Severe Low Back Research Articles

Effects of a Hardness Discrimination Task in Failed Back Surgery Syndrome with Severe Low Back Pain and Disturbed Body Image: Case study

A 20-year-old woman began experiencing low back pain (LBP) in September 2008 and dysesthesia, pain in the left leg, muscle weakness, and gait disturbance in January 2009. Three low back surgery were performed in April, May and July 2009, respectively. However, her symptoms were relieved for only a few days, eventually re-emerging and intensifying. On our initial examination, on physical contact, a sharp increase in pain was experienced in the left lower back (numerical rating scale: NRS = 10). Loss of body image in the left lower back with severe pain was presented. Lying in the supine position, independent upright sitting, and trunk flexion to the left beyond a certain point were impossible. Motor imagery and tactile discrimination training were performed. However the training was not effective. Next, the patient was asked to determine the various degrees of hardness of the sponge material that was placed on the left lower back of another person; she was simultaneously instructed to imagine it being placed on her own left lower back. Hardness discrimination training was performed for 20 min a day, 6 days a week for 4 weeks. EEG was performed to determine the cortical activation in the somatosensory cortex during motor imagery and the hardness discrimination task. Four weeks after hardness discrimination training, on contact with the left lower back, left LBP decreased from 10/10 to 5/10 on the subjective NRS. In addition, perception of body image in the left lower back improved. Lying in the supine position, independent upright sitting, and trunk flexion to the left became possible. Neural activity was observed in the right somatosensory cortex in the hardness discrimination task compared with the control task. These results raised the possibility that hardness discrimination training decreased pain through reorganization of the somatosensory cortex.

Efficacy and Safety of the Seven-Day Buprenorphine Transdermal System in Opioid-Naïve Patients with Moderate to Severe Chronic Low Back Pain: An Enriched, Randomized, Double-Blind, Placebo-Controlled Study

Context This article presents the results of a pivotal Phase 3 study that assesses a new treatment for the management of chronic low back pain: a transdermal patch containing the opioid buprenorphine. In this randomized, placebo-controlled study with an enriched enrollment design, the buprenorphine transdermal system (BTDS) was found to be efficacious and generally well tolerated. Objectives This enriched, multicenter, randomized, double-blind study evaluated the efficacy, tolerability, and safety of BTDS in opioid-naïve patients who had moderate to severe chronic low back pain. Methods Patients who tolerated and responded to BTDS (10 or 20 mcg/hour) during an open-label run-in period were randomized to continue BTDS 10 or 20 mcg/hour or receive matching placebo. The primary outcome was “average pain over the last 24 hours” at the end of the 12-week double-blind phase, collected on an 11-point scale (0 = no pain, 10 = pain as bad as you can imagine). Sleep disturbance (Medical Outcomes Study subscale) and total number of supplemental analgesic tablets used were secondary efficacy variables. Results Fifty-three percent of patients receiving open-label BTDS (541 of 1024) were randomized to receive BTDS ( n = 257) or placebo ( n = 284). Patients receiving BTDS reported statistically significantly lower pain scores at Week 12 compared with placebo (least square mean treatment difference: −0.58, P = 0.010). Sensitivity analyses of the primary efficacy variable and results of the analysis of secondary efficacy variables supported the efficacy of BTDS relative to placebo. During the double-blind phase, the incidence of treatment-emergent adverse events was 55% for the BTDS treatment group and 52% for the placebo treatment group. Laboratory, vital sign, and electrocardiogram evaluations did not reveal unanticipated safety findings. Conclusion BTDS was efficacious in the treatment of opioid-naïve patients with moderate to severe chronic low back pain. Most treatment-emergent adverse events observed were consistent with those associated with the use of opioid agonists and transdermal patches.

