Minimal Disability Research Articles

Correlation between functional MRI techniques and early disability in ambulatory patients with relapsing\u2013remitting MS

BackgroundMultiple sclerosis (MS) is a common neurological disorder which can lead to an occasional damage to the central nervous system. Conventional magnetic resonance imaging (cMRI) is an important modality in the diagnosis of MS; however, correlation between cMRI findings and clinical impairment is weak. Non-conventional MRI techniques including apparent diffusion coefficient (ADC) and magnetic resonance spectroscopy (MRS) investigate the metabolic changes over the course of MS and overcome the limits of cMRI.A total of 80 patients with MS and 20 age and sex-matched healthy control subjects were enrolled in this cross-sectional study. Ambulatory patients with relapsing–remitting MS (RRMS) were recruited. Expanded Disability Status Scale (EDSS) was used to assess the disability and the patients were categorized into three groups “no disability”, “minimal disability” and “moderate disability”. All patients underwent cMRI techniques. ADC was measured in MS plaques and in normal appearing white matter (NAWM) adjacent and around the plaque. All metabolites concentrations were expressed as ratios including N-acetyl-aspartate/creatine (NAA/Cr), choline/N-acetyl-aspartate (Cho/NAA) and choline/creatine (Cho/Cr). ADC and metabolite concentrations were measured in the normal white matter of 20 healthy control subjects.ResultsThe study was carried on 80 MS patients [36 males (45%) and 44 females (55%)] and 20 healthy control [8 males (40%) and 12 females (60%)]. The ADC values and MRS parameters in NAWM of patients with MS were significantly different from those of the control group. The number of the plaques on T2 images and black holes were significantly higher at “Minimal disability” group. Most of the enhanced plaques were at the “Moderate disability” group with P value < 0.001. The mean of ADC in the group 1, 2 and 3 of disability was 1.12 ± 0.19, 1.50 ± 0.35, 1.51 ± 0.36, respectively, with P value < 0. 001. In the group 1, 2 and 3 of disability, the mean of NAA/Cr ratio at the plaque was 1.34 ± 0.44, 1.59 ± 0.51 and 1.11 ± 0.15, respectively, with P value equal 0.001.ConclusionThe non-conventional quantitative MRI techniques are useful tools for detection of early disability in MS patients.

Cluster analysis identifies unmet healthcare needs among patients with rheumatoid arthritis

Objective To identify the patterns of healthcare resource utilization and unmet needs of persistent disease activity, pain, and physical disability in rheumatoid arthritis (RA) by cluster analysis. Method Patients attending the Jyväskylä Central Hospital rheumatology unit, Finland, were, from 2007, prospectively enrolled in a clinical database. We identified all RA patients in 2010–2014 and combined their individual-level data with well-recorded administrative data on all public healthcare contacts in fiscal year 2014. We ran agglomerative hierarchical clustering (Ward’s method), with 28-joint Disease Activity Score with three variables, Health Assessment Questionnaire index, pain (visual analogue scale 0–100), and total annual health service-related direct costs (€) as clustering variables. Results Complete-case analysis of 939 patients derived four clusters. Cluster C1 (remission and low costs, 550 patients) comprised relatively young patients with low costs, low disease activity, and minimal disability. C2 (chronic pain, disability, and fatigue, 269 patients) included those with the highest pain and fatigue levels, and disability was fairly common. C3 (inflammation, 97 patients) had rather high mean costs and the highest average disease activity, but lower average levels of pain and less disability than C2, highlighting the impact of effective treatment. C4 (comorbidities and high costs, 23 patients) was characterized by exceptionally high costs incurred by comorbidities. Conclusions The majority of RA patients had favourable outcomes and low costs. However, a large group of patients was distinguished by chronic pain, disability, and fatigue not unambiguously linked to disease activity. The highest healthcare costs were linked to high disease activity or comorbidities.

How patients with multiple sclerosis acquire disability.

