Biering-Sorensen test scores in coal miners

ObjectivesBiering-Sorensen test is an isometric back endurance test. Biering-Sorensen test scores have varied in different cultural and occupational groups. The aims of this study were to collect normative data on Biering-Sorensen holding times, to determine the discriminative ability of the Biering-Sorensen test in Turkish coal miners, and to examine the association between Biering-Sorensen test result and functional disability.MethodsOne hundred and fifty male coal miners participated in this study. Trunk extensor muscle strength was measured using the Biering-Sorensen test. Oswestry disability index was used to measure the functional disability level of low back pain.ResultsThe mean Biering-Sorensen holding time for the total subject group was 107.3 ± 22.5 s. The mean time of Biering-Sorensen test of the subjects with and without low back pain were 99.9 ± 19.8 and 128.6 ± 15.2 s, respectively. The difference between the subjects with and without low back pain was statistically significant (p < 0.001). There was a statistically significant negative correlation between Oswestry functional disability score and Biering-Sorensen holding time (r = ?0.824, p < 0.001).ConclusionsTurkish coal miners have low mean back extensor endurance holding times. Biering-Sorensen test had a good discriminative ability in our study group. Trunk muscle strength has a significant effect on the disability level of low back pain. Thus trunk muscle endurance training exercise therapy may be effective for the reduction of disability in patients with low back pain.     

Evaluation of the benefits of low back pain patients’ education workshops during spa therapy

ObjectivesTo evaluate the medium-term impact of education workshops on low back pain (LBP) in the setting of a thermal spa on: fear-avoidance beliefs, disability, pain, and satisfaction.MethodsRandomized prospective alternate-month design-type study including 360 individuals having thermal spa therapy for LBP: 188 in the intervention group (three standardized education workshops lasting 1 h 30 each and usual thermal therapy for 3 weeks), 172 in the control group (usual thermal therapy and non-standardized verbal information). The principal analysis criterion was the difference in the fear-avoidance beliefs (physical FABQ) score between baseline and 6 months after the therapy; secondary criteria were: evolution of disability (Quebec Scale) and pain intensity (Visual Analogue Scale), and satisfaction with the information received.ResultsThere was a significant reduction in the physical FABQ score at 6 months (P < 0.05), and this reduction was more marked in the intervention group (?5.8 ± 0.7 vs. ?2 ± 0.72 points out of 24; P < 0.0001). Disability and pain significantly decreased in both groups (P < 0.05), with no difference between groups. These workshops also had a significant effect on satisfaction with the information received.ConclusionStandardized education workshops have a beneficial impact on LBP and contribute to an improvement in the medical services provided during spa therapy by reducing the effect of fear-avoidance beliefs as well as relieving pain. Extending the use of such workshops could contribute to enhance the positive impact of spa therapy in the management of chronic disabling diseases.     

Dor lombar inespecífica em adultos jovens: fatores de risco associados

ObjectiveThe aim of the study was to evaluate potential risk factors related to low back pain in the daily routines of two sets of youths: individuals complaining of chronic low back pain and a control group.MethodsThe sample consisted of 198 university‐age students (male and female) aged between 18 and 29. In accordance with back pain diagnoses, they were separated into two groups: with or without nonspecific chronic low back pain. Both groups were evaluated by a “blinded” observer with no knowledge to the presence or otherwise of lower back pain. Questionnaires concerning clinical‐demographic characteristics, life style, quality of life (SF‐36 questionnaire), pain visual analogical scales (VAS), and physical examination were applied.ResultsA univariate analysis showed a statistically significant association (P < 0.05) with the presence of low back pain and some factors. There was a negative association between low back pain and the following variables: BMI, health self‐assessment, VAS and some SF‐36 domains (physical functioning, body pain, general health, vitality, social functioning). There was a positive correlation with the following variables: global pain by VAS, presence of diffuse pain and number of tender points. However, the multivariate analysis showed statistically significant correlations (P < 0.05) between low back pain and few variables: global pain VAS and number of tender points.ConclusionSome variables related to chronic diffuse pain and lower quality of life might be associated to chronic low back pain in young adults. However, longitudinal studies are necessary.     

