Graphic Rating Scale Research Articles

A Comparative Assessment of Graphic and 0–10 Rating Scales Used to Measure Entrepreneurial Competences

This article presents an empirical comparative assessment of the measurement quality of two instruments commonly used to measure fuzzy characteristics in computer-assisted questionnaires: a graphic scale (a line production scale using a slider bar) and an endecanary scale (a 0–10 rating scale using radio buttons). Data are analyzed by means of multitrait–multimethod models estimated as structural equation models with a mean and covariance structure. For the first time in such research, the results include bias, valid variance, method variance, and random error variance. The data are taken from a program that assesses entrepreneurial competences in undergraduate Economics and Business students by means of questionnaires administered on desktop computers. Neither of the measurement instruments was found to be biased with respect to the other, meaning that their scores are comparable. While both instruments achieve valid and reliable measurements, the reliability and validity are higher for the endecanary scale. This study contributes to the still scarce literature on fuzzy measurement instruments and on the comparability and relative merits of graphic and discrete rating scales on computer-assisted questionnaires.

A pilot study to assess the effectiveness of local application of salbutamol and nitroglycerine for improvement of hand dexterity and comfort in extreme cold climate at high altitude

Background: Reduced manual dexterity and hand comfort affect all people exposed to extreme cold. Ointment nitroglycerine 0.2% (NTG) and ointment salbutamol 0.5% (Sal) applied topically to the extremities could result in increased local blood flow and temperature, improving hand comfort and dexterity in extreme cold. Aim and Objectives: This study was designed to elucidate if the application of NTG or Sal would improve manual dexterity and hand comfort in extreme cold conditions. Materials and Methods: A double-blind, randomized controlled trial was conducted at 3500 m altitude in 105 individuals divided into three equal-sized groups. Group A received NTG, Group B placebo (white soft paraffin), and Group C Sal, for application to the extremities twice daily, for 2 weeks. Hand skin temperatures (Tsk), Pegboard scores, and a Graphic Rating Scale (GRS) for pain were compared before and after the intervention. Adverse effects and user acceptability criteria were recorded. Results: Participants of all three groups showed significant improvement in Tsk, Pegboard scores, and GRS scores postintervention, however none of the parameters were different between groups. The acceptability questionnaire scores were best in the placebo group. Conclusion: Neither NTG nor Sal was superior to placebo for improvement in hand comfort or dexterity, in extreme cold at high altitude.

Immersive Virtual Reality as an Adjunctive Non-opioid Analgesic for Pre-dominantly Latin American Children With Large Severe Burn Wounds During Burn Wound Cleaning in the Intensive Care Unit: A Pilot Study

Background/Aim: Using a within-subjects, within-wound care design, this pilot study tested for the first time, whether immersive virtual reality (VR) can serve as an adjunctive non-opioid analgesic for children with large severe burn wounds during burn wound cleaning in the ICU, in a regional burn center in the United States, between 2014–2016.Methods: Participants included 48 children from 6 years old to 17 years of age with >10% TBSA burn injuries reporting moderate or higher worst pain during no VR on Day 1. Forty-four of the 48 children were from developing Latin American countries. Patients played adjunctive SnowWorld, an interactive 3D snowy canyon in virtual reality during some portions of wound care, vs. No VR during comparable portions of the same wound care session (initial treatment condition randomized). Using Graphic Rating scales, children's worst pain ratings during “No VR” (treatment as usual pain medications) vs. their worst pain during “Yes VR” was measured during at least 1 day of wound care, and was measured for up to 10 study days the patient used VR.Results: VR significantly reduced children's “worst pain” ratings during burn wound cleaning procedures in the ICU on Day 1. Worst pain during No VR = 8.52 (SD = 1.75) vs. during Yes VR = 5.10 (SD = 3.27), t(47) = 7.11, p < 0.001, SD = 3.33, CI = 2.45–4.38, Cohen's d = 1.03 (indicating large effect size). Patients continued to report the predicted pattern of lower pain and more fun during VR, during multiple sessions.Conclusion: Immersive virtual reality can help reduce the pain of children with large severe burn wounds during burn wound cleaning in the Intensive Care Unit. Additional research and development is recommended.