Patients with multiple sclerosis acquire disability either through relapse-associated worsening (RAW) or progression independent of relapse activity (PIRA). This study addresses the relative contribution of relapses to disability worsening over the course of the disease, how early progression begins and the extent to which multiple sclerosis therapies delay disability accumulation.Using the Novartis-Oxford multiple sclerosis (NO.MS) data pool spanning all multiple sclerosis phenotypes and paediatric multiple sclerosis, we evaluated ∼200 000 Expanded Disability Status Scale (EDSS) transitions from >27 000 patients with ≤15 years follow-up. We analysed three datasets: (i) A full analysis dataset containing all observational and randomized controlled clinical trials in which disability and relapses were assessed (n = 27 328); (ii) all phase 3 clinical trials (n = 8346); and (iii) all placebo-controlled phase 3 clinical trials (n = 4970). We determined the relative importance of RAW and PIRA, investigated the role of relapses on all-cause disability worsening using Andersen-Gill models and observed the impact of the mechanism of worsening and disease-modifying therapies on the time to reach milestone disability levels using time continuous Markov models.PIRA started early in the disease process, occurred in all phenotypes and became the principal driver of disability accumulation in the progressive phase of the disease. Relapses significantly increased the hazard of all-cause disability worsening events; following a year in which relapses occurred (versus a year without relapses), the hazard increased by 31–48% (all P < 0.001). Pre-existing disability and older age were the principal risk factors for incomplete relapse recovery. For placebo-treated patients with minimal disability (EDSS 1), it took 8.95 years until increased limitation in walking ability (EDSS 4) and 18.48 years to require walking assistance (EDSS 6). Treating patients with disease-modifying therapies delayed these times significantly by 3.51 years (95% confidence limit: 3.19, 3.96) and 3.09 years (2.60, 3.72), respectively. In patients with relapsing-remitting multiple sclerosis, those who worsened exclusively due to RAW events took a similar length of time to reach milestone EDSS values compared with those with PIRA events; the fastest transitions were observed in patients with PIRA and superimposed relapses.Our data confirm that relapses contribute to the accumulation of disability, primarily early in multiple sclerosis. PIRA begins in relapsing-remitting multiple sclerosis and becomes the dominant driver of disability accumulation as the disease evolves. Pre-existing disability and older age are the principal risk factors for further disability accumulation. The use of disease-modifying therapies delays disability accrual by years, with the potential to gain time being highest in the earliest stages of multiple sclerosis.

Health and study dropout: health aspects differentially predict attrition

BackgroundParticipant dropout poses significant problems in longitudinal survey studies. Although it is often assumed that a participant’s health predicts future study dropout, only a few studies have examined this topic, with conflicting findings. This study aims to contribute to the literature by clarifying the relationship between different aspects of health and study dropout.MethodsThe 2008 baseline sample of the German Aging Survey was used to predict study dropout (N = 4442). Indicators of health included physical health using the number of chronic conditions, physical functioning using the SF-36 Physical Functioning subscale, cognitive functioning using the digit symbol substitution test, and depression using the CESD-15.ResultsIt was found that different aspects of health had differential associations with survey dropout: Worse physical functioning and in part worse cognitive functioning predicted increased dropout rates; contrarily, worse physical health predicted decreased dropout when controlling for other health aspects and covariates. Depression was not significantly related to study dropout.ConclusionsTherefore, participants with chronic conditions, but minimal physical and cognitive disability were most likely to participate in the future. These findings suggest that health has a complex relationship with survey dropout and must be accounted for in longitudinal studies. Neglecting this systematic attrition due to health problems bears the risk of severely under- or overestimating health-related effects and trends.

Variability of objective gait measures across the expanded disability status scale in people living with multiple sclerosis: A cross-sectional retrospective analysis

BackgroundThe Expanded Disability Status Scale (EDSS) is widely utilized in clinical trials and routine care to evaluate disease burden and progression among people with multiple sclerosis (pwMS). However, instrumental gait measures may be more suitable than EDSS to track walking disability in pwMS. In this cross-sectional study, we aimed to quantify the variability of spatiotemporal gait measures within homologous EDSS categories. MethodsA total of 205 pwMS (age=46.5[SD=10.5] years, 72.2% female, EDSS range=1.0–6.5) were studied in this retrospective analysis. Participants underwent walking assessments through the GAITRite system and the following spatiotemporal gait measures were recorded: gait speed, mean normalized velocity (MNV), base of support, stride length, step length, percentage of gait cycle spent in double support and single support, and functional ambulation profile. The EDSS was evaluated by a certified neurologist. ResultsAll gait measures exhibited fair to very strong correlations with scores on the EDSS (-0.81≤ρs≤0.25) and poor to fair correlations with disease duration (-0.32≤ρs≤0.17). Overall, the percent variability of gait measures increased across EDSS categories, with coefficients of variation ranging from 6.9% to 37.2% in the minimal disability group (EDSS≤2.5), 8.1% to 33.4% and 22.3% to 53.8% in the moderate (2.5<EDSS≤4.5) and severe (EDSS>4.5) disability groups, respectively. ConclusionSpatiotemporal gait measures have great variability within homologous EDSS categories. The high percent variability of gait speed and MNV (up to more than 50%) suggests that walking ability varies substantially within and across disability levels. Therefore, in addition to the EDSS, more comprehensive (multidimensional), objective patient-centric metrics would be needed to accurately evaluate disability in pwMS.