Efficacy and Safety of Buprenorphine Transdermal System (BTDS) for Chronic Moderate to Severe Low Back Pain: A Randomized, Double-Blind Study

In this enriched design study, 1,160 opioid-experienced patients with chronic, moderate to severe low back pain entered an open-label run-in period; 660 demonstrated analgesic benefit from and tolerability to buprenorphine transdermal system 20 mcg/hour (BTDS 20) treatment and were randomized to receive either BTDS 20, BTDS 5 mcg/hour (BTDS 5), or the active control (immediate release oxycodone 40-mg/day) during an 84-day double-blind phase. The primary endpoint, “average pain in the last 24 hours” during double-blind weeks 4, 8, and 12, was significantly lower for patients receiving BTDS 20 compared with patients receiving BTDS 5 ( P < .001, treatment difference of −.67). A treatment difference of −.75 in favor of oxycodone 40 mg/day versus BTDS 5 ( P < .001) indicated the assay sensitivity of the study. Four sensitivity analyses, secondary, and exploratory analyses supported the results of the primary analysis. Incidences of treatment-emergent adverse events were 56% during the open-label period, and 59, 77, and 73% for the BTDS 5, BTDS 20, and oxycodone 40 mg/day treatment groups, respectively, during the double-blind phase. One death considered unrelated to study treatment occurred in a patient receiving BTDS 10 during the run-in period. BTDS 20 treatment was demonstrated to be efficacious and generally well tolerated. Perspective This article presents results of a pivotal Phase 3 study that assesses a new treatment for the management of chronic low back pain: a transdermal patch containing the opioid buprenorphine (BTDS). In this active controlled, superiority study with an enriched design, BTDS 20 was found to be efficacious and generally well tolerated.

Long-Term Safety of Remoxy®(Extended-Release Oxycodone) in Patients with Moderate to Severe Chronic Osteoarthritis or Low Back Pain

Evaluate the long-term safety, tolerability, and efficacy of Remoxy® (extended-release oxycodone) in patients with chronic pain related to osteoarthritis of the hip and/or knee or chronic low back pain. Open-label, 12-month, phase 3 trial. Fifty-nine US sites. Men and women with moderate to severe hip and/or knee pain caused by osteoarthritis or persistent moderate to severe low back pain. Remoxy 5 mg twice daily, which could be increased in fixed increments up to 80 mg twice daily. Safety and tolerability assessments included adverse events (AEs), laboratory tests, vital signs, physical examinations, and electrocardiograms. Efficacy was assessed through ratings of pain intensity, quality of analgesia, and global assessment of study drug. Of the 828 patients enrolled, 823 received ≥1 dose of Remoxy, with 469 exposed for ≥180 days and 381 for ≥358 days. At least one AE was experienced by 678 patients (82%), the most common of which were opioid related, including constipation, nausea, and somnolence; 173 patients (21%) discontinued treatment because of AEs. No clinically relevant changes were seen in other safety assessments. Mean pain intensity scores decreased significantly from baseline at all time points (P < 0.001). At month 12, quality of analgesia and global assessment of study drug were rated positively (good, very good, or excellent) by 64% and 61% of patients (last observation carried forward), respectively. Long-term treatment with Remoxy was safe, well tolerated, and efficacious in patients with chronic pain related to osteoarthritis of the hip and/or knee or chronic low back pain.

Efficacy and safety of tapentadol extended release for the management of chronic low back pain: results of a prospective, randomized, double-blind, placebo- and active-controlled Phase III study

Objective: To evaluate the efficacy and safety of tapentadol extended release (ER) for the management of moderate to severe chronic low back pain.Research design: Patients (N = 981) were randomized 1:1:1 to receive tapentadol ER 100 – 250 mg b.i.d., oxycodone HCl controlled release (CR) 20 – 50 mg b.i.d., or placebo over 15 weeks (3-week titration period, 12-week maintenance period).Main outcome measures: Efficacy was assessed as change from baseline in average pain intensity (11-point NRS) at week 12 of the maintenance period and throughout the maintenance period; last observation carried forward was used to impute missing pain scores. Adverse events (AEs) were monitored throughout the study.Results: Tapentadol ER significantly reduced average pain intensity versus placebo at week 12 (least squares mean difference vs placebo [95% confidence interval], −0.8 [−1.22, −0.47]; p < 0.001) and throughout the maintenance period (−0.7 [−1.06,−0.35]; p < 0.001). Oxycodone CR significantly reduced average pain intensity versus placebo at week 12 (−0.9 [−1.24,−0.49]; p < 0.001) and throughout the maintenance period (−0.8 [−1.16,−0.46]; p < 0.001). Tapentadol ER was associated with a lower incidence of treatment-emergent AEs (TEAEs) than oxycodone CR. Gastrointestinal TEAEs, including constipation, nausea, and vomiting, were among the most commonly reported TEAEs (placebo, 26.3%; tapentadol ER, 43.7%; oxycodone CR, 61.9%). The odds of experiencing constipation or the composite of nausea and/or vomiting were significantly lower with tapentadol ER than with oxycodone CR (both p < 0.001).Conclusions: Tapentadol ER (100 – 250 mg b.i.d.) effectively relieved moderate to severe chronic low back pain over 15 weeks and had better gastrointestinal tolerability than oxycodone HCl CR (20 – 50 mg b.i.d.).

