Revised Oswestry Disability Questionnaire Research Articles

Managing pain and stiffness through individualized homoeopathy in lumbar spondylosis: Results of a prospective consecutive case series

Background: Low back pain affects approximately 60 – 85% of adults during some point in their lives and LS is responsible for about 10 % of all the back-pain. Common conventional treatments like NSAIDS and Epidural steroid injections (ESI) deleterious side effects. Objectives: This case series of lumbar spondylosis presented here tries to show response to individualized homoeopathic medicine in context of pain, stiffness through Visual Analog Scale (VAS) and RODQ. Method: Patients with spondylotic changes in lumbar spine were included in this case series. Individualized homoeopathic medicines were prescribed in singledose in each case and followed up every 2 weeks for eight months. Pain and stiffness in every case was assessed using Visual Analog Scale (VAS)at baseline and every two weeks for eight months. Revised Oswestry disability questionnaire (RODQ) scoresto assess quality of life was used at baseline and at the end of 8 months. Results: Mean VAS score for pain reduced from 78.07 ± 13.72mm (baseline)to 38 ± 25.55 mm (end); 95% CI: 22.05 - 58.09; P

Management of low back pain with a combination of static and dynamic Yogasanas and Siddha Medicine- A Case Series

Background: Siddha philosophical concepts reveal that the disruptions in the flow of life force (Prana) are the cause of dysfunctions in a particular part of the body. As per this fact, chronic low back pain is due to the disruptions in the flow of life force in and around the spine. Objective: was to evaluate whether the regular practice of a specific set of static and dynamic Yogasanas along with Siddha Medicine would reduce chronic low back pain by regulating the flow of Prana. Material & Methods: The clinical trial was undertaken in Santhigiri Siddha Medical College & Hospital, Pothencode, Thiruvananthapuram, Kerala, with a sample size of 10 patients. As per the inclusion, exclusion criteria, after obtaining consent to participate and to follow yoga therapies this study was carried out. The degree of illness and prognosis is quantitatively assessed with the Revised Oswestry Disability Questionnaire (Revised ODI) and pain is assessed by Visual Analog Scale (VAS). Results: The clinical outcome of ODI score revealed marked improvement in range of movements. Out of 10 patients, 8 patients showed good improvement (Minimal Disability) and 2 patients had moderate pain relief (Moderate Disability). Pain assessment by VAS and the score plot also revealed remarkable pain relief. Conclusion: The outcome of this case series suggests that a combination of static and dynamic Yogasanas with suitable internal medicines of Siddha system gives a marked improvement in chronic low back pain.

Low Back Pain--Related Disability in Parkinson Disease: Impact on Functional Mobility, Physical Activity, and Quality of Life.

People with Parkinson disease (PD) frequently experience low back pain (LBP), yet the impact of LBP on functional mobility, physical activity, and quality of life (QOL) has not been described in PD. The objectives of this study were to describe body positions and functional activities associated with LBP and to determine the relationships between LBP-related disability and PD motor sign severity, physical activity level, and QOL. The study was a cross-sectional study. Thirty participants with idiopathic PD (mean age=64.6 years [SD=10.3]; 15 women) completed the Revised Oswestry Disability Questionnaire (RODQ), a measure of LBP-related disability. PD motor symptom severity was measured using the Movement Disorder Society-Unified Parkinson Disease Rating Scale Part III (MDS-UPRDS III). The Physical Activity Scale for the Elderly (PASE) was used to measure self-reported physical activity. The Parkinson Disease Questionnaire-39 (PDQ-39) was used to measure QOL. Descriptive statistics were used to characterize LBP intensity and LBP-related disability. Spearman correlations were used to determine relationships between the RODQ and the MDS-UPDRS III, PASE, and PDQ-39. LBP was reported to be of at least moderate intensity by 63.3% of participants. LBP most frequently impaired standing, sleeping, lifting, and walking. The RODQ was significantly related to the MDS-UPDRS III (r=0.38), PASE (r=-0.37), PDQ-39 summary index (r=0.55), PDQ-39 mobility subdomain (r=0.54), and PDQ-39 bodily pain subdomain (r=0.44). Limitations included a small sample of people with mild to moderate PD severity, the fact that RODQ is a less frequently used measure of LBP-related disability, and the lack of a non-PD control group. LBP affected walking, sleeping, standing, and lifting in this small sample of people with mild to moderate PD. Greater LBP-related disability was associated with greater motor sign severity, lower physical activity level, and lower QOL in people with PD.