Comparative effects of Core Stability Exercises and Endurance Training in Patients with Mechanical Low Back Pain

Low back pain is a major health problem resulting in psychosocial and physical disability. The prevalence of LBP and risk of recurrence is rising due to the sedentary life style, poor postural awareness and short term oriented intervention plans. It is the need of the time to design one or more exercise plans that can improve pain and functional disability and prevent recurrence of symptoms in patients with mechanical low back pain. Objective: The objective of this study is to compare the effects of core stability exercises and endurance training on the pain and functional disability in the population having mechanical low back pain. Materials and Methods: It was a quasi-experimental study with 74 patients with chronic low back pain, divided equally in two groups containing 37 patients each. Both groups were treated with baseline of moist heat pack in combination with interferential. Group A was treated with core stability exercises and group B was treated with endurance training for five times a week. Pre and post treatment scores were compared with NPRS for intensity of pain and Oswestry Disability Index for functional disability scores. Results: Data was analysis by SPSS.25 on 74 patients. In type of pain, about 79% of patients were suffering from moderate and severe type of pain while there were only 21% of patients who came with mild pain in both groups. Independent t-test was applied for changes between the group on NPRS scale, the results shows significant results with p&lt;0.05. In core stability group the difference between pretreatment and post treatment was 6.08 to 1.4 and in stability group the difference was 6.13 to 1.10. Endurance training exercises on ODI, there was no one with severe disability, and 94.6 %were with minimal disability and only 5.4 % were with moderate disability. It shows that endurance training exercises were better than stability exercises. Conclusion: It is concluded that endurance training has more clinical difference on outcome measures of NPRS and ODI as compared to core stability exercises in patients with mechanical low back pain.

Extension-Block Pinning for Unstable Dorsal Proximal Interphalangeal Joint Fracture-Dislocations: A Simple, Percutaneous Technique With Reproducible Outcomes.

Proximal interphalangeal (PIP) joint fracture-dislocations can be technically challenging injuries to treat, and no technique has proven to be superior nor lead to predictably good outcomes. We describe our experience of treating unstable dorsal fracture-dislocations of the PIP joint with extension-block pinning (EBP) at our institution over a 22-year period. In all, 23 patients with 24 unstable dorsal fracture-dislocations of the PIP joint treated with EBP between January 1998 and October 2020 were identified. All patients underwent closed reduction of the PIP joint and insertion of a Kirschner wire into the proximal phalanx, creating a mechanical block. Range of motion and joint congruity were assessed at final clinic follow-up. Long-term function was assessed via completion of a Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire. Spearman's correlation coefficient was utilized to assess if any association existed between treatment delay, pin-in-body days, or amount of articular surface involved and QuickDASH score. Mean range of motion at final follow-up was 83.3° and 22 of 24 PIP joints demonstrated a congruent reduction. In all, 15 of the 23 patients completed the QuickDASH questionnaire at a median long-term follow-up of 57.5 months (range: 3-157 months). Average QuickDASH score was 18.8, indicating minimal long-term disability. No statistically significant associations were found between treatment delay, pin-in-body days, or amount of articular surface involved and QuickDASH score. EBP offers a simple and innovative method to treat a complex injury of the PIP joint. It is technically straightforward and cheap, and produces excellent functional outcomes with minimal long-term disability.

Association of foot arch types with chronic low back pain among selected adults in Sri Lanka

BACKGROUND: Abnormal foot posture has been extensively discussed as a risk factor for chronic low back pain (CLBP). The present study aimed at assessing the association of foot arch types with CLBP in a selected population.METHODOLOGY: A descriptive study was conducted at the Department of Rheumatology and Rehabilitation Clinic of National Hospital of Sri Lanka with employing a 100 of patients diagnosed with CLBP (50 cases and 50 controls). The data were collected during December 1, 2019, and February 28, 2020. Foot arch type was detected using the arch index method. The modified Oswestry low back pain disability questionnaire was used to measure the disability level and Numerical Rating Scale (NRS) for pain. Chi-square test and Pearson's correlation tests were used for data analysis.RESULTS: Out of the patients with CLBP, 82% (n = 41) were with normal foot arch (NFA), 16% (n = 8) with low foot arch (LFA), and 2% (n = 1) with high foot arch (HFA). In the control group, there were 94% (n = 47) with NFA, 4% (n = 2) with LFA, and 2% (n = 1) with HFA. Sample size was small to extract a significant P value for the observed difference between cases and controls with regard to the presence of LFA. The majority (66%) of the patients had severe disability followed with moderate disability (28%), minimal disability (4%), and crippled (2%). A positive correlation was found between disability level and the pain scale (P < 0.01).CONCLUSIONS: Further research with large sample size is necessary to make firm conclusions on association of LFA type with low back pain. However, the pain and the disability level among the patients with CLBP seems to be highly correlated.

