 10.1007/s11136-022-03082-6.
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Affiliation(s)
- Sylvia Pellekooren
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Research Institute, De Boelelaan 1105, 1081 HV, Amsterdam, The Netherlands.
- Department Human Movement Sciences, Faculty of Behavioral & Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands.
| | - Ângela J Ben
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Judith E Bosmans
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Raymond W J G Ostelo
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Research Institute, De Boelelaan 1105, 1081 HV, Amsterdam, The Netherlands
- Department of Epidemiology and Data Science, Amsterdam UMC, Location VUmc, Amsterdam Movement Sciences Research Institute, Amsterdam, The Netherlands
| | - Maurits W van Tulder
- Department Human Movement Sciences, Faculty of Behavioral & Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | - Esther T Maas
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Research Institute, De Boelelaan 1105, 1081 HV, Amsterdam, The Netherlands
| | - Frank J P M Huygen
- Center of Pain Medicine Erasmusmc, Rotterdam, The Netherlands
- Center of Pain Medicine UMCU, Utrecht, The Netherlands
| | - Teddy Oosterhuis
- Netherlands Society of Occupational Medicine, Centre of Excellence, Utrecht, the Netherlands
- Coronel Institute of Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Adri T Apeldoorn
- Rehabilitation Departement, Noordwest Ziekenhuisgroep, Alkmaar, Netherlands, Breederode Hogeschool, Rotterdam, Netherlands
| | - Miranda L van Hooff
- Departement Research, Sint Maartenskliniek, Nijmegen, The Netherlands
- Department of Orthopedic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Johanna M van Dongen
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Research Institute, De Boelelaan 1105, 1081 HV, Amsterdam, The Netherlands
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Affiliation(s)
- Morgan Angotti
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA,International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
| | - G. Michael Mallow
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA,International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
| | - Arnold Wong
- International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA,Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Scott Haldeman
- World Spine Care, Santa Ana, CA, USA,Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada,Department of Neurology, University of California, Irvine, CA, USA
| | - Howard S. An
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA,International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
| | - Dino Samartzis
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA,International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA,Dino Samartzis, Department of Orthopaedic Surgery, Rush University Medical Center, Orthopaedic Building, Suite 204-G, 1611 W. Harrison Street, Chicago, IL 60612, USA.
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Cook E, Scantlebury A, Booth A, Turner E, Ranganathan A, Khan A, Ahuja S, May P, Rangan A, Roche J, Coleman E, Hilton C, Corbacho B, Hewitt C, Adamson J, Torgerson D, McDaid C. Surgery versus conservative management of stable thoracolumbar fracture: the PRESTO feasibility RCT. Health Technol Assess 2021; 25:1-126. [PMID: 34780323 DOI: 10.3310/hta25620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There is informal consensus that simple compression fractures of the body of the thoracolumbar vertebrae between the 10th thoracic vertebra and the second lumbar vertebra without neurological complications can be managed conservatively and that obvious unstable fractures require surgical fixation. However, there is a zone of uncertainty about whether surgical or conservative management is best for stable fractures. OBJECTIVES To assess the feasibility of a definitive randomised controlled trial comparing surgical fixation with initial conservative management of stable thoracolumbar fractures without spinal cord injury. DESIGN External randomised feasibility study, qualitative study and national survey. SETTING Three NHS hospitals. METHODS A feasibility randomised controlled trial using block randomisation, stratified by centre and type of injury (high- or low-energy trauma) to allocate participants 1 : 1 to surgery or conservative treatment; a costing analysis; a national survey of spine surgeons; and a qualitative study with clinicians, recruiting staff and patients. PARTICIPANTS Adults aged ≥ 16 years with a high- or low-energy fracture of the body of a thoracolumbar vertebra between the 10th thoracic vertebra and the second lumbar vertebra, confirmed by radiography, computerised tomography or magnetic resonance imaging, with at least one of the following: kyphotic angle > 20° on weight-bearing radiographs or > 15° on a supine radiograph or on computerised tomography; reduction in vertebral body height of 25%; a fracture line propagating through the posterior wall of the vertebra; involvement of two contiguous vertebrae; or injury to the posterior longitudinal ligament or annulus in addition to the body fracture. INTERVENTIONS Surgical fixation: open spinal surgery (with or without spinal fusion) or minimally invasive stabilisation surgery. Conservative management: mobilisation with or without a brace. MAIN OUTCOME MEASURE Recruitment rate (proportion of eligible participants randomised). RESULTS Twelve patients were randomised (surgery, n = 8; conservative, n = 4). The proportion of eligible patients recruited was 0.43 (95% confidence interval 0.24 to 0.63) over a combined total of 30.7 recruitment months. Of 211 patients screened, 28 (13.3%) fulfilled the eligibility criteria. Patients in the qualitative study (n = 5) expressed strong preferences for surgical treatment, and identified provision of information about treatment and recovery and when and how they are approached for consent as important. Nineteen surgeons and site staff participated in the qualitative study. Key themes were the lack of clinical consensus regarding the implementation of the eligibility criteria in practice and what constitutes a stable fracture, alongside lack of equipoise regarding treatment. Based on the feasibility study eligibility criteria, 77% (50/65) and 70% (46/66) of surgeons participating in the survey were willing to randomise for high- and low-energy fractures, respectively. LIMITATIONS Owing to the small number of participants, there is substantial uncertainty around the recruitment rate. CONCLUSIONS A definitive trial is unlikely to be feasible currently, mainly because of the small number of patients meeting the eligibility criteria. The recruitment and follow-up rates were slightly lower than anticipated; however, there is room to increase these based on information gathered and the support within the surgical community for a future trial. FUTURE WORK Development of consensus regarding the population of interest for a trial. TRIAL REGISTRATION Current Controlled Trials ISRCTN12094890. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 62. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Elizabeth Cook
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | | | - Alison Booth
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Emma Turner
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | | | - Almas Khan
- Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
| | - Sashin Ahuja
- Cardiff & Vale University Health Board, University Hospital of Wales, Cardiff, UK
| | - Peter May
- Barts Health NHS Trust, The Royal London Hospital, London, UK
| | - Amar Rangan
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Jenny Roche
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Elizabeth Coleman
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | | | - Belén Corbacho
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Joy Adamson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - David Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Catriona McDaid
- York Trials Unit, Department of Health Sciences, University of York, York, UK
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Niederer D, Engel T, Pfeifer AC, Arampatzis A, Beck H, Wippert PM, Schiltenwolf M, Mayer F. Which Functional Outcomes Can be Measured in Low Back Pain Trials and Therapies?: A Prospective 2-Year Factor-, Cluster-, and Reliability-Multicenter Analysis on 42 Variables in 1049 Individuals. Spine (Phila Pa 1976) 2021; 46:1495-1508. [PMID: 33731576 DOI: 10.1097/brs.0000000000004028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective 2-year factor-, cluster-, and reliability-multicenter analysis. OBJECTIVE To provide evidence on the uniqueness and usefulness of a set of potential relevant functional outcomes. SUMMARY OF BACKGROUND DATA A very high number of functional outcomes that can be utilized as variables in low back pain (LBP) trials exists. METHODS Participants (n = 1049) with and without current LBP were included. At 7 visits (baseline, 4 wk, 3 mo, 6 mo, 9 mo, 1 yr, and 2 yr), 42 different functional outcomes were assessed. Two exploratory factor analyses (for baseline-values and for changes scores to 3 mo post-baseline) were calculated (maximum likelihood extraction, varimax factor rotation). The strongest factor-loading outcomes were selected for the following hierarchical cluster analyses (average linkage, Euclidean distance measure). For each cluster, time point, and outcome, reliability analyses were subsequently calculated using intraclass correlation coefficients, standard error of measurements and coefficients of variation. RESULTS The factor analysis for the cross-sectional values revealed 9 factors with a cumulative variance explanation of 61.7% and 13 unique ones. The change-score factor analysis revealed nine factors with a total variance explanation of 61.8%, seven outcomes were unique. Ten outcomes were important for both cross-sectional and change-score analyses, 11 were most valuable for cross-sectional and four for the change scores. Patients with pain grades 1 to 3 show comparable patterns (cluster 2). Grade 0 (cluster 1) and grade 4 (cluster 3) are unique and cannot be cumulated with other grades. Most biomechanical outcomes were highly reliable and display low measurement errors. CONCLUSION We found 25 potentially meaningful functional outcomes in the context of objective functional measurements (such as trunk range of motion, dynamic and static balance, strength, and muscle fatigue resistance) and body characteristics. The present framework may help to select appropriate functional outcomes and rate effects beyond the known core set of outcomes.Level of Evidence: 1.
