Roland-Morris Disability Questionnaire Research Articles

Predictive validity of the STarT Back screening tool among older adults with back pain.

The predictive validity of the STarT Back screening tool among older adults is uncertain. This study aimed to assess the predictive validity of the SBT among older adults in primary care. This prospective cohort study included 452 patients aged ≥55 years seeking Norwegian primary care with a new episode of back pain. A poor outcome (persistent disabling back pain) was defined as a score of ≥7/24 on the Roland-Morris Disability Questionnaire (RMDQ) at 3, 6 or 12 months of follow-up. The ability of the SBT risk groups to identify persistent disabling back pain was assessed with multivariable logistic regression, area under receiver operating characteristics curve (AUC), and with the accuracy measures sensitivity, specificity, predictive values and likelihood ratios. The adjusted odds ratios (95% CI) for persistent disabling back pain were 2.40 (1.34-4.30) at 3 months, 3.42 (1.76-6.67) at 6 months and 2.81 (1.47-5.38) at 12 months for the medium-risk group (n = 118), and 8.90 (1.83-43.24), 2.66 (0.81-8.67) and 4.53 (1.24-16.46) for the high-risk group (n = 27), compared to the low-risk group (n = 282). There were no statistically significant differences in odds between the medium- and high-risk groups at any time point. AUC values (95% CI) were 0.65 (0.59-0.71), 0.67 (0.60-0.73) and 0.65 (0.58-0.71) at 3, 6 and 12 months. Accuracy measures were poor at all time points, with particularly poor sensitivity and negative likelihood ratio values. The predictive validity of the SBT risk groups in predicting persistent disabling back pain in older adults was poor. This study found that the STarT Back screening tool had poor predictive validity among older adults and that it may need recalibration or extension before widespread implementation among older adults. Having valid tools for this population may aid clinicians with allocating scarce healthcare resources, which is especially important considering the rapidly ageing population and its expected challenge to the healthcare systems.

Low back pain, work overload, and associated factors among hospital caregivers.

Caregivers assist patients in treatment based on their care needs and living activities. Very few studies have been conducted specifically on the occupational health and safety of hospital caregivers. This study aimed to investigate the prevalence of excessive workload and low back pain among hospital caregivers and to identify potential associated factors. This cross-sectional study included caregivers working at Gazi University Hospital. Socio-demographic and working-life characteristics were assessed. The Role Overload Scale was used to determine excessive workload and the Roland-Morris Disability Questionnaire was used to evaluate low back pain. The study included 528 participants. A total of 18.7% had work accidents in their department. 49.0% had sharp injuries. 68.9% of the participants performed tasks such as positioning, turning, lifting, or helping patients to walk. 72.2% stood for a long time during the workday. 52.8% thought that they worked under stress. 57.6% had low back pain in the last year and 38.6% in the last month, Significant differences exist in low back pain according to gender, body-mass index, standing for a long time and working under stress. Those who worked at night, had a work accident, positioned patients, stood for a long time, and worked under stress had higher mean scores on the Role Overload Scale. Tools should be used to lift and transport patients. In addition to occupational health and safety training, awareness of musculoskeletal risks should be increased. Employee well-being can be improved through exercise and stress reduction techniques.

Comparison of diclofenac with tramadol, tizanidine or placebo in the treatment of acute low back pain and sciatica: multi-center randomized controlled trial.

Low back pain (LBP) is a leading cause of disability worldwide and has posed numerous health and socioeconomic challenges. This study compared whether nonsteroidal anti-inflammatory drugs (NSAIDs) in combination with tramadol, tizanidine or placebo would be the best treatment regime to improve the Roland Morris Disability Questionnaire (RMDQ) scores at 1 week. This was a multi-center, double-blind, randomized, and placebo-controlled trial including adult patients with acute LBP and sciatica in three emergency departments in Hong Kong. Patients were randomized to the receive tramadol 50mg, tizanidine 2mg, or placebo every 6hours for 2weeks in a 1:1:1 ratio. The RMDQ and other secondary outcomes were measured at baseline, Day 2, 7, 14, 21, and 28. Data were analyzed on an intention to treat basis. Crude and adjusted mean differences in the changes of RMDQ and NRS scores from baseline to Day 7 between tizanidine/tramadol and placebo were determined with 95% confidence intervals. Two hundred and ninety-one patients were analyzed with the mean age of 47.4years and 57.7% were male. The primary outcome of mean difference in RMDQs on Day 7 (compared with baseline) was non-significant for tizanidine compared with placebo (adjusted mean difference - 0.56, 95% CI -2.48 to 1.37) and tramadol compared with placebo (adjusted mean difference - 0.85, 95% CI -2.80 to 1.10). Only 23.7% were fully compliant to the treatment allocated. Complier Average Causal Effect analysis also showed no difference in the primary outcome for the tizanidine and tramadol versus placebo. Among patients with acute LBP and sciatica presenting to the ED, adding tramadol or tizanidine to diclofenac did not improve functional recovery.