Pediatric pelvic ring injuries: How benign are they?

IntroductionWith an incidence of less than 0.2% of all pediatric fractures, pelvic ring injuries are rare. Historically they were conservatively treated, but because malunion and long-term morbidity are associated with unstable injuries, a trend towards operative treatment can be observed. The purpose was to determine clinical and radiographic outcomes following these complex pediatric pelvic ring injuries.Patients and methodsThis Level IV retrospective analysis was completed at a private orthopaedic practice in association with a Level One teaching trauma center. There were 33 children with pelvic ring injuries with a mean age of 12.6 years (4–16) and an average follow up of 28.6 months (range 6–101). Injuries were 2 A2, 3 B1, 16 B2, 10 B3, and 2 C2 according to OTA/AO classification. Group 1 had 16 unstable, operatively treated injuries and Group 2 had 17 stable, non-operatively treated injuries. Radiographic deformity, leg length discrepancy, low back, and SI joint pain were evaluated.ResultsFor Group 1, 10 of 15 patients (67%) had a permanent ischial height difference >5 mm compared to Group 2, in which 5 of 12 (42%) had an ischial height difference of >5 mm. Group 1 had more pelvic asymmetry (12.3 mm vs. 6.6 mm) and ring width difference (6.9 mm vs. 3.9 mm) on final X-rays as compared to Group 2. Children with 5–10 mm posterior sacral displacement had significantly more pain than children with 0–4 mm displacement (p = 0.034). Thirteen children (39%) had residual low back/SI joint pain; the rate was significantly higher in the Group 1 (3/17 vs. 10/16, p = 0.008). In three (9%) children with 2 B2 and 1 B3 injury, leg length discrepancy between 5 mm to 15 mm occurred.Discussion and conclusionIn pediatric patients with pelvic ring injuries, radiographic deformity persisted and did not remodel. Pelvic ring deformity occurred more commonly with complex unstable ring injuries. The complex displaced injuries have higher rates of operative intervention, residual deformity, and low back and SI joint pain.     

The effect of multimodal balanced anaesthesia and long term gabapentin on neuropathic pain,nitric oxide and interleukin-1β following breast surgery

ObjectivesTo evaluate the effect of multimodal balanced anaesthesia and gabapentin (6 months) on neuropathic pain qualities, nitric oxide (NO) and interleukin 1-beta (IL-1β).MethodologyThis randomized study was conducted on 50 women scheduled for conservative breast surgery for cancer followed by chemotherapy and/or radiotherapy. Women enrolled into two groups; either to receive balanced general anaesthesia (GA) (control group) or ultrasound guided thoracic paravertebral with GA, multimodal balanced anaesthesia, (intervention group). Nociceptive pain was evaluated for 24 h. Neuropathic pain was evaluated using pain questionnaire 1 month postoperatively and neuropathic pain scale at 1, 3, 6 and 9 months. Gabapentin was prescribed to women reporting neuropathic pain 1 month postoperatively and for 6 months. NO and IL-1β were measured before operation, 1, 3, 6 & 9 months, postoperatively. Their relationship with neuropathic pain was assessed.ResultsNociceptive pain was less in intervention group than control group immediately post operative, 4 h after surgery at rest and 8 h with movement. Neuropathic pain started few days postoperatively, in both groups. Its onset, sites, duration and precipitating factors did not differ between the groups. Sensitive, hot pain and unpleasantness reduced significantly 1 month postoperatively, in intervention group. Two months later, itchy, dull and sharp pain was significantly less in intervention group. At 6 months, most of neuropathic pain items except sharp and deep pain lowered significantly in intervention group. At 9 months, hot and superficial pain was still less in intervention group. NO decreased significantly 1 and 3 months postoperatively, while IL-1β was significantly lower through different times, in intervention group. IL-1β correlated well with neuropathic pain intensity and unpleasantness.ConclusionBreast surgery for cancer was associated with neuropathic pain that continued for 9 months after surgery. Multimodal balanced GA had positive impact on acute nociceptive and neuropathic pain. Gabapentin reduced almost all neuropathic pain qualities.     