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Affiliation(s)
- Daniel Niederer
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Tilman Engel
- University Outpatient Clinic, Centre of Sports Medicine, University of Potsdam, Potsdam, Germany
| | - Ann-Christin Pfeifer
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Adamantios Arampatzis
- Department of Pain Management, Center of Orthopaedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Heidrun Beck
- University Hospital Carl Gustav Carus at Technical University Dresden, Dresden, Germany
| | - Pia-Maria Wippert
- Department of Sociology of Physical Activity and Health, University of Potsdam, Potsdam, German
| | - Marcus Schiltenwolf
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Frank Mayer
- University Outpatient Clinic, Centre of Sports Medicine, University of Potsdam, Potsdam, Germany
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Ibsen C, Maribo T, Nielsen CV, Hørder M, Schiøttz-Christensen B. ICF-Based Assessment of Functioning in Daily Clinical Practice. A Promising Direction Toward Patient-Centred Care in Patients With Low Back Pain. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:732594. [PMID: 36188866 PMCID: PMC9397761 DOI: 10.3389/fresc.2021.732594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/27/2021] [Indexed: 11/13/2022]
Abstract
Background: Patient-centred care has received increased attention in recent years. Patient-Reported Outcomes (PROs) and shared decision-making are key components of Patient-Centred care. Low back pain (LBP) is a complex symptom affected by multiple, interacting factors. Therefore, evidence strongly recommend a biopsychosocial and patient-centred approach in the assessment and management. The International Classification of Functioning, Disability and Health (ICF) provide a biopsychosocial model for describing functioning and disability. ICF is widely acknowledged, but implementation into clinical practice is lacking. To support the use of a biopsychosocial and patient-centred approach in daily clinical practice among patients with LBP we developed a practice-friendly tool based on ICF; the LBP assessment tool. Objective: To compare an ICF-based assessment facilitated by the LBP assessment tool with standard care in terms of the use of PROs and shared decision-making in order to promote patient-centred care in patients with LBP. Methods: A non-randomized controlled design was used. Eligible patients were allocated to one of two groups: the ICF group, assessed with the LBP assessment tool or the control group, assessed with a conventional LBP assessment. Primary outcome includes use of PROs. Secondary outcomes include use of a graphical overview displaying the patient profile and shared decision-making. A patient evaluation questionnaire was used to collect data. Results: Seven hundred ten patients were assessed for eligibility of whom 531 were allocated to the ICF group (n = 299) or the control group (n = 232). A significantly higher use of PRO data (p < 0.00) and the patient profile (p < 0.00) was reported in favor of the ICF group. Patients in the ICF group also experienced being more involved in decision-making (p = 0.01). Conclusions: This study showed that a functioning assessment, by means of the LBP assessment tool, increased use of PROs and shared decision-making when compared to a conventional LBP assessment. Additionally, this study demonstrated that routine use of ICF-based PRO data and shared decision-making promoted patient-centred care in patients with LBP. The LBP assessment tool may be a strong candidate for a user-friendly ICF-based tool with the potential to support health professionals in a shift toward a biopsychosocial and patient-centred approach to patients with LBP.
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Affiliation(s)
- Charlotte Ibsen
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
- *Correspondence: Charlotte Ibsen
| | - Thomas Maribo
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | - Claus Vinther Nielsen
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
- Regional Hospital West Jutland, Herning, Denmark
| | - Mogens Hørder
- Department of Public Health, Research Unit of User Perspectives, University of Southern Denmark, Odense, Denmark
| | - Berit Schiøttz-Christensen
- Spine Centre of Southern Denmark, Hospital Lillebaelt, Middelfart, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Terwee CB, Zuidgeest M, Vonkeman HE, Cella D, Haverman L, Roorda LD. Common patient-reported outcomes across ICHOM Standard Sets: the potential contribution of PROMIS®. BMC Med Inform Decis Mak 2021; 21:259. [PMID: 34488730 PMCID: PMC8420145 DOI: 10.1186/s12911-021-01624-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 08/27/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The International Consortium for Health Outcomes Measurement (ICHOM) develops condition-specific Standard Sets of outcomes to be measured in clinical practice for value-based healthcare evaluation. Standard Sets are developed by different working groups, which is inefficient and may lead to inconsistencies in selected PROs and PROMs. We aimed to identify common PROs across ICHOM Standard Sets and examined to what extend these PROs can be measured with a generic set of PROMs: the Patient-Reported Outcomes Measurement Information System (PROMIS®). METHODS We extracted all PROs and recommended PROMs from 39 ICHOM Standard Sets. Similar PROs were categorized into unique PRO concepts. We examined which of these PRO concepts can be measured with PROMIS. RESULTS A total of 307 PROs were identified in 39 ICHOM Standard Sets and 114 unique PROMs are recommended for measuring these PROs. The 307 PROs could be categorized into 22 unique PRO concepts. More than half (17/22) of these PRO concepts (covering about 75% of the PROs and 75% of the PROMs) can be measured with a PROMIS measure. CONCLUSION Considerable overlap was found in PROs across ICHOM Standard Sets, and large differences in terminology used and PROMs recommended, even for the same PROs. We recommend a more universal and standardized approach to the selection of PROs and PROMs. Such an approach, focusing on a set of core PROs for all patients, measured with a system like PROMIS, may provide more opportunities for patient-centered care and facilitate the uptake of Standard Sets in clinical practice.