Evaluation of study discontinuations with tapentadol immediate release and oxycodone immediate release in patients with low back or osteoarthritis pain

To examine discontinuations due to nausea and/or vomiting or constipation with tapentadol immediate release (IR) or oxycodone IR treatment. Post hoc analyses of a 90-day, phase 3, randomized, double-blind, flexible-dose study. United States, Canada, United Kingdom. Adults with moderate to severe low back or osteoarthritis (OA) pain for > or =3 months. Tapentadol IR 50 or 100 mg or oxycodone HCI IR 10 or 15 mg every 4-6 hours as needed. Adverse events and discontinuations were recorded. Post hoc analyses included data from 679 patients receiving tapentadol IR and 170 receiving oxycodone IR (4:1 randomization). Tapentadol IR 50 or 100 mg and oxycodone HCI IR 10 or 15 mg provided similar levels of pain relief Overall, 21.2 percent of patients receiving tapentadol IR discontinued treatment for adverse events versus 31.2 percent of patients receiving oxycodone IR. The percentage of patients who discontinued for nausea and/or vomiting was significantly lower with tapentadol IR (5.9 percent) than oxycodone IR (14.7 percent; p = 0.0003); patients treated with oxycodone IR discontinued because of nausea and/or vomiting significantly earlier than with tapentadol IR (p < 0.0001). The percentage of patients who discontinued because of constipation was significantly lower with tapentadol IR (1.5 percent) than with oxycodone IR (5.9 percent; p = 0.0023); patients treated with oxycodone IR discontinued because of constipation significantly earlier versus tapentadol IR (p = 0.0003). A lower percentage of patients discontinued because of nausea and/or vomiting or constipation with tapentadol IR versus oxycodone IR while receiving comparable pain relief suggesting tapentadol may improve the management of low back and OA pain.

G127R: A novel SOD1 mutation associated with rapidly evolving ALS and severe pain syndrome

We describe a patient with apparently sporadic amyotrophic lateral sclerosis (SALS) with a novel g > c point mutation at position 382 in the SOD1 gene, leading to a substitution of glycine for arginine in amino acid position 127 (G127R). The disease presented with flaccid leg paresis, and progressed rapidly with generalized paresis resulting in respiratory failure after seven months. In addition to a predominating lower motor neuron syndrome, the phenotype was characterized by a severe lower back and leg pain syndrome which was treated successfully with spinal anaesthesia.

P141. Tapentadol Extended Release vs. Oxycodone Controlled Release for Treating Moderate to Severe Chronic Low Back Pain: Study Discontinuations from a Randomized, Double-Blind Phase 3 Trial

P141. Tapentadol Extended Release vs. Oxycodone Controlled Release for Treating Moderate to Severe Chronic Low Back Pain: Study Discontinuations from a Randomized, Double-Blind Phase 3 Trial

Percutaneous Sacroplasty for the Sacral Insufficiency Fracture Caused by Metastasis

Insufficiency fractures of the sacrum are relatively common and cause severe low back and buttock pain. Percutaneous vertebroplasty is effective for treating vertebral compression fractures. We present a case of percutaneous sacroplasty for the treatment of low back and buttock pain in a sacral insufficiency fracture. A 79-year-old male with non-small lung cancer presented with seve re low back and buttock pain after series of radiation treatments. Preoperative MRI showed both a sacral ala and S2 metastatic insufficiency fracture. An epidural port was inserted for continuous morphine infusion and sacral nerve root blocks were performed. However, his pain did not diminish and we attempted percutaneou s sacroplasty. Both sides of the sacroplasty were done with a fluoroscopy-guided technique with 1.7 ml and 2.3 ml of bone cement injected into the right and left sacral ala. Pain relief was significant and the patient was able to sit down 1 day after the procedure. (Korean J Pain 2008; 21: 229-232)