Do the management and functional outcomes of the surgically treated spinal fractures change in suicidal jumpers?

The aim of the study was to determine the effect of trauma etiology on the management, functional outcomes and psychiatric characteristics of suicide jumpers and patients who accidentally fall from height. 89 patients (48 accidental falls and 41 suicidal jumpers) who had undergone spinal surgery were included in the study. The patients were evaluated clinically and radiologically. Visual Analog Scale (VAS), Roland Morris Disability Questionnaire (RMDQ) and McGill Pain Questionnaire (MPQ) were performed for functional evaluation. BECK hopelessness scale (BHS), BECK depression inventory (BDI), and SF-36 scales were used for the psychiatric evaluation. All outcomes were compared between suicidal jumpers and accidental falls. The RMDQ and ODI questionnaires stated a higher disability in the suicide jump group (p = 0.001 and p = 0.029, respectively). However, the VAS and MPQ questionnaires did not differ in significance between groups (p = 0.182 and p = 0.306, respectively). The SF-36 scale showed that physical function, role emotional, vitality and mental health subdomains were worse in the suicide jump group (p = 0.001, p = 0.029, p = 0.014 and p = 0.030, respectively). BDI scores were significantly higher in the suicide jump group while no difference was observed between the groups in terms of BSH (p = 0.017 and p = 0.940, respectively). Psychiatric disorders are more common in patients in the suicidal jumpers. The presence of underlying psychiatric problems adversely affects the postoperative functional outcomes of patients with surgically treated spinal fractures. A multidisciplinary approach together with raising awareness in this way can improve the clinical outcomes after orthopedic treatment, even if there is physical disability.

The Fremantle Back Awareness Questionnaire: cross-cultural adaptation, reliability, and validity of the Italian version in people with chronic low back pain

Background and aimThere is evidence to suggest that assessing back-specific altered self-perception may be useful when seeking to understand and manage low back pain (LBP). The Fremantle Back Awareness Questionnaire (FreBAQ) is a patient-reported measure of back-specific body perception that has never been adapted and psychometrically analysed in Italian. Hence, the objectives of this research were to cross-culturally adapt and validate the Italian version of this outcome measure (namely, the FreBAQ-I), to make it available for use with Italians suffering from chronic LBP.MethodsThe FreBAQ-I was developed by forward and backward translation, review by a committee skilled in patient-reported measures and test of the pre-final version to assess its clarity, acceptability, and relevance. The statistical analyses examined: structural validity based on Rasch analysis; hypotheses testing by investigating correlations of the FreBAQ-I with the Roland Morris Disability Questionnaire (RMDQ), a pain intensity numerical rating scale (PI-NRS), the Pain Catastrophising Scale (PCS), and the Tampa Scale of Kinesiophobia (TSK) (Pearson’s correlations); reliability by internal consistency (Cronbach’s alpha) and test–retest repeatability (intraclass correlation coefficient, ICC (2,1)); and measurement error by determining the minimum detectable change (MDC). After the development of a consensus-based translation of the FreBAQ-I, the new outcome measure was delivered to 100 people with chronic LBP.ResultsRasch analysis confirmed the substantial unidimensionality and the structural validity of the FreBAQ-I. Hypothesis testing was considered good as at least 75% of the hypotheses were confirmed; correlations: RMDQ (r = 0.35), PI-NRS (r = 0.25), PCS (r = 0.41) and TSK (r = 0.38). Internal consistency was acceptable (alpha = 0.82) and test–retest repeatability was excellent (ICC (2,1) = 0.88, 95% CI: 0.83, 0.92). The MDC95 corresponded to 6.7 scale points.ConclusionThe FreBAQ-I was found to be a unidimensional, valid, and reliable outcome measure in Italians with chronic LBP. Its application is advised for clinical and research use within the Italian speaking community.