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Affiliation(s)
- Caroline B Terwee
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1089a, 1081 HV, Amsterdam, The Netherlands.
| | | | - Harald E Vonkeman
- Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, The Netherlands
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Lotte Haverman
- Psychosocial Department, Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Leo D Roorda
- Amsterdam Rehabilitation Research Center | Reade, Amsterdam, The Netherlands
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Bussières A, Cancelliere C, Ammendolia C, Comer CM, Zoubi FA, Châtillon CE, Chernish G, Cox JM, Gliedt JA, Haskett D, Jensen RK, Marchand AA, Tomkins-Lane C, O'Shaughnessy J, Passmore S, Schneider MJ, Shipka P, Stewart G, Stuber K, Yee A, Ornelas J. Non-Surgical Interventions for Lumbar Spinal Stenosis Leading To Neurogenic Claudication: A Clinical Practice Guideline. THE JOURNAL OF PAIN 2021; 22:1015-1039. [PMID: 33857615 DOI: 10.1016/j.jpain.2021.03.147] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/14/2021] [Accepted: 03/16/2021] [Indexed: 12/14/2022]
Abstract
Lumbar spinal stenosis (LSS) causing neurogenic claudication (NC) is increasingly common with an aging population and can be associated with significant symptoms and functional limitations. We developed this guideline to present the evidence and provide clinical recommendations on nonsurgical management of patients with LSS causing NC. Using the GRADE approach, a multidisciplinary guidelines panel based recommendations on evidence from a systematic review of randomized controlled trials and systematic reviews published through June 2019, or expert consensus. The literature monitored up to October 2020. Clinical outcomes evaluated included pain, disability, quality of life, and walking capacity. The target audience for this guideline includes all clinicians, and the target patient population includes adults with LSS (congenital and/or acquired, lateral recess or central canal, with or without low back pain, with or without spondylolisthesis) causing NC. The guidelines panel developed 6 recommendations based on randomized controlled trials and 5 others based on professional consensus, summarized in 3 overarching recommendations: (Grade: statements are all conditional/weak recommendations) Recommendation 1. For patients with LSS causing NC, clinicians and patients may initially select multimodal care nonpharmacological therapies with education, advice and lifestyle changes, behavioral change techniques in conjunction with home exercise, manual therapy, and/or rehabilitation (moderate-quality evidence), traditional acupuncture on a trial basis (very low-quality evidence), and postoperative rehabilitation (supervised program of exercises and/or educational materials encouraging activity) with cognitive-behavioral therapy 12 weeks postsurgery (low-quality evidence). Recommendation 2. In patients LSS causing NC, clinicians and patients may consider a trial of serotonin-norepinephrine reuptake inhibitors or tricyclic antidepressants. (very low-quality evidence). Recommendation 3. For patients LSS causing NC, we recommend against the use of the following pharmacological therapies: nonsteroidal anti-inflammatory drugs, methylcobalamin, calcitonin, paracetamol, opioids, muscle relaxants, pregabalin (consensus-based), gabapentin (very low-quality), and epidural steroidal injections (high-quality evidence). PERSPECTIVE: This guideline, on the basis of a systematic review of the evidence on the nonsurgical management of lumbar spine stenosis, provides recommendations developed by a multidisciplinary expert panel. Safe and effective non-surgical management of lumbar spine stenosis should be on the basis of a plan of care tailored to the individual and the type of treatment involved, and multimodal care is recommended in most situations.
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Affiliation(s)
- André Bussières
- School of Physical Medicine & Occupational Therapy, McGill University, Montreal, Quebec, Canada; Département Chiropratique, Université du Québec à Trois-Rivières, Quebec, Canada.
| | - Carolina Cancelliere
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada
| | - Carlo Ammendolia
- Faculty of Medicine, University of Toronto and Mount Sinai Hospital, Ontario, Canada
| | - Christine M Comer
- Leeds Community Healthcare NHS Trust, Leeds, United Kingdom/ Faculty of Medicine, University of Leeds, United Kingdom
| | - Fadi Al Zoubi
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | | | - Greg Chernish
- Family Medicine at the University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Jordan A Gliedt
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Rikke Krüger Jensen
- NIKKB and Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
| | - Andrée-Anne Marchand
- Département Chiropratique, Université du Québec à Trois-Rivières, Quebec, Canada
| | - Christy Tomkins-Lane
- Department of Health and Physical Education, Mount Royal University, Calgary, Canada
| | - Julie O'Shaughnessy
- Département Chiropratique, Université du Québec à Trois-Rivières, Quebec, Canada
| | - Steven Passmore
- Faculty of Kinesiology & Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael J Schneider
- Department of Physical Therapy, University of Pittsburgh, Pennsylvania; Clinical and Translational Science Institute, University of Pittsburgh, Pennsylvania
| | | | | | - Kent Stuber
- Canadian Memorial Chiropractic College, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Albert Yee
- Health Systems Management, Rush University, Chicago, Illinois
| | - Joseph Ornelas
- American Hip Institute, Des Plaines, Illinois; Clinical and Translational Science Institute, University of Pittsburgh, Pennsylvania
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Karhade AV, Bono CM, Makhni MC, Schwab JH, Sethi RK, Simpson AK, Feeley TW, Porter ME. Value-based health care in spine: where do we go from here? Spine J 2021; 21:1409-1413. [PMID: 33857667 DOI: 10.1016/j.spinee.2021.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/30/2021] [Accepted: 04/06/2021] [Indexed: 02/03/2023]
Affiliation(s)
- Aditya V Karhade
- Institute for Strategy and Competitiveness, Harvard Business School, Boston, MA, USA; Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Christopher M Bono
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Melvin C Makhni
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph H Schwab
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rajiv K Sethi
- Neuroscience Institute, Virginia Mason Medical Center, Seattle, WA, USA; Department of Neurosurgery, Virginia Mason Medical Center, Seattle, WA, USA
| | - Andrew K Simpson
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Thomas W Feeley
- Institute for Strategy and Competitiveness, Harvard Business School, Boston, MA, USA
| | - Michael E Porter
- Institute for Strategy and Competitiveness, Harvard Business School, Boston, MA, USA
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Wei FL, Liu Y, Zhou CP, Sun SG, Zhu KL, Du MR, Gao HR, Yuan YF, Song Y, Qian S, An B, Wang H, Li XX, Guo SK, Gao QY, Wu SD, Yan XD, Sun LL, Qian JX. Management for lumbar spinal stenosis: Protocol for a network meta-analysis and systematic review. J Orthop Surg (Hong Kong) 2021; 28:2309499020975212. [PMID: 33295239 DOI: 10.1177/2309499020975212] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Lumbar spinal stenosis (LSS) is caused by structural changes of the spine, which lead to several severe symptoms, including back pain, leg pain, numbness and tingling in the legs, as well as reduced physical function. However, there is little evidence suggesting whether a patient with LSS should be treated with surgery. If surgery is recommended, which type of surgery benefits the patient most? To answer these questions, we will conduct a network meta-analysis and a systematic review to compare surgical and nonsurgical interventions in terms of efficacy as well as safety in adult patients with LSS. METHODS AND ANALYSIS We will search the PubMed, Cochrane library, and EMBASE databases for articles published prior to October 10, 2019. We will search for randomized controlled trials assessing surgical and nonsurgical interventions for adult patients with degenerative LSS without any language restrictions. The primary outcome measures will be pain and disability. The secondary outcomes will include adverse events (number of events or number of people with each type of adverse event), reoperations, complications, blood loss and operation time. We will obtain the full texts of the potentially relevant studies and independently assess them. The quality of evidence will be evaluated according to the Grading of Recommendations Assessment, Development and Evaluation framework. A random-effects network meta-analysis will be performed to analyze all the evidence under the frequentist framework, and the ranking results will be presented. We will generate plots depicting the network geometry using Stata. The network meta-analysis will be performed according to the Bayesian framework. Ethics and dissemination Ethics approval is not required. The research will be published in a peer-reviewed journal.
