An Outcome Measure of Functionality and Pain in Patients with Low Back Disorder: A Validation Study of the Iranian version of Low Back Outcome Score

Psychometric Properties of Chosen Scales Evaluating Disability in Low Back Pain-Narrative Review

Low back pain (LBP) is one of the most common disabling conditions. This disability significantly reduces the quality of life of LBP patients. This article reviews the most common and well-known measures currently used to assess disability in LBP, such as the Oswestry Disability Index (ODI), the Roland-Morris Disability Questionnaire (RMDQ), the Quebec Back Pain Disability Scale (QBPDS), the Low Back Outcome Score (LBOS), and the Low Back Pain Rating Scale (LBPRS). To reliably evaluate questionnaires and other measurement methods, there are parameters known as psychometric properties, which consist primarily of the validity, reliability and sensitivity. These methods are based on a multi-item questionnaire assessing physical functioning that is completed independently by the patient. They can be used to assess the disability associated with many conditions. All are specific to LBP, and their psychometric properties have been tested on a relevant population of patients with the condition and published in peer-reviewed publications.

A Cross-cultural Perspective on Intrathecal Opioid Therapy Between German and Iranian Patients

Patients often adhere to intrathecal opioid therapy (IOT) for many years, despite the lack of scientific evidence for its efficacy and the scarce knowledge about long-term effects. Moreover, there is no knowledge on how the efficacy of IOT is influenced by cultural factors. We assessed the long-term efficacy and frequency of side effects of IOT in two culturally different patient samples. A chart review was conducted of all patients with IOT, who had been treated in interdisciplinary pain centers in Freiburg and in Tehran in a 15-year span. Personal data, diagnosis, duration of pain disease, pump type in use, revision operations, and opioid doses were recorded. Patients completed a questionnaire containing pain scores, pain-related disability (PDI), anxiety, depression, and unwanted side effects. Fourteen Iranian and 36 German patients (32 m/18 f) were studied. Mean duration of IOT was 10.2 years. Pain levels prior to IOT were 7.64 (NRS) (range 4-10, SD 1.64), 3.86 (range 0-9, SD 2.32) directly after pump implantation, and 4.17 (range 0-10, SD 2.11) at time of follow-up. Iranian patients had significantly lower pain levels directly after implantation, depression scores, and pain-related disability. Frequent side effects were obstipation, sexual dysfunction, urinary retention, and fatigue. Most side effects were significantly less frequent in the Iranian sample. There were no severe complications or permanent neurological deficit. Our study demonstrates the effectiveness of IOT also for long-term application. Differences in clinical efficacy are partially due to cultural factors. Side effects are frequent but not limiting patient satisfaction.

Cross-Cultural Adaptation and Validation of the Nepali Version of the Pelvic Girdle Questionnaire

OBJECTIVE

The purpose of this study was to translate, cross-culturally adapt, and assess the reliability and validity of the Pelvic Girdle Questionnaire (PGQ) in pregnant Nepalese women.

METHODS

The cross-cultural adaptation process was conducted according to the Guillemin guidelines. Reliability and validity were assessed using cross-sectional design. The participants responded to questionnaires of sociodemographics, the Nepali version of the PGQ, the Oswestry Disability Index, the Patient-Specific Functional Scale, the 5-item version of the Edinburgh Depression Scale, and the Numerical Pain Rating Scale. The internal consistency was assessed with Cronbach's alpha. The test-retest reliability was calculated using the intraclass correlation coefficient and smallest detectable change. Construct validity was assessed by testing 9 a priori hypotheses that examine correlations between the PGQ activity and symptom subscales, and also among the PGQ subscales and Oswestry Disability Index, Numerical Pain Rating Scale, Patient-Specific Functional Scale, and 5-item version of the Edinburgh Depression Scale. Spearman and Pearson's correlation were used to assess the correlations.

RESULTS

A sample of 111 pregnant women were included in the study. The Cronbach's alpha for the Nepali version of the total PGQ was good (α = 0.83), and the test-retest reliability was acceptable (ICC_2.1, 0.72) with a measurement error of SDC_95% 18.6 points. Seven of the 9 hypotheses found support, which confirms acceptable construct validity of the Nepali PGQ.

