Prediction of functional disability, recurrences, and chronicity after 1 year in 180 patients who required sick leave for acute low-back pain

The aim of the study was to identify factors that predict low-back pain outcome at 12 months and thus to identify patients at risk for poor long-term outcomes. One hundred-eighty patients, all disabled by acute low-back pain, were included. Outcome (dependent) variables were Oswestry disability score, recurrences during the study year, and chronicity defined as 90 or more days off work for low-back pain during the study year, or a disease-specific sick-leave rate (a variable created by the authors) of more than 25%. Stepwise logistic regression analysis was performed. Thirty-three percent of the patients had an Oswestry score greater than 25, indicating moderate disability at the 1-year follow-up evaluation. Pain on coughing at study entry predicted a high likelihood of disability at 1 year, with a threefold risk. Many work days missed as a result of low-back pain in the past 2 years and lack of stimulating work tasks predicted recurrences during the year. A high Oswestry score assessed at study entry was the only factor that predicted chronicity. The factors revealed in the current study should help the clinician to identify patients at risk. The authors propose that the revealed predictors should be investigated extensively at the patient's first visit for acute low-back pain.     

Success of lumbar microdiscectomy in patients with modic changes and low-back pain: a prospective pilot study

STUDY DESIGN: Prospective case controlled. OBJECTIVE: To determine the outcome after microdiscectomy in patients with disc herniation, concordant sciatica, and low-back pain with Modic I and II degenerative changes compared with similar patients without Modic changes. SUMMARY OF BACKGROUND DATA: The decision to perform a microdiscectomy versus a fusion or total disc replacement in a patient with a disc herniation and sciatica may be confounded by the presence of low-back pain, degenerative disc disease, and marrow and endplate (Modic) changes. METHODS: Thirty consecutive patients underwent a microdiscectomy by a single surgeon. Group 1 consisted of 15 patients, 6 men and 9 women, with a mean age of 36.7 years (range, 21 to 48 y), with Modic I and II changes. Group 2 contained 15 patients, 9 men and 6 women, with a mean age of 34.1 years (range, 20 to 68 y), without Modic changes. The average duration of low-back pain before surgery was 25.6 months (range 4 to 120 mo) in group 1 and 17.5 months (range 5 to 120 mo) in group 2. The visual analog scale (VAS) was used to grade low-back pain and the Oswestry score was used to grade overall disability. RESULTS: There was no significant difference in preoperative sciatica, low-back pain, VAS or Oswestry scores for group 1 versus group 2 patients. Postoperatively, all patents had improved sciatica and resolution of any nerve tension sign. Eighty-six percent of patients in group 1 versus 93% of patients in group 2 had improvements in postoperative VAS score for low-back pain at 6 months. Average improvement within each group was 67% and 75%, respectively. VAS scores for low-back pain at 6 months improved from 6.9 to 2.3 (P=0.0005) in group 1 and 6.3 to 1.6 (P=0.0002) in group 2. Group 1 and 2 had 89% and 100% of patients show improvement in postoperative Oswestry score at 6 months with an average improvement of 58% and 84%, respectively. Oswestry scores at 6 months improved from 68.7% to 28.8% (P=0.0007) in group 1 and 61.2% to 9.9% (P=0.00003) in group 2. CONCLUSIONS: There was a trend toward greater improvement in Oswestry scores in patients without Modic changes (P=0.09). Both groups reported statistically significant improvement in sciatica, low-back pain, and disability after microdiscectomy. Microdiscectomy was therefore an effective treatment for disc herniation and concordant sciatica despite low-back pain and Modic I and II degenerative changes. LEVELS OF EVIDENCE: Therapeutic II.     