Physician Empathy and Chronic Pain Outcomes

Empathy is an aspect of the patient-physician relationship that may be particularly important in patients with chronic pain. To measure the association of physician empathy with pain, function, and health-related quality of life (HRQOL) among patients with chronic low back pain. This cohort study included adult enrollees from the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation national pain research registry. Study dates were from April 1, 2016, to July 25, 2023, with up to 12 months of follow-up. Physician empathy was assessed with the Consultation and Relational Empathy measure and dichotomized to yield very empathic physician and slightly empathic physician groups. Main outcomes were patient-reported pain, function, and HRQOL measured with a numerical rating scale for low back pain intensity, the Roland-Morris Disability Questionnaire for back-related disability, and the Patient-Reported Outcomes Measurement Information System for HRQOL deficits pertaining to anxiety, depression, fatigue, sleep disturbance, and pain interference. Data were collected at 5 quarterly encounters from registry enrollment through 12 months and analyzed with generalized estimating equations, including multivariable models to measure temporal trends and to adjust for baseline and longitudinal covariates. Among the 1470 patients, the mean (SD) age was 53.1 (13.2) years, and 1093 (74.4%) were female. Patients completed 5943 encounters in which multivariable analyses demonstrated that greater physician empathy was inversely associated with pain intensity (β = -0.014; 95% CI, -0.022 to -0.006; P < .001), back-related disability (β = -0.062; 95% CI, -0.085 to -0.040; P < .001), and HRQOL deficits on each measure (eg, pain interference: β = -0.080; 95% CI, -0.111 to -0.049; P < .001). Correspondingly, compared with the slightly empathic physician group, the very empathic physician group reported lower mean pain intensity (6.3; 95% CI, 6.1-6.5 vs 6.7; 95% CI, 6.5-6.9; P < .001), less mean back-related disability (14.9; 95% CI, 14.2-15.6 vs 16.8; 95% CI, 16.0-17.6; P < .001), and fewer HRQOL deficits on each measure (eg, fatigue: 57.3; 95% CI, 56.1-58.5 vs 60.4; 95% CI, 59.0-61.7; P < .001). All physician empathy group differences were clinically relevant, with Cohen d statistics ranging from 0.21 for pain intensity to 0.30 for back-related disability, fatigue, and pain interference. Physician empathy was associated with more favorable outcomes than non-pharmacological treatments, opioid therapy, and lumbar spine surgery. In this cohort study of adult patients with chronic pain, physician empathy was associated with better outcomes over 12 months. Greater efforts to cultivate and improve physician empathy appear warranted.

Translation, cross-cultural adaptation, and validation of the 10-item spine functional index (SFI-10) in the Brazilians with musculoskeletal spine disorders

PurposeTo translate and cross-culturally adapt the Spine Functional Index (SFI) into Brazilian Portuguese (SFI-Br) in individuals with musculoskeletal spine disorders.MethodsParticipants (n=194) answered the Numerical Pain Rating Scale (NPRS), 36-item Short-Form Health Survey (SF-36), Roland-Morris Disability Questionnaire for General Pain (RMDQ-g), and SFI-25 incorporating the SFI-10. Structural validity, from confirmatory factor analysis (CFA), used comparative fit index (CFI), Tucker-Lewis index (TLI), root mean square error of approximation (RMSEA), and chi-square/degrees of freedom (DF). The best structure was considered from the lower values of the Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC). Construct and criterion validity used Spearman’s correlation coefficient (rho). Internal consistency used Cronbach’s alpha, reliability used intraclass correlation coefficient (ICC2,1), with ceiling and floor effects determined. Error used the standard error of the measurement (SEM) and minimal detectable change, 90% level (MDC90).ResultsAdequate fit indices demonstrated an unequivocal one-factor structure only for the SFI-10 (chi-square/DF <3.00, CFI and TLI >0.90, RMSEA <0.08). The SFI-10-Br correlation was high with the SFI-Br (rho=0.914, p<0.001), moderate for the RMDQ-g (rho=-0.78), SF-36 functional capacity domain (rho=0.718) and NPRS (rho=-0.526); and adequate for the remaining SF-36 domains (rho>0.30). Test-retest reliability (ICC2,1=0.826) and internal consistency (alpha=0.864) were high. No ceiling or floor effects were observed, and error was satisfactory (SEM=9.08%, MDC90=25.15%).ConclusionThe SFI Brazilian version was successfully produced with the 10-item version showing an unequivocal one-factor structure, high construct and criterion validity, reliability, internal consistency, and satisfactory error. Further research on responsiveness is required.

Pain control and functional recovery as therapeutic goals in patients with chronic musculoskeletal pain: two experiences with tapentadol hydrochloride.

