Preference-based health outcome measures in low back pain

Preference-based health outcome measures were considered in two settings. In the clinical context, utility assessment using the VAS, TTO or SG was described. It is recognized that formal utility assessment is generally not needed in day-to-day clinical practice. When the need to explicitly value alternative health outcomes arises, the VAS is recommended because of its ease of implementation. In the health policy context, preference classification systems are recommended for valuing health when a cost-effectiveness analysis of alternative health care interventions is planned. At present, there is little evidence to base choice of one system over another for assessing the cost-effectiveness of low back pain interventions.     

Condition-specific outcome measures for low back pain

A literature review of the most widely used, condition-specific, self-administered assessment questionnaires for low back pain has been undertaken. In part I, technical issues such as validity, reliability, availability and comparability were analyzed for the nine most widely used outcome tools. This second part focuses on the content and wording of questions and answers in each of the nine questionnaires, and an analysis of the different score results is performed. The issue of score bias is discussed and suggestions are given in order to increase the construct validity in the practical use of the individual questionnaires.     

Condition-specific outcome measures for low back pain

A literature review of the nine most widely used, condition-specific, self-administered assessment questionnaires for low back pain has been undertaken. General and historic aspects, reliability, responsiveness and minimum clinically important difference, external validity, floor and ceiling effects and available languages were analysed for the nine most-used outcome tools. When considering which condition-specific measure to employ, the present overview on assessment tools should provide the necessary information to define the technical aspects of the nine questionnaires. These criteria, however, are only part of the consideration. In part II the construction of these scales in relationship to the measurement domains will be evaluated.     

Preoperative pain catastrophizing affects pain outcome after total knee arthroplasty

BackgroundsPreoperative widespread pain sensitization or pain catastrophizing could be associated with chronic pain after total knee arthroplasty (TKA). The aim of the present study was to examine the association between postoperative pain in patients undergoing TKA and preoperative factors, including patient characteristics and preoperative central sensitization as well as pain catastrophizing.MethodsPreoperative TKA patients were evaluated using the Central Sensitization Inventory (CSI)-9 and Pain Catastrophizing Scale (PCS). Postoperative knee pain was evaluated using a numerical rating scale (NRS) 6 months after TKA. Statistical analyses were performed to assess the relationship between NRS 6 months after TKA and preoperative factors, including patient characteristics, CSI-9, and PCS.ResultsWe enrolled 58 consecutive patients with osteoarthritis who underwent TKA. Using cutoff of 14, postoperative NRS was higher in the patients with ≥14 than the patients with <14 in CSI (p = 0.025). Postoperative NRS was higher in the patients with ≥30 than the patients with <30 in PCS (p = 0.043). Preoperative PCS was a significant risk factor of postoperative pain using a multivariate analysis.ConclusionsSurgeon should recognize preoperative PCS could affect postoperative pain 6 months after TKA.     

BMI, pain and hyper-mobility are determinants of long-term outcome for women with low back pain and pelvic pain during pregnancy

Low back pain and pelvic pain (LBPP) is common during pregnancy and up to 40% of women still have symptoms half a year after delivery. The aim of the study was to investigate determinants and the prevalence of persistent LBPP after pregnancy in a Swedish cohort. In a previous study 891 women had responded to a questionnaire on risk factors and prevalence of LBPP during pregnancy. Altogether 72% (n=639) of the women had reported LBPP during pregnancy. These respondents were sent a second questionnaire at approximately 6 months after delivery. The response rate was 72.6% (n=464). Independent t-test and Pearson’s chi-squared test were used to test the difference between the two groups. In response to the questionnaire, 43.1% of the women reported persistent LBPP 6 months after delivery. Women with persistent LBPP after pregnancy had had significantly earlier onset of pain during pregnancy, higher maternal age, higher body mass index (BMI), and assessed a higher level of pain due to LBPP during pregnancy and after pregnancy, and included a higher proportion of women with joint hyper-mobility. In summary, recurrent or continuous LBPP is prevalent after pregnancy. BMI as well as hyper-mobility are prominent determinants of persistent LBPP after pregnancy. Level and onset of pain during pregnancy were strong predictors of persistent LBPP.     

Hip fractures: failure of fixation and outcome of salvage arthroplasty

Between 1999 and 2005, we treated 41 patients with a total hip arthroplasty for failed fixation of a hip fracture. This study had three purposes: (1) to determine the reason/s for fixation failure (2) to record difficulties/complications encountered in converting to a salvage arthroplasty and (3) to compare the outcome of these patients (Group 1) with a matched group of patients who underwent a primary hip arthroplasty (Group 2). Failure to achieve a good reduction and optimal screw placement was evident in 80% of cases of failed fixation. A high incidence of complications was recorded in the perioperative period during conversion to a salvage arthroplasty. Functional outcome was statistically inferior in Group1; this group also had a higher incidence of complications. Radiographs at 2 years postoperatively showed evidence of femoral stem loosening in 16% of the salvage group compared with 3% in the primary hip arthroplasty group.     