Normal trunk muscle strength and endurance in women and the effect of exercises and electrical stimulation. Part 2: Comparative analysis of electrical stimulation and exercises to increase trunk muscle strength and endurance

Several studies have shown positive correlations between muscle strength, flexibility, and the frequency of low-back pain. Weak trunk musculature and decreased endurance have thereby come to be identified as significant risk factors in the development of occupational back problems. Because it is widely accepted that exercise plays an important role in the conservative treatment and prevention of low-back pain, the goals of most rehabilitative programs involves improving the strength and endurance of the low-back pain patient. Whereas electrical stimulation has been shown to increase the muscle strength of the lower extremities, this effect has not been demonstrated for the trunk muscles. Part 2 is a prospective controlled study designed to document and to compare objectively the effects of electrical stimulation and exercise on trunk muscle strength. A total of 117 healthy women were divided randomly into four groups. Two groups received electrical stimulation with different electrical parameters, one group received exercises, and one group acted as a control group. The results showed that low-frequency electrical stimulation and exercises significantly (P less than .05) increased isokinetic back-muscle strength compared to the control and medium-high-frequency electrical stimulation groups. Both types of electrical stimulation, however, significantly increased (P less than .05) the endurance in the back muscles compared with the control and the exercise groups. This study showed that electrical stimulation may be a valuable treatment in the early care of low-back pain patients in maintaining and increasing strength and endurance of back muscles when a more active exercise program is too painful to perform.     

Observed outcomes associated with a quota-based exercise approach on measures of kinesiophobia in patients with chronic low back pain

STUDY DESIGN: Prospective series of consecutive cases. OBJECTIVES: To observe if kinesiophobia was altered through an education- and quota-based exercise physical therapy program, and to observe the relationship of kinesiophobia with other measures related to chronic low back pain. BACKGROUND: The role of kinesiophobia in worsening the chronic low back pain predicament has been documented in numerous studies. However, less is known of the effect of an exerciseonly-based physical therapy program's ability to alter kinesiophobia and improve functional abilities in patients with chronic low back pain. METHODS: Eighty-two patients with at least 3 months of low back pain, and a moderate level of disability (Oswestry score greater than or equal to 20) were willing to participate in this study. Sixty-eight of these patients completed treatment. For 68 compliant patients, females comprised 56%, the mean age was 43 years, the mean duration of symptoms was 28 months, and the primary anatomic diagnosis was disc degeneration (70%). Patients underwent a course of non-pain-contingent, quota-based physical therapy to address impairments in flexibility, strength, and lifting capacity. These were quantified prior to and following treatment using validated methods. Before and after treatment, patients completed the Fear-Avoidance Beliefs Questionnaire (FABQ), Tampa Scale of Kinesiophobia (TSK) Questionnaire, Oswestry Disability Index (ODI) Questionnaire, and a 0-to-10 visual analog scale for back and lower extremity pain. A 12-month follow-up was conducted using mailed questionnaires. RESULTS: The mean number of physical therapy visits was 14. Clinically and statistically significant (P<.001) improvement in flexibility, strength, and lifting ability were observed. Statistically significant (P<.001) improvement in back pain, disability, and measures of kinesiophobia were also noted at discharge and maintained at 12-month follow-up. At discharge, Oswestry scores correlated with TSK (r = .59, P<.001), FABQ-Activities (r = .55, P<.001), and FABQ-Work (r = .50, P<.001) scores. CONCLUSION: In this study we observed that kinesiophobia decreased during an intensive physical therapy program in which exercises were performed in a quota-based manner. Following the successful performance of non-pain-contingent, quota-based exercise, patients' fears of injury lessened, and this may have had a positive influence on disability.     

The influence of intense exercise-based physical therapy program on back pain anticipated before and induced by physical activities.

