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Lüssi MR, Fischer G, Bertulli L, Stienen MN, Stengel FC. Reliability of self-measured objective functional impairment using the timed up and go test in patients with diseases of the spine. Acta Neurochir (Wien) 2024; 166:391. [PMID: 39356349 DOI: 10.1007/s00701-024-06293-7] [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: 07/04/2024] [Accepted: 09/28/2024] [Indexed: 10/03/2024]
Abstract
BACKGROUND Accurate assessment of a patient's functional status is crucial for determining the need for treatment and evaluating outcomes. Objective functional impairment (OFI) measures, alongside patient-reported outcome measures (PROMs), have been proposed for spine diseases. The Timed-Up and Go (TUG) test, typically administered by healthcare professionals, is a well-studied OFI measure. This study investigates whether patient self-measurement of TUG is similarly reliable. METHODS In a prospective, observational study, patients with spinal diseases underwent two TUG assessments: one measured by a healthcare professional and one self-measured by the patient. Interrater reliability was assessed using the intraclass correlation coefficient (ICC) with a two-way random-effects model, considered excellent between 0.75 - 1.00. Paired t-tests directly compared both measurements. The impact of variables such as age, sex, disease type, symptom severity (via PROMs), comorbidities, and frailty on reliability was also analysed. RESULTS Seventy-four patients were included, with a mean age of 62.9 years (SD 17.8); 29 (39.2%) were female. The majority (64.9%) were treated for degenerative disc disease. The lumbo-sacral region was most affected (71.6%), and 47.3% had previous surgeries. Patient self-measurement reliability was excellent (ICC 0.8740, p < 0.001), and the difference between healthcare professional (19.3 ± 9.4 s) and patient measurements (18.4 ± 9.7 s) was insignificant (p = 0.116). Interrater reliability remained high in patients > 65 years (ICC 0.8584, p < 0.001), patients with ASA grades 3&4 (ICC 0.7066, p < 0.001), patients considered frail (ICC 0.8799, p < 0.001), and in patients not using any walking aid (ICC 0.8012, p < 0.001). High symptom severity still showed strong reliability (ICC 0.8279, p < 0.001 for Oswestry Disability Index > 40; ICC 0.8607, p = 0.011 for Neck Disability Index > 40). CONCLUSIONS Patients with spine diseases can reliably self-measure OFI using the TUG test. The interrater reliability between self-measurements and those by healthcare professionals was excellent across all conditions. These findings could optimize patient assessments, especially in resource-limited settings.
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Affiliation(s)
- Melvyn R Lüssi
- Department of Neurosurgery & Spine Center of Eastern Switzerland, Kantonsspital St.Gallen & Medical School of St.Gallen, Rorschacher Str. 95, CH-9007, St.Gallen, Switzerland
| | - Gregor Fischer
- Department of Neurosurgery & Spine Center of Eastern Switzerland, Kantonsspital St.Gallen & Medical School of St.Gallen, Rorschacher Str. 95, CH-9007, St.Gallen, Switzerland
| | - Lorenzo Bertulli
- Department of Neurosurgery & Spine Center of Eastern Switzerland, Kantonsspital St.Gallen & Medical School of St.Gallen, Rorschacher Str. 95, CH-9007, St.Gallen, Switzerland
| | - Martin N Stienen
- Department of Neurosurgery & Spine Center of Eastern Switzerland, Kantonsspital St.Gallen & Medical School of St.Gallen, Rorschacher Str. 95, CH-9007, St.Gallen, Switzerland.
| | - Felix C Stengel
- Department of Neurosurgery & Spine Center of Eastern Switzerland, Kantonsspital St.Gallen & Medical School of St.Gallen, Rorschacher Str. 95, CH-9007, St.Gallen, Switzerland
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Reyes JL, Coury JR, Dionne A, Miller R, Katiyar P, Smul A, Bakarania P, Lombardi JM, Sardar ZM. Preoperative rehabilitation optimization for spinal surgery: a narrative review of assessment, interventions, and feasibility. Spine Deform 2024; 12:1261-1267. [PMID: 38789728 DOI: 10.1007/s43390-024-00893-0] [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: 02/21/2024] [Accepted: 05/01/2024] [Indexed: 05/26/2024]
Abstract
PURPOSE Postoperative physical therapy (PT) is a cornerstone of orthopedic and musculoskeletal rehabilitation, proven to provide various positive clinical benefits. However, there is a paucity of literature evaluating the utility of preoperative rehabilitation specific to spine surgery. Thus, this review article aims to provide an overview of previously published studies discussing the efficacy of preoperative rehabilitation programs and its role in spinal surgery. Special emphasis was given to preoperative frailty assessments, physical performance tests, interventional strategies, feasibility, and future directions. METHODS We performed a literature review using PubMed, Google Scholar, EMBASE, and PubMed Central (PMC) using directed search terms. Articles that examined preoperative rehabilitation in adult spine surgery were compiled for this review. Prehabilitation programs focused on exercise, flexibility, and behavioral modifications have been shown to significantly improve pain levels and functional strength assessments in patients undergoing elective spine surgery. In addition, studies suggest that these programs may also decrease hospital stays, return to work time, and overall direct health care expenditure costs. Screening tools such as the FRAIL scale can be used to assess frailty while physical function tests like the timed-up-and go (TUGT), 5 repetition sit-to-stand test (5R-STST), and hand grip strength (HGS) can help identify patients who would most benefit from prehabilitation. CONCLUSIONS This review illustrates that prehabilitation programs have the potential to increase quality of life, improve physical function and activity levels, and decrease pain, hospital stays, return to work time, and overall direct costs. However, there is a paucity of literature in this field that requires further study and investigation.
