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1.
Matt Fernandez Lucia Colodro-Conde Jan Hartvigsen Manuela L. Ferreira Kathryn M. Refshauge Marina B. Pinheiro Juan R. Ordoñana Paulo H. Ferreira 《The spine journal》2017,17(7):905-912
Background Context
Pain is commonly associated with symptoms of depression or anxiety, although this relationship is considered bidirectional. There is limited knowledge regarding causal relationships.Purpose
This study aims to investigate whether chronic low back pain (LBP) increases the risk of depression or anxiety symptoms, after adjusting for shared familial factors.Study Design
This is a longitudinal, genetically informative study design from the Murcia Twin Registry in Spain.Patient Sample
The patient sample included 1,269 adult twins with a mean age of 53 years.Outcome Measures
The outcome of depression or anxiety symptoms was evaluated with EuroQol questionnaire.Methods
Using logistic regression analyses, twins were initially assessed as individuals in the total sample analysis, followed by a co-twin case-control, which was partially (dizygotic [DZ] twins) and fully (monozygotic [MZ] twins) adjusted for shared familial factors. There was no external funding for this study and no conflict of interest was declared.Results
There was a significant association between chronic LBP and the risk of depression or anxiety symptoms in the unadjusted total sample analysis (odds ratio [OR]: 1.81, 95% confidence interval [CI]: 1.34–2.44). After adjusting for confounders, the association remained significant (OR: 1.43, 95% CI: 1.05–1.95), although the adjusted co-twin case-control was non-significant in DZ (OR: 1.03, 95% CI: 0.50–2.13) and MZ twins (OR: 1.86, 95% CI: 0.63–5.51).Conclusions
The relationship between chronic LBP and the future development of depression or anxiety symptoms is not causal. The relationship is likely to be explained by confounding from shared familial factors, given the non-statistically significant associations in the co-twin case-control analyses. 相似文献2.
Amabile Borges Dario Anelise Moreti Cabral Lisandra Almeida Manuela Loureiro Ferreira Kathryn Refshauge Milena Simic Evangelos Pappas Paulo Henrique Ferreira 《The spine journal》2017,17(9):1342-1351
Background
Telehealth has emerged as a potential alternative to deliver interventions for low back pain (LBP); however, its effectiveness has not been investigated.Purpose
The aim of this review was to evaluate whether interventions delivered by telehealth improve pain, disability, function, and quality of life in non-specific LBP.Study Design
This is a systematic review with meta-analysis.Methods
Seven databases were searched from the earliest records to August 2015. Eligible studies were randomized controlled trials that investigated the effectiveness of telehealth-based interventions, solo or in combination with other interventions, for non-specific LBP compared with a control group. Trials deemed clinically homogeneous were grouped in meta-analyses.Results
Eleven studies were included (n=2,280). In chronic LBP, telehealth interventions had no significant effect on pain at short-term follow-up (four trials: 1,089 participants, weighted mean difference [WMD]: ?2.61 points, 95% confidence interval [CI]: ?5.23 to 0.01) or medium-term follow-up (two trials: 441 participants, WMD: ?0.94 points, 95% CI: ?6.71 to 4.84) compared with a control group. Similarly, there was no significant effect for disability. Results from three individual trials showed that telehealth was superior to a control intervention for improving quality of life. Interventions combining telehealth and usual care were more beneficial than usual care alone in people with recent onset of LBP symptoms.Conclusion
There is moderate-quality evidence that current telehealth interventions, alone, are not more effective than minimal interventions for reducing pain and disability in chronic LBP. To date, modern telehealth media (eg, apps) and telehealth as an adjunct to usual care remain understudied. 相似文献3.
Hazel J. Jenkins Aron S. Downie Chris G. Maher Niamh A. Moloney John S. Magnussen Mark J. Hancock 《The spine journal》2018,18(12):2266-2277
Background Context
The problem of imaging patients with low back pain (LBP) when it is not indicated is well recognized. The converse is also possible, although rarely considered. The extent of these two problems is presently unclear.Purpose
This study aimed to estimate how commonly overuse, and also underuse, of imaging occurs in the management of LBP, and how appropriate use of imaging is assessed.Design
This is a systematic review and meta-analysis.Patient Sample
The sample comprised patients with LBP presenting to primary care.Outcome Measures
Proportions of inappropriate referral, and inappropriate non-referral, for diagnostic imaging for LBP were the outcome measures.Methods
MEDLINE, EMBASE, and CINAHL were searched from January 1, 1995 to December 17, 2017. Two authors independently assessed study quality and extracted data. Meta-analyses were performed where appropriate, and strength of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation system.Results
Thirty-three studies were included. In patients referred for lumbar imaging, 34.8% (95% confidence interval [CI]: 27.1, 43.3) were judged inappropriate by the absence of red flags for serious pathology and 31.6% (95% CI: 28.3, 35.1) were judged inappropriate by the criteria of no clinical suspicion of pathology. In patients presenting for care, imaging was inappropriately performed in 27.7% of cases (95% CI: 21.3, 35.1) when judged by duration of episode, 9.0% of cases (95% CI: 7.4, 11.0) when judged by absence of red flags, and 7.0% (95% CI: 1.8, 23.3) when judged by no clinical suspicion of pathology. In patients presenting for care, imaging was not performed where appropriately indicated in 65.6% (95% CI: 51.8, 77.2) of patients who presented with red flags, and 60.8% (95% CI: 42.0, 76.8) with clinical suspicion of serious pathology.Conclusions
Inappropriate imaging is common in LBP management, including both overuse in those where imaging is not indicated and underuse of imaging when it is indicated. Appreciating that both underuse and overuse can occur is fundamental to efforts to improve imaging practice to align with current guidelines and best evidence. 相似文献4.