Clinical outcomes and predictors of patient satisfaction in displaced midshaft clavicle fractures in adults: Results from a retrospective multicentre study

BackgroundThe optimal treatment of displaced midshaft clavicle fractures (Robinson Type 2B1 & 2B2) in adults remains controversial. Little is known about patient satisfaction with treatment for this type of injury. The purpose of this study was to compare clinical outcomes and explore predictors of patient satisfaction after nonoperative and direct-operative treatment of displaced midshaft clavicle fractures in adults.MethodsA retrospective multicentre study was conducted. Clinical data were retrieved from electronic patient charts. A questionnaire informing on current subjective function (QuickDASH), pain levels (VAS), health-related quality of life (Eq-5D-5L), impact on employment and satisfaction with treatment results was sent to all patients. Univariate and multivariate linear regression was performed to identify predictors of satisfaction.ResultsA total of 278 patients were identified (nonoperative n = 150, direct-operative n = 128). 67% of eligible patients returned the questionnaire. Median questionnaire follow-up was 2.1 years. No differences were found between groups for QuickDASH, Eq-5D-5L or pain VAS scores. Impaired union was observed in 13.2% of nonoperative cases vs. 2.3% in the direct-operative group. Patients in the nonoperative group could resume work after a median of 30.0 days, compared to 13.5 days in the direct-operative group. Patient satisfaction was higher in the direct-operative group, 8/10 vs. 7/10 for overall treatment results respectively. Patients’ rating for the level of shared decision-making was the main predictor of overall satisfaction.ConclusionDirect-operative management led to higher patient satisfaction, despite similar long-term patient reported outcomes with nonoperative treatment. Patients’ rating for the level of shared decision-making was the main predictor of overall satisfaction. This study highlights the need to enhance communication to facilitate shared decision-making.     

Factors associated with patient satisfaction with foot and ankle surgery in a large prospective study

BackgroundThere is minimal published research on outcomes and satisfaction with foot and ankle surgery.ObjectiveTo investigate patient-reported outcomes and satisfaction, and investigate which factors influence satisfaction at 9 months following foot or ankle surgery.MethodsProspective study of 671 adult patients having foot or ankle surgery. Pre-and post-surgery, patients self-completed MOXFQ, SF-36 and EQ-5D questionnaires. Using ratings to a satisfaction item, patients who were ‘very pleased’ with the outcome were compared with everyone else, using multiple logistic regression, regarding their pre-, peri- and post-operative characteristics.ResultsOf 628 eligible patients, 491 (73%) completed pre-and post-operative questionnaires. Following adjustment, satisfaction with surgery was influenced by patients’ perceptions of their foot/ankle's appearance (OR 0.12, 95% CIs 0.06–0.23, p < 0.001); wearable range of shoes (OR 0.36, 95% CIs 0.17–0.79, p = 0.01); continued foot/ankle pain (OR 0.06, 95% CIs 0.03–0.14, p < 0.001); impairment in Social-Interaction (MOXFQ SI scale) (OR 0.98, 95% CIs 0.96–0.99, p = 0.009). The final explanatory model explained 67% of the variance in patient satisfaction.ConclusionsFoot appearance, wearable shoe range, the (full) alleviation of pain and the ability/confidence to interact socially are crucial to peoples’ satisfaction with their foot or ankle surgery.     

Fluoroscopic percutaneous lumbar zygapophyseal joint cyst rupture: a clinical outcome study