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Affiliation(s)
- Justin L Reyes
- The Och Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, 5141 Broadway, 3 Field West, New York, NY, 10034, USA
| | - Josephine R Coury
- The Och Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, 5141 Broadway, 3 Field West, New York, NY, 10034, USA
| | - Alexandra Dionne
- The Och Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, 5141 Broadway, 3 Field West, New York, NY, 10034, USA
| | - Roy Miller
- The Och Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, 5141 Broadway, 3 Field West, New York, NY, 10034, USA
| | - Prerana Katiyar
- The Och Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, 5141 Broadway, 3 Field West, New York, NY, 10034, USA
| | - Abigail Smul
- Conservative Care for Spine and Scoliosis/ Columbia University Irving Medical Center, New York, NY, USA
| | - Prachi Bakarania
- Conservative Care for Spine and Scoliosis/ Columbia University Irving Medical Center, New York, NY, USA
| | - Joseph M Lombardi
- The Och Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, 5141 Broadway, 3 Field West, New York, NY, 10034, USA
| | - Zeeshan M Sardar
- The Och Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, 5141 Broadway, 3 Field West, New York, NY, 10034, USA
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Staartjes VE, Klukowska AM, Stumpo V, Vandertop WP, Schröder ML. Identifying clusters of objective functional impairment in patients with degenerative lumbar spinal disease using unsupervised learning. 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; 33:1320-1331. [PMID: 38127138 DOI: 10.1007/s00586-023-08070-z] [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: 04/30/2023] [Revised: 10/22/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES The five-repetition sit-to-stand (5R-STS) test was designed to capture objective functional impairment (OFI), and thus provides an adjunctive dimension in patient assessment. It is conceivable that there are different subsets of patients with OFI and degenerative lumbar disease. We aim to identify clusters of objectively functionally impaired individuals based on 5R-STS and unsupervised machine learning (ML). METHODS Data from two prospective cohort studies on patients with surgery for degenerative lumbar disease and 5R-STS times of ≥ 10.5 s-indicating presence of OFI. K-means clustering-an unsupervised ML algorithm-was applied to identify clusters of OFI. Cluster hallmarks were then identified using descriptive and inferential statistical analyses. RESULTS We included 173 patients (mean age [standard deviation]: 46.7 [12.7] years, 45% male) and identified three types of OFI. OFI Type 1 (57 pts., 32.9%), Type 2 (81 pts., 46.8%), and Type 3 (35 pts., 20.2%) exhibited mean 5R-STS test times of 14.0 (3.2), 14.5 (3.3), and 27.1 (4.4) seconds, respectively. The grades of OFI according to the validated baseline severity stratification of the 5R-STS increased significantly with each OFI type, as did extreme anxiety and depression symptoms, issues with mobility and daily activities. Types 1 and 2 are characterized by mild to moderate OFI-with female gender, lower body mass index, and less smokers as Type I hallmarks. CONCLUSIONS Unsupervised learning techniques identified three distinct clusters of patients with OFI that may represent a more holistic clinical classification of patients with OFI than test-time stratifications alone, by accounting for individual patient characteristics.
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Affiliation(s)
- Victor E Staartjes
- Machine Intelligence in Clinical Neuroscience (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
- Amsterdam UMC, Vrije Universiteit Amsterdam, Neurosurgery, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
- Department of Neurosurgery, Bergman Clinics, Amsterdam, The Netherlands.
| | - Anita M Klukowska
- Amsterdam UMC, Vrije Universiteit Amsterdam, Neurosurgery, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Department of Neurosurgery, Bergman Clinics, Amsterdam, The Netherlands
- Department of Surgery, Royal Derby Hospital, Derby, UK
| | - Vittorio Stumpo
- Machine Intelligence in Clinical Neuroscience (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - W Peter Vandertop
- Amsterdam UMC, Vrije Universiteit Amsterdam, Neurosurgery, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Marc L Schröder
- Department of Neurosurgery, Bergman Clinics, Amsterdam, The Netherlands
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Sahebalam M, ShahAli S, Komlakh K, Shanbehzadeh S. The association between disability and physical performance, pain intensity, and pain-related anxiety in patients after lumbar decompression surgery: a cross-sectional study. J Orthop Surg Res 2023; 18:961. [PMID: 38093340 PMCID: PMC10717370 DOI: 10.1186/s13018-023-04462-5] [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: 11/10/2023] [Accepted: 12/10/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Most patients with lumbar spinal stenosis improve significantly within 6 months of lumbar decompression surgery, however, unfavorable long-term disability may persist in some patients. It was unclear which potential influencing factors were more likely to be associated with disability. This study aimed to assess the association between disability and physical performance, pain, and pain-related anxiety in patients after lumbar decompression surgery. METHODS Patients who underwent decompression for lumbar spinal stenosis were included. Participants completed the visual analog scale, Oswestry Disability Index, and Pain Anxiety Symptoms Scale-20 to collect pain intensity, disability, and pain-related anxiety information. For physical performance assessment, participants performed timed up and go (TUG), functional reach test (FRT), 6-min walking test, and modified Sorensen test, 6-12 months after lumbar decompression surgery. The associations were examined with bivariate and multivariable linear regression analyses. RESULTS A total of 80 patients were included. A significant association between disability and pain-related anxiety, the FRT, and the modified Sorensen test scores was confirmed in multivariable analyses. Both bivariate (r = - 0.75) and multivariable (β = 0.60, 95% CI, 0.24, 0.54; P = 0.00) analyses confirmed that pain-related anxiety was the strongest indicator of disability. The association between disability and pain intensity, TUG, and 6-min walking test scores was not confirmed. CONCLUSION Pain-related anxiety should be considered in the rehabilitation programs after lumbar decompression surgery. The evaluation of all aspects of physical performance following lumbar decompression surgery is also recommended.
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Affiliation(s)
- Mohamad Sahebalam
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Shabnam ShahAli
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Khalil Komlakh
- Imam Hossein Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sanaz Shanbehzadeh
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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Tominaga H, Tokumoto H, Maeda S, Kawamura I, Sanada M, Kawazoe K, Taketomi E, Taniguchi N. High prevalence of lumbar spinal stenosis in cases of idiopathic normal-pressure hydrocephalus affects improvements in gait disturbance after shunt operation. World Neurosurg X 2023; 20:100236. [PMID: 37435396 PMCID: PMC10331591 DOI: 10.1016/j.wnsx.2023.100236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 05/24/2023] [Accepted: 06/12/2023] [Indexed: 07/13/2023] Open
Abstract
Objective Idiopathic normal-pressure hydrocephalus (iNPH) is characterized by symptoms of dementia, urinary incontinence, and gait disturbance; however, gait disturbance tends to persist after shunt surgery. Gait disturbance and urinary dysfunction are also major symptoms of lumbar spinal stenosis (LSS). Currently, the epidemiology of the complications of LSS in iNPH is unclear. Here, we evaluated the coexistence rate of LSS in iNPH cases. Methods This was a retrospective case-control study. Between 2011 and 2017, 224 patients with a median age of 78 years, including 119 males, were diagnosed with iNPH and underwent lumboperitoneal shunts or ventriculoperitoneal shunts. LSS was diagnosed with magnetic resonance imaging by two spine surgeons. Age, sex, body mass index (BMI), Timed Up and Go (TUG) test, Mini Mental State Examination (MMSE) score, and urinary dysfunction were examined. We compared the changes in these variables in the group of patients with iNPH without LSS versus those with both iNPH and LSS. Results Seventy-three iNPH patients (32.6%) with LSS had significantly higher age and BMI. The existence of LSS did not alter the postoperative improvement rates of MMSE and urinary dysfunction; however, TUG improvement was significantly impaired in the LSS-positive group. Conclusions LSS affects improvements in gait disturbance of iNPH patients after shunt operation. Because our results revealed that one-third of iNPH patients were associated with LSS, gait disturbance observed in iNPH patients should be considered a potential complication of LSS.