Pengaruh Keadilan Organisasi dalam Penilaian Kinerja terhadap Kepuasan Penilaian dan Kinerja Karyawan

Since 2012, management of PTPN V Pekanbaru implemented a new system of performance appraisal, named Competency-Based Performance Management (CBPM) for replaced the earlier system. The difference between CBPM and the earlier system is CBPM use a set of measured performance indicator, while in the old system, performance appraisal done by graphic rating scale method. One of performance appraisal effectiveness indicator is organizational justice on performance appraisal. The purpose of this study is to analyze organizational justice in performance appraisal and their influence on satisfaction toward performance appraisal and employee’s performance. Data collected from 196 respondents from managerial employee by a set of online questionnaire with purposive sampling’s technique. Descriptive analysis carried out by mean value’s analysis and range’s criteria analysis. Hypothesis testing has done by Structural Equation Modelling-Partial Least Square (SEM-PLS) analysis. The descriptive analysis shows that organizational justice in the performance appraisal had run well and the employees had satisfied toward the performance appraisal. SEM-PLS analysis shows that organizational justice in performance appraisal effect to satisfaction of performance appraisal and employee’s performance significantly. Satisfaction toward performance appraisal does not play a role in mediating the influence of justice in the performance appraisal to employee performance

PENERAPAN METODE GRAPHIC RATING SCALE (GRS) DALAM PENILAIAN KINERJA KARYAWAN

Competition increasingly competitive business trigger Muliadana company to be more innovative in improving the quality of the company. One technique used by management companies in improving the quality of human resources is to conduct employee performance appraisal. To the authors try to establish a scoring system using the Graphic Rating Scale (GRS), which is a methodology for assessing the scale of the graph by comparing the individual performance against an absolute standard. The purpose of this valuation method is to minimize the less objective assessment and can determine the development of the employee's performance over several periods. The results of the performance appraisal company can provide feedback to the employees so they can decide the steps taken in making decisions such as: promotion, promotion or class, mutation, degradation as well as training for employees in need.

Virtual Reality Analgesia for Pediatric Dental Patients.

Background: Dental procedures often elicit pain and fear in pediatric dental patients.Aim: To evaluate the feasibility and effectiveness of immersive virtual reality as an attention distraction analgesia technique for pain management in children and adolescents undergoing painful dental procedures.Design: Using a within-subjects design, five patients (mean age 13.20 years old, SD 2.39) participated. Patients received tethered immersive interactive virtual reality distraction in an Oculus Rift VR helmet (experimental condition) during one dental procedure (a single dental filling or tooth extraction). On a different visit to the same dentist (e.g., 1 week later), each patient also received a comparable dental procedure during the control condition “treatment as usual” (treatment order randomized). After each procedure, children self-rated their “worst pain,” “pain unpleasantness,” “time spent thinking about pain,” “presence in VR,” “fun,” and “nausea” levels during the dental procedures, using graphic rating scales.Results: Patients reported significantly lower “worst pain” and “pain unpleasantness,” and had significantly more fun during VR, compared to a comparable dental procedure with No VR. Using Oculus Rift VR goggles, patients reported a “strong sense of going inside the computer-generated world,” without side effects. The dentist preferred having the patients in VR.Conclusion: Results of this pilot study provide preliminary evidence of the feasibility of using immersive, interactive VR to distract pediatric dental patients and increase fun of children during dental procedures.

Virtual reality analgesia for burn joint flexibility: A randomized controlled trial.

We conducted a randomized controlled study to determine the effects of virtual reality (VR) distraction on pain and range of motion (ROM) in patients hospitalized for burn care during active physical therapy exercises. Thirty-nine participants aged 15 to 66 (M = 36) years with significant burn injuries (mean burn size = 14% TBSA) participated. Under therapist supervision, using a within-subjects design, participants performed unassisted active ROM exercises both with and without VR distraction in a randomized order. Therapists provided participants with instructions but did not physically assist with stretches. Maximum active ROM was measured using a goniometer. A 0-100 Graphic Rating Scale (GRS) was used to assess the cognitive, affective, and sensory components of pain. A GRS rating of the amount of "fun" during stretching served as a measure of positive experience. Participants reported lower mean GRS ratings during VR, relative to No VR, for worst pain, pain unpleasantness, and time spent thinking about pain. They also reported having a more positive experience during VR than during No VR. However, patients did not show greater ROM during VR. Immersive VR reduced pain during ROM exercises that were under the control of the patient. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Delayed surgery in neurologically intact patients affected by thoraco-lumbar junction burst fractures: to reduce pain and improve quality of life.

