Roland-Morris Disability Scale Research Articles

AN AYURVEDIC APPROACH IN THE MANAGEMENT OF KATISHOOLA: A CASE STUDY

Background: Lower back pain can have causes other than underlying disorders, and this pain is the type that typically starts in the lower back and spreads to the buttocks and sacroiliac joints. People with chronic pain frequently struggle to balance work, family, and social obligations, which is a major contributor to disability around the world. This symptom affects 80% of people at some point in their lives. Alternative, efficient, non-invasive therapy modalities have received a lot of interest as a result of the rising prevalence of low back pain and the transient and decreased success rates of current invasive treatment methods. The primary symptom of Kati shoola, a Vata vyadhi, is Pain in Kati Pradesha. Methods: An Abhyanga, Swedana, and Kati Pichu treatment regimen was used to treat a 60-year-old Female patient with Low back ache. The patient received treatment for twenty-seven days. The response to treatment was noted, and symptom relief served as a measure of the therapeutic impact. Results & Conclusion: Clinically, the severity of the cardinal symptoms was greatly reduced, and the overall score on the Oswestry low back pain disability scale and Roland-Morris low back pain and disability scale had shown significant improvement.

Injection Botulinum Toxin A in Treatment of Resistant Chronic Low Back Pain: A Prospective Open-Label Study.

ObjectiveThe aim of this study was to evaluate the effect of botulinum toxin A (BTX-A) injection on patients with chronic low back pain (CLBP).DesignIn this open-label prospective study, patients with CLBP who satisfied inclusion and exclusion criteria received 100 units of BTX-A injection. Patients were followed up at four weeks, three months, and six months after injection. Pain and function were assessed with visual analog scale (VAS), Roland-Morris Disability Scale (RMS), and Oswestry Disability Index (ODI) at baseline and subsequent visits.ResultsA total of 19 participants with a mean age of 41.11 years completed the study. Compared to baseline, a significant improvement in all scores was observed that persisted up to six months post-injection (P<0.001). Only two patients reported transient injection site pain that improved over two to three days without any treatment.ConclusionBTX-A injection is safe and improves pain and function in patients with resistant CLBP. The effects are more beneficial when the population is more homogenous in diagnosis and devoid of negative predictors for the outcome.

Translation, cultural adaptation, and psychometric testing of the Yoruba version of Fear-Avoidance Beliefs Questionnaire in patients with low-back pain

Purpose To translate, culturally adapt, and validate the Fear-Avoidance Beliefs Questionnaire into Yoruba language. Materials and Methods Translation and cultural adaptation of the Yoruba version of the Fear-Avoidance Beliefs Questionnaire was carried out following the Guillemin criteria. One hundred and thirty-one individuals with chronic low-back pain participated in the psychometric evaluation of the Yoruba language translation. Cronbach’s alpha (α), principal component analysis, intra-class correlation, Bland–Altman analysis, Spearman rank correlation coefficient, and minimal detectable difference were used for the analysis. Alpha level was set at p < 0.05. Results and Conclusion The mean age of the respondents was 53.6 ± 11.6 years. The internal consistency of the Yoruba language version of the Fear Avoidance Beliefs Questionnaire yielded a Cronbach’s alpha of 0.9. Principal component analysis yielded a three-factor structure including the “work”, “beliefs related to work”, and “physical activity” which accounted for 61.6% of variance in the Yoruba translation. Test–retest reliability of the Yoruba translation yielded an Intra class correlation coefficient 0.97 (0.95–0.98). The Yoruba Fear Avoidance Beliefs Questionnaire was poorly correlated with the Visual Analog Scale (r = 0.01) and Roland–Morris Disability Questionnaire (r = 0.3). The minimal detectable difference of the Yoruba translation was 7.0. The Yoruba Fear Avoidance Beliefs Questionnaire demonstrated excellent psychometric properties similar to existing versions and is appropriate for clinical use among Yoruba-speaking patients. IMPLICATIONS FOR REHABILITATION The Fear-Avoidance Beliefs Questionnaire is a culturally sensitive psychosocial outcome measure, necessitating its existence, and adaptation into different languages. The instrument was translated and culturally adapted into the Yoruba language following the Guillemin criteria. The Yoruba translation demonstrated excellent internal consistency, test–retest reliability and weak correlations with the Visual analog scale and Roland–Morris Disability Scale. The Yoruba version of the Fear-Avoidance Beliefs Questionnaire can be used to assess fear-avoidance beliefs among Yoruba speaking patients with low-back pain.