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Affiliation(s)
- Hiroyuki Tominaga
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Hiroto Tokumoto
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Shingo Maeda
- Department of Bone and Joint Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Ichiro Kawamura
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Masato Sanada
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Kazumasa Kawazoe
- Department of Neurosurgery, Japanese Red Cross Kagoshima Hospital, 2545 Hirakawa, Kagoshima, 891-0133, Japan
| | - Eiji Taketomi
- Department of Orthopaedic Surgery, Japanese Red Cross Kagoshima Hospital, 2545 Hirakawa, Kagoshima, 891-0133, Japan
| | - Noboru Taniguchi
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
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Otsubo R, Hashida R, Murotani K, Iwanaga S, Hirota K, Koya S, Tsukada Y, Ogata Y, Yokosuka K, Yoshida T, Nakae I, Fudo T, Morito S, Shimazaki T, Yamada K, Sato K, Matsuse H, Shiba N, Hiraoka K. Phase angle is related to physical function and quality of life in preoperative patients with lumbar spinal stenosis. Sci Rep 2023; 13:13909. [PMID: 37626144 PMCID: PMC10457364 DOI: 10.1038/s41598-023-40629-0] [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: 12/06/2022] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
Lumbar spinal stenosis (LSS) can interfere with daily life and quality of life (QOL). Evaluating physical function and QOL and helping patients to improve is the focus of rehabilitation. Phase angle (PhA) assessment is widely used to measure body composition and is considered an indicator of physical function and QOL. This study investigated the relationship between PhA and physical function, physical activity, and QOL in patients with LSS. PhA, handgrip strength, walking speed, Timed Up and Go test (TUG), Life Space Assessment (LSA), Prognostic Nutritional Index (PNI), Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), and EQ-5D were assessed and statistically analyzed. The study included 133 patients with LSS. Multiple regression analysis of PhA adjusted for age, sex, and body mass index (Model 1) and for Model 1 + PNI (Model 2) showed significant correlations (P < 0.05) with handgrip strength, walking speed, TUG, and LSA. Regarding QOL, PhA was significantly correlated (P < 0.05) with lumbar function in JOABPEQ. PhA was associated with physical function and QOL in patients with LSS and might be a new clinical indicator in this population.
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Affiliation(s)
- Ryota Otsubo
- Division of Rehabilitation, Kurume University Hospital, 67 Asahi-machi, Kurume, Fukuoka, Japan, 830-0011
| | - Ryuki Hashida
- Division of Rehabilitation, Kurume University Hospital, 67 Asahi-machi, Kurume, Fukuoka, Japan, 830-0011.
- Department of Orthopaedics, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, Japan.
| | - Kenta Murotani
- Biostatistics Center, Kurume University, 67 Asahi-machi, Kurume, Fukuoka, Japan
| | - Sohei Iwanaga
- Division of Rehabilitation, Kurume University Hospital, 67 Asahi-machi, Kurume, Fukuoka, Japan, 830-0011
- Department of Orthopaedics, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, Japan
| | - Keisuke Hirota
- Division of Rehabilitation, Kurume University Hospital, 67 Asahi-machi, Kurume, Fukuoka, Japan, 830-0011
| | - Shunji Koya
- Division of Rehabilitation, Kurume University Hospital, 67 Asahi-machi, Kurume, Fukuoka, Japan, 830-0011
| | - Yuya Tsukada
- Institute of Health and Sports Sciences, Kurume University, Kurume, Japan
| | - Yuta Ogata
- Division of Rehabilitation, Kurume University Medical Center, Kurume, Japan
| | - Kimiaki Yokosuka
- Department of Orthopaedics, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, Japan
| | - Tatsuhiro Yoshida
- Department of Orthopaedics, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, Japan
| | - Ichiro Nakae
- Department of Orthopaedics, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, Japan
| | - Takuma Fudo
- Department of Orthopaedics, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, Japan
| | - Shinji Morito
- Department of Orthopaedics, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, Japan
| | - Takahiro Shimazaki
- Department of Orthopaedics, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, Japan
| | - Kei Yamada
- Department of Orthopaedics, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, Japan
| | - Kimiaki Sato
- Department of Orthopaedics, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, Japan
| | - Hiroo Matsuse
- Division of Rehabilitation, Kurume University Hospital, 67 Asahi-machi, Kurume, Fukuoka, Japan, 830-0011
- Department of Orthopaedics, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, Japan
| | - Naoto Shiba
- Division of Rehabilitation, Kurume University Hospital, 67 Asahi-machi, Kurume, Fukuoka, Japan, 830-0011
- Department of Orthopaedics, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, Japan
| | - Koji Hiraoka
- Department of Orthopaedics, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, Japan
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Abraham I, Lewandrowski KU, Elfar JC, Li ZM, Fiorelli RKA, Pereira MG, Lorio MP, Burkhardt BW, Oertel JM, Winkler PA, Yang H, León JFR, Telfeian AE, Dowling Á, Vargas RAA, Ramina R, Asefi M, de Carvalho PST, Defino H, Moyano J, Montemurro N, Yeung A, Novellino P, On Behalf Of Teams/Organizations/Institutions. Randomized Clinical Trials and Observational Tribulations: Providing Clinical Evidence for Personalized Surgical Pain Management Care Models. J Pers Med 2023; 13:1044. [PMID: 37511657 PMCID: PMC10381640 DOI: 10.3390/jpm13071044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/11/2023] [Accepted: 06/12/2023] [Indexed: 07/30/2023] Open
Abstract
Proving clinical superiority of personalized care models in interventional and surgical pain management is challenging. The apparent difficulties may arise from the inability to standardize complex surgical procedures that often involve multiple steps. Ensuring the surgery is performed the same way every time is nearly impossible. Confounding factors, such as the variability of the patient population and selection bias regarding comorbidities and anatomical variations are also difficult to control for. Small sample sizes in study groups comparing iterations of a surgical protocol may amplify bias. It is essentially impossible to conceal the surgical treatment from the surgeon and the operating team. Restrictive inclusion and exclusion criteria may distort the study population to no longer reflect patients seen in daily practice. Hindsight bias is introduced by the inability to effectively blind patient group allocation, which affects clinical result interpretation, particularly if the outcome is already known to the investigators when the outcome analysis is performed (often a long time after the intervention). Randomization is equally problematic, as many patients want to avoid being randomly assigned to a study group, particularly if they perceive their surgeon to be unsure of which treatment will likely render the best clinical outcome for them. Ethical concerns may also exist if the study involves additional and unnecessary risks. Lastly, surgical trials are costly, especially if the tested interventions are complex and require long-term follow-up to assess their benefit. Traditional clinical testing of personalized surgical pain management treatments may be more challenging because individualized solutions tailored to each patient's pain generator can vary extensively. However, high-grade evidence is needed to prompt a protocol change and break with traditional image-based criteria for treatment. In this article, the authors review issues in surgical trials and offer practical solutions.