This study aimed to evaluate pain control, functioning, and quality of life (QoL) recovery in patients with chronic low back pain (cLBP) or post-traumatic osteoarthritis (OA) pain in the ankle/foot area, treated with tapentadol prolonged release and unresponsive to other treatments. Two observational retrospective studies were conducted using clinical practice datasets of patients with chronic pain in cLBP and OA foot/ankle at different time points (total follow-up=60-90 days). The studies assessed pain intensity by the Numerical Rating Scale (NRS) pain scale (patients were classified as responder in case of ≥30% pain reduction), QoL by the 5-level EQ-5D (EQ-5D-5L) questionnaire, patient satisfaction by the 7-point Patients' Global Impression of Change (PGIC) scale; cLBP health status by the Roland Morris Disability Questionnaire (RMDQ); foot and ankle functional status by European Foot and Ankle Society (EFAS) score; and treatment-related AEs. For the cLBP setting, 37 patients were enrolled, of which 86.50% were classified as responders (n=32; CI: 75.5% ÷ 97.5%). For the foot/ankle OA pain setting, 21 patients were enrolled. Pain assessment at final follow-up was available only for 11 patients, of which 72.73% (n=8; CI: 39.0% ÷ 94.0%) were classified as responders. Statistically significant improvements were seen in the RMDQ, EQ-5D-5L, and PGIC scores in cLBP. Improvements in the EFAS, EQ-5D-5L, and PGIC scores were seen in OA as well. The incidence of treatment-related adverse reactions was low in both studies. In the study population, tapentadol prolonged release was effective and well tolerated in treating cLBP and post-traumatic foot/ankle OA chronic pain when used in a multimodal manner. The reduction in pain was accompanied by clinically relevant improvements in patients' functionality and QoL.

Frequency of Low Back Pain and its Effect on Function and HealthRelated Quality of Life across Three Levels of Lower Limb Amputation: A Cross-Sectional Study

Background: Amputation is a profoundly life-altering event that can have both physical and psychological impacts on individuals. Objective: This study aimed to investigate the frequency of low back pain and its effect on function and health-related quality of life in individuals with various levels of lower limb amputation. Methods: It was a cross-sectional study at the Pakistan Institute of Prosthetic and Orthotics Peshawar (PIPOS) from May to September 2020, 264 participants were purposively selected. Inclusion criteria: males and females aged 18-65 with unilateral transfemoral, knee disarticulation, or transtibial amputations. Exclusion criteria: hearing/speech impairments, hip pathology, or bilateral lower limb amputation. Data collected via selfadministered questionnaires, including the Roland Morris Disability Questionnaire (RMDQ) and the Short Form 36 Health Survey (SF-36). Data analyzed using SPSS v.25. Results: Of the 264 participants, 219 were males (83%), and 45 were females (17%). There was significant connection between before and after amputation back pain (P &lt; 0.05). However, no notable link was observed between low back pain and the three amputation levels (P &gt; 0.05). Moreover, there was no statistical disparity in disability based on the level of amputation (P &gt; 0.05). Significantly, low back pain differed across all quality of life domains (P &lt; 0.05), except for mental and physical health. In contrast, no statistical variation was noted in the quality of life among the three amputation levels (P &gt; 0.05). Conclusion: This study underscores the prevalence of low back pain in lower limb amputees. However, we did not find a clear association between low back pain and specific amputation levels (unilateral transfemoral, knee disarticulation, or transtibial amputation). Additionally, low back pain appears to impact disability and select aspects of quality of life, such as physical function, social function, and general health in individuals with lower limb amputation.

Effects of Manual Therapy Plus Pain Neuroscience Education with Integrated Motivational Interviewing in Individuals with Chronic Non-Specific Low Back Pain: A Randomized Clinical Trial Study.

Background and Objectives: Chronic non-specific low back pain (CNLBP) persists beyond 12 weeks. Manual therapy recommended for CNLBP demonstrates short-term efficacy. Pain Neuroscience Education (PNE) teaches patients to modify pain perception through explanations, metaphors, and examples, targeting brain re-education. Motivational Interviewing (MI) enhances motivation for behavioral change, steering patients away from ambivalence and uncertainty. These approaches collectively address the multifaceted nature of CNLBP for effective management. The aim of this study was to investigate a manual therapy intervention combined with PNE with MI on pain, pressure pain threshold (PPT), disability, kinesiophobia, catastrophizing, and low back functional ability in individuals experiencing CNLBP. Materials and Methods: Sixty adults with CNLBP were randomly divided into three equal groups (each n = 20). The first group received manual therapy and PNE with integrated MI (combined therapy group), the second group underwent only manual therapy (manual therapy group), and the third group followed a general exercise program at home (control group). Pain in the last 24 h was assessed using the Numeric Pain Rating Scale (NPRS), functional ability with the Roland-Morris Disability Questionnaire (RMDQ), PPT in the lumbar region through pressure algometry, kinesiophobia with the Tampa Scale for Kinesiophobia (TSK), catastrophizing with the Pain Catastrophizing Scale (PCS), and performance using the Back Performance Scale (BPS) at baseline, in the fourth week, and six months post-intervention. Results: Statistically significant differences between the intervention groups and the control group were found in both the fourth-week measurement and the six-month follow-up, as evident in the NPRS and RMDQ scores, as well as in the total values of tested PPTs (p < 0.05). Differences were also observed between the two intervention groups, with a statistically greater improvement in the combined therapy group at both time points (fourth week and six-month follow-up) (p < 0.05). Regarding the TSK and PCS scores in the fourth week, statistically significant differences were observed between the two intervention groups compared to the control group, as well as between the two intervention groups (p < 0.05). However, in the six-month follow-up, statistically significant differences were found only between the combined therapy group and the other two groups, with the combined therapy group showing significant improvements (p < 0.05). In relation to BPS, both intervention groups exhibited statistically significant differences compared to the control group in the fourth week, without any significant differences between the two intervention groups. However, in the six-month follow-up, significant differences were noted between the combined therapy group and the other two groups (p < 0.05), with combined therapy demonstrating greater improvement. Conclusions: The addition of PNE with integrated MI enhanced the positive effects of a manual therapy intervention in all outcome measures. The combination of manual therapy plus PNE with integrated MI appeared to provide greater improvements compared to the isolated application of manual therapy, and these improvements also lasted longer. These short- and long-term positive effects are likely attributed to the combination of PNE with integrated MI, which contributed to increasing the effectiveness of the treatment. Further studies are required to investigate the optimum dosage of manual therapy and PNE with integrated MI in individuals with CNLBP.