Physical Activity and Low Back Pain in Medical Student

Low back pain (LBP) is a disease that can negatively affect all people with the prevalence of 38% per year. Risk factors of LBP are lifestyle and physical activities, incorrect sitting and lifting position, age, and psychological factors such as stress. Medical students become one of the risk groups of LBP due to limited time of physical activity that leads to inactivity. This research is aiming to understand the correlation between physical activity and LBP in medical students. This is an analytical observational research with cross sectional study design. The subject was 100 medical students of Sebelas Maret University who fulfill the criteria of sampling. Sampling was done using purposive sampling technique. Data was collected using IPAQ-SF (International Physical Activity Questionnaire Short Form) and Oswestry Low Back Pain Disability Index questionnaire. Data was then analyzed with Rank Spearman Correlation Test. As a result of this research, 57 medical students of Sebelas Maret University do moderate physical activity and 91 medical students have LBP with minimal disability. Results showed there was no significant correlation between physical activity and LBP with p = 0,064 (p&gt;0,05) and there was also no significant correlation between gender and LBP with p = 0,176 (p&gt;0,05) in medical students of Sebelas Maret University.In conclusion, there was no significant correlation between physical activity, gender, and LBP in medical students of Sebelas Maret University.

The Effect of L5-S1 Degenerative Disc Disease on Outcomes of L4-L5 Fusion.

Retrospective cohort study. The aim was to investigate the clinical relevance of preoperative caudal adjacent segment degeneration (ASD) in patients undergoing isolated L4-5 fusion to determine a threshold of degeneration at which a primary L4-S1 fusion would be warranted. Increased motion and biomechanical forces across the adjacent caudal segment in isolated L4-L5 fusion leads to concerns regarding the increased incidence of revision surgery because of the development of ASD. Patients who underwent isolated L4-L5 fusion between 2014 and 2019 were reviewed. Pfirrmann grading and the disc heights of the caudal level relative to the rostral level were used to quantify preoperative adjacent degenerative disc disease. To assess the influence of preoperative caudal degenerative disc disease, preoperative disc height ratios (DHRs) were compared for patients who reported minimal, moderate, and severe Oswestry disability index (ODI) sores on postoperative assessment. For each patient-reported outcome measure (PROM), adjacent DDD was compared for those who did and did not meet MCID. An area under curve analysis was used to identify a threshold of degeneration impacting outcomes from the preoperative DHR. A total of 123 patients were studied with an average follow-up of 2.11 years. All patients demonstrated a significant improvement in all PROMs after surgery. When categorizing patients based on the severity of postoperative ODI scores, there were no preoperative differences in the L5-S1 Pfirrmann grading or DHRs. There was a significant association between greater preoperative anterior DHR and an increased number patients who met MCID for visual analog scale back. There were no radiographic differences in preoperative L5-S1 Pfirrmann grade or DHR for ODI, visual analog scale leg, MCS-12, or PCS-12. area under curve analysis was not able to identify a preoperative DHR threshold that reflected worse MCID for any PROM. No preoperative radiographic indicators of caudal ASD were predictive of worse clinical outcomes after isolated L4-5 fusion. Level III.

Leveraging Visual Outcome Measures to Advance Therapy Development in Neuroimmunologic Disorders.

The visual system offers unparalleled precision in the assessment of neuroaxonal damage. With the majority of patients with multiple sclerosis (MS) experiencing afferent and efferent visual dysfunction, outcome measures capturing these deficits provide insight into neuroaxonal injury, even in those with minimal disability. Ideal for use in clinical trials, visual measures are generally inexpensive, accessible, and reproducible. Quantification of visual acuity, visual fields, visual quality of life, and electrophysiologic parameters allows assessment of function, whereas optical coherence tomography (OCT) provides reliable measures of the structural integrity of the anterior afferent visual pathway. The technology of oculomotor biometrics continues to advance, and discrete measures of fixation, smooth pursuit, and saccadic eye movement abnormalities are ready for inclusion in future trials of MS progression. Visual outcomes allow tracking of neuroaxonal injury and aid in distinguishing MS from diseases such as neuromyelitis optica spectrum disorder (NMOSD) or myelin oligodendrocyte glycoprotein antibody–associated diseases (MOGAD). OCT has also provided unique insights into pathophysiology, including the identification of foveal pitting in NMOSD, possibly from damage to Müller cells, which carry an abundance of aquaporin-4 channels. For some study designs, the cost-benefit ratio favors visual outcomes over more expensive MRI outcomes. With the next frontier of therapeutics focused on remyelination and neuroprotection, visual outcomes are likely to take center stage. As an international community of collaborative, committed, vision scientists, this review by the International MS Visual System Consortium (IMSVISUAL) outlines the quality standards, informatics, and framework needed to routinely incorporate vision outcomes into MS and NMOSD trials.

