Reliability of the clinical examination in the diagnosis of neurogenic versus vascular claudication

Background contextAs research increasingly challenges the diagnostic accuracy of advanced imaging for lumbar spinal stenosis, the impression gleaned from the office evaluation becomes more important. Neurogenic claudication is a hallmark of lumbar spinal stenosis, but the reliability of clinical impression of claudication has not been studied.PurposeTo determine the reliability of the clinical examination for neurogenic claudication in an idealized setting.Study designProspective masked controlled trial.Patient samplePersons aged 55 to 90 years were recruited to form three groups: those offered surgery for spinal stenosis by academic spine surgeons, those who had peripheral vascular symptoms and positive ankle-brachial index (ABI), and those who were asymptomatic. All were extensively screened against confounding diseases. Forty-three neurogenic, 12 vascular, and 35 asymptomatic recruits were tested.Outcome measuresClinical impression of neurogenic claudication.MethodsA neurosurgeon and a vascular surgeon, masked to each other's findings, imaging, and recruitment status, performed a codified but unconstrained comprehensive spine and vascular history and physical examination for each subject. The surgeon's impression was recorded.ResultsMasked surgeons strongly agreed with the recruitment diagnosis (neurosurgeon kappa 0.761, vascular surgeon kappa 0.803, both p<.001) and with each other (kappa 0.717, p<.001). However, disagreements did occur between examiners and recruitment diagnosis (neurosurgeon n=13 cases, vascular surgeon n=10) and between examiners (n=14 cases). Pain level and marginally some measures of disability related to the agreement, but specific aspects of the physical examination, showed poor interrater reliability and did not contribute to the agreement.ConclusionsThe clinical impression of neurogenic claudication is a reliable construct. The history, but not the poorly reproduced physical examination, contributes to reliability. The level of disagreement between experts in this simplified, yet severely involved, population raises concern about the risk of misdiagnosis in individual cases. Thus, surgical and other consequential decisions about diagnosis may require ancillary tests such as electromyography or ABI.     

Which NDI domains best predict change in physical function in patients undergoing cervical spine surgery?

Background ContextPhysical function is a critical aspect of patient outcomes. NDI is a widely validated outcome measure in cervical spine disease, yet to what extent its individual domains predict changes in physical function remains unknown.PurposeTo examine the impact of individual NDI domains on changes in physical function in patients undergoing cervical spine surgery.Study Design/SettingProspective Cohort Study.Patient SampleAdult patients undergoing cervical spine surgery, excluding those undergoing surgery for instability due to trauma.Outcome MeasuresAbsolute change in outcome measures (Patient Reported Outcomes Measurement Information System [PROMIS] Physical Function [PF], Short Form 36 [SF-36] Physical Component Score [PCS], and Neck Disability Index [NDI]) from pre- to postoperatively, correlation of NDI individual domains with PROMIS PF and SF-36 PCS (preoperatively, postoperatively, and change from pre- to postoperatively).MethodsPatients undergoing cervical spine surgery between 2016 and 2018 were prospectively enrolled. Patients completed questionnaires (NDI, SF-36 PCS, and PROMIS PF) preoperatively and at 6 months postoperatively. Patient demographics, including age, body mass index, Charlson Comorbidity Index, and underlying diagnoses were collected. Comparisons between NDI scores preoperatively versus postoperatively were conducted using Wilcoxon signed rank sum test. Correlations of NDI individual items and PROMIS/SF-36 were assessed using Pearson correlation. A stepwise linear regression analysis was performed to identify NDI items that are independently predictive of PROMIS PF and SF-36 PCS.ResultsA total of 137 patients were included in the study, with mean age 56.9 years (range 24.4–84.9). Each of the NDI domains as well as PROMIS PF and SF-36 PCS demonstrated significant improvement following cervical spine surgery (p<.001). Changes in all NDI domains demonstrated significant negative correlation with changes in PROMIS PF, with recreation (R=−0.537, p<.001), work (R=−0.514, p<.001), and pain intensity (R=−0.488, p<.001) having the greatest negative correlation. Changes in all NDI domains demonstrated significant negative correlation with changes in SF-36 PCS, with recreation (R=−0.451, p<.001), work (R=−0.443, p<.001), lifting (R=−0.373, p<.001), and driving (R=−0.373, p<.001) having the greatest negative correlation. For PROMIS PF, the NDI domains that were independently associated with changes in PF were work (R=−0.092, p=.001), pain intensity (R=−0.089, p=.003), and recreation (R=−0.067, p=.004). For SF-36 PCS, the NDI items that were independently associated with changes in PCS were work (R=−0.269, p=.003) and recreation (R=−0.215, p=.002).ConclusionsAll NDI domains improve significantly after cervical spine surgery and demonstrate significant correlation with changes in PROMIS PF and SF-36 PCS. The work, recreation, and pain intensity domains were the only independent predictors of physical function changes postoperatively. Considering physical function, our findings highlight the importance of presenting changes in individual NDI domains in addition to the total score.     