This is a retrospective study on 18 patients affected by thoraco-lumbar junction burst fractures (TLJBF) A3 or A4 at computed tomography (CT) scan who referred to our hospital. To assess the surgical results in terms of pain and quality of life in a series of neurologically intact patients affected by TLJBF who underwent surgery after 3-4 months from the injury. In literature there is controversy if pain could be an indication for surgery in TLJBF and series of patients conservatively managed with success have been reported. A retrospective study on 18 patients is reported. Patients included in this series were neurologically intact and affected by a TLJBF A3 or A4 at CT scan, the height of the burst vertebral body was >50%, spinal canal invasion was <30% and kyphosis deformity <30 degrees. Pain and quality of life were evaluated using graphic rating scale (GRS) and EuroQol (EQ-5D) scores on admission, at the clinical follow-up and in post-surgical period. Comparing pre- and post-operative EQ-5D, the scores had a statistically significant decrease after the operation (P<0.001) [pre-surgery EQ-5D was 2.60 (SD =0.67), post-surgery EQ-5D was 1.37 (SD =0.41)]. Also analyzing the EQ5D-VAS scores, the t-test revealed that surgery (P<0.01) improved the quality of life with statistically significance (EQ5D-VAS pre =43.89, SD =12.43 and EQ5D-VAS post =73.33, SD =10.84). Analyzing pre- and post-surgical GRS scores, the pain decreased significantly with the maximum mean difference among the 2nd and 3rd month before surgery and at 12 months after surgery (respectively D =5.444, P<0.001 and D =5.167, P<0.001). Conservatively managed patients affected by TLJBF require a strict clinical follow-up since pain sometimes is present in the following months and it affects the quality of life. Surgery should be considered for these cases.

Effectiveness of Extension Delivery Techniques for Rice Production Technologies Among Farmers in Gbako Local Government Area of Niger State, Nigeria

The study was conducted to evaluate effectiveness of extension delivery techniques in dissemination of rice production technologies in Gbako Local Government Area of Niger state. A probability sampling method involving random sampling of 150 respondents was used, and data were collected with aid of structured questionnaire. The study employed both descriptive and inferential statistics for analysis of the data. The results of a 3-point graphic rating scale (Likert ratio) indicated that method-cum-result demonstration, farmers’ participation in On-Farm Adaptive Research (OFAR) trials, Management Training Plot (MTP) and use of contact farmers were the very effective extension delivery methods. The results of a paired t- test for mean comparison revealed a highly significant (P?0.01) difference between the mean output (kg/ha.) before and after the dissemination of rice production technologies at 95% confidence interval. The study therefore concluded that extension delivery methods were effective and sources of information were utilized, which culminated in the increased yield of farmers; hence participatory extension delivery approach should be emphasized in policy formulation and program planning for intervention and technology transfer.

Catastrophizing, pain and traumatic stress symptoms following burns: A prospective study.

Pain and posttraumatic stress disorder (PTSD) symptoms are significant problems in the aftermath of a burn injury and they often co-occur. Catastrophizing has been linked to both phenomena. The aim of this study was to investigate the underlying role of catastrophizing in PTSD symptoms and pain following burns. This prospective study included 216 patients with burns. PTSD symptoms and pain were measured during hospitalization (T1) and 6 (T2) and 12months (T3) postburn. The Impact of Event Scale-Revised (IES-R) indexed PTSD symptoms. Acute pain (T1) was the mean pain during the first two weeks of hospitalization measured using an 11-point graphic numeric rating scale. Chronic pain was indexed using the single item 'average' pain from the Brief Pain Inventory (BPI). Catastrophizing was measured at T1 and T2 using the Cognitive Emotion Regulation Questionnaire (CERQ). Data were analysed using structural equationmodelling (SEM). The results showed that T2 catastrophizing mediated between acute and chronic PTSD symptoms, and T3 pain. Furthermore, the study revealed significant associations between catastrophizing, PTSD symptoms and pain at the respective measurements, and significant longitudinal associations between the constructs. A negative cognitive-affective response to a burn event, such as catastrophizing, mediated the relationship between acute and chronic PTSD symptoms and later chronic pain. Screening for catastrophizing and acute PTSD symptoms is recommended to identify persons at risk for chronic PTSD symptoms and pain. The identification of individuals who have the tendency to catastrophize may assist in finding those at risk for development of both chronic PTSD symptoms and chronic pain. Individuals may benefit from early psychological therapy focussing on catastrophizing and acute PTSD symptoms that may ameliorate both chronic PTSD symptoms and pain.