BACKGROUND CONTEXT: Pain anticipated before and induced by physical activities has been shown to influence the physical performance of patients with chronic back pain. Limited data exist as to the influence of treatment on this component of pain. PURPOSE: This study attempted to determine if pain anticipated before and induced by physical activities was altered during an exercise-oriented physical therapy program for chronic back pain. STUDY DESIGN/SETTING: Subjects were recruited from three physical therapy sites with similar spine rehabilitation programs that used intense exercise delivered in a group format. During the recruitment period, 70 subjects with chronic low back pain and disability agreed to participate and complied with recommended treatments. The primary outcome measures were anticipated and induced pain as assessed by visual analog scales (VAS) during six tests of back flexibility and strength. Additional outcome measures included the performance levels of these six tests (trunk flexion, extension, straight leg raising, back strength, lifting from floor to waist and waist to shoulder height), global back and leg VAS and Oswestry Low Back Pain Disability Questionnaire scores. METHODS: At evaluation for the spine rehabilitation programs, we recorded the anticipated and induced pain levels associated with the six tests of back function, the performance levels on each test and global pain and disability scores. Subjects then participated in the spine rehabilitation program that consisted of intense exercise delivered up to three times per week, for 2 hours over a period of 6 weeks. All outcome measures were reassessed at discharge. Pre- and posttreatment outcome scores were statistically compared using paired sample t tests and chi-squared test. Spearman correlation coefficients were used to compare anticipated and induced pain results with global back and leg pain VAS scores, Oswestry scores and physical performance levels for each physical test. RESULTS: Most measures of anticipated and induced pain improved between evaluation and discharge. Improvements were noted for global back pain (p<.001), leg pain (p=.001), disability (p<.001) and performance on each physical testing (p<.001) after treatment. Performances on all physical testing correlated with anticipated and induced pain for all tests at evaluation but only for measures of flexibility at discharge. Improvements in global pain and disability correlated with improvements in anticipated and induced pain with physical testing. CONCLUSION: Anticipated and induced pain with physical activities was lessened after physical therapy using exercise. Anticipated and induced pain with physical activities related to physical performance levels, global pain and disability ratings. These findings may help explain how exercise exerts a positive influence on chronic back pain and disability.     

Posterior lumbar interbody fusion. Association between disability and psychological disturbance in noncompensation patients.

STUDY DESIGN: An observational study of the relation between disability and psychological distress in patients with no on-going compensation claim who underwent posterior lumbar interbody fusion for chronic low back pain. OBJECTIVES: To study the change in the relation between disability and psychological distress after surgical management for low back pain. SUMMARY OF BACKGROUND DATA: Patient-related factors such as an on-going compensation claim and patient psychology are thought to influence the outcome of low back pain management. METHODS: Of the 58 patients who underwent posterior lumbar interbody fusion for low back pain between 1990 and 1995, 53 were observed for a mean duration of 2.7 years after surgery. Oswestry Disability scores and Distress and Risk Assessment Method scores were collected before surgery and at the follow-up examination. RESULTS: Improvement of 10 points on the Oswestry Disability Score was observed in 52.8% of the patients. However, the results in patients who were distressed before surgery were similar to the results observed in healthy patients. The difference in the Oswestry Disability Scores was 3.1 (95% confidence intervals [-9.9, 16.2], P = 0.297). The change in Distress and Risk Assessment Method scores showed a significant relation to change in the Oswestry Disability Scores (P = 0.033). CONCLUSIONS: Postoperative improvement in disability was not found to be related to preoperative psychology as measured by the Distress and Risk Assessment Method score. Change in disability is significantly related to change in distress.     

Spinal mobility and trunk muscle strength in 15-year-old schoolchildren with and without low-back pain.

From a population of 1,503 schoolchildren, 38 15-year-old children suffering from low-back pain and 38 asymptomatic controls were selected for testing of spinal mobility and trunk muscle strength. The asymptomatic controls were matched by age, sex, and school class. In the group with recurrent or continual low-back pain (17 boys and 21 girls), the boys were over 4 cm taller than those in the control group. In both sexes sagittal mobility was decreased in lumbar extension and straight leg raising, and increased in lumbar flexion. Endurance strength in the abdominal and back muscles was decreased compared to the control pupils, who reported no back pain at all in the questionnaire collected 1 year before the testing procedure. The pupils reporting sciatica (n = 7) at some time, in addition to recurrent low-back pain, had decreased lumbar flexion and side bending compared to those with recurrent low-back pain (n = 31) without sciatica. The results of the study indicated that in this growing-age population there was a subgroup with recurrent low-back pain having a different spinal mobility pattern as well as decreased trunk muscle strength.     