Amabile Borges Dario Manuela Loureiro Ferreira Kathryn Refshauge Alejandro Luque-Suarez Juan Ramon Ordoñana Paulo Henrique Ferreira 《The spine journal》2017,17(2):282-290
Background Context
Obesity is commonly investigated as a potential risk factor for low back pain (LBP); however, current evidence remains unclear. Limitations in previous studies may explain the inconsistent results in the field, such as the use of a cross sectional design, limitations in the measures used to assess obesity (eg, body mass index—BMI), and poor adjustment for confounders (eg, genetics and physical activity).Purpose and Design
To better understand the effects of obesity on LBP, our aim was to investigate in a prospective cohort whether obesity-related measures increase the risk of chronic LBP outcomes using a longitudinal design. We assessed obesity through measures that consider the magnitude as well as the distribution of body fat mass. A within-pair twin case-control analysis was used to control for the possible effects of genetic and early shared environmental factors on the obesity-LBP relationship.Patient Sample and Outcome Measures
Data were obtained from the Murcia Twin Registry in Spain. Participants were 1,098 twins, aged 43 to 71 years, who did not report chronic LBP at baseline. Follow-up data on chronic LBP (>6 months), activity-limiting LBP, and care-seeking for LBP were collected after 2 to 4 years.Risk Factors
The risk factors were BMI, percentage of fat mass, waist circumference, and waist-to-hip ratio.Methods
Sequential analyses were performed using logistic regression controlling for familial confounding: (1) total sample analysis (twins analyzed as independent individuals); (2) within-pair twin case-control analyses (all complete twin pairs discordant for LBP at follow-up); and within-pair twin case-control analyses separated for (3) dizygotic and (4) monozygotic twins.Results
No increase in the risk of chronic LBP was found for any of the obesity-related measures: BMI (men/women, odds ratio [OR]: 0.99; 95 % confidence interval [CI]: 0.86–1.14), % fat mass (women, OR: 0.87; 95% CI: 0.66–1.14), waist circumference (women, OR: 0.98; 95% CI: 0.74–1.30), and waist-to-hip ratio (women, OR: 1.05; 95% CI: 0.81–1.36). Similar results were found for activity-limiting LBP and care-seeking due to LBP. After the adjustment for genetics and early environmental factors shared by twins, the non-significant results remained unchanged.Conclusions
After 2 to 4 years, obesity-related measures did not increase the risk of developing chronic LBP or care-seeking for LBP with or without adjustment for familial factors such as genetics in Spanish adults. 相似文献5.
Jeffrey G. Jarvik Laura S. Gold Katherine Tan Janna L. Friedly Srdjan S. Nedeljkovic Bryan A. Comstock Richard A. Deyo Judith A. Turner Brian W. Bresnahan Sean D. Rundell Kathryn T. James David R. Nerenz Andrew L. Avins Zoya Bauer Larry Kessler Patrick J. Heagerty 《The spine journal》2018,18(9):1540-1551
Background Context
Although back pain is common among older adults, there is relatively little research on the course of back pain in this age group.Purpose
Our primary goals were to report 2-year outcomes of older adults initiating primary care for back pain and to examine the relative importance of patient factors versus medical interventions in predicting 2-year disability and pain.Study Design/Setting
This study used a predictive model using data from a prospective, observational cohort from a primary care setting.Patient Sample
The study included patients aged ≥65 years at the time of new primary care visits for back pain.Outcome Measures
Self-reported 2-year disability (Roland-Morris Disability Questionnaire [RDQ]) and back pain (0–10 numerical rating scale [NRS]).Methods
We developed our models using a machine learning least absolute shrinkage and selection operator approach. We evaluated the predictive value of baseline characteristics and the incremental value of interventions that occurred between 0 and 90 days, and the change in patient disability and pain from 0 to 90 days. Limitations included confounding by indication and unmeasured confounding.Results
Of 4,665 patients (89%) with follow-up, both RDQ (from mean 9.6 [95% confidence interval {CI} 9.4–9.7] to mean 8.3 [95% CI 8.0–8.5]) and back pain NRS (from mean 5.0 [95% CI 4.9–5.1] to mean 3.5 [95% CI 3.4–3.6]) scores improved slightly. Only 16% (15%-18%) reported no back pain-related disability or back pain at 2 years after initial visits. Regression model parameters explained 40% of the variation (R2) in 2-year RDQ scores, and the addition of 0- to 3-month change in RDQ score and pain improved prediction (R2=51%). The most consistent predictors of 2-year RDQ scores and back pain NRS scores were 0- to 90-day change in each respective outcome and patient confidence in improvement. Patients experienced 50% and 43% improvement in back pain and disability, respectively, 2 years after their initial visit. However, fewer than 20% of patients had complete resolution of their back pain and disability at that time.Conclusions
Baseline patient factors were more important than early interventions in explaining disability and pain after 2 years. 相似文献6.