Percutaneous vertebroplasty: Current controversy

Percutaneous vertebroplasty: Current controversy

A tailored exercise program versus general exercise for a subgroup of patients with low back pain and movement control impairment: Short-term results of a randomised controlled trial

Exercise is an effective treatment for patients with sub-acute and chronic low back pain (LBP). Patients with a movement control impairment (MCI) can be diagnosed as a subgroup of patients with LBP. Unknown is which exercise intervention is most beneficial for this subgroup. This study assessed the short-term effect of a specific exercise program targeting movement control impairment versus general exercise treatment on disability in patients with LBP and MCI. In a multicentre parallel group randomised controlled pragmatic trial, patients with sub-acute and chronic LBP were included. Further inclusion criteria were disability of ≥5 points on the Roland-Morris Disability Questionnaire and ≥2 positive tests out of a set of 6 movement control impairment tests. A total of 106 patients were randomly assigned to either tailored movement control exercise intervention (MC, n=52) or a general exercise intervention (GE, n=54); both 9-18 individual treatment sessions, over a maximum of 12 weeks. The primary outcome was disability measured with the Patient Specific Functional scale (PSFS). Secondary outcome was the Roland-Morris disability scale (RMDQ). Measurements were taken pre- and posttreatment. No significant difference was found following the treatment period. Baseline-adjusted between-group mean difference for the PSFS was 0.5 (SD=0.5; p=0.32) in favour of MC exercises. The Roland-Morris Disability Questionnaire revealed a significant, but not clinically relevant, between-group difference of 2.0 points (SD=0.8; p=0.01). Disability in LBP patients was reduced considerably by both interventions. However, the limited contrast between the two exercise programs may have influenced outcomes.

The Roland–Morris disability scale for the assessment of non-specific low back pain outcomes among disability sector workers

Low back pain (LBP) is the most common cause of time lost from work and has significant personal impacts and societal burdens. Caregivers for patients with disabilities have a high LBP prevalence that requires attention in the public health system. This study aimed to understand the LBP disability outcomes and determinants of care workers for people with intellectual, autistic and associated multiple disabilities. Study subjects included 678 care workers in 15 disability institutions who reported that they had experienced acute or chronic nonspecific LBP in the previous year. The effects of the LBP outcome were measured by the Roland–Morris Disability Questionnaire (RDQ), which is a self-rated assessment of pain-related disability used in this study. The mean score of the RDQ was 3.97 (range 0–24). Of the respondents, 14% expressed that they were free from pain disability (score=0), 66.4% subjects expressed they had a little pain disability (score 1–6), 14.7% subjects reported that they were mildly affected by pain disability (score 7–12), 3.8% subjects reported that they were moderately affected by pain disability (score 13–18), and 1% reported they had severe pain disability (score 19–24). A multiple linear regression of the pain disability score revealed that those care workers who expressed that LBP affects their work and living (p<0.001), had ever sought pain care (p=0.008), with moderate (p=0.001) and severe (p=0.001) levels of LBP were significantly associated with a higher score of pain disability than their counterparts (R2=22.6%). This study suggests that a comprehensive assessment of pain disability and treatment strategies for LBP should be undertaken regarding the needs of care workers in disability sectors.