Impact of Musculoskeletal Pain on Health-Related Quality of Life Among Adults in Saudi Arabia.

Background Musculoskeletal pain (MSP) is widely recognized as a prevalent public health issue that affects individuals of various genders and age groups. The aim of this study is to assess the influence of musculoskeletal pain on the quality of life (QoL)of adult individuals living in Saudi Arabia. Method This is a cross-sectional study using an online-administered questionnaire that was distributed via online platforms in Saudi Arabia for the duration between January and August 2023. Three questionnaire instruments were used in this study. The 36-item Short Form Health Survey questionnaire (SF-36), The 5-level EQ-5D version (EQ-5D-5L), and Roland-Morris Disability Questionnaire. Binary logistic regression analysis was used to identify predictors of better QoL and having mild to moderate disability. Results A total of 8359 participants were involved in this study. The most commonly reported sites of musculoskeletal pain were the lower back, neck, and shoulder, accounting for 36.8% (n= 3072), 30.5% (n= 2549), and 30.1% (n= 2514), respectively. The mean pain score for the study participants was 4.3 (SD: 2.3), which indicates mild degree of pain. The median EQ-5D-5L index value for the study participants was 0.827 (0.756-1.00), which demonstrates a high quality of life. The mean SF-36 score for the study participants was 63.11 (17.4), which demonstrates moderate quality of life. The median Roland-Morris Disability score for the study participants was 1.00 (0.00-7.00), which demonstrates a low level of pain-related disability. Male gender, younger age (30-39 years), having higher education attainment, having higher monthly income (more than SAR 20000), and having lower BMI (less than 25.8 kg/cm2) were predictors of better QoL (p<0.05). Conclusion Musculoskeletal pain is a multifactorial condition influenced by structural, physical, psychological, social, lifestyle, and comorbid health elements. It ranges from acute to chronic pain and, despite rarely being fatal, has a significant impact on QoL. Musculoskeletal discomfort varies in terms of intensity, affected regions, and demographic and lifestyle factors. This study sheds light on the multifaceted nature of MSP, its impact on QoL, and the significance of early intervention and individualized management strategies to improve the QoLof those affected.

The Impact of Frailty on Surgical Outcome of Patients with Lumbar Spinal Canal Stenosis.

Frailty is an important factor in surgical outcomes. The current study aimed to evaluate the effect of preoperative frailty on postoperative outcomes in older patients with lumbar spinal canal stenosis (LSCS). We retrospectively examined 209 patients aged ≥65 years who underwent surgery for LSCS. Health-related quality-of-life (HRQOL) tools, including the Roland-Morris Disability Questionnaire (RDQ), Zurich Claudication Questionnaire (ZCQ), and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), were used in the assessment conducted before surgery and at 6 months and 1 year after surgery. Frailty was categorized based on the 11-item modified frailty index (mFI-11). Patients with mFI-11 of 0, <0.21, and >0.21 were classified under the robust (R), pre-frailty (P), and frailty (F) groups, respectively. According to the mFI-11, 24, 138, and 47 patients were included in the R, P, and F groups, respectively. Regarding preoperative radiographic parameters, there was a remarkable increase in the sagittal vertical axis and a significant decrease in the development of lumbar lordosis with frailty progression. The preoperative scores of RDQ and ZCQ, and lumbar function, walking ability, social life, and psychological disorder domain scores of JOABPEQ differed significantly among these groups. The frequency of revision surgery was not higher in the F group than in the other groups. After adjustment for factors have shown different distributions among the three groups, the frequency of effective surgical cases did not show a clear trend among the three groups in all domains of the JOABPEQ. The preoperative HRQOL scores and the radiographic parameters of patients with LSCS worsened with frailty severity. However, frailty did not affect the rate of revision surgery and surgical efficacy in patients with LSCS. Although this study has limitations, our findings indicated that even LSCS patients with frailty can be considered for surgery if they have an indication for LSCS surgery.