Se-Woong Chun Chai-Young Lim Keewon Kim Jinseub Hwang Sun G. Chung 《The spine journal》2017,17(8):1180-1191
Background Context
Clinicians regard lumbar lordotic curvature (LLC) with respect to low back pain (LBP) in a contradictory fashion. The time-honored point of view is that LLC itself, or its increment, causes LBP. On the other hand, recently, the biomechanical role of LLC has been emphasized, and loss of lordosis is considered a possible cause of LBP. The relationship between LLC and LBP has immense clinical significance, because it serves as the basis of therapeutic exercises for treating and preventing LBP.Purpose
This study aimed to (1) determine the difference in LLC in those with and without LBP and (2) investigate confounding factors that might affect the association between LLC and LBP.Study Design
Systematic review and meta-analysis.Patient Sample
The inclusion criteria consisted of observational studies that included information on lumbar lordotic angle (LLA) assessed by radiological image, in both patients with LBP and healthy controls. Studies solely involving pediatric populations, or addressing spinal conditions of nondegenerative causes, were excluded.Methods
A systematic electronic search of Medline, Embase, Cochrane Library, CINAHL, Scopus, PEDro, and Web of Science using terms related to lumbar alignment and Boolean logic was performed: (lumbar lordo*) or (lumbar alignment) or (sagittal alignment) or (sagittal balance). Standardized mean differences (SMD) and 95% confidence intervals (CI) were estimated, and chi-square and I2 statistics were used to assess within-group heterogeneity by random effects model. Additionally, the age and gender of participants, spinal disease entity, and the severity and duration of LBP were evaluated as possible confounding factors.Results
A total of 13 studies consisting of 796 patients with LBP and 927 healthy controls were identified. Overall, patients with LBP tended to have smaller LLA than healthy controls. However, the studies were heterogeneous. In the meta-regression analysis, the factors of age, severity of LBP, and spinal disease entity were revealed to contribute significantly to variance between studies. In the subgroup analysis of the five studies that compared patients with disc herniation or degeneration with healthy controls, patients with LBP had smaller LLA (SMD: ?0.94, 95% CI: ?1.19 to ?0.69), with sufficient homogeneity based on significance level of .1 (I2=45.7%, p=.118). In the six age-matched studies, patients with LBP had smaller LLA than healthy controls (SMD: ?0.33, 95% CI: ?0.46 to ?0.21), without statistical heterogeneity (I2=0%, p=.916).Conclusions
This meta-analysis demonstrates a strong relationship between LBP and decreased LLC, especially when compared with age-matched healthy controls. Among specific diseases, LBP by disc herniation or degeneration was shown to be substantially associated with the loss of LLC. 相似文献7.
Minji K. Lee Kathleen J. Yost Jennifer S. McDonald Ryne W. Dougherty Roanna L. Vine David F. Kallmes 《The spine journal》2017,17(6):821-829
Background Context
The majority of validation done on the Roland-Morris Disability Questionnaire (RMDQ) has been in patients with mild or moderate disability. There is paucity of research focusing on the psychometric quality of the RMDQ in patients with severe disability.Purpose
To evaluate the psychometric quality of the RMDQ in patients with severe disability.Study Design/Setting
Observational clinical study.Sample
The sample consisted of 214 patients with painful vertebral compression fractures who underwent vertebroplasty or kyphoplasty.Outcome Measures
The 23-item version of the RMDQ was completed at two time points: baseline and 30-day postintervention follow-up.Methods
With the two-parameter logistic unidimensional item response theory (IRT) analyses, we derived the range of scores that produced reliable measurement and investigated the minimal clinically important difference (MCID).Results
Scores for 214 (100%) patients at baseline and 108 (50%) patients at follow-up did not meet the reliability criterion of 0.90 or higher, with the majority of patients having disability due to back pain that was too severe to be reliably measured by the RMDQ. Depending on methodology, MCID estimates ranged from 2 to 8 points and the proportion of patients classified as having experienced meaningful improvement ranged from 26% to 68%. A greater change in score was needed at the extreme ends of the score scale to be classified as having achieved MCID using IRT methods.Conclusions
Replacing items measuring moderate disability with items measuring severe disability could yield a version of the RMDQ that better targets patients with severe disability due to back pain. Improved precision in measuring disability would be valuable to clinicians who treat patients with greater functional impairments. Caution is needed when choosing criteria for interpreting meaningful change using the RMDQ. 相似文献8.