Background contextLumbar zygapophyseal joint (Z-joint) synovial cysts can cause low back pain (LBP), spinal stenosis, and lower extremity radiculopathy. In the literature, there are several minimally invasive techniques described with mixed results. Typical recommended treatment is surgical resection of the cyst. Currently, there is little information available concerning the efficacy and outcome with treatment of Z-joint synovial cyst by percutaneous, fluoroscopic, contrast-enhanced distention, and rupture.PurposeTo evaluate the therapeutic value and safety of Z-joint cyst rupture in symptomatic patients.Study design/settingRetrospective cohort study in an academic outpatient physiatric spine practice.Patient sampleThirty-two patients with moderate-to-severe LBP and leg pain (18 women and 14 men with an age range of 46–86 y; mean age, 66 y) with an average preprocedure symptom duration of 5 months. The patient's clinical symptoms correlated with magnetic resonance imaging studies documenting the presence of a synovial cyst at the corresponding level and side of symptoms. Patients had at least 6 months follow-up (range, 6–24).Outcome measuresNumerical Pain Rating Scale, Roland-Morris Disability Questionnaire, North American Spine Society four-point patient satisfaction survey, recurrence of synovial cyst requiring repeat rupture, and need for surgical intervention.MethodsPatients with symptomatic lumbar Z-joint synovial cyst were identified and their charts were reviewed. Patients included in the study either had symptomatic lumbar LBP or LBP with associated lower extremity radiculopathy. All patients in the study had magnetic resonance imaging's documenting Z-joint synovial cyst that corresponded with the patients' clinical symptoms. All patients received fluoroscopically guided, contrast-enhanced, percutaneous facet cyst distention and rupture followed by an intra-articular facet joint injection of 1 cc kenalog and 1 cc of 1% lidocaine. Seventeen of the patients also received a transforaminal epidural steroid injection just before facet cyst rupture. Telephone follow-up was conducted on all patients.ResultsExcellent long-term (average follow-up 1 y; range, 6–24 mo) pain relief was achieved in 23 (72%) of 32 patients undergoing facet cyst rupture. Twelve patients (37.5%) had synovial cyst recurrence and 11 chose to undergo repeat rupture, which resulted in 5 patients (45%) obtaining complete relief of symptoms and 6 patients (55%) requiring surgical intervention for cyst removal. Fisher exact test demonstrated that all patients who did not have a cyst recurrence were a success and obtained complete relief of symptoms (p<.0002). Patients who underwent a repeat rupture had a 50% chance of a successful outcome. There was no statistical significance between a successful outcome and level of facet cyst rupture, the presence of spondylolisthesis, sex, age, or having a transforaminal epidural steroid injection at the time of the procedure. Wilcoxon signed-rank test demonstrated that the difference in Numerical Pain Rating Scale and Roland-Morris Disability Questionnaire scores before and after the procedure was statistically significant (p<.0001). No complications were reported.ConclusionsFluoroscopic percutaneous Z-joint cyst rupture appears to be a safe and effective minimally invasive treatment option. This procedure should be considered before surgical intervention.     

Factors associated with satisfaction with bunion surgery in women: A prospective study

BackgroundHallux valgus is a common indication for foot surgery. Over 25% of patients are dissatisfied with the outcome.ObjectiveTo examine women's pre- and post-surgical characteristics, regarding satisfaction with surgery for hallux valgus (‘bunions’).MethodProspective cohort of 95 consecutive female patients (132 ‘foot cases’) undergoing bunion surgery. Baseline interview and questionnaire asked about attitudes to fashion and footwear, plus SF-36 general health survey. At 12 months post-surgery, patients who were ‘very pleased’ with their surgery were compared with everyone else regarding their pre-, peri- and post-operative characteristics.ResultsBy 12 months, key SF-36 domains had significantly improved. The 75 foot operations (n = 75/116, 64.7%) were associated with respondents being ‘very pleased’ with their foot surgery. Following adjustment, the odds of being ‘very pleased’ were severely reduced where respondents were not ‘very pleased’ their foot's appearance (p < 0.001), or where foot pain was anything but absent (p = 0.018). There was significant interaction between pre-operative expectations of resumption of hiking/sports activities and range of footwear able to be worn post-operatively.ConclusionsThe perceived appearance of their foot and range of shoes that women can wear, are crucial to womens’ satisfaction with the outcome of bunion surgery. The (total) alleviation of pain is also important.     