Middle cluneal nerve entrapment sites in the surgical field.

Middle cluneal nerve (MCN) entrapment around the sacroiliac joint elicits low back pain (LBP). For surgical decompression to be successful, the course of the MCN must be known. We retrospectively studied the MCN course in 15 patients who had undergone MCN neurolysis. Enrolled in this retrospective study were 15 patients (18 sides). We inspected their surgical records and videos to determine the course of the entrapped MCN. The area between the posterior superior- and the posterior inferior iliac spine was divided into areas A-D from the rostral side. The MCN transit points were identified at the midline and the lateral edge connecting the posterior superior- and posterior inferior iliac spine. Before and 6months after surgery, the patients recorded the degree of LBP on the numerical rating scale and the Roland-Morris Disability Questionnaire. We decompressed 24 MCNs. The mean number was 1.3 nerves per patient (range 1-2). The MCN course was oblique in the cranio-caudal direction; the nerve tended to be observed in areas C and D. In six patients (40%), we detected two MCN branches, they were in the same area and adjacent. Postoperatively, LBP was improved significantly in all patients. Between the posterior superior- and the posterior inferior iliac spine, the MCN ran obliquely in the cranio-caudal direction; it was prominent in areas on the caudal side. In six (40%) patients, we decompressed two adjacent MCNs. Our findings are useful for MCN decompression surgery.

Short-Term Clinical and Radiographic Evaluation of Patients Treated With Expandable and Static Interbody Spacers Following Lumbar Lateral Interbody Fusion

ObjectiveThe goal of this study was to evaluate, using computed tomography (CT) and magnetic resonance imaging (MRI), patients who underwent oblique lateral interbody fusion (OLIF) using either expandable or static interbody spacers. MethodsThirty-five patients with degenerative disc disease were surgically treated with one-level OLIF and were followed up for more than six months. The Static group consisted of 22 patients, and 13 patients were in the Expandable group. Intraoperative findings included operative time (min), blood loss (ml), and cage size.Low back pain, leg pain, and leg numbness were measured using the Japanese Orthopedic Association score, visual analogue score, and the Roland–Morris Disability Questionnaire. Radiological evaluation using CT and MRI allowed measurement of cage subsidence, cross-sectional area (CSA) of the dural sac, disc height, segmental lordosis, foraminal height, and foraminal CSA preoperatively and six months postoperatively. ResultsThe Expandable group had significantly larger cage height and lordosis than the Static group (p < 0.05). The Expandable group also had greater dural sac area expansion and enlargement of the intervertebral foramen, as well as better correction of vertebral body slip (p < 0.05). Cage subsidence was significantly lower in the Expandable group (p < 0.05). JOA score and VAS for leg numbness were significantly better in the Expandable group (p < 0.05). ConclusionsCompared with static spacers, expandable spacers significantly enlarged the dural sac area, corrected vertebral body slippage, expanded the intervertebral foramen, and achieved good indirect decompression while reducing cage subsidence, resulting in improvement in clinical symptoms.

The effects of back extensor strength in different body positions on health-related quality of life in patients with degenerative spinal deformity.

Degenerative spinal deformity (DSD) is believed to originate from degeneration of the discs and facet joints and vertebral wedging. Currently, the nosogeny of DSD is not yet fully clarified and there has been no systematic study on the impact of their lower back muscle strength on quality of life. To determine the characteristics of back extensor strength (BES) in different body positions and examine their correlations with health-related quality of life (HQOL) in degenerative spinal deformity (DSD) patients. Participants comprised 60 DSD patients and 40 healthy volunteers. Maximal isometric BES was evaluated by dynamometers with the subject in three different positions (standing, prone, sitting). The visual analogue scale (VAS) score, Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RMQ), and 36-item Short Form Health Survey (SF-36) score were used to evaluate patient HQOL. Correlations between the BES in different body positions and HQOL wereanalysed. The BES values in three body positions were significantly smaller in DSD patients than healthy subjects (P< 0.05). The standing BES was found to be negatively associated with ODI and RMQ (R= 0.313, p< 0.05 and R= 0.422, p< 0.01, respectively). A negative relationship between sitting BES and RMQ was also seen (R= 0.271, p< 0.05). In addition, the standing and prone BES were positively correlated with the physical functioning score of the SF-36 (R= 0.471, p< 0.01 and R= 0.289, p< 0.05, respectively), and the sitting BES was positively correlated with the role-physical score of the SF-36 (R= 0.436, p< 0.01). The results indicate that the back extensor muscle is compromised in DSD patients and there are differences in predicting the severity of disability and physical HQOL scores with BES in different positions. Standing BES was the most reliable contributor to HQOL among three body positions.