Mediators of Yoga and Stretching for Chronic Low Back Pain

Although yoga is an effective treatment for chronic low back pain, little is known about the mechanisms responsible for its benefits. In a trial comparing yoga to intensive stretching and self-care, we explored whether physical (hours of back exercise/week), cognitive (fear avoidance, body awareness, and self-efficacy), affective (psychological distress, perceived stress, positive states of mind, and sleep), and physiological factors (cortisol, DHEA) mediated the effects of yoga or stretching on back-related dysfunction (Roland-Morris Disability Scale (RDQ)). For yoga, 36% of the effect on 12-week RDQ was mediated by increased self-efficacy, 18% by sleep disturbance, 9% by hours of back exercise, and 61% by the best combination of all possible mediators (6 mediators). For stretching, 23% of the effect was mediated by increased self-efficacy, 14% by days of back exercise, and 50% by the best combination of all possible mediators (7 mediators). In open-ended questions, ≥20% of participants noted the following treatment benefits: learning new exercises (both groups), relaxation, increased awareness, and the benefits of breathing (yoga), benefits of regular practice (stretching). Although both self-efficacy and hours of back exercise were the strongest mediators for each intervention, compared to self-care, qualitative data suggest that they may exert their benefits through partially distinct mechanisms.

OA11.03. Mediators of the effects of yoga and stretching on chronic low back pain (cLBP) outcomes: results from the YES RCT

Methods 228 persons with non-specific cLBP recruited from primary care and the general community were randomized to 12 weekly 75-minute classes of either yoga or intensive stretching, or to a self-care book. Back-related function (Roland-Morris Disability Scale), symptoms (0-10 score) and psychological mediators (fear avoidance, body awareness, self-efficacy, psychological distress, perceived stress, positive affect) were assessed at baseline and 6, 12, and 26 weeks later by blinded interviewers. Physical function was assessed at baseline and 12 weeks and saliva samples were collected for cortisol and DHEA analyses at baseline, 6 and 12 weeks. Open-ended questions were asked about benefits of yoga and stretching. Statistical analyses for mediators were conducted using the framework of Baron and Kenney.

A modified Roland–Morris disability scale for the assessment of sciatica

The Roland-Morris disability scale (RMS) for disability secondary to low back pain is a validated and popular instrument in clinical practice and research. We have made a simple modification to the questionnaire to increase sensitivity to sciatica (RMS-L) and validated this in patients with lumbar disc prolapse and radiculopathy. The original RMS and modified RMS-L were prospectively administered to 203 patients presenting with lumbar radiculopathy and intervertebral disc prolapse demonstrated on MRI. Scores at pre-operative assessment and follow-up at 3 months and 12-24 months were compared against visual analogue scores (VAS) and Short Form 36 generic health domains. Correlation between RMS-L and VAS leg pain was significantly greater than between original RMS and VAS leg pain pre-operatively (r = 0.57 vs. 0.17, p < 0.001) and at 3 months follow-up (r = 0.78 vs. 0.49, p < 0.001). Conversely, correlation between RMS and VAS back pain was significantly higher (r = 0.58 vs. 0.15, p < 0.001). Compared with RMS, at pre-operative assessment, RMS-L showed greater correlation with SF-36 physical function (PF; r = -0.57 vs. -0.32, p < 0.001) and bodily pain (r = -0.58 vs. -0.35, p < 0.001). Similarly, the change in PF to 3 months follow-up showed significantly higher correlation with change in RMS-L compared with the change in RMS (r = -0.60 vs. -0.37, p < 0.001). Effect sizes were good for RMS-L (1.19-1.24) but only moderate for RMS (0.69-0.79). The original and modified RMS can discriminate disability due to low back pain and sciatica, respectively. Separate assessment of these symptoms and their contribution to functional impairment is useful in assessing suitability for surgery and predicting outcome.

Spinal segmental stabilisation exercises for chronic low back pain: programme adherence and its influence on clinical outcome