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Affiliation(s)
- Fei-Long Wei
- Department of Orthopaedics, Tangdu Hospital, 56697Fourth Military Medical University, Xi'an, China
| | - Ya Liu
- Department of Outpatient, Xijing Hospital, 56697Fourth Military Medical University, Xi'an, China
| | - Cheng-Pei Zhou
- Department of Orthopaedics, Tangdu Hospital, 56697Fourth Military Medical University, Xi'an, China
| | - Si-Guo Sun
- Department of Orthopaedics, Air Force Medical Center, 56697Fourth Military Medical University, Beijing, China
| | - Kai-Long Zhu
- Department of Orthopaedics, Tangdu Hospital, 56697Fourth Military Medical University, Xi'an, China
| | - Ming-Rui Du
- Department of Orthopaedics, Tangdu Hospital, 56697Fourth Military Medical University, Xi'an, China
| | - Hao-Ran Gao
- Department of Orthopaedics, Tangdu Hospital, 56697Fourth Military Medical University, Xi'an, China
| | - Yi-Fang Yuan
- Department of Orthopaedics, Tangdu Hospital, 56697Fourth Military Medical University, Xi'an, China
| | - Yang Song
- Department of Orthopaedics, Tangdu Hospital, 56697Fourth Military Medical University, Xi'an, China
| | - Shu Qian
- Department of Orthopaedics, Tangdu Hospital, 56697Fourth Military Medical University, Xi'an, China
| | - Bo An
- Department of Orthopaedics, Tangdu Hospital, 56697Fourth Military Medical University, Xi'an, China
| | - Huan Wang
- Department of Orthopaedics, Tangdu Hospital, 56697Fourth Military Medical University, Xi'an, China
| | - Xiao-Xiang Li
- Department of Orthopaedics, Tangdu Hospital, 56697Fourth Military Medical University, Xi'an, China
| | - Shi-Kong Guo
- Department of Orthopaedics, Tangdu Hospital, 56697Fourth Military Medical University, Xi'an, China
| | - Quan-You Gao
- Department of Orthopaedics, Tangdu Hospital, 56697Fourth Military Medical University, Xi'an, China
| | - Sheng-Da Wu
- Department of Orthopaedics, Tangdu Hospital, 56697Fourth Military Medical University, Xi'an, China
| | - Xiao-Dong Yan
- Department of Orthopaedics, Tangdu Hospital, 56697Fourth Military Medical University, Xi'an, China
| | - Li-Li Sun
- Department of Neurology, Xijing Hospital, 56697Fourth Military Medical University, Xi'an, China
| | - Ji-Xian Qian
- Department of Orthopaedics, Tangdu Hospital, 56697Fourth Military Medical University, Xi'an, China
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Harbaugh RE, Devin C, Leavy MB, Ghogawala Z, Archer KR, Bydon M, Goertz C, Dinstein D, Nerenz DR, Eakin GS, Lavelle W, Shaffer WO, Arnold PM, Washabaugh CH, Gliklich RE. Harmonized outcome measures for use in degenerative lumbar spondylolisthesis patient registries and clinical practice. J Neurosurg Spine 2021; 34:888-896. [PMID: 33740766 DOI: 10.3171/2020.9.spine20437] [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: 03/27/2020] [Accepted: 09/16/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The development of new treatment approaches for degenerative lumbar spondylolisthesis (DLS) has introduced many questions about comparative effectiveness and long-term outcomes. Patient registries collect robust, longitudinal data that could be combined or aggregated to form a national and potentially international research data infrastructure to address these and other research questions. However, linking data across registries is challenging because registries typically define and capture different outcome measures. Variation in outcome measures occurs in clinical practice and other types of research studies as well, limiting the utility of existing data sources for addressing new research questions. The purpose of this project was to develop a minimum set of patient- and clinician-relevant standardized outcome measures that are feasible for collection in DLS registries and clinical practice. METHODS Nineteen DLS registries, observational studies, and quality improvement efforts were invited to participate and submit outcome measures. A stakeholder panel was organized that included representatives from medical specialty societies, health systems, government agencies, payers, industries, health information technology organizations, and patient advocacy groups. The panel categorized the measures using the Agency for Healthcare Research and Quality's Outcome Measures Framework (OMF), identified a minimum set of outcome measures, and developed standardized definitions through a consensus-based process. RESULTS The panel identified and harmonized 57 outcome measures into a minimum set of 10 core outcome measure areas and 6 supplemental outcome measure areas. The measures are organized into the OMF categories of survival, clinical response, events of interest, patient-reported outcomes, and resource utilization. CONCLUSIONS This effort identified a minimum set of standardized measures that are relevant to patients and clinicians and appropriate for use in DLS registries, other research efforts, and clinical practice. Collection of these measures across registries and clinical practice is an important step for building research data infrastructure, creating learning healthcare systems, and improving patient management and outcomes in DLS.
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Affiliation(s)
- Robert E Harbaugh
- 1Department of Neurosurgery, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | - Clinton Devin
- 2Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Zoher Ghogawala
- 4Department of Neurosurgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
- 5Tufts University School of Medicine, Boston, Massachusetts
| | - Kristin R Archer
- 6Department of Orthopaedic Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Mohamad Bydon
- 7Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | | | - David R Nerenz
- 10Department of Neurosurgery, Henry Ford Medical Group, Detroit, Michigan
| | | | - William Lavelle
- 12Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, New York
| | | | - Paul M Arnold
- 14Department of Neurosurgery, University of Kansas Hospital, Kansas City, Kansas
| | - Charles H Washabaugh
- 15Division of Extramural Research, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland; and
| | - Richard E Gliklich
- 3OM1, Inc., Boston, Massachusetts
- 16Harvard Medical School, Boston, Massachusetts
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Garratt AM, Furunes H, Hellum C, Solberg T, Brox JI, Storheim K, Johnsen LG. Evaluation of the EQ-5D-3L and 5L versions in low back pain patients. Health Qual Life Outcomes 2021; 19:155. [PMID: 34049574 PMCID: PMC8160396 DOI: 10.1186/s12955-021-01792-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/19/2021] [Indexed: 12/16/2022] Open
Abstract
Background The EuroQol EQ-5D is one of the most widely researched and applied patient-reported outcome measures worldwide. The original EQ-5D-3L and more recent EQ-5D-5L include three and five response categories respectively. Evidence from healthy and sick populations shows that the additional two response categories improve measurement properties but there has not been a concurrent comparison of the two versions in patients with low back pain (LBP). Methods LBP patients taking part in a multicenter randomized controlled trial of lumbar total disc replacement and conservative treatment completed the EQ-5D-3L and 5L in an eight-year follow-up questionnaire. The 3L and 5L were assessed for aspects of data quality including missing data, floor and ceiling effects, response consistency, and based on a priori hypotheses, associations with the Oswestry Disability Index (ODI), Pain-Visual Analogue Scales and Hopkins Symptom Checklist (HSCL-25). Results At the eight-year follow-up, 151 (87%) patients were available and 146 completed both the 3L and 5L. Levels of missing data were the same for the two versions. Compared to the EQ-5D-5L, the 3L had significantly higher floor (pain discomfort) and ceiling effects (mobility, self-care, pain/discomfort, anxiety/depression). For these patients the EQ-5D-5L described 73 health states compared to 28 for the 3L. Shannon’s indices showed the 5L outperformed the 3L in tests of classification efficiency. Correlations with the ODI, Pain-VAS and HSCL-25 were largely as hypothesized, the 5L having slightly higher correlations than the 3L. Conclusion The EQ-5D assesses important aspect of health in LBP patients and the 5L improves upon the 3L in this respect. The EQ-5D-5L is recommended in preference to the 3L version, however, further testing in other back pain populations together with additional measurement properties, including responsiveness to change, is recommended. Trial registration: retrospectively registered: https://clinicaltrials.gov/ct2/show/NCT01704677.