Kinesiophobia, self-efficacy and pain-related disability in patients with non-specific low back pain

Psychological factors like kinesiophobia and self-efficacy have been shown to be associated with pain and disability perception in patients with non-specific low back pain (NSLBP). The association among extent of kinesiophobia, self efficacy, pain intensity and disability in patients presenting with NSLBP and the predictor of disability among pain intensity, self-efficacy and kinesiophobia in these patients were investigated in this study.The research design was an analytical cross sectional survey involving 275 consecutively selected individuals diagnosed with NSLBP at a tertiary hospital in southwestern Nigeria. The main outcome measures used were: Quadruple Visual Analogue Scale (QVAS), Tampa Scale for Kinesiophobia (TSK), Revised Oswestry Disability Questionnaire (RODQ) and Self-Efficacy in Rehabilitation Scale (SER).The mean age of the participants was 51.62±13.4 years. The extent of kinesiophobia and measure of selfefficacy were high and above average as seen in 71.7% and 94.3% of the participants respectively. The mean scores on TSK, RODQ, SER and pain intensity were 39.45±5.91, 36.98±15.97, 98.68±21.4 and 7.35±1.94 respectively. Participants with high scores on TSK had significantly high scores on RODQ and low scores on SER. There was a significant positive association between extent of kinesiophobia, disability and selfefficacy (p<0.05). Self-efficacy, pain intensity and kinesiophobia significantly predicted extent of disability (p<0.05).Patients with NSLBP exhibited fear of re-injury (kinesiophobia). Patients with high level of kinesiophobia had increased pain intensity and reduced self-efficacy. High levels of kinesiophobia accompanied by increased pain intensity and decreased self-efficacy were significant predictors of pain related disability in patients with NSLBP.Keywords: Non-specific low back pain, self-efficacy, kinesiophobia, perceived disability

Augmenting conventional treatment of non-specific low back pain with progressive goal attainment programme

Background: Prospective studies on the effects of progressive goal attainment programme (PGAP) on treatment outcomes and specifically psychosocial variables in individuals with non-specific low back pain (NSLBP) are scarce. The study was aimed at investigating the effects of a 10-week PGAP adjunct therapy on selected pain and psychosocial characteristics in patients with NSLBP.Methods: The quasi-experimental study involved consecutive 70 (42 females; 28 males) patients with NSLBP. Participants were alternately assigned into experimental and control groups. Both groups received conventional treatment of back education, soft tissue mobilisation, transcutaneous electrical nerve stimulation, flexibility, coordination and isometric trunk muscle strengthening exercises thrice a week for 10 weeks but the experimental group had PGAP in addition. Participants’ pain intensity, pain catastrophising, kinesiophobia, perceived disability and self-efficacy were assessed at baseline, end of 5th and 10th week of intervention and 22nd week (follow-up) using Visual Analogue Scale, Pain Catastrophising Scale, Tampa Scale for Kinesiophobia, Revised Oswestry Disability Questionnaire and Self-Efficacy for Rehabilitation Outcome Scale, respectively.Results: Between-group comparison at the end of intervention did not reveal significant difference (p > 0.05) between experimental and control groups in all five measures. There were significant reductions (p < 0.05) in pain intensity, pain catastrophising, kinesiophobia, perceived disability and increase in self-efficacy scores for both groups from baseline to 10th week. At follow-up (22nd week), experimental group had significantly lower scores of pain intensity (p = 0.031), pain catastrophising (p = 0.050), kinesiophobia (p < 0.001), perceived disability (p = 0.001) and higher self-efficacy (p = 0.016) than the controls.Conclusion: Addition of PGAP to conventional treatment is effective for achieving sustained improvement in pain and psychosocial characteristics of patients with NSLBP having psychosocial overlay.

Catastrophising, pain, and disability in patients with nonspecific low back pain.

Attention has been drawn to examining the contributions of "catastrophising" to the prediction of pain and disability in individuals with low back pain (LBP). This study investigated the proportion of patients with LBP who engaged in catastrophic thinking about pain and its association with pain intensity and disability. We also investigated the components of pain catastrophising that is predictive of disability. A total of 275 participants with nonspecific LBP completed the Pain Catastrophizing Scale, the quadruple visual analog scale, and the Revised Oswestry Disability Questionnaire (RODQ). The associations among pain intensity, disability, and catastrophising were investigated using t test. The components of catastrophising that best predicts disability were investigated using multiple linear regressions, and the level of significance was set at 0.05. The majority (85.5%) of the participants had LBP for more than 6 weeks, with 45.5% of the participants having moderate disability and 52.7% being high catastrophisers. High catastrophisers to pain had a significantly higher rating of pain intensity (p < 0.001) and higher score on the RODQ than low catastrophisers to pain. The main components of catastrophising that predicts disability were magnification (p < 0.001) and rumination (p = 0.006). Clinicians should screen patients with nonspecific LBP for a heightened level of catastrophic thinking and endeavour to manage such when present.