Efficacy and Safety of OPANA ER (Oxymorphone Extended Release) for Relief of Moderate to Severe Chronic Low Back Pain in Opioid-Experienced Patients: A 12-Week, Randomized, Double-blind, Placebo-controlled Study

Opioid-experienced (N = 250) patients with chronic, moderate to severe low back pain (LBP) were converted from their prestudy opioid(s) to an approximately equianalgesic dose of OPANA ⁎ ER (oxymorphone extended release). Patients continued slow titration, with 56% stabilized within 1 month to a dose of OPANA ER that reduced average pain to <40 mm on a visual analog scale with good tolerability. Stabilized patients (n = 143) were randomized to placebo or their stabilized dose of OPANA ER every 12 hours for a 12-week double-blind period. Pain intensity increased significantly more for patients randomized to placebo than for patients who continued their stabilized dose of OPANA ER; the increase from baseline (at randomization) to final visit was 31.6 mm for placebo versus 8.7 mm with OPANA ER ( P < .0001). During double-blind treatment, placebo patients were approximately 8-fold more likely than OPANA ER patients to discontinue because of lack of efficacy ( P < .001). Discontinuations as a result of adverse events were similar between groups, 10% with placebo and 11% with OPANA ER. Opioid-related adverse events included constipation (6%), somnolence (3%), and nausea (3%). Fifty-seven percent of opioid-experienced patients with chronic, moderate to severe LBP achieved a stable dose of OPANA ER that was efficacious and generally well-tolerated for up to 12 weeks. Perspective In a 12-week, double-blind, randomized, placebo-controlled trial in opioid-experienced patients with chronic, moderate to severe LBP, OPANA ER provided efficacious, long-term analgesia and was generally well-tolerated. OPANA ER may provide clinicians with a new treatment option for patients experiencing suboptimal analgesic responses or poor tolerability with other opioids. ⁎ OPANA is a registered trademark of Endo Pharmaceuticals, Chadds Ford, PA.

Epidural extension of a lumbar vertebral haemangioma

Vertebral haemangiomas are relatively common, but those extending into the epidural space are rare. A 59-year-old man with severe lower back and right leg pain that did not resolve with conservative treatment was seen in an outpatient clinic. Magnetic resonance imaging of the lumbar spine identified an L3 vertebral corpus lesion with epidural extension. The diagnosis was unclear, so the patient underwent surgery. The pathologic diagnosis was capillary haemangioma, so angiography-guided embolization was performed postoperatively. Vertebral haemangioma must be considered when there is evidence of a vertebral corpus lesion with epidural extension on magnetic resonance imaging.

Risk factors and musculoskeletal complaints in non-specialized nurses, IC nurses, operation room nurses, and X-ray technologists

To gain more insight into the prevalence rates of musculoskeletal complaints of neck-shoulder and low back and to determine the relation between physical and psychosocial work-related risk factors and the complaints mentioned in non-specialized nurses, operation room nurses, Intensive Care (IC) nurses and X-ray technologists. The study population consists of 3,169 employees affiliated to eight university hospitals in the Netherlands. The study was conducted using a cross-sectional survey design. The parameters under study were having or having had (severe) low back or neck-shoulder complaints during the past year. In logistic regression analyses odds ratio's and CI 95% were estimated for all relevant risk factors for each of the four professional groups. In all groups prevalence rates of musculoskeletal complaints were high: low back 76%, neck-shoulder 60%. Operation room nurses perceived more neck-shoulder complaints (12 months prevalence) than non-specialized nurses and IC nurses perceived less severe low back complaints than non-specialized nurses. Four physical risk factors and one psychosocial factor were associated with low back complaints in all groups. The results of the present study indicate that both low back complaints and neck-shoulder complaints are major health problems in the four professional groups under study. The prevalence rate of neck-shoulder complaints in operation room nurses is higher than in non-specialized nurses and IC nurses, the latter groups having high prevalence rates already. The exposure to risk factors is perceived differently by each of the professional groups. The professional groups under study all are target for preventive interventions; these interventions need to be specified for each of the professional groups.