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Affiliation(s)
- Ivo Abraham
- Pharmacy Medicine, and Clinical Translational Sciences, University of Arizona, Roy P. Drachman Hall, Rm. B306H, Tucson, AZ 85721, USA
| | - Kai-Uwe Lewandrowski
- Center for Advanced Spine Care of Southern Arizona, Tucson, AZ 85712, USA
- Department of Orthopaedics, Fundación Universitaria Sanitas, Bogotá 111321, Colombia
- Department of Orthopedics, Hospital Universitário Gaffre e Guinle, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro 20270-004, Brazil
| | - John C Elfar
- Department of Orthopaedic Surgery, College of Medicine-Tucson Campus, Health Sciences Innovation Building (HSIB), University of Arizona, 1501 N. Campbell Avenue, Tower 4, 8th Floor, Suite 8401, Tucson, AZ 85721, USA
| | - Zong-Ming Li
- Department of Orthopaedic Surgery, College of Medicine-Tucson Campus, Health Sciences Innovation Building (HSIB), University of Arizona, 1501 N. Campbell Avenue, Tower 4, 8th Floor, Suite 8401, Tucson, AZ 85721, USA
| | - Rossano Kepler Alvim Fiorelli
- Department of General and Specialized Surgery, Gaffrée e Guinle University Hospital, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro 20270-004, Brazil
| | - Mauricio G Pereira
- Faculty of Medicine, University of Brasilia, Federal District, Brasilia 70919-900, Brazil
| | - Morgan P Lorio
- Advanced Orthopaedics, 499 E. Central Pkwy, Ste. 130, Altamonte Springs, FL 32701, USA
| | - Benedikt W Burkhardt
- Wirbelsäulenzentrum/Spine Center-WSC, Hirslanden Klinik Zurich, Witellikerstrasse 40, 8032 Zurich, Switzerland
| | - Joachim M Oertel
- Klinik für Neurochirurgie, Universität des Saarlandes, Kirrberger Straße 100, 66421 Homburg, Germany
| | - Peter A Winkler
- Department of Neurosurgery, Charite Universitaetsmedizin Berlin, 13353 Berlin, Germany
| | - Huilin Yang
- Orthopaedic Department, The First Affiliated Hospital of Soochow University, No. 899 Pinghai Road, Suzhou 215031, China
| | - Jorge Felipe Ramírez León
- Minimally Invasive Spine Center Bogotá D.C. Colombia, Reina Sofía Clinic Bogotá D.C. Colombia, Department of Orthopaedics, Fundación Universitaria Sanitas, Bogotá 110141, Colombia
| | - Albert E Telfeian
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Álvaro Dowling
- Department of Orthopaedic Surgery, University of São Paulo, Ribeirão Preto 14071-550, Brazil
| | - Roth A A Vargas
- Department of Neurosurgery, Foundation Hospital Centro Médico Campinas, Campinas 13083-210, Brazil
| | - Ricardo Ramina
- Neurological Institute of Curitiba, Curitiba 80230-030, Brazil
| | - Marjan Asefi
- Department of Biology, Nano-Biology, University of North Carolina, Greensboro, NC 27413, USA
| | | | - Helton Defino
- Department of Orthopaedic Surgery, University of São Paulo, Ribeirão Preto 14071-550, Brazil
| | - Jaime Moyano
- La Sociedad Iberolatinoamericana De Columna (SILACO), The Spine Committee of the Ecuadorian Society of Orthopaedics and Traumatology (Comité de Columna de la Sociedad Ecuatoriana de Ortopedia y Traumatología), Quito 170521, Ecuador
| | - Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana, University of Pisa, 56124 Pisa, Italy
| | - Anthony Yeung
- Desert Institute for Spine Care, Phoenix, AZ 85020, USA
| | - Pietro Novellino
- Guinle and State Institute of Diabetes and Endocrinology, Rio de Janeiro 20270-004, Brazil
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The Most Significant Factor Affecting Gait and Postural Balance in Patients’ Activities of Daily Living Following Corrective Surgery for Deformity of the Adult Spine. Medicina (B Aires) 2022; 58:medicina58081118. [PMID: 36013585 PMCID: PMC9414781 DOI: 10.3390/medicina58081118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/06/2022] [Accepted: 08/15/2022] [Indexed: 12/05/2022] Open
Abstract
Background and Objectives: Gait ability and spinal postural balance affect ADL in patients who underwent adult spinal deformity (ASD) surgery. However, it is still unclear how to determine what the cause is. This study was done to investigate various factors affecting gait, postural balance and activities of daily living (ADL) in patients who were operated on for ASD over a period of one year, following corrective surgery. Materials and Method: A cohort of 42 (2 men, 40 women, mean age, 71.1 years) who were operated on for ASD were included in this study. According to Oswestry Disability Index (ODI), based on their ADL, patients were segregated into satisfied and unsatisfied groups. Gait and postural balance abilities were evaluated before and after the operative procedure. Radiographs of spine and pelvis as well as the rehabilitation data (static balance, standing on single-leg; dynamic postural adaptation, timed up and go test (TUG); Gait Capability, walk velocity for a distance of 10 m) were acquired 12 months after surgery and analyzed. Spinopelvic parameters such as (lumbar lordosis (LL), pelvic tilt (PT), sagittal vertical axis (SVA), pelvic incidence (PI)) were marked and noted. The factors which affect patients’ satisfaction with their ADL were evaluated. Results: The ADL satisfied group included 18 patients (1 man, 17 women, mean age 68.6 years) and the unsatisfied group included 24 patients (1 man, 23 women, mean age 73.1 years). One year after the surgery, the two groups were tested. TUG (8.5 s vs. 12.8 s), 10 m walk velocity (1.26 m/s vs. 1.01 m/s), and single leg standing test (25 s vs. 12.8 s) were regarded as notably different. According to logistic regression analysis, only TUG was extracted as a significant factor. The cut-off value was 9.7 s, with sensitivity 75%, specificity 83%, area under the curve 0.824, and a 95% confidence interval of 0.695–0.953. Conclusions: A significant factor among all evaluations in postoperative ASD patients was TUG, for which the cut-off value for ADL satisfaction was 9.7 s.