Pain and its Impact on the Functional Ability in Children Treated at the Children's Cancer Center of Lebanon

PurposeThe purpose of this study was to describe the characteristics of pain in children under treatment at the Children Cancer Centre of Lebanon at the American University of Beirut Medical Centre.Design and MethodsA cross-sectional correlational survey was used. The Adolescent Pediatric Pain Tool and the Functional Disability Inventory were used to examine the characteristics of pain experienced in a consecutive sample of children treated at the CCCL and its impact on their functional abilities. ResultsThe mean age of the 62 participants was 12.3 (SD 2.9). The overall mean pain intensity rating for the sample was 5.06 (SD 1.87) on a 10 cm Word Graphic Rating Scale. More than one-half of the children in the sample (57.4%) reported having pain “sometimes” with a median duration of two hours per pain episode. The most frequently reported locations of pain were the forehead, the abdomen, and the lower back. For the most part, the children used sensory words to describe their pain experience. The children reported moderate levels of functional disability (mean FDI score 25.04, SD 13.81). Multivariable linear regression analysis identified frequency, duration, location, use of affective descriptors, and treatments as statistically significant predictors of pain intensity. ConclusionRegrettably, the findings reported attest once again to unrelieved pain in a pediatric oncology population. Practice ImplicationsPolicy makers can contribute to pain control by introducing legislation and national policies to ensure adequate pain management for children with cancer in Lebanon.

Electrically-evoked auditory steady-state responses as neural correlates of loudness growth in cochlear implant users

Loudness growth functions characterize how the loudness percept changes with current level between the threshold and most comfortable loudness level in cochlear implant users. Even though loudness growth functions are highly listener-dependent, currently default settings are used in clinical devices. This study investigated whether electrically-evoked auditory steady-state response amplitude growth functions correspond to behaviorally measured loudness growth functions. Seven cochlear implant listeners participated in two behavioral loudness growth tasks and an EEG recording session. The 40-Hz sinusoidally amplitude-modulated pulse trains were presented to CI channels stimulating at a more apical and basal region of the cochlea, and were presented at different current levels encompassing the listeners' dynamic ranges. Behaviorally, loudness growth was measured using an Absolute Magnitude Estimation and a Graphic Rating Scale with loudness categories. A good correspondence was found between the response amplitude functions and the behavioral loudness growth functions. The results are encouraging for future advances in individual, more automatic, and objective fitting of cochlear implants.

Posterior lumber interbody fusion with pedicle screw fixation for the management of spondylolisthesis: An analysis of 40 cases

Spondylolisthesis is forward slipping of upper vertebra in relations to its lower one, commonest is L4-L5. The ideal surgical treatment of spondylolisthesis is still controversial. Posterior lumber interbody fusion with pedicle fixation is one of treatment choices for the lumber spondylolisthesis. Forty patients who operated through posterior lumber interbody fusion and pedicle screw fixation by single surgeon was included from January 2012 to March 2015. Periodical follow-up was done both clinically and radiologically up to 6 months. Patient outcome was completed based on pain relief graphic rating scale and Oswestry disability index. In our series, the excellent outcome were 25 patients (62.5%), good were 12 patients (30%), and fair were 3 patients (7.5%). There were no poor outcome and no new neurological deficit. This study concludes that posterior lumber inter-body fusion with pedicle is an effective treatment for the lumber spondylolisthesis. It helps to maintain the biomechanics, associated with less complication and improve the quality of life of patient.