Bloqueo del plano del músculo erector de la columna para analgesia de dolor lumbar crónico: serie de casos

BackgroundChronic low back pain (CLBP) is a frequent condition, poorly managed with conventional treatments. The ultrasound-guided erector spinae plane block has increasingly been used in the management of acute and chronic pain. We aimed to determine this technique's analgesic efficacy in patients with moderate to severe CLBP.MethodsTen consecutively selected patients: adults, regularly followed in our Pain Clinic with moderate/severe long-term CLBP refractory to pharmacological treatment, VAS > 4. Prospective data collection: before the intervention –demographical data, past medical history, current pain therapies, VAS pain level, Brief Pain Inventory– Short Form and Neuropathic Pain Questionnaire; 30 minutes after – VAS and satisfaction level; 24 and 72 hours, 7 days and 1 month after - complications and pain level.ResultsMajority of females (90%), mean age of 70.3 years-old. All had primary musculoskeletal CLBP. 90% experienced severe pain (VAS > = 7) in the last 24 hours. Half presented neuropathic characteristics. Patients were very satisfied with the technique (mean: 8.75) with immediate pain relief (VAS mean: 2.3). 24 and 72 hours, 7 days and 1 month after the treatment VAS means were 3.2, 3.1, 3.8 and 6.2. We report a 20.8 days duration mean. No short or long-term complications.Discussion and conclusionsUltrasound-guided erector spinae plane block has preliminary advantages in CLBP: easily performed with low complications risk, immediate discharge home with absence of motor block, 100% efficacy at short and medium-terms. Even though pain's relief was shorter than a month, it is a useful tool allowing patients’ well-being, physical rehabilitation and exercise during this period.     

Foot orthoses in the management of chronic subtalar and talo crural joint pain in rheumatoid arthritis

BackgroundThis pilot study investigated whether semi-rigid and soft orthoses had an effect on pain, disability and functional limitation in participants with chronic rheumatoid hindfoot involvement.MethodsParticipants with chronic hindfoot pain were randomly assigned to 2 groups, commencing either with semi-rigid Subortholene orthoses or soft EVA orthoses. The Foot Function Index and the Ritchie Articular Index were administered pre- and post-intervention, which lasted for 3 months. Following a 2 week washout period, each group was switched over to the other type of orthoses.ResultsNine female participants (mean age 52.2 years (SD 9.1); mean weight 71 kg (SD 12.64); mean height 160 cm (SD 5.18)) with a mean RA duration of 11.7 years (SD 7.83), and a mean ankle/subtalar joint pain duration of 5.7 years (SD 2.62), completed the programme. Mean improvement in FFI score for both orthoses resulted in the same statistical significance (p = 0.001). Statistically significant reduction in pain, disability and functional limitation was observed for both interventions, together with improvement in the Ritchie Articular Index score.ConclusionBoth Subortholene and EVA orthoses significantly reduced pain, disability and functional limitations in participants with chronic ankle/subtalar joint pain in rheumatoid arthritis.     

The effect of foot reflexology massage on burn-specific pain anxiety and sleep quality and quantity of patients hospitalized in the burn intensive care unit (ICU)

BackgroundBurn-specific pain anxiety and sleep disorders are common factors in burned patients that affect wound healing process, as well as the severity of burn pain. This study aimed to investigate the effect of foot reflexology massage on burn-specific pain anxiety and sleep condition of patients hospitalized in the burn ICU.MethodIn this randomized controlled clinical trial, 52 patients were assigned by permuted block randomization 1:1 to the intervention (n = 26) and control (n = 26) groups. The intervention group received 20 min of foot reflexology massage during 3 days on their third, fourth and fifth days of hospitalization and 15 min before changing wound dressings. Patients in the control group merely received routine care. The Burn-Specific Pain Anxiety Scale (BSPAS) was completed for three consecutive days before and after changing wound dressings, and St. Mary's Hospital Sleep Questionnaire (SMHSQ) was filled out for four consecutive days before changing wound dressings for patients in both groups. The data were analyzed by IBM SPSS 16 software, Chicago, independent t, Chi-square, Friedman, Mann–Whitney and Wilcoxon tests.FindingsWe found no significant difference between pain-anxiety in the two groups before the intervention. The trend of different days in each groups were compared with Friedman test and showed that pain anxiety (p < 0.001), sleep latency (p < 0.001), duration of the last day's sleep (p < 0.001) and satisfaction of the last night sleep (p < 0.001) had a significant difference. In addition, Mann–Whitney test results showed that there were significant differences between the two groups at different times in terms of the above variables (p < 0.05). The effect size was = 0.82 for pain anxiety between group after the intervention.ConclusionBased on the results, foot reflexology massage can effectively reduce pain anxiety levels and improve sleep quality and quantity of patients with burn injuries; therefore, this non- pharmacological therapeutic method is recommended to be used in the burn ICUs. (Clinical trial’s registration code: IRCT20110906007494N27)     