Laura Hill David Aboud James Elliott John Magnussen Michele Sterling Daniel Steffens Mark J. Hancock 《The spine journal》2018,18(5):880-891
Background Context
Magnetic resonance imaging (MRI) has the potential to identify pathology contributing to neck pain. However, the importance of findings on MRI remains unclear.Purpose
We aimed to investigate whether findings on cervical spine MRI predict future neck pain.Study Design
A systematic review was carried out.Patient Sample
People with or without neck pain comprised the study sample.Outcome Measures
Clinically important neck pain outcomes such as pain and disability.Methods
The review protocol was registered on PROSPERO [CRD42016049228]. MEDLINE, CINAHL, and EMBASE databases were searched. Prospective cohort studies investigating the association between baseline MRI findings and clinical outcome were included. Cohorts with serious underlying diseases as the cause of their neck pain were excluded. Associations between MRI findings and neck pain outcomes were extracted from the included studies.Results
A total of 12 studies met all inclusion criteria. Eight studies presented data on participants with current neck pain, two studies included a mixed sample, and two studies included a sample of participants with no current neck pain. Because of the heterogeneity between the studies in terms of MRI findings, populations, and clinical outcomes investigated, it was not possible to pool the results. No consistent associations between MRI findings and future outcomes were identified. Single studies of populations with neck pain reported significant associations for neck muscle fatty infiltrate (risk ratio [RR]: 21.00, 95% confidence interval [CI]: 2.97–148.31) with persistent neck disability; disc protrusion (mean difference ranged from ?1.83 to ?2.88 on a 10-point pain scale), and disc degeneration (RR: 0.59; 95% CI: 0.36–0.98) with neck pain. In a population without pain, the development of foraminal stenosis over a 10-year period was associated with development of neck pain (RR: 2.99; 95% CI: 1.23–7.23).Conclusion
The limited number, heterogeneity, and small sample size of the included studies do not permit definitive conclusions on the association between MRI findings of the cervical spine with future neck pain. 相似文献9.
Patricia Parreira Chris G. Maher Daniel Steffens Mark J. Hancock Manuela L. Ferreira 《The spine journal》2018,18(9):1715-1721
Background
Low back pain (LBP) is a highly prevalent condition and it is associated with significant disability and work absenteeism worldwide. A variety of environmental and individual characteristics have been reported to increase the risk of LBP. To our knowledge, there has been no previous attempt to summarize the evidence from existing systematic reviews of risk factors for LBP or sciatica.Purpose
To provide an overview of risk factors for LBP, we completed an umbrella review of the evidence from existing systematic reviews.Study Design
An umbrella review was carried out.Methods
A systematic literature search was conducted in MEDLINE, EMBASE, PubMed PsychINFO, and CINAHL databases. To focus on the most recent evidence, we only included systematic reviews published in the last 5 years (2011–2016) examining any risk factor for LBP or sciatica. Only systematic reviews of cohort studies enrolling participants without LBP and sciatica at baseline were included. The methodological quality of the reviews was assessed independently by two review authors, using the Assessment of Multiple Systematic Reviews tool.Results
We included 15 systematic reviews containing 134 cohort studies. Four systematic reviews were of high methodological quality and 11 were of moderate quality. Of the 54 risk factors investigated, 38 risk factors were significantly associated with increased risk of LBP or sciatica in at least one systematic review and the odds ratios ranged from 1.26 to 13.00. Adverse risk factors included characteristics of the individual (eg, older age), poor general health (eg, smoking), physical stress on spine (eg, vibration), and psychological stress (eg, depression).Conclusion
Poor general health, physical and psychological stress, and characteristics of the person increase risk for a future episode of LBP or sciatica. 相似文献10.
Background Context
Radiofrequency denervation is commonly used for the treatment of chronic facet joint pain that has been refractory to more conservative treatments, although the evidence supporting this treatment has been controversial.Purpose
We aimed to elucidate the precise effects of radiofrequency denervation in patients with low back pain originating from the facet joints relative to those obtained using control treatments, with particular attention to consistency in the denervation protocol.Study Design/Setting
A meta-analysis of randomized controlled trials was carried out.Patient Sample
Adult patients undergoing radiofrequency denervation or control treatments (sham or epidural block) for facet joint disease of the lumbar spine comprised the patient sample.Outcome Measures
Visual analog scale (VAS) pain scores were measured and stratified by response of diagnostic block procedures.Method
We searched PubMed, Embase, Web of Science, and the Cochrane Database for randomized controlled trials regarding radiofrequency denervation and control treatments for back pain. Changes in VAS pain scores of the radiofrequency group were compared with those of the control group as well as the minimal clinically important difference (MCID) for back pain VAS. Meta-regression model was developed to evaluate the effect of radiofrequency treatment according to responses of diagnostic block while controlling for other variables. We then calculated mean differences and 95% confidence intervals (CIs) using random-effects models.Results
We included data from seven trials involving 454 patients who had undergone radiofrequency denervation (231 patients) and control treatments such as sham or epidural block procedures (223 patients). The radiofrequency group exhibited significantly greater improvements in back pain score when compared with the control group for 1-year follow-up. Although the average improvement in VAS scores exceeded the MCID, the lower limit of the 95% CI encompassed the MCID. A subgroup of patients who responded very well to diagnostic block procedures demonstrated significant improvements in back pain relative to the control group at all times. When placed into our meta-regression model, the response to diagnostic block procedure was responsible for a statistically significant portion of treatment effect. Studies published over the last two decades revealed that radiofrequency denervation reduced back pain significantly in patients with facet joint disease compared with the MCID and control treatments.Conclusions
Conventional radiofrequency denervation resulted in significant reductions in low back pain originating from the facet joints in patients showing the best response to diagnostic block over the first 12 months when compared with sham procedures or epidural nerve blocks. 相似文献11.