Assessment of abdominal and back extensor function. A quantitative approach and results for chronic low-back patients

A method was developed to obtain static and dynamic measures of trunk flexor and extensor strength and endurance. The method was evaluated using 32 normal subjects. Variables of trunk strength and endurance were used to compare 24 normals (12 men and 12 women) and 24 patients (16 men and eight women) with chronic low-back dysfunction. The Iowa Trunk Dynamometer is acceptably reliable and provides for assessment of isolated function of the abdominal and back muscles. For peak abdominal and back extensor strength, the range of superiority of men over women was 39-57%, and the range of superiority of normals over patients with chronic low-back dysfunction was 48-82%. Using time to percent decrement of peak strength as a criterion, the abdominals were more susceptible to fatigue than the back extensors, women demonstrated more endurance than men, and the endurance for normals was less than those patients who were able to perform dynamic reciprocal trunk movements.     

The effects of compensation on recovery from low-back injury

The influence of compensation on recovery from low-back pain was assessed in a retrospective controlled cohort study. One hundred fifty compensable and 150 noncompensable back injury patients were invited for review between 1 and 5 years from presentation. A 91.3% follow-up was achieved, and there was no difference in the median age, follow-up, and initial injury score between the two groups. The incidence of reported pain, disability, psychological disturbance, unemployment, and length of time off work was greater in the compensation group (P less than 0.001). Settlement of the claim did not result in any reduction in morbidity, even up to 5 years later. These results demonstrate that the payment of compensation delays recovery from low-back injury.     

The natural history of trunk list, its associated disability and the influence of McKenzie management

Lumbosacral list is a clinical sign that is frequently associated with low back pain and intervertebral disc lesions. This study examines the influence of McKenzie management on the natural history of trunk list. Patients with trunk list and low back pain were randomised into two groups: a control group receiving non-specific back massage and general back care advice, and a group treated according to the McKenzie protocol. Trunk list was measured over a period of 90 days and patients completed Oswestry Disability Questionnaires. There was a significantly greater resolution of list after 90 days in the group receiving McKenzie treatment compared to the control group. There was poor correlation between list magnitude and Oswestry scores. These data support previous observations that trunk list is not necessarily related to the degree of physical disability. The McKenzie method of assessment and treatment may assist in the resolution of trunk list, but it was ineffective in improving clinical condition. Received: 29 August 1997 Revised: 11 May 1998 Accepted: 28 May 1998     

发散式冲击波治疗间盘源性下腰痛近期疗效观察

目的：评价发散式冲击波（RSWT）治疗间盘源性下腰痛的近期疗效。方法：对43例间盘源性下腰痛患者进行发散式冲击波治疗,配合适当的卧床休息和躯干核心稳定肌功能锻炼,比较治疗1w、2w及治疗结束后1月、3月随访时的患者的VAS疼痛评分及Oswestry功能指数的变化。结果：治疗后1w、2w、1月、3月不同时段所观察记录VAS疼痛分值及Oswestry功能指数均较治疗前明显下降,差异有显著性（P〈0．05）。结论：发散式冲击波可有效缓解下腰背部疼痛并能改善腰部功能,其近期疗效满意,值得推广并行进一步前瞻对照研究。     

Radiofrequency facet joint denervation in the treatment of low back pain: a placebo-controlled clinical trial to assess efficacy.

STUDY DESIGN: A prospective double-blind randomized controlled trial was performed. OBJECTIVE: To assess the efficacy of percutaneous radiofrequency articular facet denervation for low back pain. SUMMARY OF BACKGROUND DATA: Uncontrolled observational studies in patients with low back pain have reported some benefits from the use of facet joint radiofrequency denervation. Because the efficacy of percutaneous radiofrequency had not been clearly shown in previous studies, a randomized controlled trial was conducted to assess the efficacy of the technique for improving functional disabilities and reduce pain. METHODS: For this study, 70 patients with low back pain lasting of more than 3 months duration and a good response after intraarticular facet injections under fluoroscopy were assigned randomly to receive percutaneous radiofrequency articular facet denervation under fluoroscopic guidance or the same procedure without effective denervation (sham therapy). The primary outcomes were functional disabilities, as assessed by the Oswestry and Roland-Morris scales, and pain indicated on a visual analog scale. Secondary outcomes included spinal mobility and strength. RESULTS: At 4 weeks, the Roland-Morris score had improved by a mean of 8.4% in the neurotomy group and 2.2% in the placebo group, showing a treatment effect of 6.2% (P = 0.05). At 4 weeks, no significant treatment effect was reflected in the Oswestry score (0.6% change) or the visual analog pain score (4.2% change). At 12 weeks, neither functional disability, as assessed by the Roland-Morris scale (2.6% change) and Oswestry scale (1.9% change), nor the pain level, as assessed by the visual analog scale (-7.6% change), showed any treatment effect. CONCLUSIONS: Although radiofrequency facet joint denervation may provide some short-term improvement in functional disability among patients with chronic low back pain, the efficacy of this treatment has not been established.     