Disorders of Consciousness Associated With COVID-19: A Prospective Multimodal Study of Recovery and Brain Connectivity.

Background and ObjectivesIn patients with severe coronavirus disease 2019 (COVID-19), disorders of consciousness (DoC) have emerged as a serious complication. The prognosis and pathophysiology of COVID-DoC remain unclear, complicating decisions about continuing life-sustaining treatment. We describe the natural history of COVID-DoC and investigate its associated brain connectivity profile.MethodsIn a prospective longitudinal study, we screened consecutive patients with COVID-19 at our institution. We enrolled critically ill adult patients with a DoC unexplained by sedation or structural brain injury and who were planned to undergo a brain MRI. We performed resting-state fMRI and diffusion MRI to evaluate functional and structural connectivity compared to healthy controls and patients with DoC resulting from severe traumatic brain injury (TBI). We assessed the recovery of consciousness (command following) and functional outcomes (Glasgow Outcome Scale Extended [GOSE] and the Disability Rating Scale [DRS]) at hospital discharge and 3 and 6 months after discharge. We also explored whether clinical variables were associated with recovery from COVID-DoC.ResultsAfter screening 1,105 patients with COVID-19, we enrolled 12 with COVID-DoC. The median age was 63.5 years (interquartile range 55–76.3 years). After the exclusion of 1 patient who died shortly after enrollment, all of the remaining 11 patients recovered consciousness 0 to 25 days (median 7 [5–14.5] days) after the cessation of continuous IV sedation. At discharge, all surviving patients remained dependent: median GOSE score 3 (1–3) and median DRS score 23 (16–30). Ultimately, however, except for 2 patients with severe polyneuropathy, all returned home with normal cognition and minimal disability: at 3 months, median GOSE score 3 (3–3) and median DRS score 7 (5–13); at 6 months, median GOSE score 4 (4–5), median DRS score 3 (3–5). Ten patients with COVID-DoC underwent advanced neuroimaging; functional and structural brain connectivity in those with COVID-DoC was diminished compared to healthy controls, and structural connectivity was comparable to that in patients with severe TBI.DiscussionPatients who survived invariably recovered consciousness after COVID-DoC. Although disability was common after hospitalization, functional status improved over the ensuing months. While future research is necessary, these prospective findings inform the prognosis and pathophysiology of COVID-DoC.Trial Registration InformationClinicalTrials.gov identifier: NCT04476589.

Digital Survey Assessment of Factors Associated with Musculoskeletal Complaints Among US Ophthalmologists.

PurposeTo quantify features of musculoskeletal (MSK) complaints among US ophthalmologists and analyze factors related to symptom severity.MethodsCornea, glaucoma, retina, and comprehensive practitioners were invited to complete a web-based survey via email. Data on demographics, practice and procedural volumes, wellness activities, job stress, MSK health, the Total Disability Index (TDI), and ergonomics were collected. Significance testing was performed to evaluate factors related to TDI score.ResultsOf the 245 ophthalmologists contacted, 58.8% (n = 144) responded at least in part to the survey. Pain episodes were reported in 81.4% (n = 83) of 102 respondents, with 48.1% (n = 49) experiencing daily or weekly attacks. The neck, low back, and shoulders were commonly affected, yet only 57.1% (n=20) of those with shoulder pain reported a corresponding diagnosis. The mean TDI score was 6.2 ± 7.3%, indicating minimal disability related to the spine. Demographics, volume metrics, and wellness hours were each not significantly associated with TDI score (p > 0.05). Higher job stress ratings were reported by those who experienced more frequent pain attacks (p = 0.02) and those with higher TDI scores (p = 0.001). Greater difficulty with clinic, laser, and surgery job tasks was observed in respondents with higher TDI scores (p < 0.001, p = 0.005, and p < 0.001) and more bodily pain locations (p = 0.002, p = 0.002, and p = 0.001). Respondents who pursued practice modifications (p = 0.03) and treatments (p = 0.01) to reduce or prevent pain had higher mean TDI scores, and 94.2% of respondents (n = 97) were interested in learning more about ergonomics.ConclusionMild MSK complaints were highly prevalent among the surveyed ophthalmologists, and a similar trend could be expected for other US ophthalmologists. Greater frequency and severity of pain may contribute to physician burnout. There may be underdiagnosis of MSK pathology yet also high demand for ergonomic strategies and MSK treatments, suggesting a need for practical solutions.