Johnny J. Wei Silky Chotai Ahilan Sivaganesan Kristin R. Archer Byron J. Schneider Aaron J. Yang Clinton J. Devin 《The spine journal》2018,18(5):788-796
Background Context
Chronic opioid therapy is associated with worse patient-reported outcomes (PROs) following spine surgery. However, little literature exists on the relationship between opioid use and PROs following epidural steroid injections for radicular pain.Purpose
We evaluated the association between pre-injection opioid use and PROs following spine epidural steroid injection.Study Design
This study is a retrospective analysis of a prospective longitudinal registry database.Patient Sample
A total of 392 patients within our database who were undergoing epidural steroid injections (ESIs) at our institution for degenerative structural spine diagnoses and met our inclusion criteria were included in this study.Outcome Measures
Patient-reported outcomes for disability (Oswestry Disability Index/Neck Disability Index [ODI/NDI)]), quality of life (EuroQol-5D [EQ-5D]), and pain (Numerical Rating Scale scores for back pain, neck pain, leg pain, and arm pain [NRS-BP/NP/LP/AP]) were assessed at baseline and at 3 and 12 months post-injection.Methods
Multivariable proportional odds logistic regression models were created to examine the relationship between pre-injection opioid use and post-injection PROs. A logistic regression with Bayesian Markov chain Monte Carlo parameter estimation was used to investigate a possible cutoff value of pre-injection opioid use above which the effectiveness of ESI (as measured by minimum clinically important difference [MCID] for ODI/NDI) decreases.Results
A total of 276 patients with complete 12-month follow-up following ESI were analyzed. The mean pre-injection daily morphine equivalent amount (MEA) was 14.7?mg (95% confidence interval [CI] 12.4?mg–19.1?mg) for the cohort. Pre-injection opioid use was associated with slightly higher odds of worse disability (odds ratio [OR] 1.03, p=.03) and leg/arm pain (OR 1.01, p=.04) scores at 3 months post-injection only. No significant association between pre-injection opioid use and MCID for ODI/NDI was found, although a cutoff of 55.5?mg/day might serve as a significant threshold.Conclusion
Increased pre-injection opioid use does not impact long-term outcomes after ESIs for degenerative spine diseases. A pre-injection MEA around 50?mg/day may represent a threshold above which the 3-month effectiveness of ESI for back- and neck-related disability decreases. Epidural steroid injection is an effective treatment modality for pain in patients using opioids, and can be part of a multimodal strategy for opioid independence. 相似文献12.
Håvard Furunes Kjersti Storheim Jens Ivar Brox Lars Gunnar Johnsen Jan Sture Skouen Eric Franssen Tore K. Solberg Leiv Sandvik Christian Hellum 《The spine journal》2017,17(10):1480-1488
Background Context
Lumbar total disc replacement (TDR) is a treatment option for selected patients with chronic low back pain (LBP) that is non-responsive to conservative treatment. The long-term results of disc replacement compared with multidisciplinary rehabilitation (MDR) have not been reported previously.Purpose
We aimed to assess the long-term relative efficacy of lumbar TDR compared with MDR.Design
We undertook a multicenter randomized controlled trial at five university hospitals in Norway.Patient Sample
The sample consisted of 173 patients aged 25–55 years with chronic LBP and localized degenerative changes in the lumbar intervertebral discs.Outcome Measures
The primary outcome was self-reported physical function (Oswestry Disability Index [ODI]) at 8-year follow-up in the intention-to-treat population. Secondary outcomes included self-reported LBP (visual analogue scale [VAS]), quality of life (EuroQol [EQ-5D]), emotional distress (Hopkins Symptom Checklist [HSCL-25]), occupational status, patient satisfaction, drug use, complications, and additional back surgery.Methods
Patients were randomly assigned to lumbar TDR or MDR. Self-reported outcome measures were collected 8 years after treatment. The study was powered to detect a difference of 10 ODI points between the groups. The study has not been funded by the industry.Results
A total of 605 patients were screened for eligibility, of whom 173 were randomly assigned treatment. Seventy-seven patients (90%) randomized to surgery and 74 patients (85%) randomized to rehabilitation responded at 8-year follow-up. Mean improvement in the ODI was 20.0 points (95% confidence interval [CI] 16.4–23.6, p≤.0001) in the surgery group and 14.4 points (95% CI 10.7–18.1, p≤.0001) in the rehabilitation group. Mean difference between the groups at 8-year follow-up was 6.1 points (95% CI 1.2–11.0, p=.02). Mean difference in favor of surgery on secondary outcomes were 9.9 points on VAS (95% CI 0.6–19.2, p=.04) and 0.16 points on HSCL-25 (95% CI 0.01–0.32, p=.04). There were 18 patients (24%) in the surgery group and 4 patients (6%) in the rehabilitation group who reported full recovery (p=.002). There were no significant differences between the groups in EQ-5D, occupational status, satisfaction with care, or drug use. In the per protocol analysis, the mean difference between groups was 8.1 ODI points (95% CI 2.3–13.9, p=.01) in favor of surgery. Forty-three of 61 patients (70%) in the surgery group and 26 of 52 patients (50%) in the rehabilitation group had a clinically important improvement (15 ODI points or more) from baseline (p=.03). The proportion of patients with a clinically important deterioration (six ODI points or more) was not significantly different between the groups. Twenty-one patients (24%) randomized to rehabilitation had crossed over and had undergone back surgery since inclusion, whereas 12 patients (14%) randomized to surgery had undergone additional back surgery. One serious adverse event after disc replacement is registered (<1%).Conclusions
Substantial long-term improvement can be expected after both disc replacement and MDR. The difference between groups is statistically significant in favor of surgery, but smaller than the prespecified clinically important difference of 10 ODI points that the study was designed to detect. Future research should aim to improve selection criteria for disc replacement and MDR. 相似文献13.