Impairment magnification during dynamic trunk motions

STUDY DESIGN: An examination of a group of patients with low back disorder and a group of healthy (asymptomatic) individuals asked to produce trunk motions under sincere and insincere experimental conditions. Trunk motion components were examined to determine which combination of motion components could best distinguish between sincere and insincere efforts. OBJECTIVE: To determine whether examination of trunk motion components could be used to identify impairment magnification during unresisted repeated bending tasks. SUMMARY OF BACKGROUND DATA: Trunk motion measures can be used to assess and "benchmark" the status of the low back. However, these measures typically are clinically useful only if the individual is producing an effort that does not magnify the impairment during the functional evaluation. This study addressed the issue of impairment magnification during the production of free dynamic trunk motion. METHODS: The trunk motion characteristics of 100 healthy individuals and 100 patients with chronic low back disorders were documented. All participants were asked to produce the trunk motions in two different types of conditions. In the one experimental condition, they were asked to produce sincere trunk motions. In the other experimental condition they were asked to pretend either that they were experiencing low back pain (the asymptomatic group) or that their pain was worse than it actually was (group with low back pain). RESULTS: A combination of trunk motion measures was able to distinguish well between the conditions. Sensitivity and specificity for the asymptomatic group were 92%, whereas they were 75% for the group with low back pain. Overall, sensitivity and specificity were 81.5% for all the participants combined. CONCLUSIONS: These results indicate that motion measures can be used to help assess impairment magnification during functional trunk motion testing. These measures can provide a means by which to scrutinize the quality of quantitative measures indicating the extent of a low back disorder. These objective motion measures also can be used to complement other subjective observational methods for the assessment of impairment.     

Lumbar muscle fatigue and chronic lower back pain

There currently is a clinical need for an objective technique to assess muscle dysfunction associated with chronic lower back pain. A Back Analysis System for objectively measuring local fatigue in the back extensor muscles is presented. The reliability and validity of this technique was evaluated by testing chronic low-back pain patients and control subjects without back pain. Concurrent surface electromyograms (EMG) were detected from multiple back muscles during sustained isometric contractions at different force levels of trunk extension. Median frequency parameters of the EMG power density spectrum were monitored to quantify localized muscle fatigue. Results indicated: 1) high reliability estimates for repeated trials; 2) significant differences (P less than 0.05) in median frequency parameters between lower back pain patients and control subjects for specific combinations of contractile force level and muscle site tested; 3) Median Frequency parameters correctly classified lower back pain and control subjects using a two-group discriminant analysis procedure. The applicability of this technique as a treatment outcome measure and diagnostic screening method for lower back pain patients is discussed.     

Sense of coherence and outcome of low-back surgery: 5-year follow-up of 80 patients