Hallux Valgus: A modified Kramer osteotomy

ObjectiveThe purpose of this study is to evaluate the outcomes for surgical treatment of Hallux Valgus deformity with the use of modified Kramer osteotomy.MethodsFrom January 2003 to January 2005, 101 (23 bilaterally) modified Kramer osteotomies were performed in 78 patients evaluated clinically (74 of 78) with a phone interview and radiographic assessment with a mean follow up of 23.3 ± 6.9 months.ResultsThe average grade of satisfaction score was 7.9 ± 2.0 (0–10). 82.4% of patients would come back to be operated by the same surgery if necessary, 6.7% needed special shoes, 21.6% needed insoles, 87.8% practiced sports activity. The postoperative radiographic assessments in metatarsophalangeal, intermetatarsal, distal metatarsal articular angle and sesamoid reduction showed a significant change (p < 0.001), compared with the preoperative values. Complications: 1.2% vein thrombosis, 1.2% deep infection, 6.7% recurrences and 17.8% hipercorrected distal metatarsal articular angle.ConclusionThe modified Kramer osteotomy enables a good correction in mild and moderate HV deformity with low rate of complications.     

A randomised comparison of regular oral oxycodone and intrathecal morphine for post-caesarean analgesia

BackgroundPrimary post-caesarean analgesia based on oral opioid has not been adequately studied. This approach may show a good side-effect profile and high satisfaction and avoid neuraxial complications.MethodsIn a double-blind, double-dummy, placebo-controlled clinical trial 120 women were randomised to receive either sustained-release oral oxycodone 20 mg in the recovery room followed by immediate-release oxycodone 10 mg 6-hourly for the first 24 h (group O) or intrathecal morphine 100 μg at the time of spinal anaesthesia (group I). All women received regular postoperative diclofenac, paracetamol and standardised supplemental analgesia.ResultsOne hundred and eleven women completed the study. The area under the curve for pain scores to 24 h did not differ significantly between groups for pain at rest (P=0.465) or on movement (P=0.533). Numerical pain scores were low and similar, except at rest at 12 h (group I 1 [0-2] vs. group O 2 [1-3]; P=0.030). The time to first analgesic request was similar but additional postoperative analgesics were required more often in group O (82% vs. 63%, P=0.034). Group O more frequently reported high worst pain scores (score 4-10 in 87% vs. 64%, P=0.007). Pruritus was more common and more severe in group I (87% vs. 56%, P=0.001). At 24 h maternal satisfaction with the analgesic regimen was lower in group O (P=0.010).ConclusionOral oxycodone produced comparable postoperative pain relief to intrathecal morphine with a lower incidence of pruritus, but was associated with a lower satisfaction score.     

Efficacy of a functional restoration program for chronic low back pain: Prospective 1-year study

ObjectiveTo evaluate the efficacy of a functional restoration program for patients with chronic low back pain, using overall disability and work ability as the primary evaluation criteria.Patients and methodsWe prospectively studied patients aged 18 years or older who had been on sick leave because of nonspecific low back pain for at least 3 months and whose job position was still open. The program was delivered on a day-hospital basis 5 days a week for 5 weeks. Patients were followed up for 1 year.ResultsWe included 39 patients, 11 females and 28 males with a mean (± SD) age of 43 ± 8 years and a mean sick-leave duration of 10 ± 7 months. After 1 year, 26 (67%) patients reported improvements and 25 (64%) had returned to work. Compared to the year before the program, the number of sick leave days was decreased by 51% (120 ± 140 vs. 244 ± 114, P < 0.05). The work-and-leisure-activities subscore of the validated French version of the Dallas Pain Questionnaire (DRAD) was significantly improved (57 ± 24 vs. 70 ± 17 at baseline, P < 0.05). The patients still on sick leave after 1 year were older and had greater alterations in baseline DRAD subscores for anxiety/depression and daily activities, compared to the patients who had returned to work.ConclusionsOur functional restoration program was effective and allowed two-thirds of patients to resume work. Factors associated with failure to resume work were well-known correlates of chronicity. Our results support the use of functional restoration programs in patients with incapacitating low back pain. They suggest that functional restoration may deserve to be started earlier, after only 3 months with chronic pain, in patients who are unable to work.     