Sang-Min Park Ho-Joong Kim Hyunseok Jeong Hyoungmin Kim Bong-Soon Chang Choon-Ki Lee Jin S. Yeom 《The spine journal》2018,18(11):2051-2058
Background Context
There is increasing evidence supporting an association between sitting time and low back pain (LBP). However, the degree of the association between the total daily sitting time and LBP in the general population is poorly understood.Purpose
The present study aimed (1) to analyze the association between the duration of sitting time and LBP, and (2) to examine this association according to the degree of physical activity in population over 50 years of age with a nationally representative sample of Korean adults.Study Design
This is a cross-sectional study.Patient Sample
Data from version VI-2, 3 of the Korea National Health and Nutrition Examination Survey (KNHANES) performed in 2014 and 2015 were analyzed.Outcome Measures
Multiple logistic regression was performed to find the rates of association between chronic LBP, level of sitting time, and physical activity.Methods
Nationwide health surveys and examinations were conducted in general Korean representative populations (n=7,550 in 2014, n=7,380 in 2015). Chronic LBP was defined as self-reported LBP lasting for more than 30 days during the past 3 months in a health survey. Sitting time and daily physical activity were evaluated using the long version of the International Physical Activity Questionnaires (IPAQ). The duration of sitting time was divided into two categories according to the median value (7 hours) and further divided into four categories using quartiles. Physical activity was also divided into low and high physical activity according to duration of mid- to high-intensity activities. There were no sources of funding and no conflicts of interest associated with the present study.Results
On multiple logistic regression analysis, sitting time more than 7 hours/day was significantly associated with LBP (adjusted odds ratio 1.33, p<.001). The risk of LBP increased with increasing duration of sitting time. In participants with low levels of physical activity, the duration of sitting time showed more positive association with LBP than that in all the participants and participants with high levels of physical activity.Conclusions
Longer duration of sitting time is a risk factor for LBP. Furthermore, long duration of sitting time with low physical activity further increases the risk of LBP. 相似文献14.
Jan Triebel Greta Snellman Bengt Sandén Fredrik Strömqvist Yohan Robinson 《The spine journal》2017,17(5):656-662
Background Context
Proper patient selection is of utmost importance in the surgical treatment of degenerative disc disease (DDD) with chronic low back pain (CLBP). Among other factors, gender was previously found to influence lumbar fusion surgery outcome.Purpose
This study investigates whether gender affects clinical outcome after lumbar fusion.Study Design
This is a national registry cohort study.Patient sample
Between 2001 and 2011, 2,251 men and 2,521 women were followed prospectively within the Swedish National Spine Register (SWESPINE) after lumbar fusion surgery for DDD and CLBP.Outcome measures
Patient-reported outcome measures (PROMs), visual analog scale (VAS) for leg and back pain, Oswestry Disability Index (ODI), quality of life (QoL) parameter EQ5D, and labor status and pain medication were collected preoperatively, 1 and 2 years after surgery.Methods
Gender differences of baseline data and PROM improvement from baseline were analyzed. The effect of gender on clinically important improvement of PROM was determined in a multivariate logistic regression model. Furthermore, gender-related differences in return-to-work were investigated.Results
Preoperatively, women had worse leg pain (p<.001), back pain (p=.002), lower QoL (p<.001), and greater disability than men (p=.001). Postoperatively, women presented greater improvement 2 years from baseline for pain, function, and QoL (all p<.01). Women had better chances of a clinically important improvement than men for leg pain (odds ratio [OR]=1.39, 95% confidence interval [CI]: 1.19–1.61, p<.01) and back pain (OR=1.20,95% CI:1.03–1.40, p=.02) as well as ODI (OR=1.24, 95% CI:1.05–1.47, p=.01), but improved at a slower pace in leg pain (p<.001), back pain (p=.009), and disability (p=.008). No gender differences were found in QoL and return to work at 2 years postoperatively.Conclusions
Swedish women do not have worse results than men after spinal fusion surgery. Female patients present with worse pain and function preoperatively, but improve more than men do after surgery. 相似文献15.