Bouncing back after lumbar spine surgery: early postoperative resilience is associated with 12-month physical function,pain interference,social participation,and disability

BACKGROUND CONTEXTPositive psychosocial factors early after surgery, such as resilience and self-efficacy, may be important characteristics for informing individualized postoperative care.PURPOSETo examine the association of early postoperative resilience and self-efficacy on 12-month physical function, pain interference, social participation, disability, pain intensity, and physical activity after lumbar spine surgery.STUDY DESIGN/SETTINGPooled secondary analysis of prospectively collected trial data from two academic medical centers.PATIENT SAMPLETwo hundred and forty-eight patients who underwent laminectomy with or without fusion for a degenerative lumbar condition.OUTCOME MEASURESPhysical function, pain inference, and social participation (ability to participate in social roles and activities) were measured using the Patient Reported Outcomes Measurement Information System. The Oswestry Disability Index, Numeric Rating Scale, and accelerometer activity counts were used to measure disability, pain intensity, and physical activity, respectively.METHODSParticipants completed validated outcome questionnaires at 6 weeks (baseline) and 12 months after surgery. Baseline positive psychosocial factors included resilience (Brief Resilience Scale) and self-efficacy (Pain Self-Efficacy Questionnaire). Multivariable linear regression analyses were used to assess the associations between early postoperative psychosocial factors and 12-month outcomes adjusting for age, sex, study site, randomized group, fusion status, fear of movement (Tampa Scale for Kinesiophobia), and outcome score at baseline. This study was funded by Patient-Centered Outcomes Research Institute and Foundation for Physical Therapy Research. There are no conflicts of interest.RESULTSResilience at 6 weeks after surgery was associated with 12-month physical function (unstandardized beta=1.85 [95% confidence interval [CI]: 0.29; 3.40]), pain interference (unstandardized beta=?1.80 [95% CI: ?3.48; ?0.12]), social participation (unstandardized beta=2.69 [95% CI: 0.97; 4.41]), and disability (unstandardized beta=?3.03 [95% CI: ?6.04; ?0.02]). Self-efficacy was associated with 12-month disability (unstandardized beta=?0.21 [95% CI: ?0.37; ?0.04].CONCLUSIONSPostoperative resilience and pain self-efficacy were associated with improved 12-month patient-reported outcomes after spine surgery. Future work should consider how early postoperative screening for positive psychosocial characteristics can enhance risk stratification and targeted rehabilitation management in patients undergoing spine surgery.     

Correlation between ankle-brachial index, symptoms, and health-related quality of life in patients with peripheral vascular disease

OBJECTIVE: Improving health-related quality of life (HRQL) is the main goal of surgery to treat peripheral vascular disease (PVD); however, HRQL is rarely measured directly. Rather, most surgeons use other measures, such as patient symptoms and ankle-brachial index (ABI) to determine the need for intervention in PVD. The accuracy of these surrogates in representing HRQL has been untested. The purpose of this study was to determine the correlation of these measures with HRQL in patients undergoing evaluation for intervention in symptomatic PVD. METHODS: Patients (n=108) referred to the vascular surgery service with symptoms of PVD were enrolled in a prospective study of HRQL. Patients completed two validated HRQL questionnaires: the short form-36 (SF-36) and the Walking Impairment Questionnaire (WIQ). All patients had symptoms consistent with PVD, including claudication (n=69; 63.9%), ischemic rest pain (n=17; 15.7%), or tissue loss (n=22; 20.4%). ABI was measured at presentation. RESULTS: The mean ABI was 0.53 (range, 0.00-0.98). The maximal correlation between SF-36 score and ABI was reflected in the Physical Component Summary score (r=0.25). WIQ score also exhibited modest correlation with ABI, with maximal correlation noted for stair climbing (r=0.26). Both SF-36 and WIQ scores exhibited a highly significant association with symptoms. Patients with more severe symptoms, such as lifestyle-limiting claudication or limb-threatening ischemia, had lower HRQL scores compared with patients with non-lifestyle-limiting claudication. Multivariate analysis demonstrated that SF-36 and WIQ physical summary scores are better predicted by symptoms than by ABI (P<.01). CONCLUSIONS: HRQL in patients with PVD correlates weakly with ABI, but exhibits a closer association with vascular symptoms. However, neither variable fully expresses patient HRQL. These data suggest that sole reliance on these surrogates may not accurately reflect the effect of PVD on HRQL, or the potential benefit of vascular surgery in improving HRQL.     