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Affiliation(s)
- A M Garratt
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway.
| | - H Furunes
- Department of Surgery, Innlandet Hospital Gjøvik, Gjøvik, Norway.,University of Oslo, Oslo, Norway
| | - C Hellum
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - T Solberg
- Department of Neurosurgery and The Norwegian Registry for Spine Surgery (NORspine), University Hospital of Northern Norway, Tromsø, Norway.,Institute for Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
| | - J I Brox
- University of Oslo, Oslo, Norway.,Department for Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - K Storheim
- Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, Norway.,Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
| | - L G Johnsen
- Department of Neuromedicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Orthopaedic Surgery, St. Olav's University Hospital, Trondheim, Norway
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Verburg AC, van Dulmen SA, Kiers H, Nijhuis-van der Sanden MWG, van der Wees PJ. Patient-Reported Outcome-Based Quality Indicators in Dutch Primary Care Physical Therapy for Patients With Nonspecific Low Back Pain: A Cohort Study. Phys Ther 2021; 101:6258995. [PMID: 33929546 PMCID: PMC8336590 DOI: 10.1093/ptj/pzab118] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 02/13/2021] [Accepted: 04/07/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The purpose of this study was to define and select a core set of outcome-based quality indicators, accepted by stakeholders on usability and perceived added value as a quality improvement tool, and to formulate recommendations for the next implementation step. METHODS In phase 1, 15 potential quality indicators were defined for patient-reported outcome measures and associated domains, namely the Numeric Pain Rating Scale (NPRS) for pain intensity, the Patient Specific Functioning Scale (PSFS) for physical activity, the Quebec Back Pain Disability Scale for physical functioning, and the Global Perceived Effect-Dutch Version for perceived effect. Their comparability and discriminatory characteristics were described using cohort data. In phase 2, a core set of quality indicators was selected based on consensus among stakeholders in focus group meetings. RESULTS In total, 65,815 completed treatment episodes for patients with nonspecific low back pain were provided by 1009 physical therapists from 219 physical therapist practices. The discriminability between physical therapists of all potential 15 quality indicators was adequate, with intraclass correlation coefficients between 0.08 and 0.30. Stakeholders selected a final core set of 6 quality indicators: 2 process indicators (the routine measurement of NPRS and the PSFS) and 4 outcome indicators (pretreatment and posttreatment change scores for the NPRS, PSFS, Quebec Back Pain Disability Scale, and the minimal clinically important difference of the Global Perceived Effect-Dutch Version). CONCLUSION This study described and selected a core set of outcome-based quality indicators for physical therapy in patients with nonspecific low back pain. The set was accepted by stakeholders for having added value for daily practice in physical therapy primary care and was found useful for quality improvement initiatives. Further studies need to focus on improvement of using the core set of outcome-based quality indicators as a quality monitoring and evaluation instrument. IMPACT Patient-reported outcome-based quality indicators developed from routinely collected clinical data are promising for use in quality improvement in daily practice.
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Affiliation(s)
- Arie C Verburg
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, PO Box 9101, 6500 HB, Nijmegen, The Netherlands,Address all correspondence to Dr Verburg at:
| | - Simone A van Dulmen
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Henri Kiers
- Institute of Human Movement Studies, Utrecht University of Applied Sciences, Utrecht, The Netherlands,Association for Quality in Physical Therapy (SKF), Zwolle, The Netherlands
| | - Maria W G Nijhuis-van der Sanden
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Philip J van der Wees
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
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Patricio P, Roy JS, Macedo L, Roy M, Léonard G, Hodges P, Massé-Alarie H. Repetitive transcranial magnetic stimulation alone and in combination with motor control exercise for the treatment of individuals with chronic non-specific low back pain (ExTraStim trial): study protocol for a randomised controlled trial. BMJ Open 2021; 11:e045504. [PMID: 33762244 PMCID: PMC7993312 DOI: 10.1136/bmjopen-2020-045504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION While multiple pharmacological and non-pharmacological interventions treating chronic non-specific low back pain (CLBP) are available, they have been shown to produce at best modest effects. Interventions such as repetitive transcranial magnetic stimulation (rTMS), a form of non-invasive brain stimulation, have exhibited promising results to alleviate chronic pain. However, evidence on the effectiveness of rTMS for CLBP is scarce due to limited rigorous clinical trials. Combining rTMS with motor control exercises (MCE) may help to address both central and nociceptive factors contributing to the persistence of LBP. The primary aim of this randomised controlled trial is to compare the effectiveness of a combination of rTMS and MCE to repeated rTMS sessions alone, sham rTMS and a combination of sham rTMS and MCE on pain intensity. METHODS AND ANALYSIS One hundred and forty participants (35/group) with CLBP will be randomised into four groups (active rTMS+MCE, sham rTMS+MCE, active rTMS and sham rTMS) to receive 10 sessions of their allocated intervention. The primary outcome will be the pain intensity, assessed at baseline, 4, 8, 12 and 24 weeks. Secondary outcomes will include disability, fear of movement, quality of life and patient global rating of change. ETHICS AND DISSEMINATION Ethics approval was obtained from the Comité d'éthique de la recherche sectoriel en réadaptation et intégration sociale, CIUSS de la Capitale Nationale in June 2019 (#2020-1844 - CER CIUSSS-CN). The results of the study will be submitted to a peer-reviewed journal and scientific meetings. TRIAL REGISTRATION NUMBER NCT04555278.