Kika Konstantinou Kate M. Dunn Reuben Ogollah Martyn Lewis Danielle van der Windt Elaine M. Hay 《The spine journal》2018,18(6):1030-1040
Background Context
Evidence is lacking on the prognosis and prognostic factors of back-related leg pain and sciatica in patients seeing their primary care physicians. This evidence could guide timely appropriate treatment and referral decisions.Purpose
The present study aims to describe the prognosis and prognostic factors in primary care patients with low back-related leg pain and sciatica.Study Design
This is a prospective cohort study.Patient Sample
The present study included adults visiting their family doctor with back-related leg pain in the United Kingdom.Outcome Measures
Information about pain, function, psychological, and clinical variables, was collected. Good outcome was defined as 30% or more reduction in disability (Roland-Morris Disability Questionnaire).Methods
Participants completed the questionnaires, underwent clinical assessments, received a magnetic resonance imaging scan, and were followed-up 12 months later. Mixed-effects logistic regression evaluated the prognostic value of six a priori defined variable sets (leg pain duration, pain intensity, neuropathic pain, psychological factors, clinical examination, and imaging variables). A combined model, including variables from all models, examined independent effects. The National Institute for Health Research funded the study. There are no conflicts of interest.Results
A total of 609 patients were included. At 12 months, 55% of patients improved in both the total sample and the sciatica group. For the whole cohort, longer leg pain duration (odds ratio [OR] 0.41; confidence interval [CI] 0.19–0.90), higher identity score (OR 0.70; CI 0.53–0.93), and patient's belief that the problem will last a long time (OR 0.27; CI 0.13–0.57) were the strongest independent prognostic factors negatively associated with improvement. These last two factors were similarly negatively associated with improvement in the sciatica subgroup.Conclusions
The present study provides new evidence on the prognosis and prognostic factors of back-related leg pain and sciatica in primary care. Just over half of patients improved at 12 months. Patient's belief of recovery timescale and number of other symptoms attributed to the pain are independent prognostic factors. These factors can be used to inform and direct decisions about timing and intensity of available therapeutic options. 相似文献16.
Pradeep Suri Edward J. Boyko Nicholas L. Smith Jeffrey G. Jarvik Frances M.K. Williams Gail P. Jarvik Jack Goldberg 《The spine journal》2017,17(1):4-14
Background
Inconsistent associations between modifiable risk factors and chronic back pain (CBP) may be due to the inability of traditional epidemiologic study designs to properly account for an array of potential genetic and environmental confounding factors. The co-twin control research design, comparing modifiable risk factors in twins discordant for CBP, offers a unique way to remove numerous confounding factors.Purpose
The study aimed to examine the association of modifiable lifestyle and psychological factors with lifetime CBP.Study Design/Setting
This is a cross-sectional co-twin control study in a nationwide sample of male twin members of the Vietnam Era Twin Registry.Patient Sample
The sample is composed of 7,108 participants, including 1,308 monozygotic (MZ) pairs and 793 dizygotic pairs.Outcome Measure
The outcome measure is the self-reported lifetime history of CBP.Methods
Lifestyle factors included body mass index (BMI), smoking history, alcohol consumption, habitual physical activity, and typical sleep duration. Psychological factors included depression (Patient Health Questionnaire-9) and posttraumatic stress disorder (PTSD) symptoms (PTSD Checklist). Covariates included age, race, education, and income. Odds ratios (ORs) and 95% confidence intervals (CI) were estimated for the association of risk factors with lifetime CBP when considering twins as individuals, and a within-pair co-twin control analysis that accounted for familial and genetic factors. Funding was through VA Grant 5IK2RX001515; there were no study-specific conflicts of interest.Results
The mean age of respondents was 62 years and the prevalence of lifetime CBP was 28%. All lifestyle factors were associated with CBP in the individual level analysis. However, none of these persisted in the within-pair analyses, except for severe obesity (BMI ≥35.0), which was associated with lifetime CBP in both individual-level (OR=1.6, 95% CI: 1.3–1.9) and within-pair analyses (MZ analysis: OR=3.7, 95% CI: 1.2–11.4). Symptoms of PTSD and depression were strongly associated with lifetime CBP in both the individual-level (moderate or severe depression: OR=4.2, 95% CI: 3.6–4.9, and severe PTSD: OR=4.8, 95% CI: 4.0–5.7) and within-pair (MZ) analyses (moderate or severe depression: OR=4.6, 95% CI: 2.4–8.7, and severe PTSD: OR=3.2, 95% CI: 1.6–6.5).Conclusions
Many associations between modifiable lifestyle risk factors and CBP are due to confounding by familial and genetic factors. Severe obesity, depression, and PTSD should be considered in the development of intervention strategies to reduce the prevalence of CBP. 相似文献17.