Lumbar juxta-facet cyst after trauma

We report a post-traumatic lumbar facet cyst in which results of magnetic resonance imaging (MRI) performed at the time of injury were available. The patient was a 59-year-old man who presented with severe low back and right leg pain immediately after injury of his sacroiliac region in a traffic accident. MRI at the time of injury revealed high intensity signal change in the right facet joint at L4/5. Re-examination 5 months after the injury with MRI revealed a cyst, which was continuous with the facet joint. Surgical resection of the cyst yielded satisfactory results. We describe detailed MRI findings for this case and review the literature on traumatic juxta-facet cyst in the lumbar spine.

The level and time course of disability: Trajectories of disability in adults and young elderly

Objectives. The objectives of this study were: (i) to identify trajectories in the level and time course of disability, (ii) to determine the relative frequency of each trajectory, and (iii) to assess the relationship of these trajectories with age, sex and the presence of four chronic diseases (asthma/chronic obstructive pulmonary disease (COPD), heart disease, severe low back complaints and diabetes mellitus).Methods. We used six measurements of disability and information on mortality from a longitudinal study in Dutch persons aged 15 – 74. We used cluster analyses to group persons with similar levels and time courses of disability into disability trajectories. Deaths were classified into a separate trajectory. Multinomial regression was used to assess the relationship of the trajectories with age, sex and the four chronic diseases. Information on disability in the last year(s) prior to death was used to examine disability prior to death.Results. Nine trajectories of disability were identified, while all deaths were classified into a separate trajectory; 74% was entirely non-disabled. The size of the other trajectories varied from 10% (permanently mildly disabled) to 0.5% (severely disabled with large increase in disability). Significant associations were found with age and, correcting for age and sex, with asthma/COPD, heart disease and low back complaints, but not with diabetes. The ORs were generally highest for trajectories characterized by severe disability, although disease-specific associations were also found. Among the deaths, 41% of the trajectories were associated with disability prior to death. Disability prior to death was more prevalent among persons with heart disease, back complaints, and asthma/COPD.Conclusions. These findings suggest that disability is a dynamic process, and that important differences exist within the ‘disabled’ population. This is important for assessing the need for care and shows the limitations of modeling disability change based on two measurements only.

Poster 168: Transforaminal Volume Aided Foraminoplasty for Postsurgical Scarring: A Case Report

Setting: Office-based subspecialty practice. Patient: A 44-year-old woman with postlaminectomy pain syndrome and postsurgical fibrosis after L5-S1 fusion with instrumentation. Case Description: The patient was seen for severe low back and leg pain. Patient had a fusion with instrumentation at L5-S1 in July 2003. Magnetic resonance imaging showed diffuse granulation tissue encircling the thecal sac at L5 and around L5 and S1 nerve root sleeves. Electrodiagnostic testing showed an acute on chronic L5-S1 radiculopathy.

Physical workload, ergonomic problems, and incidence of low back injury: A 7.5‐year prospective study of San Francisco transit operators

The etiologic role of biomechanical factors for low back injury (LBI) needs to be confirmed in prospective studies that control for psychosocial factors. Complete baseline information on 1,233 vehicle operators was gathered during medical examinations and by questionnaire. First LBI during 7.5 years of follow-up was ascertained from insurance records. Hazard ratios and etiologic fractions were analyzed with Cox regression models stratified by injury severity and controlling for age, sex, height, weight, ethnicity, and biomechanical and psychosocial job factors. Severe LBI was defined as medically diagnosed postlaminectomy syndrome, spinal stenosis, herniated lumbar disc, sciatica, or spinal instability. An exponential dose-response relationship was found between weekly driving hours and incidence of first LBI. Indicators of physical workload were more strongly associated with more severe low back injuries compared to less severe injuries. Rates of severe LBI increased 39% for every 10-hr increase in weekly driving (hazard ratio 1.39, 95% confidence interval 1.15-1.68). Higher risks of severe LBI were also found among operators performing heavy physical labor on cable cars (hazard ratio 2.76, 95% confidence intervals 1.24-6.14) or reporting more ergonomic problems at baseline (HR for upper quartile 1.65 (95% confidence interval 1.08-2.50). Estimates of etiologic fractions suggest that reduction of ergonomic problems to the low level currently experienced by 25% of drivers would result in a 19% reduction of severe LBI among all drivers. A change from full- (more than 30 hr) to part-time driving (20-30 hr) could reduce the number of severe LBI by 59%, although this gain would be reduced to 28% at the company level if injuries expected among additional employees, hired to maintain full service are included. Duration of professional driving and ergonomic problems are independent and preventable risk factors for LBI even after adjustment for psychosocial factors.