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Affiliation(s)
- Philippe Patricio
- Faculté de médecine, Université Laval, Quebec, Quebec, Canada
- CIRRIS, Quebec, Quebec, Canada
| | - Jean-Sébastien Roy
- CIRRIS, Quebec, Quebec, Canada
- Département de réadaptation, Faculté de médecine, Université Laval, Quebec, Quebec, Canada
| | - Luciana Macedo
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Mathieu Roy
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | | | - Paul Hodges
- The University of Queensland, Brisbane, Queensland, Australia
| | - Hugo Massé-Alarie
- Faculté de médecine, Université Laval, Quebec, Quebec, Canada
- CIRRIS, Quebec, Quebec, Canada
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Benz T, Lehmann S, Elfering A, Sandor PS, Angst F. Comprehensiveness and validity of a multidimensional assessment in patients with chronic low back pain: a prospective cohort study. BMC Musculoskelet Disord 2021; 22:291. [PMID: 33743669 PMCID: PMC7981999 DOI: 10.1186/s12891-021-04130-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 03/02/2021] [Indexed: 12/19/2022] Open
Abstract
Background Chronic low back pain is a multidimensional syndrome affecting physical activity and function, health-related quality of life and employment status. The aim of the study was to quantify the cross-sectional and longitudinal validity of single measurement scales in specific construct domains and to examine how they combine to build a comprehensive outcome, covering the complex construct of chronic low back pain before and after a standardized interdisciplinary pain program. Methods This prospective cohort study assessed 177 patients using the Short Form 36 (SF-36), the Multidimensional Pain Inventory (MPI), the Symptom Checklist-90-Revised (SCL-90-R), the Oswestry Disability Index (ODI), and 2 functional performance tests, the Back Performance Scale (BPS) and the 6-Minute Walking Distance (6MWD). The comprehensiveness and overlap of the constructs used were quantified cross-sectionally and longitudinally by bivariate correlations, exploratory factor analysis, and effect sizes. Results The mean age of the participants was 48.0 years (+/− 12.7); 59.3% were female. Correlations of baseline scores ranged from r = − 0.01 (BPS with MPI Life control) to r = 0.76 (SF-36 Mental health with MPI Negative mood). SF-36 Physical functioning correlated highest with the functional performance tests (r = 0.58 BPS, 0.67 6MWD) and ODI (0.56). Correlations of change scores (difference of follow-up – baseline score) were consistent but weaker. Factor analysis revealed 2 factors: “psychosocial” and “pain & function” (totally explained variance 44.0–60.9%). Psychosocial factors loaded strongest (up to 0.89 SCL-90-R) on the first factor, covering 2/3 of the explained variance. Pain and function (ing) loaded more strongly on the second factor (up to 0.81 SF-36 Physical functioning at follow-up). All scales showed improvements, with effect sizes ranging from 0.16–0.67. Conclusions Our results confirm previous findings that the chronic low back pain syndrome is highly multifactorial and comprises many more dimensions of health and quality of life than merely back-related functioning. A comprehensive outcome measurement should include the predominant psychosocial domain and a broad spectrum of measurement constructs in order to assess the full complexity of the chronic low back syndrome. Convergence and divergence of the scales capture the overlapping contents and nuances within the constructs.
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Affiliation(s)
- Thomas Benz
- Research Department, Rehaklinik Bad Zurzach, Zurzach Care Group, Quellenstrasse 34, Bad Zurzach, Switzerland. .,Institute of Psychology, University of Bern, Fabrikstrasse 8, Bern, Switzerland. .,Graduate School for Health Sciences, University of Bern, Bern, Switzerland. .,Institute of Physiotherapy, School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland.
| | - Susanne Lehmann
- Research Department, Rehaklinik Bad Zurzach, Zurzach Care Group, Quellenstrasse 34, Bad Zurzach, Switzerland
| | - Achim Elfering
- Institute of Psychology, University of Bern, Fabrikstrasse 8, Bern, Switzerland
| | - Peter S Sandor
- Research Department, Rehaklinik Bad Zurzach, Zurzach Care Group, Quellenstrasse 34, Bad Zurzach, Switzerland
| | - Felix Angst
- Research Department, Rehaklinik Bad Zurzach, Zurzach Care Group, Quellenstrasse 34, Bad Zurzach, Switzerland
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Raymer M, Mitchell L, Window P, Cottrell M, Comans T, O’Leary S. Disparities in Service and Clinical Outcomes in State-Wide Advanced Practice Physiotherapist-Led Services. Healthcare (Basel) 2021; 9:healthcare9030278. [PMID: 33802624 PMCID: PMC7999298 DOI: 10.3390/healthcare9030278] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 01/12/2023] Open
Abstract
This study explored variations in the primary service and clinical outcomes of a state-wide advanced practice physiotherapist-led service embedded in public medical specialist orthopaedic and neurosurgical outpatient services across Queensland, Australia. An audit of the service database over a six-year period was taken from 18 service facilities. The primary service and clinical outcomes were described. Variations in these outcomes between facilities were explored with a regression analysis adjusting for known patient- and service-related characteristics. The findings showed substantial positive impacts of the advanced practice model across all facilities, with 69.4% of patients discharged without a need for medical specialist review (primary service outcome), consistent with 68.9% of patients reporting clinically important improvements in their condition (primary clinical outcome). However, 15 facilities significantly varied from the state average for the primary service outcome (despite only three facilities varying in the primary clinical outcome). While this disparity in the primary service outcomes appears to be influenced by potentially modifiable differences in the service-related processes between facilities, these process differences only explained part of the variation. This study described the subsequent development of a new, more comprehensive set of service evaluation metrics to better inform future service planning.
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Affiliation(s)
- Maree Raymer
- Department of Physiotherapy, Metro North Hospital Health Service, Royal Brisbane and Women’s Hospital, Brisbane, QLD 4029, Australia; (M.R.); (P.W.); (M.C.); (S.O.)
| | - Louise Mitchell
- Department of Health Queensland, Epidemiology and Research, Aboriginal and Torres Strait Islander Health Division, Brisbane, QLD 4001, Australia;
| | - Peter Window
- Department of Physiotherapy, Metro North Hospital Health Service, Royal Brisbane and Women’s Hospital, Brisbane, QLD 4029, Australia; (M.R.); (P.W.); (M.C.); (S.O.)
| | - Michelle Cottrell
- Department of Physiotherapy, Metro North Hospital Health Service, Royal Brisbane and Women’s Hospital, Brisbane, QLD 4029, Australia; (M.R.); (P.W.); (M.C.); (S.O.)
| | - Tracy Comans
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4106, Australia
- Correspondence: ; Tel.: +61-7-334-65-345
| | - Shaun O’Leary
- Department of Physiotherapy, Metro North Hospital Health Service, Royal Brisbane and Women’s Hospital, Brisbane, QLD 4029, Australia; (M.R.); (P.W.); (M.C.); (S.O.)