全髋关节置换术对下腰痛的影响

目的探讨行全髋关节置换术(THA)治疗患者下腰痛的特点,评估THA手术对下腰痛的影响。方法分析98例行THA患者的腰椎影像学特点及下腰痛的发生率,术后随访THA患者功能恢复情况并评估其下腰痛的转归。结果 80例患者获得随访,时间3~36个月,其中64例(80%)术前合并下腰痛,术后下腰痛患者中57例明显好转,5例无好转,2例加重。下腰痛VAS评分由术前的2.85分±1.75分下降至术后的1.44分±1.24分(P0.01),ODI评分由术前的32.53%±18.96%下降至17.70%±11.71%(P0.01),髋关节Harris评分由术前的54.06分±11.78分上升至术后的93.88分±2.49分(P0.01)。结论行THA的患者中下腰痛的发生率较高,THA手术可以明显缓解下腰痛的症状,改善患者生活质量。     

Functional versus patient-reported outcome of the bicruciate and the standard condylar-stabilizing total knee arthroplasty

Introduction

The purpose of this retrospective comparative analysis in patients undergoing primary total knee arthroplasty (TKA) was to evaluate whether different TKA implant design would influence patient-rated outcomes, functioning, and range of motion (ROM). A secondary purpose of this study was to test for relationships between the patient-rated outcomes and the passive ROM.

Materials and methods

Thirty-one patients who had a primary bicruciate stabilized TKA performed between May 2010 and November 2012 were retrospectively reviewed and compared with a cohort of 30 patients who had condylar-stabilizing TKA during the same period.

Results

No significant differences were observed between the two groups with respect to preoperative demographic characteristics, ROM and radiographic knee alignment. At a mean follow-up of 37 months (SD 7), the Triathlon group had higher mean Knee Injury and Osteoarthritis Outcome Score (KOOS) score in all subscales and a higher Knee Society Score (KSS) score than the Journey group. This difference was statistically significant for the KOOS subscales of pain (p = 0.0099) and activities of daily living (ADL) (p = 0.0003), as well as the KSS score (p = 0.03846). The ROM was significantly higher in the Journey group when compared to the Triathlon group (p = 0.0013). No significant correlation was observed between the ROM and KOOS pain, QOL and ADL subscores and KSS score.

Conclusions

Postoperative knee ROM and patient perception of knee function after primary TKA can be affected by the different prosthetic designs. However, functionality afforded by the bicruciate TKA is not equivalent to patient satisfaction.

Level of evidence

III.

     

Evaluation of two time-specific back pain outcome measures.

STUDY DESIGN: Postal questionnaire to individuals with back pain. OBJECTIVE: To assess the acceptability, validity, and reliability of two existing back pain outcome measures, the Roland-Morris Questionnaire and the Von Korff scales, modified to measure the preceding 4 weeks. SUMMARY OF BACKGROUND DATA: The ideal outcome measure for studies of low back pain and disability remains elusive. Most existing measures assess current pain and disability. Measuring these factors over a preceding 4-week period may be more appropriate. METHODS: Individuals with back pain identified in a community survey were asked to complete the modified questionnaires. Validity was assessed by comparison with the Medical Outcome Study Short Form 36 and two general comparator questions on self-reported pain and disability. Repeatability was assessed using retest questionnaires. RESULTS: Completed questionnaires were returned by 95 individuals with chronic back pain. The modified Roland-Morris Questionnaire and Von Korff pain and Von Korff disability scales were completed satisfactorily by 83 (87%), 89 (94%), and 87 (92%) participants, respectively. Mean scores of the modified measures changed significantly and in a predictable manner with increasing ratings of pain and disability. They also correlated with aspects of the Medical Outcome Study Short Form 36 questionnaire. Retest data suggest that these measures are repeatable. The modified Roland-Morris Questionnaire provided adequate analyzable data only if missing values were imputed, and it explained less of the variance in the comparator questions than the modified Von Korff scales. CONCLUSIONS: The modified Von Korff scales were completed easily and appear to be valid and repeatable in this format.     

Worse patient-reported outcome after lateral approach than after anterior and posterolateral approach in primary hip arthroplasty

Background — The surgical approach in total hip arthroplasty (THA) is often based on surgeon preference and local traditions. The anterior muscle-sparing approach has recently gained popularity in Europe. We tested the hypothesis that patient satisfaction, pain, function, and health-related quality of life (HRQoL) after THA is not related to the surgical approach.

Patients — 1,476 patients identified through the Norwegian Arthroplasty Register were sent questionnaires 1–3 years after undergoing THA in the period from January 2008 to June 2010. Patient-reported outcome measures (PROMs) included the hip disability osteoarthritis outcome score (HOOS), the Western Ontario and McMaster Universities osteoarthritis index (WOMAC), health-related quality of life (EQ-5D-3L), visual analog scales (VAS) addressing pain and satisfaction, and questions about complications. 1,273 patients completed the questionnaires and were included in the analysis.