Anaplastic oligodendroglioma presenting with drop metastases in the cauda equina

Metastatic involvement of the cerebro-spinal fluid (CSF) pathway in oligodendrogliomas is not uncommon; however, symptomatic involvement of the spinal cord is very rare: less of 10 cases have been published. To our knowledge, an intracranial oligodendroglioma presenting with symptoms of drop metastases in the cauda equina has never been reported. We report a case of 67-year-old woman who after 1 month of severe low back and legs pain developed symptoms of raised intracranial pressure. A spinal cord MRI showed multiple intradural nodular lesions at the level of the cauda equina, a MRI of the brain showed an intraventricular brain tumor. The histopathological diagnosis of both surgically treated lesions was anaplastic oligodendroglioma. The choices adopted in planning diagnostic and therapeutical procedures are discussed. The importance of the clinical and neuroradiological data in the diagnosis is stressed. Pathophysiology of the seeding of intracranial tumours via the cerebrospinal fluid is reviewed.

Chiropractic Care of a Patient with Low Back Pain Associated with Subluxations and a Malgaigne-Type Pelvic Fracture

Objective To describe the chiropractic care of a patient with a pelvic ring fracture and concomitant subluxations of multiple segments of the spinal column. Clinical Features A 23-year-old male, after falling down a flight of stairs, was initially hospitalized for fractures of the pelvis. Five weeks posthospitalization, the patient initiated chiropractic care with complaints of severe low back pain with lower extremity involvement. He also complained of neck pain and occipital headache. The patient had several positive low back orthopedic tests with bilaterally absent Achilles deep tendon reflexes. The anteroposterior radiographic view revealed ununited fractures at the left superior and inferior pubic ramus, noted as a type I Malgaigne fracture. Subluxations were detected at the left innominate (ie, fracture-subluxation) and at the patient's lumbar, thoracic, and cervical spine. Intervention and Outcome The patient was cared for with contact-specific, high-velocity, low-amplitude adjustments to sites of vertebral and sacroiliac subluxations. The patient's response to care was positive, receiving great pain relief. Less than 3 months after initiating care, the patient returned to work on regular duty. Conclusion There are indications that patients suffering from the injuries described above may derive benefits from chiropractic care. The practitioner must pay careful attention to issues of biomechanical and vascular stability and adjustment modifications in these types of patients.

Effectiveness of Percutaneous Neuromodulation Therapy for Patients with Chronic and Severe Low Back Pain

Abstract: Percutaneous neuromodulation therapy (PNT) is a minimally invasive approach to the treatment of low back pain (LBP), involving electrical stimulation applied to percutaneous electrodes placed within the lumbar paraspinal tissues during 30‐minute treatment sessions. This study reports the effects of PNT on a population of patients with chronic and severe levels of LBP. This study was performed in an outpatient clinical research setting. Thirty‐nine patients were enrolled who had stable levels of LBP lasting at least 6 months, with enrollment LBP visual analog scale (VAS) scores of at least 5 on a scale of 10. The patients were treated with PNT 2 times per week for 4 weeks. Baseline VAS scores of LBP, physical activity, sleep, and the Oswestry Questionnaire were recorded. The final assessment was made 48 hours after the last treatment. After 4 sessions, the patients completed a “responder screen” questionnaire whereby, to continue treatment, they had to indicate both a perceived benefit and improvement in LBP and/or activity levels. Thirty‐one patients completed the study protocol. Of the 18 patients (58% of 31) who passed the responder screen, 14 (78% of 18, 45% of 31) had ≥30% improvement in LBP and/or activity levels. Mean LBP scores decreased by 37% to 4.5 ± 2.2 from 7.1 ± 1.0 (P=0.0001); activity scores improved by 39% to 4.0 ± 2.1 from 6.7 ± 1.5 (P=0.0005); sleep scores improved by 40% from 6.2 ± 2.6 to 4.0 ± 2.6 (P=0.0003). Oswestry scores improved from 44 ± 12 to 33 ± 15 (P=0.002). In conclusion, for patients with chronic and severe stable levels of low back pain, PNT appears promising for pain level reduction and improvement in function.

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