Long-term changes of patient-reported quality of life after major trauma: The importance of the time elapsed after injury

BackgroundNumerous studies have identified various risk factors for a poor health-related quality of life (HRQOL) after severe trauma. The relative importance of the time elapsed after injury, however, is unknown and results of clinical studies have been conflicting.MethodsA cross-sectional study was performed in two trauma centres using data from the German TraumaRegister DGU^®, which contained prospectively collected information on the type and severity of the injury, on critical care, and on outcome. To evaluate HRQOL in patients surviving more than 500 days after the injury, we used a self-rating instrument, the EQ-5D which contains a visual analogue scale (EQ-VAS), and which allows the calculation of a global outcome indicator, the EQ-D5 index value. Complex statistical models were used to evaluate independent associations between the time elapsed after injury and a poor HRQOL.ResultsOf 380 contacted patients, follow-up assessments could be obtained in 168 patients (44.2%) 3.6 ± 1.6 (SD) years after the injury. There was a linear association between the time elapsed after the injury and the% of contacted patients not participating in the study (p = 0.013). In participating subjects, average EQ-5D index value was 0.599 ± 0.299, and average EQ-VAS rating 67.8 ± 22.0. A very poor quality of life (EQ-5D index value < 0.6, EQ-VAS rating ≤ 50) could be found in 43.5% and 28.0% of the patients, respectively. After adjusting for multiple confounders, the number of days elapsed after injury showed a complex non-linear and independent association with a poor HRQOL (low EQ-5D index value: p = 0.027; low EQ-VAS rating: p = 0.008). Frequencies of a poor HRQOL reached their minimum about four to five years after the injury and increased thereafter.ConclusionsThere is an independent, U-shaped association between the frequency of extreme values of HRQOL and the time elapsed after injury. Time patterns of HRQOL may be sensitive to increasing rates of attrition since patients with a good outcome are less likely to respond to questionnaires. Time from injury should be incorporated into all future cross sectional studies trying to identify predictors of HRQOL.     

Metalwork removal in elective foot and ankle practice: Does it make any difference to the patient?

BackgroundIncreasing use of metalwork in foot and ankle surgery has led to an increasing number of subsequent surgeries for metalwork removal. The aim of the current study was to determine whether removing metalwork from foot and ankle makes any difference to the patients in terms of pain, function or shoe wear related outcomes.Methods27 consecutive patients were identified from a single surgeon database that had undergone metalwork removal over a four year period and sent out a validated Visual Analogue Scale-Foot and Ankle questionnaire. Additional demographic and radiographic data were collected.Results24 patients returned completed questionnaires. Mean interval between index procedure and metalwork removal was 18 months. Overall for the whole group, only moderate satisfaction was noted after metalwork removal with mean VAS-FA scores of 60.39. The mean VAS-FA scores and the pain, function and other complaints sub-scores were significantly better in patients who had metalwork removal after 1st ray surgery (p = 0.07 for total VAS-FA score and p = 0.006, p = 0.005, and p = 0.032 for pain, function and other complaints sub-scores respectively).ConclusionWe can recommend removal of metalwork in symptomatic patients after 1st ray surgeries but other foot and ankle surgeries require further investigation.     

Towards a multidimensional patient reported outcome measures assessment: Development and validation of a questionnaire for patients with ankylosing spondylitis/spondyloarthritis