CONCLUSION

The Nepali version of the PGQ is a reliable and valid tool for assessing pelvic girdle pain in pregnant Nepalese women.

Reliability and validation of the Turkish version of the Low Back Outcome Score

OBJECTIVE

This study aimed to validate the Turkish version of the Low Back Outcome Score and check its reliability in patients with chronic low back pain (LBP).

METHODS

Overall, 105 patients (81 women and 24 men; mean age: 49.5 years (18-65 years)) with a complaint of LBP for at least 3 months were included in this study. Test-retest reliability was assessed after 7 days. Overall score of LBOS was compared with the overall scores of "Rolland-Morris Disability Questionnaire," "Oswestry Disability Index," "Quebec Back Pain Disability Scale," "SF-36," and "Bournemouth Questionnaire for Back Pain" to calculate the convergent validity by using Pearson correlation coefficient.

RESULTS

The questionnaire was noted to have high internal consistency. The test-retest analysis revealed an excellent correlation (ICC=0.80). Pearson correlation coefficient of the LBOS was assessed using VAS and had an excellent correlation with all the questionnaires included in this study.

CONCLUSION

The Turkish version of the LBOS questionnaire appeared to be a valid and reliable outcome measure.

LEVEL OF EVIDENCE

Level III, Diagnostic study.

The Low-Back Outcome Scale and the Oswestry disability index: are they reflective of patient satisfaction after discectomy? A cross sectional study

Background

The Low-Back Outcome Scale (LBOS) of Greenough and Fraser and the Oswestry disability index (ODI) were compared to the patient satisfaction index (PSI) in lumbar disc herniation (LDH) surgery.

Methods

A total of 134 patients who underwent discectomy were followed through assessment of pre- and post-surgical satisfaction by the PSI, the LBOS, and the ODI. The LBOS were rated as satisfied if the outcomes were excellent or good and as dissatisfied if fair and poor. Considering the ODI, clinically satisfied was defined as a 13-point improvement from the baseline ODI scores. Phi (Φ) correlation analysis was used to study the correlation among the PSI, the LBOS and the ODI scores as proxy for patients' satisfaction.

Results

Mean age of patients was 48.9 years. Significant improvement from the pre- to post-operative ODI scores was observed. Post-surgical satisfaction based on the PSI, the ODI, and the LBOS were 70.9%, 76.8%, and 81.3%, respectively. Regarding patient satisfaction, there were weak associations between LBOS vs. PSI and ODI vs. PSI (Φ=-0.054, P=0.533) and (Φ=-0.129, P=0.136), respectively.

Conclusions

Our study showed that the ODI and the LBOS were not reflective of patients' satisfaction after discectomy.

Central Sagittal Angle of the Sacrum as a New Risk Factor for Patients with Persistent Low Back Pain after Caesarean Section

Study Design

Retrospective.

Purpose

This study investigated the possible association of persistent low back pain (LBP) with caesarean section (CS) under spinal anesthesia.

Overview of Literature

Many women suffer from LBP after CS, which is commonly performed under spinal anesthesia. However, this type of LBP is poorly understood, and there is poor consensus regarding increased risk after spinal anesthesia.

Methods

We examined two groups of patients who underwent cesarean delivery under spinal anesthesia. Group I included patients who presented to a neurosurgical clinic complaining of LBP for at least 6 months. Group II was a control group with patients without LBP. We analyzed clinical and sagittal angle parameters, including age, body mass index, parity, central sagittal angle of the sacrum (CSAS), and sacral slope (SS).

Results

Fifty-three patients participated in this study: 23 (43.1%) in Group I and 30 (56.9%) in Group II. Non-parametric Mann–Whitney U-tests showed that age, parity, and CSAS significantly differed between the two groups at 6 months.

Conclusions

Age, parity, and CSAS appear to be associated with increased risk for LBP after CS under spinal anesthesia. Future prospective studies on this subject may help validate our results.