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Staartjes VE, Joswig H, Corniola MV, Schaller K, Gautschi OP, Stienen MN. Association of Medical Comorbidities With Objective Functional Impairment in Lumbar Degenerative Disc Disease. Global Spine J 2022; 12:1184-1191. [PMID: 33334183 PMCID: PMC9210248 DOI: 10.1177/2192568220979120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Analysis of a prospective 2-center database. OBJECTIVES Medical comorbidities co-determine clinical outcome. Objective functional impairment (OFI) provides a supplementary dimension of patient assessment. We set out to study whether comorbidities are associated with the presence and degree of OFI in this patient population. METHODS Patients with degenerative diseases of the spine preoperatively performed the timed-up-and-go (TUG) test and a battery of questionnaires. Comorbidities were quantified using the Charlson Comorbidity Index (CCI) and the American Society of Anesthesiology (ASA) grading. Crude and adjusted linear regression models were fitted. RESULTS Of 375 included patients, 97 (25.9%) presented at least some degree of medical comorbidity according to the CCI, and 312 (83.2%) according to ASA grading. In the univariate analysis, the CCI was inconsistently associated with OFI. Only patients with low-grade CCI comorbidity displayed significantly higher TUG test times (p = 0.004). In the multivariable analysis, this effect persisted for patients with CCI = 1 (p = 0.030). Regarding ASA grade, patients with ASA = 3 exhibited significantly increased TUG test times (p = 0.003) and t-scores (p = 0.015). This effect disappeared after multivariable adjustment (p = 0.786 and p = 0.969). In addition, subjective functional impairment according to ODI, and EQ5D index was moderately associated with comorbidities according to ASA (all p < 0.05). CONCLUSION The degree of medical comorbidities appears only weakly and inconsistently associated with OFI in patients scheduled for degenerative lumbar spine surgery, especially after controlling for potential confounders. TUG testing may be valid even in patients with relatively severe comorbidities who are able to complete the test.
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Affiliation(s)
- Victor E. Staartjes
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Holger Joswig
- Department of Neurosurgery, Health and Medical University Potsdam, Ernst von Bergmann Hospital, Potsdam, Germany
| | - Marco V. Corniola
- Department of Neurosurgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
| | - Karl Schaller
- Department of Neurosurgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
| | - Oliver P. Gautschi
- Neuro- und Wirbelsäulenzentrum Zentralschweiz, Klinik St.Anna, Luzern, Switzerland
| | - Martin N. Stienen
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland,Department of Neurosurgery, Kantonsspital St.Gallen, St.Gallen, Switzerland,Martin N. Stienen, MD/FEBNS, Department of Neurosurgery, Kantonsspital St.Gallen, Rorschacher Str. 95, 9007 St.Gallen, Switzerland.
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Efficacy and characteristics of physiotherapy interventions in patients with lumbar spinal stenosis: a systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:1370-1390. [PMID: 35511368 DOI: 10.1007/s00586-022-07222-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 12/15/2021] [Accepted: 04/11/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To determine the efficacy of physiotherapy approaches used in the treatment of LSS and compare their delivery characteristics. METHODS A systematic search was conducted using MEDLINE/PubMed, EMBASE, Scopus, PEDro, CINAHL and Web of Science databases, from inception until March 2021. Inclusion criteria were clinical diagnosis of LSS confirmed through imaging techniques, RCTs written in English comparing physiotherapy interventions among them or versus placebo or usual care without restrictions on treatment and follow-up duration, outcomes related to pain, physical function, disability and quality of life. Two independent reviewers assessed records for eligibility and methodological quality (PEDro scale) and extracted participants' characteristics, interventions details and outcome measures at each timepoint. Pooled or un-pooled findings were reported as mean difference with 95% confidence interval, depending on heterogeneity. Evidence quality was rated using the GRADE approach. RESULTS Twelve studies (944 patients, mean PEDro score 7.6, range 5-9) were included. Three weeks of weight-supported walking improved pain and disability, while 8 weeks of aquatic exercises improved pain and walking tolerance (very low evidence). Six weeks of cycling reduced disability compared to weight-supported walking (low evidence). Six weeks of manual therapy plus exercise was not superior to supervised exercises (low evidence), but improved pain, walking tolerance, disability and quality of life compared to home/group exercises (moderate to very low evidence). Very low evidence supported 2 weeks of electromagnetic fields, whereas TENS (low evidence) and ultrasounds (very low evidence) revealed no effects. CONCLUSIONS These findings may assist clinicians in delivering effective physiotherapy interventions in LSS patients.