Correction of Abdominal Distention by Biofeedback-Guided Control of Abdominothoracic Muscular Activity in a Randomized, Placebo-Controlled Trial

Abdominal distention is produced by abnormal somatic postural tone. We developed an original biofeedback technique based on electromyography-guided control of abdominothoracic muscular activity. We performed a randomized, placebo-controlled study to demonstrate the superiority of biofeedback to placebo for the treatment of abdominal distention. At a referral center in Spain, we enrolled consecutive patients with visible abdominal distention who fulfilled the Rome III criteria for functional intestinal disorders (47 women, 1 man; 21-74 years old); 2 patients assigned to the placebo group withdrew and 2 patients assigned to biofeedback were not valid for analysis. Abdominothoracic muscle activity was recorded by electromyography. The patients in the biofeedback group were shown the signal and instructed to control muscle activity, whereas patients in the placebo received no instructions and were given oral simethicone. Each patient underwent 3 sessions over a 10-day period. The primary outcomes were subjective sensation of abdominal distention, measured by graphic rating scales for 10 consecutive days before and after the intervention. Patients in the biofeedback group effectively learned to reduce intercostal activity (by a mean 45% ± 3%), but not patients in the placebo group (reduced by a mean 5% ± 2%; P < .001). Patients in the biofeedback group learned to increase anterior wall muscle activity (by a mean 101% ± 10%), but not in the placebo group (decreased by a mean 4% ± 2%; P < .001). Biofeedback resulted in a 56% ± 1% reduction of abdominal distention (from a mean score of 4.6 ± 0.2 to 2.0 ± 0.2), whereas patients in the placebo group had a reduction of only 13% ± 8% (from a mean score of 4.7 ± 0.1 to 4.1 ± 0.4) (P < .001). In a randomized trial of patients with a functional intestinal disorder, we found that abdominal distention can be effectively corrected by biofeedback-guided control of abdominothoracic muscular activity, compared with placebo. ClincialTrials.gov no: NCT01205100.

Brain Activation Follows Adding-Type Integration Laws: Brain and Rating Responses in an Integration Task with pairs of Emotional Faces

This study was designed to investigate the relation between rating responses and the patterns of cortical activation in an integration task using pairs of emotional faces. Participants judged on a graphic rating scale the overall affective intensity conveyed by two emotional faces, each presented to one of the two hemispheres via a Divided Visual Field technique (DVF). While they performed the task, EEG was recorded from 6 scalp locations. Three discrete emotions were considered (Joy, Fear, and Anger) and varied across three levels of expression intensity. Some face pairs portrayed the same emotion (same-emotion pairs), others two different emotions (distinct-emotions pairs). The patterns of integration of the two sources of information were examined both at the level of the ratings and of the brain response (event-related-#-desynchronization: ERD) recorded at each EEG lead. Adding-type rules were found for the ratings of both same-emotion and different-emotions pairs. Addingtype integration was also commonly found when #-ERD was taken as a response. Outcomes are discussed with a link to the lateralization of emotional processing and the relations between the observable R (e.g.,&#x0D; ratings) and possible implementational aspects of the implicit R posited by Information Integration Theory (IIT).

Auditory steady-state responses as neural correlates of loudness growth

The aim of this study was to find an objective estimate of individual, complete loudness growth functions based on auditory steady-state responses. Both normal-hearing and hearing-impaired listeners were involved in two behavioral loudness growth tasks and one EEG recording session. Behavioral loudness growth was measured with Absolute Magnitude Estimation and a Graphic Rating Scale with loudness categories. Stimuli were sinusoidally amplitude-modulated sinusoids with carrier frequencies of either 500 Hz or 2000 Hz, a modulation frequency of 40 Hz, a duration of 1 s, and presented at intensities encompassing the participants’ dynamic ranges. Auditory steady-state responses were evoked by the same stimuli using durations of at least 5 min. Results showed that there was a good correspondence between the relative growth of the auditory steady-state response amplitudes and the behavioral loudness growth responses for each participant of both groups of listeners. This demonstrates the potential for a more individual, objective, and automatic fitting of hearing aids in future clinical practice.

The impact of pelvic balance, physical activity, and fear-avoidance on the outcome after decompression and instrumented fusion for degenerative lumbar stenosis.