Exercise rehabilitation is one of the few evidence-based treatments for chronic non-specific low back pain (cLBP), but individual success is notoriously variable and may depend on the patient's adherence to the prescribed exercise regime. This prospective study examined factors associated with adherence and the relationship between adherence and outcome after a programme of physiotherapeutic spine stabilisation exercises. A total of 32/37 patients with cLBP completed the study (mean age, 44.0 (SD = 12.3) years; 11/32 (34%) male). Adherence to the 9-week programme was documented as: percent attendance at therapy, percent adherence to daily home exercises (patient diary) and percent commitment to rehabilitation (Sports Injury Rehabilitation Adherence Scale (SIRAS)). The average of these three measures formed a multidimensional adherence index (MAI). Psychological disturbance, fear-avoidance beliefs, catastrophising, exercise self-efficacy and health locus of control were measured by questionnaire; disability in everyday activities was scored with the Roland-Morris disability scale and back pain intensity with a 0-10 graphic rating scale. Overall, adherence to therapy was very good (average MAI score, 85%; median (IQR), 89 (15)%). The only psychological/beliefs variable showing a unique significant association with MAI was exercise self-efficacy (Rho = 0.36, P = 0.045). Pain intensity and self-rated disability decreased significantly after therapy (each P < 0.01). Adherence to home exercises showed a moderate, positive correlation with the reduction in average pain (Rho = 0.54, P = 0.003) and disability (Rho = 0.38, P = 0.036); higher MAI scores were associated with greater reductions in average pain (Rho = 0.48, P = 0.008) and a (n.s.) tendency for greater reductions in disability (Rho = 0.32, P = 0.07) Neither attendance at therapy nor SIRAS were significantly related to any of the outcomes. The benefits of rehabilitation depended to a large extent on the patient's exercise behaviour outside of the formal physiotherapy sessions. Hence, more effort should be invested in finding ways to improve patients' motivation to take responsibility for the success of their own therapy, perhaps by increasing exercise self-efficacy. Whether the "adherence-outcome" interaction was mediated by improvements in function related to the specific exercises, or by a more "global" effect of the programme, remains to be examined.

Baseline Pain and Disability in the Investigational Vertebroplasty Efficacy and Safety Trial

Multiple case series of vertebroplasty outcomes have been published, though no large, placebo controlled trial has yet been performed. Our aim was to report baseline characteristics for the Investigational Vertebroplasty Efficacy and Safety Trial (INVEST), a randomized blinded controlled study of vertebroplasty. We compared baseline demographics, pain scores, and scores on the modified Roland-Morris Disability Scale (RMDS), a back pain-specific metric, between 2 groups. One group included subjects enrolled at the lead INVEST site (n = 27 to date). The second group consisted of eligible patients seen concurrently at the lead INVEST site, who declined enrollment (n = 70). Comparisons were made by using 2-sample t tests. Mean ages were similar between groups, averaging approximately 74 years among study participants and 77 years among nonenrolled eligible patients (P = .17). Approximately 75% of subjects were female in both groups. RMDS scores of enrolled patients at the lead site (18.0 +/- 4.2) were not statistically different from those of eligible nonenrolled patients at the lead site (18.6 +/- 3.6, P = .49). Pain scores in the enrolled subjects were measured as "average intensity over the prior 24 hours" with mean scores of 7.6 +/- 2.1 among enrolled patients at the lead site. Pain scores in eligible nonenrolled patients were measured as "pain at rest," with mean score of 3.4 +/- 3.3, and "pain with activity," with mean score of 8.5 +/- 2.0. Patient demographics among subjects enrolled in the INVEST are similar to those in a cohort of eligible nonenrolled patients. Back pain-specific disability was similar between subjects enrolled in the INVEST study and eligible nonenrolled patients at the lead site.

교통사고(交通事故) 환자(患者)의 한방치료(韓方治療)와 한양방협진치료(韓洋方協診治療) 비교(比較) 연구(硏究)

Objective The purpose of this study is to investigate the difference of treatment effect between Oriental Medicine therapy and Oriental and Western Medicine combination therapy on traffic accident patients. Methods Sixty one traffic accident patients were randomly assigned to the Oriental Medicine therapy group(group Ⅰ)and Oriental and Western Medicine combination therapy group(group Ⅱ). Evaluations were made before treatment, after one week treatment and after two weeks treatment using Visual Analog Scale(VAS), Oswestry disability Index(ODI), Neck Disability Index(NDI), Roland Morris Disability Scale(RMDS). The obtained data were analyzed and compared. Results The group Ⅰ showed significant improvement(p<0.05) according to the VAS, NDI. But that showed insignificant improvement according to the ODI, RMDS. The group Ⅱ showed significant improvement(p<0.05) according to the VAS, NDI. But that showed insignificant improvement according to the ODI, RMDS. And the difference between the two groups were insignificant according to VAS, NDI, ODI and RMDS. Conclusion There is no significant difference between the two groups after each therapy on traffic accident patients. Further studies are needed for the comparison of the Oriental Medicine therapy and Western Medicine combination therapy.