PERCUTANEOUS INSTRUMENTATION WITHOUT ARTHRODESIS FOR THORACOLUMBAR BURST FRACTURES (A3/A4, B): A RETROSPECTIVE STUDY

ABSTRACT Objective: There is still no consensus as to the treatment options for thoracolumbar burst fractures, although these fractures are widely described in the literature. The aim of this study was to evaluate the clinical and radiological outcomes of percutaneous instrumentation without arthrodesis as a method of fixation of these lesions. Methods: This retrospective, cross-sectional study evaluated 16 patients by measuring regional kyphosis using the Cobb method and the scores for quality of life and return to work (Oswestry Disability Index, VAS, SF-36 and Denis). Results: Six months after surgical treatment, 62.5% of all patients showed minimal disability according to the Oswestry Disability Index, maintenance of regional kyphosis correction and no synthesis failure. Conclusions: The clinical and radiological outcomes of the study suggest that minimally invasive fixation is indicated for the treatment of thoracolumbar burst fractures. Level of evidence IV; Observational study: retrospective cohort.

Prevalence and Management of Nonspecific Low Back Pain in Physiotherapy Students

Introduction: Low back pain is a significant health problem in all developed countries and is one of the most common cases that appear near health facilities to seek treatment. The prevalence and incidence of LBP is unchangable almost every year worldwide, being described as a pain that causes instability and inability to work, disrupts the quality of life and the reason for more frequent medical visits. The purpose of this study: The purpose of this study is to indetify and study the prevalence of nonspecific Low Back Pain among the Physical Therapy students of the Faculty of Technical Medical Science in the University of Medicine Tirana. Also this study aim’s to study the characteristics of Low Back Pain and how does it affect the every day lives of students. Methodology: This study included 80 students (73 females and 7 males) of the Physical Therapy on their Science Master Degree, first year (n=42) and second year (n=38). Students filled a questionnaire and to be participants on this study they must furfill some criteria defined by the study. Results: By the end of the study was discovered that the prevalence of nonspecific Low Back Pain among students was 73%. The mean value of pain intensity according to Visual Analogue Scale was 3.77. Where 36% of the subjects exprerienced a mild pain, 55% e moderated pain and 9% a severe pain. Disability according to the Oswestry Disability Index was 19% (minimal disability). Conclusions: In conclusion according to this study Physical Therapy students in Albania have a high prevalence of Low Back Pain among them. Low Back Pain can be an ocupational risk and may cause disability on this student group. Risk factors and the causes of Low Back Pain remain to be studied.

Spinal Curvatures, Deformities, and the Level of Disability in People with Bilateral Spastic Cerebral Palsy Living in South Africa; A 6-Year Follow-Up Study During Adulthood

ObjectiveDetermine if spinal curvatures, deformities, as well as level of disability (due to back pain) changes with aging in adults with bilateral spastic cerebral palsy after receiving orthopedic interval surgery approach treatment in childhood. DesignConsecutive case-series SettingUrban South Africa ParticipantsTwenty-seven ambulatory adults with cerebral palsy Main Outcome MeasuresSpinal curvatures (scoliosis, thoracic kyphosis and lumbar lordosis) and deformities (spondylolysis and spondylolisthesis) were determined with X-rays, while the level of disability was assessed with the Oswestry Disability Index. ResultsThe prevalence of spinal abnormalities were: 30% scoliosis (mild: <30°), 0% thoracic hyperkyphosis, 15% lumbar hyperlordosis, 0%; spondylolysis, and 0% spondylolisthesis. No changes in scoliosis and lumbar lordosis angles were observed, while the change in thoracic kyphosis angle was smaller than the minimal clinically important difference and moved closer toward the norm-values for typically developing adults. Level of disability remained similar with 63% reporting minimal disability, 26% moderate disability and 11% severe disability. No associations with spinal curvatures were found. ConclusionsNo clinically meaningful changes in spinal curvatures, deformities and level of disability due to pain were seen during the 6 years follow-up period in adults with cerebral palsy who have been treated with interval surgery approach in childhood.