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD 4072, Australia
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Patel N, Calodney A, Kapural L, Province‐Azalde R, Lad SP, Pilitsis J, Wu C, Cherry T, Subbaroyan J, Gliner B, Caraway D. High-Frequency Spinal Cord Stimulation at 10 kHz for the Treatment of Nonsurgical Refractory Back Pain: Design of a Pragmatic, Multicenter, Randomized Controlled Trial. Pain Pract 2021; 21:171-183. [PMID: 33463027 PMCID: PMC7891432 DOI: 10.1111/papr.12945] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/04/2020] [Accepted: 08/07/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Spinal cord stimulation (SCS) has been shown to provide pain relief for chronic back and leg pain due to failed back surgery syndrome. But many patients with chronic back pain have not had major back surgery or are not good candidates for surgery, and conventional medical management (CMM) provides limited relief. We have termed this condition nonsurgical refractory back pain (NSRBP). Level 1 evidence does not yet exist showing the therapeutic benefit of SCS for NSRBP. OBJECTIVE To compare 10-kHz SCS plus CMM (10-kHz SCS + CMM) to CMM alone for treatment of NSRBP in terms of clinical and cost effectiveness. STUDY DESIGN Multicenter, randomized controlled trial (RCT), with subjects randomized 1:1 to either 10-kHz SCS + CMM or CMM alone. Optional crossover occurs at 6 months if treatment does not achieve ≥50% pain relief. METHODS Patients with NSRBP as defined above may be enrolled if they are ineligible for surgery based on surgical consultation. Subjects randomized to 10-kHz SCS + CMM will receive a permanent implant if sufficient pain relief is achieved in a temporary trial. Both groups will receive CMM per standard of care and will undergo assessments at baseline and at follow-ups to 12 months. Self-report outcomes include pain, disability, sleep, mental health, satisfaction, healthcare utilization, and quality of life. RESULTS Enrollment was initiated on September 10, 2018. Prespecified independent interim analysis at 40% of the enrollment target indicated the sample size was sufficient to show superiority of treatment at the primary endpoint; therefore, enrollment was stopped at 211. CONCLUSIONS This large multicenter RCT will provide valuable evidence to guide clinical decisions in NSRBP.
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Affiliation(s)
| | | | - Leonardo Kapural
- Carolina’s Pain InstituteWinston‐SalemNorth CarolinaU.S.A.
- School of MedicineWake Forest UniversityWinston‐SalemNorth CarolinaU.S.A.
| | | | | | | | - Chengyuan Wu
- Thomas Jefferson UniversityPhiladelphiaPennsylvaniaU.S.A.
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A prognostic model for failure and worsening after lumbar microdiscectomy: a multicenter study from the Norwegian Registry for Spine Surgery. Acta Neurochir (Wien) 2021; 163:2567-2580. [PMID: 34245366 PMCID: PMC8357664 DOI: 10.1007/s00701-021-04859-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 04/19/2021] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To develop a prognostic model for failure and worsening 1 year after surgery for lumbar disc herniation. METHODS This multicenter cohort study included 11,081 patients operated with lumbar microdiscectomy, registered at the Norwegian Registry for Spine Surgery. Follow-up was 1 year. Uni- and multivariate logistic regression analyses were used to assess potential prognostic factors for previously defined cut-offs for failure and worsening on the Oswestry Disability Index scores 12 months after surgery. Since the cut-offs for failure and worsening are different for patients with low, moderate, and high baseline ODI scores, the multivariate analyses were run separately for these subgroups. Data were split into a training (70%) and a validation set (30%). The model was developed in the training set and tested in the validation set. A prediction (%) of an outcome was calculated for each patient in a risk matrix. RESULTS The prognostic model produced six risk matrices based on three baseline ODI ranges (low, medium, and high) and two outcomes (failure and worsening), each containing 7 to 11 prognostic factors. Model discrimination and calibration were acceptable. The estimated preoperative probabilities ranged from 3 to 94% for failure and from 1 to 72% for worsening in our validation cohort. CONCLUSION We developed a prognostic model for failure and worsening 12 months after surgery for lumbar disc herniation. The model showed acceptable calibration and discrimination, and could be useful in assisting physicians and patients in clinical decision-making process prior to surgery.
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Hartmann C, Fischer K, Haneke H, Kirchberger V. Patient-reported outcomes in spinal surgery-how can we keep getting better? JOURNAL OF SPINE SURGERY 2020; 6:820-824. [PMID: 33447688 DOI: 10.21037/jss-20-582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Claudia Hartmann
- Department Value-Based Health Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Kathrin Fischer
- Department Value-Based Health Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Hannah Haneke
- Department Value-Based Health Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Valerie Kirchberger
- Department Value-Based Health Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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Wei FL, Zhou CP, Liu R, Zhu KL, Du MR, Gao HR, Wu SD, Sun LL, Yan XD, Liu Y, Qian JX. Management for lumbar spinal stenosis: A network meta-analysis and systematic review. Int J Surg 2020; 85:19-28. [PMID: 33253898 DOI: 10.1016/j.ijsu.2020.11.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Conventional paired meta-analyses have shown inconsistent results regarding the safety and efficacy of different interventions. OBJECTIVE To perform a network meta-analysis (NMA) and systematic review based on randomized controlled trials (RCTs) evaluating the efficacies of different interventions for lumbar spinal stenosis (LSS). METHODS We searched PubMed, Embase, Cochrane Library, Web of Science, and major scientific websites from inception to October 10, 2019, for randomized controlled trials comparing the nine most commonly used interventions for LSS. The main outcomes were disability and pain intensity. The PROSPERO number was CRD42020154247. RESULTS First, laminotomy was better in improving patients' short- and long-term dysfunction (probability 49% and 25%, respectively). Second, decompression, decompression plus fusion, endoscopic decompression, interspinous process spacer device implantation, laminectomy, laminotomy and minimally invasive decompression were significantly more efficacious in relieving pain than non-surgical interventions (mean difference in the short-term -21.82, -22.00, -16.68, -17.47, -17.75, -17.61 and -18.86; in the long-term -37.14, -34.04, -34.07, -39.79, -36.14, -32.75 and -39.14, respectively). Third, endoscopic decompression had a lower complication rate (probability 51%). In addition, laminotomy had a lower reoperation rate (probability 45%). Fourth, decompression plus fusion resulted in more blood loss than any other surgical intervention (probability 96%). Finally, endoscopic decompression had the shortest hospitalization time (probability 96%). CONCLUSIONS There were no significant differences among the different interventions in improving patient function. Surgical interventions were associated with better pain relief but a higher incidence of complications. Decompression plus fusion is not necessary for patients. In addition, endoscopic decompression as a novel and less invasive surgical approach may be a good choice for LSS patients.
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Affiliation(s)
- Fei-Long Wei
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, 710038, Xi'an, China
| | - Cheng-Pei Zhou
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, 710038, Xi'an, China
| | - Rui Liu
- Department of Rehabilitation, Tangdu Hospital, Fourth Military Medical University, 710038, Xi'an, China
| | - Kai-Long Zhu
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, 710038, Xi'an, China
| | - Ming-Rui Du
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, 710038, Xi'an, China
| | - Hao-Ran Gao
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, 710038, Xi'an, China
| | - Sheng-Da Wu
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, 710038, Xi'an, China
| | - Li-Li Sun
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, China
| | - Xiao-Dong Yan
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, 710038, Xi'an, China.
| | - Ya Liu
- Department of Outpatient, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, China.
| | - Ji-Xian Qian
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, 710038, Xi'an, China.