Assessment of self-reported physical activity in patients with chronic pain: development of an abbreviated roland-morris disability scale

The Roland-Morris Disability Scale has been shown to be a reliable and valid measure of disability in persons with chronic pain. A short form with psychometric properties similar to the full scale would have numerous benefits, including decreased patient assessment burden and scoring time. On the basis of data obtained from 993 individuals with chronic pain screened for admission to a multidisciplinary pain management program, an 11-item short form of the Roland scale was developed using procedures and models from item response theory. This short form was found to be a good predictor of the 24-item parent scale and a previously published 18-item short form. The 11-item scale also demonstrated concurrent validity with measures of pain intensity and depression. Item content reflected limitations in specific functional behaviors. Perspective Brief measures of important pain-related variables can be created using item response theory (IRT). In this study, a reliable and valid 11-item version of the Roland-Morris Disability Scale was created using IRT. Clinicians and researchers might consider using this scale when patient or subject assessment burden is an issue.

Intradiscal Electrothermal Therapy (IDET) for Treatment of Chronic Lumbar Discogenic Pain: A Minimum 2-Year Clinical Outcome Study

To determine the long-term efficacy of IDET in the treatment of chronic lumbar discogenic pain. Prospective case series clinical outcome study. IDET was performed on 62 consecutive patients with chronic discogenic pain of greater than 6 months duration and consecutively enrolled in a non-randomized prospective case series outcome study. Outcome measures included visual numeric pain scale (VNS) for low back (LB) and lower extremity (LE) pain, Roland-Morris disability scale (RM), and North American Spine Society (NASS) patient satisfaction index. Outcome success was defined as a change of more than 2 points on VNS and RM as well as a positive NASS satisfaction response. Data were collected at baseline and post-procedure at 1, 3, and 6 months and then annually for up to 4 years. Fifty-one out of 62 patients (82%) were available for a minimum of 2-year follow-up. Average age was 41.4 years; average symptom duration was 46 months; and average follow-up was 34 months. Overall, there was statistically significant improvement in LB-VNS, RM, and LE pain scores of 3.2, 6.6, and 2.3 (p<0.001), respectively. Twenty-seven of 51 (53%) patients demonstrated clinically significant VNS and RM improvements of greater than 2. On NASS index, 63% (32/51) responded positively. Neither the number of disc levels treated nor the insurance status of patients made any difference in outcome. IDET appears to be an effective treatment for chronic lumbar discogenic pain in a well-selected group of patients with favorable long-term outcome.

Poster 25: Validation of the chronic pain coping inventory for the veteran population

Objective: To validate the Chronic Pain Coping Inventory (CPCI) for use with veterans suffering from chronic pain. Design: Patients completed study questionnaires prior to multidisciplinary treatment. Factor analysis was used to examine the factor structure of the 64-item CPCI. A series of hierarchical multiple regression analyses were performed with depression, pain interference, general activity level, disability, and pain severity as the criterion variables and the 8 CPCI factors as the predictor variables, controlling for pain severity and demographic variables. Setting: A Veterans Affairs medical center, a tertiary teaching hospital, in Texas. Participants: 554 patients with chronic nonmalignant pain. Interventions: Not applicable. Main Outcome Measures: The CPCI, the Center for Epidemiological Studies Depression Scale, the Roland-Morris Disability Scale, and the pain severity, interference, and general activity subscales of the West Haven-Yale Multidimensional Pain Inventory. Results: The CPCI assesses 8 coping factors. Regression analyses indicated that these factors accounted for unique variance in depression, pain interference, general activity level, disability, and pain severity above and beyond what is accounted for by the demographic variables and pain severity. Conclusion: The results confirmed the validity of the CPCI for use with the veterans.