Andrew J. Hahne Jon J. Ford Rana S. Hinman Matthew C. Richards Luke D. Surkitt Alexander Y.P. Chan Sarah L. Slater Nicholas F. Taylor 《The spine journal》2017,17(3):346-359
Background Context
Physical therapy is commonly sought by people with lumbar disc herniation and associated radiculopathy. It is unclear whether physical therapy is effective for this population.Purpose
To determine the effectiveness of physical therapist-delivered individualized functional restoration as an adjunct to guideline-based advice in people with lumbar disc herniation and associated radiculopathy.Study Design
This is a preplanned subgroup analysis of a multicenter parallel group randomized controlled trial.Patient Sample
The study included 54 participants with clinical features of radiculopathy (6-week to 6-month duration) and imaging showing a lumbar disc herniation.Outcome Measures
Primary outcomes were activity limitation (Oswestry Disability Index) and separate 0–10 numerical pain rating scales for leg pain and back pain. Measures were taken at baseline and at 5, 10, 26, and 52 weeks.Methods
The participants were randomly allocated to receive either individualized functional restoration incorporating advice (10 sessions) or guideline-based advice alone (2 sessions) over a 10-week period. Treatment was administered by 11 physical therapists at private clinics in Melbourne, Australia.Results
Between-group differences for activity limitation favored the addition of individualized functional restoration to advice alone at 10 weeks (7.7, 95% confidence interval [CI] 0.3–15.1) and 52 weeks (8.2, 95% CI 0.7–15.6), as well as back pain at 10 weeks (1.4, 95% CI 0.2–2.7). There were no significant differences between groups for leg pain at any follow-up. Several secondary outcomes also favored individualized functional restoration over advice.Conclusions
In participants with lumbar disc herniation and associated radiculopathy, an individualized functional restoration program incorporating advice led to greater reduction in activity limitation at 10- and 52-week follow-ups compared with guideline-based advice alone. Although back pain was significantly reduced at 10 weeks with individualized functional restoration, this effect was not maintained at later timepoints, and there were no significant effects on leg pain, relative to guideline-based advice. 相似文献18.
Deven A. Karvelas Sean D. Rundell Janna L. Friedly Alfred C. Gellhorn Laura S. Gold Bryan A. Comstock Patrick J. Heagerty Brian W. Bresnahan David R. Nerenz Jeffrey G. Jarvik 《The spine journal》2017,17(3):380-389
Background
The association between early physical therapy (PT) and subsequent health-care utilization following a new visit for low back pain is not clear, particularly in the setting of acute low back pain.Purpose
This study aimed to estimate the association between initiating early PT following a new visit for an episode of low back pain and subsequent back pain–specific health-care utilization in older adults.Design/Setting
This is a prospective cohort study. Data were collected at three integrated health-care systems in the United States through the Back Pain Outcomes using Longitudinal Data (BOLD) registry.Patient Sample
We recruited 4,723 adults, aged 65 and older, presenting to a primary care setting with a new episode of low back pain.Outcome Measures
Primary outcome was total back pain–specific relative value units (RVUs), from days 29 to 365. Secondary outcomes included overall RVUs for all health care and use of specific health-care services including imaging (x-ray and magnetic resonance imaging [MRI] or computed tomography [CT]), emergency department visits, physician visits, PT, spinal injections, spinal surgeries, and opioid use.Methods
We compared patients who had early PT (initiated within 28 days of the index visit) with those not initiating early PT using appropriate, generalized linear models to adjust for potential confounding variables.Results
Adjusted analysis found no statistically significant difference in total spine RVUs between the two groups (ratio of means 1.19, 95% CI of 0.72–1.96, p=.49). For secondary outcomes, only the difference between total spine imaging RVUs and total PT RVUs was statistically significant. The early PT group had greater PT RVUs; the ratio of means was 2.56 (95% CI of 2.17–3.03, p<.001). The early PT group had greater imaging RVUs; the ratio of means was 1.37 (95% CI of 1.09–1.71, p=.01.)Conclusions
We found that in a group of older adults presenting for a new episode of low back pain, the use of early PT is not associated with any statistically significant difference in subsequent back pain–specific health-care utilization compared with patients not receiving early PT. 相似文献19.
Geoff P. Bostick 《The spine journal》2017,17(11):1722-1728
Background Context
Psychological treatments delivered by non-psychologists have been proposed as a way to increase access to care to address important psychological barriers to recovery in people with low back pain (LBP).Purpose
This review aimed to synthesize randomized controlled trials (RCTs) that assess the effectiveness of psychological interventions delivered by non-psychologists in reducing pain intensity and disability in adults with LBP, compared with usual care.Study Design
A systematic review without meta-analysis was carried out.Methods
Randomized controlled trials including adult patients with all types of musculoskeletal LBP were eligible. Interventions included those based on psychological principles and delivered by non-psychologists. The primary outcomes of interest were self-reported pain intensity and disability. Information sources included Medline, EMBASE, and the Cochrane Central Registrar for Controlled Trials. The Cochrane Collaboration's tool for assessing risk of bias was used for the evaluation of internal validity.Results
There were 1,101 records identified, 159 were assessed for eligibility, 16 were critically appraised, and 11 studies were included. Mild to moderate risk of bias was present in the included studies, with personnel and patient blinding, treatment fidelity, and attrition being the most common sources of bias. Considerable heterogeneity existed for patient population, intervention components, and comparison groups. Although most studies demonstrated statistical and clinical improvements in pain and disability, few were statistically superior to the comparison group.Conclusions
Consistent with the broader psychological literature, psychological interventions delivered by non-psychologists have modest effects on low back pain and disability. Additional high quality research is needed to understand what patients are likely to respond to psychological interventions, the appropriate dose to achieve the desired outcome, the amount of training required to implement psychological interventions, and the optimal procedures to ensure treatment fidelity. 相似文献20.
Anita B. Amorim Gavin M. Levy Francisco Pérez-Riquelme Milena Simic Evangelos Pappas Amabile B. Dario Manuela L. Ferreira Eduvigis Carrillo Alejandro Luque-Suarez Juan R. Ordoñana Paulo H. Ferreira 《The spine journal》2017,17(7):933-942