Results — Adjusted HOOS scores for pain, other symptoms, activities of daily living (ADL), sport/recreation, and quality of life were significantly worse (p < 0.001 to p = 0.03) for the lateral approach than for the anterior approach and the posterolateral approach (mean differences: 3.2–5.0). These results were related to more patient-reported limping with the lateral approach than with the anterior and posterolateral approaches (25% vs. 12% and 13%, respectively; p < 0.001).

Interpretation — Patients operated with the lateral approach reported worse outcomes 1–3 years after THA surgery. Self-reported limping occurred twice as often in patients who underwent THA with a lateral approach than in those who underwent THA with an anterior or posterolateral approach. There were no significant differences in patient-reported outcomes after THA between those who underwent THA with a posterolateral approach and those who underwent THA with an anterior approach.     

Negative impact of waiting time for primary total knee arthroplasty on satisfaction and patient-reported outcome

Purpose

The primary objective of this study was to evaluate the influence of the time on waiting list for total knee arthroplasty (TKA) on the post-operative satisfaction and patient-reported outcomes.

Methods

This was a prospective observational study of 192 patients followed for one year. Patients were pre and post-operatively assessed with the 12-item Short-Form, reduced Western Ontario MacMaster University, and Knee Society scores. In addition, the Hospital Anxiety and Depression scale was used at time of admission, and patient satisfaction on a five point Likert scale at one post-operative year. Univariate and multivariate analyses were performed.

Results

Patients waiting longer than six months had significantly worse pre-operative anxiety score as well as post-operative SF12 (both physical and mental) and KSS-function scores compared to those with a waiting time shorter than six months. Dissatisfaction rate was also higher in patients waiting longer than six months, and it was mainly influenced by pre-operative anxiety and depression.

Conclusions

Waiting time longer than six months negatively influenced post-operative satisfaction and patient-related outcome at one year after TKA. These findings may have important clinical implications regarding the prioritization of patients on wait lists or for optimization of treatment while patients wait for surgery related to the management of the mental health and anxiety in order to reduce post-operative dissatisfaction and improve patient-reported outcomes.

     

Implant survival and patient-reported outcome following total hip arthroplasty in patients 30 years or younger: a matched cohort study of 1,008 patients in the Swedish Hip Arthroplasty Register

Background and purpose — The outcome of total hip arthroplasty (THA) in younger patients is suggested to be inferior compared with the general THA population. There is a lack of studies with long-term follow up for very young patients. We report on implant survival and patient-reported outcome in patients aged 30 years or younger.

Patients and methods — Data on THAs performed in Sweden between the years 2000 and 2016 were included. There were 504 patients 30 years or younger with complete demographic and surgical data (study group). A matched comparison group older than 30 years was identified. Implant survival was analyzed using the Kaplan–Meier method. Patient-reported outcome was analyzed in a subgroup of patients.

Results — The 10-year and 15-year implant survivorship for the study group was 90% and 78%, respectively. The corresponding figures for the patients older than 30 years were 94% and 89%. The median preoperative EQ-5D index was lower in the study group; the improvement in EQ-5D index was similar between the study and the comparison groups. The preoperative EQ-VAS was lower and the improvement in EQ-VAS at 1 year was larger in the study group.

Interpretation — The promising 10-year implant survival and 1-year improvement in patient-reported outcome suggests that THA is a feasible option in the patients 30 years or younger.     

Predicting recovery using continuous low back pain outcome measures.

BACKGROUND CONTEXT: There is a lack of research evaluating multiple follow-up visits, specifically when using continuous outcome measures. Continuous outcome measures with several follow-up assessments would allow us to evaluate rate of recovery. PURPOSE: To predict low back pain outcomes based on the quantification of initial conditions. STUDY DESIGN/SETTING: This was a prospective study where patients were enrolled within the first month of low back pain symptoms and evaluated for 3 months. Patients were recruited from several primary care facilities. PATIENT SAMPLE: Thirty-two patients with local low back pain symptoms were recruited for the study. OUTCOME MEASURES: There were four major outcome measures, including functional performance probability, symptom intensity, impairment of activities of daily living, and a summary outcome measure. METHODS: Regression models were constructed using the initial conditions, including psychological, psychosocial, physical workplace, and personal factors, to predict the rate of recovery for each outcome measure. RESULTS: Twenty-eight patients completed the study. The r2 value for the rate of recovery regression models were 0.77 symptom intensity prediction, 0.85 activities of daily living prediction, 0.87 functional performance probability prediction, and 0.96 summary outcome measure prediction. Two functional performance patterns of recovery were found, including a steady improvement and a large jump in improvement. A discriminant function model identified the pattern of recovery in 91% of cases given initial conditions. CONCLUSIONS: Continuous outcome measures can be accurately predicted given the initial conditions.