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Smith DL, Olding K, Malaya CA, McCarty M, Haworth J, Pohlman KA. The influence of flexion distraction spinal manipulation on patients with lumbar spinal stenosis: A prospective, open-label, single-arm, pilot study. J Bodyw Mov Ther 2022; 32:60-67. [DOI: 10.1016/j.jbmt.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 02/08/2022] [Accepted: 05/15/2022] [Indexed: 10/18/2022]
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Hartmann S, Lang A, Lener S, Abramovic A, Grassner L, Thomé C. Minimally invasive versus open transforaminal lumbar interbody fusion: a prospective, controlled observational study of short-term outcome. Neurosurg Rev 2022; 45:3417-3426. [PMID: 36064875 PMCID: PMC9492567 DOI: 10.1007/s10143-022-01845-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/08/2022] [Accepted: 08/09/2022] [Indexed: 02/03/2023]
Abstract
Instrumented stabilization with intersomatic fusion can be achieved by open (O-TLIF) or minimally invasive (MIS-TLIF) transforaminal surgical access. While less invasive techniques have been associated with reduced postoperative pain and disability, increased manipulation and insufficient decompression may contradict MIS techniques. In order to detect differences between both techniques in the short-term, a prospective, controlled study was conducted. Thirty-eight patients with isthmic or degenerative spondylolisthesis or degenerative disk disease were included in this prospective, controlled study (15 MIS-TLIF group vs. 23 O-TLIF group) after failed conservative treatment. Patients were examined preoperatively, on the first, third, and sixth postoperative day as well as after 2, 4, and 12 weeks postoperatively. Outcome parameters included blood loss, duration of surgery, pre- and postoperative pain (numeric rating scale [NRS], visual analog scale [VAS]), functionality (Timed Up and Go test [TUG]), disability (Oswestry Disability index [ODI]), and quality of life (EQ-5D). Intraoperative blood loss (IBL) as well as postoperative blood loss (PBL) was significantly higher in the O-TLIF group ([IBL O-TLIF 528 ml vs. MIS-TLIF 213 ml, p = 0.001], [PBL O-TLIF 322 ml vs. MIS-TLIF 30 ml, p = 0.004]). The O-TLIF cohort showed significantly less leg pain postoperatively compared to the MIS-TLIF group ([NRS leg 3rd postoperative day, p = 0.027], [VAS leg 12 weeks post-op, p = 0.02]). The MIS group showed a significantly better improvement in the overall ODI (40.8 ± 13 vs. 56.0 ± 16; p = 0.05). After 3 months in the short-term follow-up, the MIS procedure tends to have better results in terms of patient-reported quality of life. MIS-TLIF offers perioperative advantages but may carry the risk of increased nerve root manipulation with consecutive higher radicular pain, which may be related to the learning curve of the procedure.
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Affiliation(s)
- Sebastian Hartmann
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Anna Lang
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Sara Lener
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Anto Abramovic
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Lukas Grassner
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
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Basil GW, Sprau AC, Eliahu K, Borowsky PA, Wang MY, Yoon JW. Using Smartphone-Based Accelerometer Data to Objectively Assess Outcomes in Spine Surgery. Neurosurgery 2021; 88:763-772. [PMID: 33437988 DOI: 10.1093/neuros/nyaa505] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/21/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In order to deliver optimal patient care, spine surgeons must integrate technological changes to arrive at novel measures of functional outcomes. Historically, subjective patient-reported outcome (PRO) surveys have been used to determine the relative benefit of surgical treatments. Using smartphone-based accelerometers, surgeons now have the ability to arrive at objective outcome metrics. OBJECTIVE To use Apple Health (Apple Inc, Cupertino, California) data to approximate physical activity levels before and after spinal fusion as an objective outcome measurement. METHODS Personal activity data were acquired retrospectively from the cellphones of consenting patients. These data were used to measure changes in activity level (daily steps, flights climbed, and distance traveled) before and after patients underwent spine surgery at a single institution by a single surgeon. After data collection, we investigated the demographic information and daily physical activity pre- and postoperatively of participating patients. RESULTS Twenty-three patients were included in the study. On average, patients first exceeded their daily 1-yr average distance walked, flights climbed, and steps taken at 10.3 ± 14, 7.6 ± 21.1, and 8 ± 9.9 wk, respectively. Mean flights climbed, distance traveled, and steps taken decreased significantly from 6 mo prior to surgery to 2 wk postoperatively. Distance traveled and steps taken significantly increased from 6 mo prior to surgery to 7 to 12 mo postoperatively. CONCLUSION We demonstrated a valuable supplement to traditional PROs by using smartphone-based activity data. This methodology yields a rich data set that has the potential to augment our understanding of patient recovery.
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Affiliation(s)
- Gregory W Basil
- Department of Neurological Surgery, University of Miami, Miami, Florida
| | - Annelise C Sprau
- Department of Neurological Surgery, University of Miami, Miami, Florida
| | - Karen Eliahu
- Department of Neurological Surgery, University of Miami, Miami, Florida
| | - Peter A Borowsky
- Department of Neurological Surgery, University of Miami, Miami, Florida
| | - Michael Y Wang
- Department of Neurological Surgery, University of Miami, Miami, Florida
| | - Jang W Yoon
- Department of Neurological Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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Stienen MN, Maldaner N, Sosnova M, Zeitlberger AM, Ziga M, Weyerbrock A, Bozinov O, Gautschi OP. External Validation of the Timed Up and Go Test as Measure of Objective Functional Impairment in Patients With Lumbar Degenerative Disc Disease. Neurosurgery 2021; 88:E142-E149. [PMID: 33040156 DOI: 10.1093/neuros/nyaa441] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 07/19/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The Timed Up and Go (TUG) test is the most commonly applied objective measure of functional impairment in patients with lumbar degenerative disc disease (DDD). OBJECTIVE To demonstrate external content validity of the TUG test. METHODS Consecutive adult patients, scheduled for elective lumbar spine surgery, were screened for enrollment into a prospective observational study. Disease severity was estimated by patient-reported outcome measures (PROMs; Visual Analog Scales [VAS], Core Outcome Measures Index [COMI] back, Zurich Claudication Questionnaire [ZCQ]) and the TUG test. Pearson correlation coefficients (PCCs) were used to describe the relationship between logarithmic TUG test raw values and PROMs. RESULTS A total of 70 patients (mean age 55.9 ± 15.4 yr; 38.6% female; 27.1% previous spine surgery; 28.6% lower extremity motor deficits) with lumbar disc herniation (50%), lumbar spinal stenosis (34.3%), or instability requiring spinal fusion (15.7%) were included. The mean TUG test time was 10.8 ± 4.4 s; age- and sex-adjusted objective functional impairment (OFI) T-score was 134.2 ± 36.9. A total of 12 (17.1%) patients had mild, 14 (20%) moderate, and 9 (12.9%) severe OFI, while 35 (50%) had TUG test results within the normal population range (no OFI). PCCs between TUG test time and VAS back pain were r = 0.37 (P = .002), VAS leg pain r = 0.37 (P = .002), COMI back r = 0.50 (P < .001), ZCQ symptom severity r = 0.41 (P < .001), and ZCQ physical function r = 0.36 (P = .002). CONCLUSION This external validation demonstrated similar OFI rates and PCCs between logarithmic TUG test results and PROMs compared to the original article from 2016. These findings support the TUG test being a quick, easy-to-use objective test, which provides the physician with a robust estimate of pain and functional impairment.