To evaluate the impact of pelvic balance, physical activity, and fear-avoidance in a cohort of patients undergoing decompression and instrumented fusion for degenerative lumbar stenosis. This study includes consecutive patients undergoing decompression and instrumented fusion for degenerative lumbar stenosis by one main surgeon from January 2014 to January 2015. Patients were interviewed by a psychologist and underwent standing whole spine X-ray. Lumbar and pelvic parameters (PI, SS, PT, iPT, LL) were measured by an independent spinal surgeon. Physical activity was measured with the International Physical Activity Questionnaire (IPAQ). The "fear-avoidance" was measured with the Tampa Scale for Kinesiophobia (TSK). Back pain was assessed by the Graphic Rating Scale (GRS). The disability was assessed by the Roland-Morris Low Back Pain and Disability Questionnaire. Statistical interpretation of the data was performed using SPSS v19 software (SPSS Inc, Chicago, Illinois). The sample included 51 patients underwent standard posterior laminectomy and instrumented fusion. Surgery has a positive global impact on the perceived low back pain. No significant (Spearman) correlations emerged among pelvic parameters and the pre- and post-surgical GSR. Patients were divided into three groups according to the IPAQ scores after the operation: "inactive" (I), "minimally inactive" (m-I), and "HEPA". Significant differences emerged between IPAQ and Roland-Morris scores (F(2, 48)=5.48, p=0.007): the "inactive" (M(R-M)=11.3) or "minimally active" (M(R-M)=9.8) groups scored significantly higher than the "HEPA" group (M(R-M)=4.7). Tampa scores correlated with gender (rho=-0.408, p=0.003) and with BMI (rho=-0.369, p=0.008). Females and obese patients reported higher levels of Tampa scores. Significant relationship was found between Tampa scores and pre-GSR (rho(pre)=0.250, p=0.08) and significant with post-surgical GSR (rho(post)=0.275, p=0.05) and with post-Roland-Morris score (rho(post)=0.599, p<0.01). The fear-avoidance and the physical inactivity are related to the highest levels of low back pain, more than pelvic imbalance. "Inactive" and "fear-avoidant" patients have also the worst outcome after surgery and the worst level of disability.

Circumplex Model of Affect: A Measure of Pleasure and Arousal During Virtual Reality Distraction Analgesia.

Immersive virtual reality (VR) distraction provides clinically effective pain relief and increases subjective reports of "fun" in medical settings of procedural pain. The goal of this study was to better describe the variable of "fun" associated with VR distraction analgesia using the circumplex model (pleasure/arousal) of affect. Seventy-four healthy volunteers (mean age, 29 years; 37 females) received a standardized, 18-minute, multimodal pain sequence (alternating thermal heat and electrical stimulation to distal extremities) while receiving immersive, interactive VR distraction. Subjects rated both their subjective pain intensity and fun using 0-10 Graphic Rating Scales, as well as the pleasantness of their emotional valence and their state of arousal on 9-point scales. Compared with pain stimulation in the control (baseline, no VR) condition, immersive VR distraction significantly reduced subjective pain intensity (P < 0.001). During VR distraction, compared with those reporting negative affect, subjects reporting positive affect did so more frequently (41 percent versus 9 percent), as well as reporting both greater pain reduction (22 percent versus 1 percent) and fun scores (7.0 ± 1.9 versus 2.4 ± 1.4). Several factors-lower anxiety, greater fun, greater presence in the VR environment, and positive emotional valence-were associated with subjective analgesia during VR distraction. Immersive VR distraction reduces subjective pain intensity induced by multimodal experimental nociception. Subjects who report less anxiety, more fun, more VR presence, and more positive emotional valence during VR distraction are more likely to report subjective pain reduction. These findings indicate VR distraction analgesia may be mediated through anxiolytic, attentional, and/or affective mechanisms.

Decompression versus decompression and fusion for degenerative lumbar stenosis: analysis of the factors influencing the outcome of back pain and disability