Patient-Reported Long-Term Outcomes After Free Vascularized Fibula Graft in Spinal Reconstruction: a 24-year Cohort

The use of free vascularized fibula grafts (FVFG) in complex spinal deformity surgery intends to allow for life-long stability of the spine with good long-term clinical outcome. However, these long-term outcomes of this technique are still lacking. The objective of this study is to report the long-term postoperative outcomes and establish the long-term viability of this method for spinal reconstruction. A retrospective cohort study was conducted in all patients who underwent spinal reconstructive surgery utilizing a FVFG at a tertiary medical centre. Questionnaires taken from the participants were the Numeric Pain Rating Scale (NPRS), Oswestry Low Back Pain Disability (also known as Oswestry Disability Index (ODI)), Scoliosis Research Society 22r (SRS-22), the EQ-5D-5L and a self-assembled questionnaire regarding donor site comorbidities and patient satisfaction. Over a period of 24 years (1995-2019), we used FVFG for spinal reconstruction in 31 patients. A total of 25 patients were included in this study, 8 patients were deceased at the time of this study, and sixteen patients responded to the questionnaires. Patient satisfaction was rated 6.8 out of 10, the average SRS-22r score was 3.6, EQ-5D-5L score was 0.725, and the ODI score showed a minimal disability (0-20%) postoperatively. Overall complication-free survival was 8.9 years. Nine patients underwent a re-operation in the spinal area; five for the removal of the spinal instrumentation. Patients reported satisfied and good long-term outcomes following FVFG surgical procedure for complex spinal deformities. Therefore, considering the alternatives, this procedure provides a good long-term solution for complex spinal deformity surgery.

FUNCTIONAL OUTCOME BY EVALUATION OF DASH SCORE ON DROP HAND PATIENT TREATED WITH JONES’ TENDON TRANSFER: A RETROSPECTIVE STUDY

Background: Drop hands due to radial nerve injuries cause functional and structural disabilities. Tendon transfer became the last option when nerve repair could not give patients restoration. The most popular method was Jones' Tendon transfer to restore wrist dorsiflexion, extending the thumb and the fingers. The Disabilities of Arm, Shoulder, and Hand (DASH) score measures functional outcomes in patients with upper extremities injuries. This study was to acknowledge the functional outcome and evaluate the DASH score in drop hand patients who undergone surgery by Jones’ Tendon Transfer in Prof. Dr. R. Soeharso Orthopaedic Hospital Surakarta from January 2014 to June 2016.Methods: The collected data from the medical record was evaluated based on functional outcome and DASH score. Eleven patients were included, ten male patients (90.9%) and one female patient (9.1%). The mean age of patients was 27.4 years old, with the most frequently injured arm was the right arm, counted to be eight patients (72.7%), and the left arm was three patients (27.3%).Results: The result from the evaluation of the DASH score indicated ten patients (90.9%) were minimal disability, and one patient (9.1%) was moderate disability. The average score was 12.48, which means that most patients could cope with most daily living activities post-operatively.Conclusions: In conclusion, surgery for drop hand due to radial nerve palsy by Jones’ Tendon Transfer gave a satisfactory functional outcome based on the DASH score.

What underlies the difference between self-reported health and disability after stroke? A qualitative study in the UK

BackgroundLevels of self-reported health do not always correlate with levels of physical disability in stroke survivors. We aimed to explore what underlies the difference between subjective self-reported health and objectively measured disability among stroke survivors.MethodsFace to face semi-structured interviews were conducted with stroke survivors recruited from a stroke clinic or rehabilitation ward in the UK. Fifteen stroke survivors purposively sampled from the clinic who had discordant self-rated health and levels of disability i.e. reported health as ‘excellent’ or ‘good’ despite significant physical disability (eight), or as ‘fair’ or ‘poor’ despite minimal disability (seven) were compared to each other, and to a control group of 13 stroke survivors with concordant self-rated health and disability levels. Interviews were conducted 4 to 6 months after stroke and data analysed using the constant comparative method informed by Albrecht and Devlieger’s concept of ‘disability paradox’.ResultsIndividuals with ‘excellent’ or ‘good’ self-rated health reported a sense of self-reliance and control over their bodies, focussed on their physical rehabilitation and lifestyle changes and reported few bodily and post-stroke symptoms regardless of level of disability. They also frequently described a positive affect and optimism towards recovery. Some, especially those with ‘good’ self-rated health and significant disability also found meaning from their stroke, reporting a spiritual outlook including practicing daily gratitude and acceptance of limitations. Individuals with minimal disability reporting ‘fair’ or ‘poor’ self-rated health on the other hand frequently referred to their post-stroke physical symptoms and comorbidities and indicated anxiety about future recovery. These differences in psychological outlook clustered with differences in perception of relational and social context including support offered by family and healthcare professionals.ConclusionsThe disability paradox may be illuminated by patterns of individual attributes and relational dynamics observed among stroke survivors. Harnessing these wider understandings can inform new models of post-stroke care for evaluation.