ObjectiveTo assess the validity, reliability and responsiveness to change of a patient self-reported questionnaire that can assess construct outcome measures of patients with ankylosing spondylitis (AS)/spondyloarthritis.MethodsThe questionnaire was developed by integrating information obtained from patients suffering from AS/spondyloarthritis based on the Rasch model. The questionnaire includes assessment of functional disability, quality of life, VAS for spinal pain, joint pain, global status, fatigue, duration of morning stiffness, review of the systems, falls and cardiovascular risks, self-helplessness as well as self-reported joint and soft tissue pain. The questionnaire was completed by 267 consecutive patients with AS (124) and spondyloarthritis (143).ResultsThe PROMs questionnaire was reliable as demonstrated by a high-standardized alpha. The questionnaire items correlated significantly (p < 0.01) with clinical parameters of disease activity. Patient reported tender joints and enthesitis scores correlated significantly with the physician's scores (correlation coefficient 0.848 and 0.821 respectively). Changes in functional disability, quality of life as well as self-helplessness scores showed significant (p < 0.01) variation with diseases activity status. The PROMs questionnaire showed also a high degree of comprehensibility (9.3).ConclusionThe developed PROMs questionnaire is a reliable and valid instrument for assessment of patients suffering from AS and spondyloarthritis. Being short, rapid and comprehensive, this adds more to its applicability. The data support the value of completion of the simple two pages patient questionnaire, which provides a quantitative written documented record by the patient, at each visit to the rheumatologist.     

Postoperative analgesia after major abdominal surgery: Fentanyl–bupivacaine patient controlled epidural analgesia versus fentanyl patient controlled intravenous analgesia

BackgroundMajor abdominal surgeries induce neurohumoral changes responsible for postoperative pain, various organ dysfunctions and prolonged hospitalization. Inadequate pain control is harmful and costly to patients thus an appropriate pain therapy to those patients must be applicated.MethodsOne hundred patients (ASA I or II) of either sex aged from 20 to 60 years were scheduled for elective major abdominal surgery. Patients were allocated randomly into two groups (fifty patients each) to receive: patient-controlled epidural analgesia with bupivacaine 0.125% and fentanyl (PCEA group), or patient controlled intravenous analgesia with fentanyl (PCIA group). Postoperative pain was assessed over 24 h using Numerical Pain Rating scale (NPRS). The frequency of rescue analgesia, sedation score and overall patient satisfaction were recorded. Any concomitant events like nausea; vomiting, shivering, pruritus or respiratory complications were recorded postoperatively.ResultsThere was a significant less pain in PCEA group at 2, 8 and 12 h. postoperative but PCIA group had less pain at immediate postoperative time. As regard sedation scale, patients of the PCEA group were significantly less sedated than PCIA group at immediate postoperative only. Overall patient satisfaction was significantly more in PCEA group.ConclusionThis study concluded that both PCEA and PCIA were effective in pain relief after major abdominal surgery but PCEA was much better in pain relief, less sedating effect and overall patient satisfaction.     

Effectiveness of myofascial release in the management of plantar heel pain: A randomized controlled trial

BackgroundPrevious studies have reported that stretching of the calf musculature and the plantar fascia are effective management strategies for plantar heel pain (PHP). However, it is unclear whether myofascial release (MFR) can improve the outcomes in this population.ObjectiveTo investigate whether myofascial release (MFR) reduces the pain and functional disability associated with plantar heel pain (PHP) in comparison with a control group receiving sham ultrasound therapy (SUST).DesignRandomized, controlled, double blinded trial.SettingNonprofit research foundation clinic in India.MethodSixty-six patients, 17 men and 49 women with a clinical diagnosis of PHP were randomly assigned into MFR or a control group and given 12 sessions of treatment per client over 4 weeks. The Foot Function Index (FFI) scale was used to assess pain severity and functional disability. The primary outcome measure was the difference in FFI scale scores between week 1 (pretest score), week 4 (posttest score), and follow-up at week 12 after randomization. Additionally, pressure pain thresholds (PPT) were assessed over the affected gastrocnemii and soleus muscles, and over the calcaneus, by an assessor blinded to the treatment allocation.ResultsThe simple main effects analysis showed that the MFR group performed better than the control group in weeks 4 and 12 (P < 0.001). Patients in the MFR and control groups reported a 72.4% and 7.4% reduction, respectively, in their pain and functional disability in week 4 compared with that in week 1, which persisted as 60.6% in the follow-up at week 12 in the MFR group compared to the baseline. The mixed ANOVA also revealed significant group-by-time interactions for changes in PPT over the gastrocnemii and soleus muscles, and the calcaneus (P < 0.05).ConclusionsThis study provides evidence that MFR is more effective than a control intervention for PHP.