Chiropractic management of mechanical low back pain secondary to multiple-level lumbar spondylolysis with spondylolisthesis in a United States Marine Corps veteran: a case report

Objective This case report describes the evaluation and conservative management of mechanical low back pain secondary to multiple-level lumbar spondylolysis with spondylolisthesis in a United States Marine Corps veteran within a Veterans Affairs Medical Center chiropractic clinic. Clinical Features The 43-year–old patient had a 20-year history of mechanical back pain secondary to an injury sustained during active military duty. He had intermittent radiation of numbness and tingling involving the right lower extremity distal to the knee. Radiographs of the lumbosacral region demonstrated a grade I spondylolisthesis of L3 in relation to L4 and a grade II spondylolisthesis of L4 in relation to L5 secondary to bilateral pars interarticularis defects. There was marked narrowing of the L4-5 disk space with associated subchondral sclerosis. Intervention and Outcome A course of conservative management consisting of 10 treatments including lumbar flexion/distraction and activity modification was provided over an 8-week period. Despite the long-standing nature of the complaint and underlying multiple-level lumbar spondylolysis with spondylolisthesis, there was a 25% reduction in low back pain severity on the numeric rating scale and a 22% reduction in perceived disability related to low back pain on the Revised Oswestry Disability Questionnaire. Conclusions Conservative management is considered to be the standard of care for spondylolysis and should be explored in its various forms for symptomatic low back pain patients who present without neurologic deficits and with spondylolisthesis below grade III. The response to treatment for the veteran patient in this case suggests that lumbar flexion/distraction may serve as a safe and effective component of conservative management of mechanical low back pain for some patients with spondylolysis and spondylolisthesis.

A Cross-Sectional Study Comparing Pain and Disability Levels in Patients With Low Back Pain With and Without Transitional Lumbosacral Vertebrae

Objective To determine whether patients with transitional lumbosacral vertebrae report more pain and disability compared with patients with normal lumbar vertebrae. Methods Radiographic and questionnaire data were collected from 353 patients with low back pain. Back pain severity was measured using 2 scales: one for pain over the entire episode and the other for pain during the previous week. All patients completed the Revised Oswestry Disability Questionnaire before radiography was performed. Patients were divided into 2 groups: those with and those without a transitional lumbosacral vertebra. Differences between patient groups were investigated using the unpaired t test. Multiple linear regression analysis was applied to investigate the effect of the transitional lumbosacral vertebrae on pain and disability controlling for the effects of age and sex. Results Forty-three patients (12.2%) had a transitional lumbosacral vertebra. There were no differences in pain or disability levels between the 2 groups on any of the pain scales or Revised Oswestry subscales. Older patients reported significantly more pain ( P = .039) and disability ( P = .002) than younger patients. Conclusions The presence of a transitional lumbosacral vertebra in this group of patients was not related to an increased level of reported low back pain or disability.

A Practice-Based Study of Patients with Acute and Chronic Low Back Pain Attending Primary Care and Chiropractic Physicians: Two-Week to 48-Month Follow-Up

Objective This study reports pain and disability outcomes up to 4 years for chiropractic and medical patients with low back pain (LBP) and assesses the influence of doctor type and pain duration on clinical outcomes. Design Prospective, longitudinal, nonrandomized, practice-based, observational study. Setting Fifty-one chiropractic and 14 general practice community clinics. Subjects A total of 2870 acute and chronic ambulatory patients with LBP of mechanical origin. Methods Sixty chiropractic (DC) and 111 general practice (MD) physicians participated. Primary outcomes were pain, using a 100-point visual analogue scale (VAS), and functional disability, using the Revised Oswestry Disability Questionnaire. These were measured at baseline and 8 time points. Regression analysis compared acute and chronic DC and MD patients after correcting for baseline differences in the 4 cohorts. Results Most improvement was seen by 3 months and sustained for 1 year; exacerbation was seen thereafter. Acute patients demonstrated greater relief at all time points. A clinically important advantage for chiropractic patients was seen in chronic patients in the short-term (>10 VAS points), and both acute and chronic chiropractic patients experienced somewhat greater relief up to 1 year ( P< .000). The advantage for DC care was prominent for chronic patients with leg pain below the knee ( P< .001). More than 50% of chronic patients had over 50 days of pain in the third year. Conclusion Study findings were consistent with systematic reviews of the efficacy of spinal manipulation for pain and disability in acute and chronic LBP. Patient choice and interdisciplinary referral should be prime considerations by physicians, policymakers, and third-party payers in identifying health services for patients with LBP.