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Affiliation(s)
- Martin N Stienen
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland.,Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford, California
| | - Nicolai Maldaner
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland.,Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Marketa Sosnova
- Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Anna M Zeitlberger
- Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Michal Ziga
- Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Astrid Weyerbrock
- Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Oliver Bozinov
- Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Oliver P Gautschi
- Neuro- and Spine Center, Hirslanden Clinic St. Anna, Lucerne, Switzerland
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Maldaner N, Sosnova M, Zeitlberger AM, Ziga M, Gautschi OP, Regli L, Weyerbrock A, Stienen MN. Evaluation of the 6-minute walking test as a smartphone app-based self-measurement of objective functional impairment in patients with lumbar degenerative disc disease. J Neurosurg Spine 2020; 33:779-788. [PMID: 32764182 DOI: 10.3171/2020.5.spine20547] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 05/12/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Digital transformation enables new possibilities to assess objective functional impairment (OFI) in patients with lumbar degenerative disc disease (DDD). This study examines the psychometric properties of an app-based 6-minute walking test (6WT) and determines OFI in patients with lumbar DDD. METHODS The maximum 6-minute walking distance (6WD) was determined in patients with lumbar DDD. The results were expressed as raw 6WDs (in meters), as well as in standardized z-scores referenced to age- and sex-specific values of spine-healthy volunteers. The 6WT results were assessed for reliability and content validity using established disease-specific patient-reported outcome measures. RESULTS Seventy consecutive patients and 330 volunteers were enrolled. The mean 6WD was 370 m (SD 137 m) in patients with lumbar DDD. Significant correlations between 6WD and the Core Outcome Measures Index for the back (r = -0.31), Zurich Claudication Questionnaire (ZCQ) symptom severity (r = -0.32), ZCQ physical function (r = -0.33), visual analog scale (VAS) for back pain (r = -0.42), and VAS for leg pain (r = -0.32) were observed (all p < 0.05). The 6WT revealed good test-retest reliability (intraclass correlation coefficient 0.82), and the standard error of measurement was 58.3 m. A 4-tier severity stratification classified patients with z-scores > -1 (no OFI), -1 to -1.9 (mild OFI), -2 to -2.9 (moderate OFI), and ≤ -3 (severe OFI). CONCLUSIONS The smartphone app-based self-measurement of the 6WT is a convenient, reliable, and valid way to determine OFI in patients with lumbar DDD. The 6WT app facilitates the digital evaluation and monitoring of patients with lumbar DDD.
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Affiliation(s)
- Nicolai Maldaner
- 1Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich
- 2Department of Neurosurgery, Kantonsspital St. Gallen; and
| | | | | | - Michal Ziga
- 2Department of Neurosurgery, Kantonsspital St. Gallen; and
| | - Oliver P Gautschi
- 3Neurological and Spine Center, Hirslanden Clinic St. Anna, Lucerne, Switzerland
| | - Luca Regli
- 1Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich
| | | | - Martin N Stienen
- 1Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich
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Maldaner N, Stienen MN. Subjective and Objective Measures of Symptoms, Function, and Outcome in Patients With Degenerative Spine Disease. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:183-199. [DOI: 10.1002/acr.24210] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 04/02/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Nicolai Maldaner
- University Hospital Zurich and University of Zurich, Zurich, Switzerland, and Cantonal Hospital St. Gallen St. Gallen Switzerland
| | - Martin Nikolaus Stienen
- University Hospital Zurich and University of Zurich, Zurich, Switzerland, and Stanford University Hospital and Clinics Stanford California
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Tosic L, Goldberger E, Maldaner N, Sosnova M, Zeitlberger AM, Staartjes VE, Gadjradj PS, Eversdijk HAJ, Quddusi A, Gandía-González ML, Sayadi JJ, Desai A, Regli L, Gautschi OP, Stienen MN. Normative data of a smartphone app-based 6-minute walking test, test-retest reliability, and content validity with patient-reported outcome measures. J Neurosurg Spine 2020; 33:480-489. [PMID: 32470938 DOI: 10.3171/2020.3.spine2084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 03/30/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The 6-minute walking test (6WT) is used to determine restrictions in a subject's 6-minute walking distance (6WD) due to lumbar degenerative disc disease. To facilitate simple and convenient patient self-measurement, a free and reliable smartphone app using Global Positioning System coordinates was previously designed. The authors aimed to determine normative values for app-based 6WD measurements. METHODS The maximum 6WD was determined three times using app-based measurement in a sample of 330 volunteers without previous spine surgery or current spine-related disability, recruited at 8 centers in 5 countries (mean subject age 44.2 years, range 16-91 years; 48.5% male; mean BMI 24.6 kg/m2, range 16.3-40.2 kg/m2; 67.9% working; 14.2% smokers). Subjects provided basic demographic information, including comorbidities and patient-reported outcome measures (PROMs): visual analog scale (VAS) for both low-back and lower-extremity pain, Core Outcome Measures Index (COMI), Zurich Claudication Questionnaire (ZCQ), and subjective walking distance and duration. The authors determined the test-retest reliability across three measurements (intraclass correlation coefficient [ICC], standard error of measurement [SEM], and mean 6WD [95% CI]) stratified for age and sex, and content validity (linear regression coefficients) between 6WD and PROMs. RESULTS The ICC for repeated app-based 6WD measurements was 0.89 (95% CI 0.87-0.91, p < 0.001) and the SEM was 34 meters. The overall mean 6WD was 585.9 meters (95% CI 574.7-597.0 meters), with significant differences across age categories (p < 0.001). The 6WD was on average about 32 meters less in females (570.5 vs 602.2 meters, p = 0.005). There were linear correlations between average 6WD and VAS back pain, VAS leg pain, COMI Back and COMI subscores of pain intensity and disability, ZCQ symptom severity, ZCQ physical function, and ZCQ pain and neuroischemic symptoms subscores, as well as with subjective walking distance and duration, indicating that subjects with higher pain, higher disability, and lower subjective walking capacity had significantly lower 6WD (all p < 0.001). CONCLUSIONS This study provides normative data for app-based 6WD measurements in a multicenter sample from 8 institutions and 5 countries. These values can now be used as reference to compare 6WT results and quantify objective functional impairment in patients with degenerative diseases of the spine using z-scores. The authors found a good to excellent test-retest reliability of the 6WT app, a low area of uncertainty, and high content validity of the average 6WD with commonly used PROMs.