Eighty adult patients, 33 men and 47 women, mean age 46 years (SD 11.8, range 19–74 years), were evaluated 5 years after lowback surgery. The mean duration of symptoms before operation was 8.7 (SD 7.1) years. The purpose was to evaluate the 5-year outcome of lowback surgery, to find the best predictors for the outcome, and to find out if a correlation exists between the patient's sense of coherence and the outcome of low-back surgery. The mean Oswestry pain index for the whole group of patients improved from 3.8 to 2.7 (P<0.001). The greatest improvement in pain was found in the group aged 35–50 years. In those over 50 years old, pain improved significantly more in women than men. Regarding walking ability, the mean Oswestry gait index for the whole group improved from 3.0 to 1.9 (P<0.001), with men over 50 years old achieving the greatest improvement in their walking. The mean Oswestry total index for the whole group was 41% before surgery, reflecting severe disability, and 25% at follow-up, reflecting moderate disability (P<0.001). There was no difference between the mean values for men and women. Patients who had undergone several previous operations fared less well in the Oswestry total index, though their improvement was still significant (P<0.05). The postoperative Oswestry total index values correlated significantly with the sense of coherence (SOC) scale values (r=-0.23, P<0.05). In all patients, the Oswestry total index before the index operation is suggested to be a predictor of the final outcome. In multiple regression analysis, the number of previous operations and the preoperatively recorded Oswestry total index appeared to be the best predictors for outcome of low-back surgery. We also found that the SOC scale correlated significantly with the Oswestry total index and seems to provide a possible explanation of ability to cope with the disability and pain associated with low-back disorders.     

Relationship between functional evaluation measures and self-assessment in nonacute low back pain

STUDY DESIGN: The correlations between objective biomechanical indicators of function and self-assessment scores were examined retrospectively for 91 subjects with nonacute low back pain. OBJECTIVES: To examine the correlation between self-assessment, trunk range of motion (ROM), velocity, and complex mechanical coordination patterns of the spine in nonacute low back pain. SUMMARY OF BACKGROUND DATA: In low back pain, there is often little concordance between pain, physical impairment, and disability. Use of range of motion and velocity to enhance objectivity in impairment evaluations has been ineffectual. In this study, two hypotheses were examined: range of motion and velocity are controllable and inherently correlated with self-assessment; complex spinal coordination patterns such as range of lordosis cannot be controlled and are independent of self-assessment. METHODS: Self-assessment questionnaires were administered, and indexes of spinal motion and coordination were measured through skin marker kinematics. The correlation between self-assessments and biomechanical measures was determined. RESULTS: Self-assessments of function were significantly correlated with parameters prone to regulation: range of motion, velocity, and load lifted. In contrast, little correlation was found with measures of complex spinal coordination less susceptible to conscious or affective regulation, namely, range of lordosis and estimated segmental mobility. This effect was magnified with increased load. Self-assessment scores were significantly poorer among insurance referrals, regardless of functional status. CONCLUSIONS: Simple parameters of the functional examination, such as range of motion and velocity, are strongly correlated with cognitive state, and thus the information they supply is less than ideal. Complex spinal coordination is a better indicator of the degree of spinal dysfunction and enhances the process of differentiating between pain, disability, and functional impairment.     

Development of a German version of the Oswestry Disability Index. Part 1: cross-cultural adaptation, reliability, and validity

Patient-orientated assessment methods are of paramount importance in the evaluation of treatment outcome. The Oswestry Disability Index (ODI) is one of the condition-specific questionnaires recommended for use with back pain patients. To date, no German version has been published in the peer-reviewed literature. A cross-cultural adaptation of the ODI for the German language was carried out, according to established guidelines. One hundred patients with chronic low-back pain (35 conservative, 65 surgical) completed a questionnaire booklet containing the newly translated ODI, along with a 0-10 pain visual analogue scale (VAS), the Roland Morris Disability Questionnaire, and Likert scales for disability, medication intake and pain frequency [to assess ODI's construct (convergent) validity]. Thirty-nine of these patients completed a second questionnaire within 2 weeks (to assess test-retest reliability). The intraclass correlation coefficient for the test-retest reliability of the questionnaire was 0.96. In test-retest, 74% of the individual questions were answered identically, and 21% just one grade higher or lower. The standard error of measurement (SEM) was 3.4, giving a "minimum detectable change" (MDC(95%)) for the ODI of approximately 9 points, i.e. the minimum change in an individual's score required to be considered "real change" (with 95% confidence) over and above measurement error. The ODI scores correlated with VAS pain intensity (r = 0.78, P < 0.001) and Roland Morris scores (r = 0.80, P < 0.001). The mean baseline ODI scores differed significantly between the surgical and conservative patients (P < 0.001), and between the different categories of the Likert scales for disability, medication use and pain frequency (in each case P < 0.001). Our German version of the Oswestry questionnaire is reliable and valid, and shows psychometric characteristics as good as, if not better than, the original English version. It should represent a valuable tool for use in future patient-orientated outcome studies in German-speaking lands.     