154. What PROMIS scores correlate with severe disability in cervical spine surgery

BACKGROUND CONTEXT In recent years, the National Institutes of Health Patient Reported Outcomes Measurement Information System (PROMIS) has been shown to correlate well with legacy instruments such as the neck disability index (NDI) in patients with cervical pathology. However, because PROMIS is a global outcome measure, the clinical implications of a PROMIS score in patients with cervical spine surgery can be difficult to interpret. PURPOSE To better define the clinical implications of a PROMIS score in patients with cervical pathology indicated for surgery, we sought to determine how a disease-specific legacy instrument (NDI) correlated with PROMIS Pain Interference (PI) to define levels of substantial and minimal disability. We hypothesized that there would be a strong correlation between PROMIS PI and NDI, allowing for a definition of disability in cervical spine patients. STUDY DESIGN/SETTING This is an institutional review board-approved prospective cohort study. PATIENT SAMPLE Adults undergoing cervical spine surgery at a single institution were prospectively enrolled. Patients undergoing surgery for instability due to trauma were excluded. OUTCOME MEASURES Primary outcome measures included NDI and PROMIS PI scores. Methods Patients completed the NDI and PROMIS PI questionnaires preoperatively. Demographic data, presenting complaint, and procedural data were recorded. Correlation and regression analyses were performed. Results A total of 196 patients met inclusion criteria. The average age was 56.9 ± 12.9 years. The mean NDI score was 68.6 ± 38 and PROMIS PI was 60.9 ± 7.3. PROMIS PI was strongly correlated to NDI (r=0.76, p<0.001). Linear regression analysis revealed the following formula: PROMIS PI = 51.042 + 0.289*NDI (R2 = 0.57). Using an NDI score of 50 as a cut-off for severe disability, we found that PROMIS PI score of 65.5 or greater correlated with significant disability. Conclusions We performed a regression analysis allowing for conversion of PROMIS PI scores with NDI. In keeping with previous studies, our analysis showed that PROMIS PI was most strongly correlated to NDI. A PROMIS PI score greater than 66 was correlated to substantial disability (NDI=50). While a PROMIS PI score less than 59 was correlated to minimal relative impairment (NDI=28). These results provide an important reference as PROMIS reporting becomes more widespread in the literature. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. In recent years, the National Institutes of Health Patient Reported Outcomes Measurement Information System (PROMIS) has been shown to correlate well with legacy instruments such as the neck disability index (NDI) in patients with cervical pathology. However, because PROMIS is a global outcome measure, the clinical implications of a PROMIS score in patients with cervical spine surgery can be difficult to interpret. To better define the clinical implications of a PROMIS score in patients with cervical pathology indicated for surgery, we sought to determine how a disease-specific legacy instrument (NDI) correlated with PROMIS Pain Interference (PI) to define levels of substantial and minimal disability. We hypothesized that there would be a strong correlation between PROMIS PI and NDI, allowing for a definition of disability in cervical spine patients. This is an institutional review board-approved prospective cohort study. Adults undergoing cervical spine surgery at a single institution were prospectively enrolled. Patients undergoing surgery for instability due to trauma were excluded. Primary outcome measures included NDI and PROMIS PI scores. Patients completed the NDI and PROMIS PI questionnaires preoperatively. Demographic data, presenting complaint, and procedural data were recorded. Correlation and regression analyses were performed. A total of 196 patients met inclusion criteria. The average age was 56.9 ± 12.9 years. The mean NDI score was 68.6 ± 38 and PROMIS PI was 60.9 ± 7.3. PROMIS PI was strongly correlated to NDI (r=0.76, p<0.001). Linear regression analysis revealed the following formula: PROMIS PI = 51.042 + 0.289*NDI (R2 = 0.57). Using an NDI score of 50 as a cut-off for severe disability, we found that PROMIS PI score of 65.5 or greater correlated with significant disability. We performed a regression analysis allowing for conversion of PROMIS PI scores with NDI. In keeping with previous studies, our analysis showed that PROMIS PI was most strongly correlated to NDI. A PROMIS PI score greater than 66 was correlated to substantial disability (NDI=50). While a PROMIS PI score less than 59 was correlated to minimal relative impairment (NDI=28). These results provide an important reference as PROMIS reporting becomes more widespread in the literature.