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Ho E, Ferreira M, Chen L, Simic M, Ashton-James C, Comachio J, Hayden J, Ferreira P. Psychological interventions for chronic non-specific low back pain: protocol of a systematic review with network meta-analysis. BMJ Open 2020; 10:e034996. [PMID: 32948543 PMCID: PMC7500308 DOI: 10.1136/bmjopen-2019-034996] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 06/12/2020] [Accepted: 08/07/2020] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Psychological factors such as fear avoidance beliefs, depression, anxiety, catastrophic thinking and familial and social stress, have been associated with high disability levels in people with chronic low back pain (LBP). Guidelines endorse the integration of psychological interventions in the management of chronic LBP. However, uncertainty surrounds the comparative effectiveness of different psychological approaches. Network meta-analysis (NMA) allows comparison and ranking of numerous competing interventions for a given outcome of interest. Therefore, we will perform a systematic review with a NMA to determine which type of psychological intervention is most effective for adults with chronic non-specific LBP. METHODS AND ANALYSIS We will search electronic databases (MEDLINE, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, SCOPUS and CINAHL) from inception until 22 August 2019 for randomised controlled trials comparing psychological interventions to any comparison interventions in adults with chronic non-specific LBP. There will be no restriction on language. The primary outcomes will include physical function and pain intensity, and secondary outcomes will include health-related quality of life, fear avoidance, intervention compliance and safety. Risk of bias will be assessed using the Revised Cochrane risk-of-bias tool for randomised trials (RoB 2) tool and confidence in the evidence will be assessed using the Confidence in NMA (CINeMA) framework. We will conduct a random-effects NMA using a frequentist approach to estimate relative effects for all comparisons between treatments and rank treatments according to the mean rank and surface under the cumulative ranking curve values. All analyses will be performed in Stata. ETHICS AND DISSEMINATION No ethical approval is required. The research will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42019138074.
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Affiliation(s)
- Emma Ho
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Manuela Ferreira
- Institute of Bone and Joint Research, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Lingxiao Chen
- Institute of Bone and Joint Research, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Milena Simic
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Claire Ashton-James
- Pain Management Research Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Josielli Comachio
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Speech, Physical Therapy and Occupational Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, São Paulo, Brazil
| | - Jill Hayden
- Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Paulo Ferreira
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Michalk K, Schöttker-Königer T, Probst A, Lüdtke K. Entwicklung eines Konsenses zu wichtigen Zielgrößen in der Physiotherapie bei Nackenschmerzen – Eine Delphi-Studie. PHYSIOSCIENCE 2020. [DOI: 10.1055/a-1110-2096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Zusammenfassung
Hintergrund Nackenschmerzen sind in der Physiotherapie ein häufiger Behandlungsanlass. Die Messung von Behandlungsergebnissen findet im Praxisalltag oftmals nur unzureichend statt. Ein Core Outcome Set (COS) für die physiotherapeutische Praxis fehlt derzeit.
Ziel Einen Konsens zu wichtigen Zielgrößen zu entwickeln, die in der physiotherapeutischen Praxis für die Messung der Behandlungsergebnisse bei Patienten mit unspezifischen Nackenschmerzen verwendet werden sollten.
Methode Zur Identifizierung von Zielgrößen wurde zunächst eine systematische Recherche durchgeführt. Anschließend fand eine Delphi-Befragung von Physiotherapeuten und Patienten statt, bei der die Teilnehmenden die Wichtigkeit der Zielgrößen anhand einer 9-Punkte-Ratingskala beurteilten. Es wurden Lage- und Streuungsmaße für jede Zielgröße berechnet.
Ergebnisse Es nahmen 62 Physiotherapeuten und neun Patienten an der ersten Fragerunde teil. Weitere Fragerunden mit den Patienten wurden aufgrund der geringen Teilnehmerzahl eingestellt. Die Patienten erachten das „Bewegungsausmaß der Halswirbelsäule in verschiedene Bewegungsrichtungen“ sowie die „gesundheitsbezogene Lebensqualität“ als wichtige Zielgrößen. 50 (81 %) bzw. 37 (74 %) Physiotherapeuten beendeten die zweite bzw. dritte Fragerunde. Für sie sind wichtige Zielgrößen „Beschwerden und Probleme bei alltäglichen Aktivitäten durch die Nackenschmerzen“ und die „Fähigkeit zum selbstverantwortlichen Umgang mit den Nackenschmerzen“.
Schlussfolgerung Es wurde ein erster Konsens zu wichtigen Zielgrößen aus Sicht der Physiotherapeuten erreicht. In Zukunft sind aufbauende Studien für die Entwicklung eines COS erforderlich, um u. a. die benannten Zielgrößen zu bestätigen und die Sicht der Patienten mit einzubeziehen.
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Affiliation(s)
- Katrin Michalk
- HAWK Hochschule für angewandte Wissenschaft und Kunst, Fakultät Soziale Arbeit und Gesundheit, Bachelor- und Masterstudiengang Ergotherapie, Logopädie und Physiotherapie, Hildesheim, Deutschland
- Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Fakultät Angewandte Sozial- und Gesundheitswissenschaften, Fachbereich Physiotherapie Regensburg, Deutschland
| | - Thomas Schöttker-Königer
- HAWK Hochschule für angewandte Wissenschaft und Kunst, Fakultät Soziale Arbeit und Gesundheit, Bachelor- und Masterstudiengang Ergotherapie, Logopädie und Physiotherapie, Hildesheim, Deutschland
| | - Annette Probst
- HAWK Hochschule für angewandte Wissenschaft und Kunst, Fakultät Soziale Arbeit und Gesundheit, Bachelor- und Masterstudiengang Ergotherapie, Logopädie und Physiotherapie, Hildesheim, Deutschland
| | - Kerstin Lüdtke
- Universität zu Lübeck, Bachelorstudiengang Physiotherapie, Lübeck, Deutschland
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Psychometric Validation of the Danish Version of the Oswestry Disability Index in Patients With Chronic Low Back Pain. Spine (Phila Pa 1976) 2020; 45:1143-1150. [PMID: 32205707 DOI: 10.1097/brs.0000000000003486] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Registry-based repeated-measures psychometric validation of the Danish Oswestry Disability Index (ODI). OBJECTIVE The goal was to use classical and modern psychometric validation methods to assess the measurement properties and the minimally clinical important difference (MCID) of the ODI in a Danish cohort of patients with chronic low back pain being treated with spinal surgery. SUMMARY OF BACKGROUND DATA Scores for the ODI, EQ-5D, SF-36, leg pain, back pain, and a general rating of pain item from 800 patients with chronic low back pain were extracted from the National Danish Spine Registry (DaneSpine) at baseline and 1-year postspine surgery. METHODS Confirmatory factor analysis and item response theory (IRT) models were used to assess the psychometric properties of the ODI. MCID was also calculated based on generic legacy PROMs (EQ-5D and SF-36) and follow-up pain scores. RESULTS While ODI did not fit a Rasch model, adequate fit to a confirmatory factor analysis and a two-parameter item response theory model was found when accounting for differential item functioning across diagnostic subgroups (degenerative spondylolisthesis, spondylosis, spinal stenosis, and herniated intervertebral disc). In addition, each group exhibited substantially different MCID values. CONCLUSION The Danish version of the ODI is valid and responsive, but only within each of the four major diagnosis subgroups: degenerative spondylolisthesis, spondylosis, spinal stenosis, and herniated intervertebral disc. LEVEL OF EVIDENCE 4.
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