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Affiliation(s)
- Lazar Tosic
- 1Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Switzerland
| | - Elior Goldberger
- 1Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Switzerland
| | - Nicolai Maldaner
- 2Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Marketa Sosnova
- 2Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Anna M Zeitlberger
- 2Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Victor E Staartjes
- 1Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Switzerland
| | - Pravesh S Gadjradj
- 3Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Ayesha Quddusi
- 5Center for Neuroscience, Queens University, Kingston, Ontario, Canada
| | | | - Jamasb Joshua Sayadi
- 7Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford, California; and
| | - Atman Desai
- 7Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford, California; and
| | - Luca Regli
- 1Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Switzerland
| | - Oliver P Gautschi
- 8Neuro and Spine Center, Hirslanden Clinic St. Anna, Lucerne, Switzerland
| | - Martin N Stienen
- 1Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Switzerland
- 7Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford, California; and
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Erdoğanoğlu Y, Sayaca Ç, Çalık M, Noyan CO, Çetin A, Yertutanol DK, Taşcılar LN, Kaya D. Evaluation of Plantar Foot Sensation, Balance, Physical Performance, and Fear of Movement in Substance Use Disorders. J Am Podiatr Med Assoc 2020; 110:436239. [PMID: 31566442 DOI: 10.7547/18-194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Neuropathologic changes may occur in the nervous system due to long-term substance use, leading to functional disability with altering of balance. We know little about substance-related mechanisms that can cause movement disorders. This study investigated the effects of plantar foot sensation and balance on physical performance as an effect of substance use in detoxified patients. METHODS Twenty-three users of cannabis, volatile agents, or narcotic/stimulant agents alone or in combination for at least 1 year (mean age, 27.6 years) and 20 healthy volunteers (mean age, 24.6 years) were included. Participant evaluations were implemented immediately after the detoxification process with psychiatrist approval. Depression, state-trait anxiety, and fear of movement levels were evaluated with the Beck Depression Inventory, State-Trait Anxiety Inventory, and Tampa Scale for Kinesiophobia, respectively. Plantar foot sensations were evaluated with light touch, two-point discrimination, and vibration examinations. Balance was assessed with balance software and a balance board and force platform. Balance path, balance path distance, and center of pressure were recorded. Physical performance was evaluated with the Timed Up and Go (TUG) test in the final step. RESULTS There was a significant difference in two-point discrimination of patients versus controls (P < .05). Significant differences were also found in balance values, particularly in the sagittal direction (P < .05). TUG test results of patients compared with controls showed a negative influence on physical function (P < .05). CONCLUSIONS Detailed examination should be performed to understand movement disorders in substance users. Herein, substance users had impaired two-point discrimination and sagittal balance reciprocally. Thus, customized physiotherapy approaches to substance users should be considered to improve their movement disorders.
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Stienen MN, Gautschi OP, Staartjes VE, Maldaner N, Sosnova M, Ho AL, Veeravagu A, Desai A, Zygourakis CC, Park J, Regli L, Ratliff JK. Reliability of the 6-minute walking test smartphone application. J Neurosurg Spine 2019; 31:786-793. [PMID: 31518975 DOI: 10.3171/2019.6.spine19559] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 06/05/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Objective functional measures such as the 6-minute walking test (6WT) are increasingly applied to evaluate patients with degenerative diseases of the lumbar spine before and after (surgical) treatment. However, the traditional 6WT is cumbersome to apply, as it requires specialized in-hospital infrastructure and personnel. The authors set out to compare 6-minute walking distance (6WD) measurements obtained with a newly developed smartphone application (app) and those obtained with the gold-standard distance wheel (DW). METHODS The authors developed a free iOS- and Android-based smartphone app that allows patients to measure the 6WD in their home environment using global positioning system (GPS) coordinates. In a laboratory setting, the authors obtained 6WD measurements over a range of smartphone models, testing environments, and walking patterns and speeds. The main outcome was the relative measurement error (rME; in percent of 6WD), with |rME| < 7.5% defined as reliable. The intraclass correlation coefficient (ICC) for agreement between app- and DW-based 6WD was calculated. RESULTS Measurements (n = 406) were reliable with all smartphone types in neighborhood, nature, and city environments (without high buildings), as well as with unspecified, straight, continuous, and stop-and-go walking patterns (ICC = 0.97, 95% CI 0.97-0.98, p < 0.001). Measurements were unreliable indoors, in city areas with high buildings, and for predominantly rectangular walking courses. Walking speed had an influence on the ME, with worse accuracy (2% higher rME) for every kilometer per hour slower walking pace (95% CI 1.4%-2.5%, p < 0.001). Mathematical adjustment of the app-based 6WD for velocity-dependent error mitigated the rME (p < 0.011), attenuated velocity dependence (p = 0.362), and had a positive effect on accuracy (ICC = 0.98, 95% CI 0.98-0.99, p < 0.001). CONCLUSIONS The new, free, spine-specific 6WT smartphone app measures the 6WD conveniently by using GPS coordinates, empowering patients to independently determine their functional status before and after (surgical) treatment. Measurements of 6WD obtained for the target population under the recommended circumstances are highly reliable.
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Affiliation(s)
- Martin N Stienen
- 1Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Switzerland
- 2Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford, California
| | - Oliver P Gautschi
- 3Neurological and Spinal Surgery Centre, Hirslanden Klinik St. Anna, Lucerne; and
| | - Victor E Staartjes
- 1Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Switzerland
| | - Nicolai Maldaner
- 4Department of Neurosurgery, Kantonsspital St. Gallen, Switzerland
| | - Marketa Sosnova
- 4Department of Neurosurgery, Kantonsspital St. Gallen, Switzerland
| | - Allen L Ho
- 2Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford, California
| | - Anand Veeravagu
- 2Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford, California
| | - Atman Desai
- 2Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford, California
| | - Corinna C Zygourakis
- 2Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford, California
| | - Jon Park
- 2Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford, California
| | - Luca Regli
- 1Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Switzerland
| | - John K Ratliff
- 2Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford, California
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