Scaling of the revised Oswestry low back pain questionnaire

Page SJ, Shawaryn MA, Cernich AN, Linacre JM. Scaling of the revised Oswestry low back pain questionnaire. Arch Phys Med Rehabil 2002;83:1579-84. Objective: To evaluate the measurement properties of the Revised Oswestry Disability Questionnaire (RODQ) by using rating scale analyses. Design: Calibration of item responses by using a data set. Setting: Four outpatient therapy clinics in the northeastern United States. Patients: Convenience sample of 95 community-dwelling adults exhibiting mild to severe low back pain-related disability (LBP-D). Interventions: Not applicable. Main Outcome Measure: The RODQ. Results: Several Rasch analyses were performed, with 1 item deleted and 2 response categories collapsed, creating a better test without increased error. A schema for item administration and evaluation was also developed. Conclusions: By using the abbreviated scale, suggested item order, and predicted responses, abbreviated versions of the instrument can be applied to measure LBP-D more efficiently. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Pain, disability, and satisfation outcomes and predictors of outcomes: A practice-based study of chronic low back pain patients attending primary care and chiropractic physicians

Background: Few studies exist on the prognostic value of demographic, clinical, or psychosocial factors on long-term outcomes for patients with chronic low back pain. Objective: This study reports on long-term pain and disability outcomes for patients with chronic low back pain, evaluates predictors of long-term outcomes, and assesses the influence of doctor type on clinical outcome. Methods: Sixty chiropractic (DC) and 111 general practice (MD) physicians participated in data collection for a prospective, longitudinal, practice-based, observational study of ambulatory low back pain of mechanical origin. The primary outcomes, measured at 6 months and 12 months, were pain (by using the Visual Analog Scale), and functional disability (by using the Revised Oswestry Disability Questionnaire). Satisfaction was a secondary outcome. Results: Overall, long-term pain and disability outcomes were generally equivalent for patients seeking care from medical or chiropractic physicians. Medical and chiropractic care were comparable for patients without leg pain and for patients with leg pain above the knee. However, an advantage was noted for chronic chiropractic patients with radiating pain below the knee after adjusting for baseline differences in patient and complaint characteristics between MD and DC cohorts (adjusted differences = 8.0 to 15.2; P < .002). A greater proportion of chiropractic patients were satisfied with all aspects of their care ( P = .0000). The strongest predictors of primary outcomes included an interaction of radiating pain below the knee with provider type and baseline values of the outcomes. Income, smoking, comorbidity, and chronic depression were also identified as predictors of outcomes in this study. Conclusion: Chiropractic care compared favorably to medical care with respect to long-term pain and disability outcomes. Further study is required to explore the advantage seen for chiropractic care in patients with leg pain below the knee and in the area of patient satisfaction. Identification of patient and treatment characteristics associated with better or worse outcomes may foster changes in physicians' practice activities that better serve these patients' needs.

A cross-sectional study correlating lumbar spine degeneration with disability and pain.

Cross-sectional design. To investigate the correlation between degeneration in the lumbar spine and self-reported disability and pain levels in patients with and without a history of trauma. The link between lumbar spine degeneration and low back pain remains controversial, as does the correlation between trauma and spinal degeneration. Radiographic and questionnaire data were collected from 172 consecutive patients with low back pain. Back pain severity was measured using two scales: one for pain over the entire episode and one for pain during the previous week. All patients also completed the Revised Oswestry Disability Questionnaire before radiography was performed. Further questions concerning the chronicity of symptoms and trauma were included. Controlling for age, patients with low back pain with a history of trauma had a statistically significant increase in the severity of facet degeneration (P < 0.02) compared with nontrauma patients with low back pain. However, there was no difference in disability and pain scores between the trauma and nontrauma patients or between the genders. A weak correlation between pain severity ratings and the number of levels of degeneration and the severity of the degeneration at the disc and facets was noted. Patients with low back pain with a history of trauma had more severe facet arthrosis than do nontrauma patients with low back pain, but there were no differences in pain and disability. There was a weak correlation between the quantity and severity of lumbar degeneration with pain levels, but not with disability scores. These findings are discussed in the light of recent reports regarding the cervical spine.

Methods of assessing progress in a chronic low back pain patient: a case report

It is important for the chiropractor to be able to assess and monitor the progress of patients with chronic pain syndromes This case demonstrates the use of verbal pain-scaling, the Revised Oswestry Disability Questionnaire (RODQ), orthopædic straight leg raise test and active range of lumbar motion as outcome measure and illustrates their relative advantages and shortcomings. The case describes the management of a Caucasian 51-year-old male with a long history of back pain and sciatica. His condition had been resistant to all forms of treatment to date. His activities of daily living and his quality of life had been significantly affected. He was assessed on initial presentation and again after one month of treatment and the results compared. The relative value and emphasis of different outcome measures is discussed along with their practical application in a clinical setting.