Effect of Whole-Body Vibration Exercise on Pain, Disability, Balance, Proprioception, Functional Performance and Quality of Life in People with Non-Specific Chronic Low Back Pain: A Systematic Review and Meta-Analysis.

Background: Non-specific chronic low back pain (NSCLBP) presents significant treatment challenges due to its multifactorial nature. Whole-body vibration exercise (WBVE) has emerged as a potential therapeutic modality, offering benefits across various domains, including pain reduction, improved balance, and enhanced quality of life (QoL). The aim of this present systematic review and meta-analysis is to evaluate the effects of WBVE on pain, disability, balance, proprioception, functional performance, and QoL in individuals with NSCLBP. Methods: We comprehensively searched PubMed, Web of Science, Scopus, and CENTRAL databases from October 2023 to January 2024, including RCTs with a PEDro score of ≥5 for high-quality evidence. Outcome measures included pain intensity, Oswestry Disability Index (ODI) score, Roland-Morris Disability Questionnaire (RMDQ) score, balance, proprioception, functional performance (through a progressive iso-inertial lifting evaluation), and QoL (SF-36) in NSCLBP patients. The risk of bias was assessed using ROB-2, and the certainty of evidence for each outcome indicator was analyzed using GRADE. A meta-analysis was conducted using standardized mean differences (SMD) and mean differences (MD) for continuous outcomes. Results: Ten randomized controlled trials fulfilled the inclusion criteria for the systematic review, and nine were suitable for the meta-analysis. The qualitative synthesis revealed WBVE is effective in improving pain, disability, balance, proprioception, and functional performance and QoL. Further, the results of the quantitative review demonstrated WBVE significantly reduced pain [visual analogue scale: SMD = -0.81, 95% CI (-1.11, -0.50), I2 = 0%, p < 0.01], disability [ODI: MD = -3.78, 95% CI (-5.27, -2.29), I2 = 24%, p < 0.01]; RMDQ: MD = -1.43, 95% CI (-2.04, -0.82), I2 = 51%, p < 0.01], balance [SMD = -0.28, 95% CI (-0.52, -0.05), I2 = 0%, p = 0.02], and proprioception [SMD = -4.20, 95% CI (-7.50, -0.89), I2 = 99%, p = 0.01]. Conclusions: This review and meta-analysis indicate that WBVE significantly improves pain, disability, balance and proprioception in individuals with non-specific chronic low back pain. These findings suggest potential benefits of incorporating WBVE into the management strategies for NSCLBP.

Does the intensity of pain and disability affect health-related quality of life of older adults with back pain? Multilevel analysis between Brazil and Netherlands: a cross-sectional study of the BACE consortium

BackgroundThe prognosis of back pain (BP) in the older adults is less favorable than in younger adults and progress to adverse outcomes and consequent worsening of health-related quality of life (HRQoL). The present study aimed to verify the association between BP intensity, disability and HRQoL in older adults residents in Brazil and Netherlands, and to evaluate whether the country of residence influences the associations.MethodsData were collected from 602 Brazilian and 675 Dutch participants with a new episode of BP from the Back Complaints in Elders (BACE) consortium. For the present study, a cross section was used. Pain intensity and disability were assessed using the Numerical Rating Scale (NRS) and the Roland-Morris Disability Questionnaire (RMDQ), respectively. HRQoL was assessed using the Short Form Health Survey (SF-36) quality of life questionnaire. Age, sex, and education were descriptive variables. Pain intensity (NPS score) and country were the independent variables and quality of life assessed by each SF domain − 36 was the dependent variable. Analysis of models at the individual level was performed to verify the association between pain and disability, also HRQoL in Netherlands and Brazil in the total sample. The multilevel model was used to verify whether the older adults person’s country of residence influenced this relationship.ResultsThe average age of the participants was 67.00 (7.33) years. In the total sample, linear regression analysis adjusted for sex and age showed a significant association between BP intensity scores and HRQoL, for all domains. There was no association between disability and HRQoL. In the multilevel analysis, there was an association between BP intensity and HRQoL in all domains and an association between the country of residence and HRQoL, influencing the effect of pain, in all domains, except for the physical functioning.ConclusionSocioeconomic and cultural aspects of different countries can affect the perception of the elderly about their HRQoL in the presence of BP. Pain and disability in Brazilian and Dutch older adults ones are experienced differently in relation to their HRQoL.