The relationship of disability (Oswestry) and pain drawings to functional testing

There was much enthusiasm about the development of computerized dynamometry in providing large quantities of data to objectively assess muscle performance. However, a much more basic issue arose questioning what these machines actual measure, particularly in pain populations. The purpose of the present study was to determine whether patients’ self-reported disability and pain expression, as evaluated with simple questionnaires, were related to isokinetic performance in low back pain patients. Method: Oswestry Disability Questionnaires and pain drawings were collected from 76 patients undergoing isokinetic testing upon entering a physical rehabilitation program. Isokinetic trunk testing was performed in the standing position and results recorded for flexion and extension at speeds of 50°, 100°, and 150° per second. Results: Patients indicating minimal disability on the Oswestry questionnaire performed better than those indicating greater levels of disability (P < 0.05; ANOVA with Tukey adjustment for multiple comparisons). Patients with greater pain drawing scores, indicating unusual pain patterns, performed more poorly during isokinetic testing than those with normal drawings (P < 0.05). Regression analysis revealed that the lifting question from the Oswestry questionnaire, pain drawings scores, and sex were all significantly related to isokinetic performance and could account for 37.6–48.1% of the variance in performance (varying with speed of test). Conclusions: The results of this study indicate that isokinetic test values are significantly influenced by a patient’s self-reported disability and pain expression, which can be evaluated using simple tools such as pain drawings and the Oswestry questionnaire. This study supports the supposition that dynamometry testing is related to factors other than muscle performance. Received: 29 December 1998 Revised: 26 November 1999 Accepted: 8 December 1999     

The effectiveness of calcitonin on chronic back pain and daily activities in postmenopausal women with osteoporosis

The aim of this study was to investigate the effect of nasal calcitonin on chronic back pain and disability attributed to osteoporosis. The study design involved three groups of osteoporotic postmenopausal women suffering from chronic back pain. Group I consisted of 40 women with vertebral fractures, group II of 30 women with degenerative disorders and group III of 40 patients with non specific chronic back pain and without abnormality on plain X-rays. Pain intensity was measured using a numerical rating scale (NRS) and disability due to back pain was measured using the Oswestry disability questionnaire. The patients were randomly assigned to receive, for three months, either 200 IU intranasal salmon calcitonin and 1,000 mg of oral calcium daily (groups IA, IIA, IIIA) or 1,000 mg of oral calcium daily (groups IB, IIB, IIIB). Repeated measures ANOVA showed that there were no significant time, group or interaction effects for pain intensity and disability in any of the groups studied. Mean Oswestry and NRS scores were reduced during the follow-up period in the groups IA, IIIA, but the differences between the two time points were not statistically significant. Intranasal calcitonin has no effect on chronic back pain intensity and functional capacity of osteoporotic women regardless of the presence of fractures, degenerative disorders or chronic back pain of non-specific etiology.     

Vergleich ventrodorsaler und ventraler Spondylodese bei Patienten mit Spondylitis anhand klinischer Scores

The present study on spondylitis patients was carried out to compare prospectively results of clinical scores of patients treated with anteroposterior or anterior spondylodesis. A total of 22 patients with spondylitis were enrolled in the randomized trial to undergo an operation with anteroposterior or posterior spondylodesis. For quality of life adjustment, the SF-36 health survey was applied. Pain and disability were measured using the Oswestry low-back pain disability questionnaire and visual analogue scales (VAS).Twelve patients were assigned to undergo anteroposterior spondylodesis and ten patients anterior spondylodesis. Postoperative improvement of spinal function, general health, well being, back pain, and mobility could be observed in both groups of patients. Better results of patients treated with anterior spondylodesis compared with anteroposterior spondylodesis were seen. No statistical difference was found between the two groups at any time. The less invasive nature of anterior spondylodesis could be responsible for that result.Anterior spondylodesis should used if possible and deemed adequate because it causes less discomfort.