The objective of this study is to evaluate the factors influencing the outcome of back pain and disability in patients operated for lumbar stenosis without instability and deformity using two classical surgical techniques: decompression alone and decompression plus fusion. This is a retrospective cohort study of patients who underwent lumbar surgery with standard posterior decompression or standard posterior decompression plus pedicle screw fixation for degenerative lumbar stenosis without deformity, spondylolisthesis or instability at our department from June 2010 to January 2014. They were divided into two groups: decompression group (D) and decompression-fusion group (F). We analyzed the following factors: age, gender, levels of stenosis, pre-surgical "micro-instability", and post-surgical "micro-instability". A total of 174 patients were enrolled in the study. Both Graphic Rating Scale (GRS) and Oswestry Disability Index (ODI) scores were significantly decreased after surgery (P<0.001). Female patients appeared to have lesser improvements from surgery, for both D and F groups. An analysis of variance using the decrease of pain (GRS pre-post) as dependent variable and type of surgery, age, gender and their interaction as factors showed that the main effects of type of surgery and gender were significant. The analysis of variance for the decrease of pain (GRS) and disability (ODI) according to the levels of stenosis showed a significant interaction for GRS scores. Female patients that underwent fixation surgery reported the least improvement in disability. A significant interaction was found on the one-way analysis of variance for the D group without pre-surgical micro-instability using post-surgical micro-instability as factor. Our study supports posterior decompression alone as the gold standard option as treatment for lumbar stenosis without instability and deformity. Additional fusion should be considered only to prevent post-surgical instability. The "micro-instability" is a radiological finding that has its clinical surrogate but is not able to guide the choice of the type of surgery. Moreover the significance of "micro-instability" is still unclear. We suggest a prospective study following patients with asymptomatic micro-instability to definitively understand the clinical history.

What level of pain are patients happy to live with after surgery for lumbar degenerative disorders?

Background ContextA new approach to the interpretation of treatment success comprises the reporting of the proportion of patients whose symptoms have reduced to an acceptable level, ie, who have reached a satisfactory state. PurposeWe sought to evaluate the acceptable level of pain in patients after surgery for painful degenerative lumbar disorders. DesignThis is a cross-sectional study of outcome data, 12 months postoperatively. Patient SampleThe sample includes 6,943 patients registered in our in-house Spine Outcomes Registry, nested within the EUROSPINE “Spine Tango” registry, undergoing surgery for degenerative disorders of the lumbar spine (disc herniation [DH; N=1,608], spinal stenosis [SS; N=1,782], degenerative spondylolisthesis [DS; N=1,000], degenerative deformity [DegDef; N=612], and degenerative disc or segment disease [DegSeg; N=473], and 1,468 degenerative but no specific category). Outcome MeasuresThe Core Outcome Measures Index (COMI) was the outcome measure. The specific items used for this analysis were the two 0 to 10 graphic rating scales for back and leg pain and the symptom-specific well-being (SSWB) item “if you had to spend the rest of your life with the symptoms you have now, how would you feel about it?”, with a 5-point response scale from “very satisfied” to “very dissatisfied.” MethodsThe COMI was completed before and at 3, 12, and 24 months after surgery. Answers on the SSWB were dichotomized and used as the external criterion in receiver operating characteristics (ROC) analysis to derive the cutoff score for pain (the higher of back and leg pain) indicating being at least “somewhat satisfied” with the symptom state 12 months postoperatively. Sensitivity analyses were carried out for various subgroups (sex, age, pathology, comorbidity status, smoking status, preoperative pain level, previous surgery, type of health insurance, and time of follow-up [3 and 24 months]). The study was funded by the Schulthess Klinik Research Funds; there were no potential conflict of interest-associated biases for any of the authors. ResultsOf 6,943 patients, 6,248 (90%) returned a 12-month questionnaire, of which 47% reported being at least somewhat satisfied with their symptom state (52% [DH], 45% [SS], 53% [DS], 44% [DegDef], 45% [DegSeg], and 44% [others]). The areas under the curve for the ROCs were 0.89 to 0.91 for the different pathologies, indicating a good ability of the pain score to discriminate between being in a satisfactory state or not. The cutoff indicating a satisfactory symptom state was ≤2 points for DH (sensitivity: 76%; specificity: 88%) and ≤3 points for all other pathologies (sensitivity: 79%–84%; specificity 81%–85%). The sensitivity analyses revealed ≤3 points to be the most common cutoff for the various subgroups. ConclusionsMost spine interventions decrease pain but rarely do they totally eliminate it. Reporting of the percent of patients achieving a pain score equivalent to the “acceptable symptom state” may represent a more stringent target for denoting surgical success in the treatment of painful spinal disorders. For DH, this is ≤2, and for other degenerative pathologies it is ≤3.