Topical Diclofenac Versus Oral Ibuprofen Versus Diclofenac + Ibuprofen for Emergency Department Patients With Acute Low Back Pain: A Randomized Study

IntroductionTopical non-steroidal anti-inflammatory drugs (NSAIDs) are useful for a variety of musculoskeletal injuries. It is not known whether topical NSAIDs should be used for patients presenting with acute non-radicular musculoskeletal low back pain (LBP). MethodsWe conducted a randomized, placebo-controlled double-blind study in which ED patients 18-69 years with acute, non-traumatic, non-radicular, musculoskeletal LBP were randomized at the time of discharge to treatment with oral ibuprofen 400mg orally + placebo topical gel, 1% diclofenac topical gel + oral placebo, or ibuprofen 400mg + 1% diclofenac topical gel. We measured outcomes using the Roland Morris Disability Questionnaire (RMDQ), a 24-item yes/no instrument about the impact of back pain on a respondent’s daily activities. The primary outcome was change in RMDQ between ED discharge and two days later. Medication related adverse events were elicited by asking whether the study medications caused any new symptoms. Results3281 patients were screened for participation and 198 were randomized. Overall, 36% of the population were women, the mean age was 40 years (SD 13), and the median RMDQ score at baseline was 18 (25th, 75th percentile: 13, 22) indicating substantial low back related functional impairment. 183 (92%) participants provided primary outcome data. By two days after the ED visit, the ibuprofen + placebo group had improved by 10.1(95%CI 7.5 to 12.7), the diclofenac gel + placebo group by 6.4(95%CI 4.0 to 8.8), and the ibuprofen + diclofenac gel by 8.7(95%CI 6.3 to 11.1). The 95%CI for between group differences were as follows-- ibuprofen versus diclofenac: 3.7 (0.2, 7.2); ibuprofen versus both medications 1.4 (-2.1, 4.9); diclofenac versus both medications -2.3 (-5.7, 1.0). Medication related adverse events were reported by 3/60 (5%) ibuprofen patients, 1/63 (2%) diclofenac patients, and 4/64 (6%) patients who got both. ConclusionsAmong patients with non-traumatic, non-radicular acute musculoskeletal low back pain discharged from an ED, topical diclofenac was probably less efficacious than oral ibuprofen. It demonstrated no additive benefit when co-administered with oral ibuprofen.

Efficacy and safety of traditional Chinese manual therapy (Tuina) in patients with non-specific chronic low back pain: a study protocol for a randomised controlled trial

IntroductionNon-pharmacological interventions play a crucial role in the management of non-specific chronic low back pain (NSCLBP). One prime example is Tuina, a traditional Chinese manual therapy that incorporates pressing, kneading...

Comparison of facet fusion rates and clinical outcomes between cortical bone trajectory screw and percutaneous pedicle screw fixation for degenerative lumbar spondylolisthesis

BACKGROUND CONTEXTCortical bone trajectory (CBT) screws have been introduced as an alternative technique for pedicle screw (PS) insertion because they have greater contact with the cortex and a greater uniaxial pullout load than traditional PS. CBT screwing can also minimize muscle dissection. However, CBT screws and traditional PSs have not yet been compared in terms of fusion rates and clinical outcomes for particular operative procedures. PURPOSEThis study aimed to assess the fusion rate and clinical outcomes of facet fusion (FF) fixed with CBT screws (CBT-FF) and to compare them with those of FF fixed with percutaneous PS (PPS-FF). STUDY DESIGNRetrospective study. PATIENT SAMPLERecords of 68 patients who underwent CBT-FF for single-level degenerative lumbar spondylolisthesis (DLS) with at least 1 year of follow-up were retrospectively reviewed. The control group comprised 143 patients who underwent PPS-FF under the same conditions. OUTCOME MEASURESComputed tomography was performed to confirm fusion. Therapeutic effectiveness was assessed as a clinical outcome using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), Roland-Morris Disability Questionnaire (RMDQ), and visual analog scale (VAS) preoperatively and 1 year postoperatively. The rate of revision surgery was also calculated. Intraoperative blood loss was measured. METHODSFusion rate, clinical outcomes, revision surgery rate, and intraoperative blood loss of CBT-FF and PPS-FF were compared. RESULTSThe CBT-FF and PPS-FF fusion rates were 91.2% and 90.1%, respectively. The JOABPEQ category scores demonstrated therapeutic effectiveness in 74.5% and 77.1% of the patients for low back pain; the corresponding proportions for walking ability were 84.7% and 89.3%, respectively. No significant differences in therapeutic effectiveness were observed for any category, including the RMDQ and VAS scores for buttock and lower limb pain. Three patients required revision surgery for adjacent segment disease between 6 months and 3.5 years after CBT-FF (revision surgery rate, 4.4%), whereas the revision surgery rate for PPS-FF was 6.3% (9/143 cases). Average intraoperative blood loss was significantly less in the CBT-FF group than in the PPS-FF group. CONCLUSIONSBoth procedures were equally useful in terms of fusion rate and clinical outcomes for DLS management.