First metatarsophalangeal arthrodesis outcomes for hallux rigidus versus hallux valgus

BackgroundThis study compared radiographic and functional patient outcomes of 1st MTP arthrodesis between hallux rigidus (HR) and hallux valgus (HV) cohorts.MethodsA retrospective review was conducted at an academic medical center on patients who underwent 1st MTP arthrodesis during 2009–2021. In total, 136 patients (148 feet: HR=57, HV=47, combined=44) met the inclusion criteria of minimum three-month follow-up (mean=1.25 years, range=0.25–6.14 years). Data collection included patient-reported outcome measures (PROMs), radiographic markers, and complication and reoperation rates.ResultsPROMs improved overall, with HV patients significantly improving the least. The HR group had a significantly smaller improvement in HV angle (HR=?3.6, HV=?17, Combined=?15 p < .001), intermetatarsal angle (H=?0.16, HV=?2.8, Combined=?2.6 p < .001), and 1st-5th metatarsal width (HR=?0.98, HV=?4.6, Combined=?4.6, p < .001). Complication and reoperation rates did not differ by group.ConclusionOutcomes of 1st MTP arthrodesis does not appear to differ between diagnostic indications of hallux rigidus, hallux valgus, or both.Level of EvidenceLevel III, Retrospective cohort study     

Early postoperative fear of movement predicts pain,disability, and physical health six months after spinal surgery for degenerative conditions

Background contextThe fear-avoidance model offers a promising framework for understanding the development of chronic postoperative pain and disability. However, limited research has examined this model in patients undergoing spinal surgery.PurposeTo determine whether preoperative and early postoperative fear of movement predicts pain, disability, and physical health at 6 months following spinal surgery for degenerative conditions, after controlling for depressive symptoms and other potential confounding variables.Study design/settingA prospective cohort study conducted at an academic outpatient clinic.Patient sampleOne hundred forty-one patients undergoing surgery for lumbar or cervical degenerative conditions.Outcome measuresSelf-reported pain and disability were measured with the Brief Pain Inventory and the Oswestry Disability Index/Neck Disability Index, respectively. The physical composite scale of the 12-Item Short-Form Health Survey (SF-12) measured physical health.MethodsData collection occurred preoperatively and at 6 weeks and 6 months following surgery. Fear of movement was measured with the Tampa Scale for Kinesiophobia and depression with the Prime-MD PHQ-9.ResultsOne hundred and twenty patients (85% follow-up) completed the 6-month postoperative assessment. Multivariable mixed-method linear regression analyses found that early postoperative fear of movement (6 weeks) predicted pain intensity, pain interference, disability, and physical health at 6-month follow-up (p<.05). Preoperative and early postoperative depression predicted pain interference, disability, and physical health.ConclusionResults provide support for the fear-avoidance model in a postsurgical spine population. Early postoperative screening for fear of movement and depressive symptoms that do not acutely improve following surgical intervention appears warranted. Cognitive and behavioral strategies may be beneficial for postsurgical patients with high fear of movement and/or depressive symptoms.     

Long-term quality of life outcome after spondylodiscitis treatment

BACKGROUND CONTEXTSpondylodiscitis is the most common spinal infection of which the incidence has increased and the peak prevalence is between 50 and 70 years of age. Spondylodiscitis is often a complication of a distant infection. Early diagnosis can be challenging, and although improvements in diagnostic techniques and modern therapy have diminished the mortality of the disease, current literature about the outcome of spondylodiscitis is scarce.PURPOSETo evaluate the long-term clinical outcome of patients who suffered from spondylodiscitis.STUDY DESIGNA two-center cross-sectional study.PATIENT SAMPLEPatients with spondylodiscitis in two large teaching hospitals in the Netherlands between 2003 and 2017.OUTCOME MEASURESVisual Analogue Scale (VAS) for back pain, Oswestry Disability Index (ODI) for function, and Short Form 36 (SF-36) for general quality of life of spondylodiscitis patients.METHODEligible patients were identified from electronic patient databases and completed multiple patient reported outcome measures after obtaining informed consent. General demographic and clinical information (age, sex, medical history) were extracted from the patient records. SF-36 domain scores of spondylodiscitis patients were compared with a nationwide population sample.RESULTS183 patients were treated for spondylodiscitis; additional questionnaires were received from 82 patients. After a median follow-up of 63 months, the overall mortality was 28%. The mean VAS for back pain was 3.5, and the mean ODI score was 22. In all SF-36 domains a significantly lower score was found in the spondylodiscitis group compared with a normative national Dutch cohort. There was a strong correlation between back pain and ODI scores (ρ=0.81, p<.05).CONCLUSIONSOur study confirms that spondylodiscitis is a disease causing a profound impact on back pain, function and quality of life. The results suggest that chronic back pain is a debilitating problem, as it has an extensive influence on daily activities and social and psychological well-being, causing significant disability.     

Minimally invasive transforaminal lumbar interbody fusion using the biportal endoscopic techniques versus microscopic tubular technique

BACKGROUND CONTEXTMinimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) with microscopic tubular technique is an established surgical procedure with several potential advantages, including decreased surgical-related morbidity, reduced length of hospital stay, and accelerated early rehabilitation. A recently introduced biportal endoscopic technique for spine surgery presents familiar surgical anatomy and can be conducted using a conventional approach with a minimal footprint; it is also applicable to TLIF.PURPOSETo compare the clinical and radiological outcomes of biportal endoscopic technique transforaminal lumbar interbody fusion (BE-TLIF) and microscopic tubular technique transforaminal lumbar interbody (MT-TLIF) in patients with single- or two-segment lumbar spinal stenosis with or without spondylolisthesis.STUDY DESIGNA retrospective cohort study.PATIENT SAMPLEOne hundred two participants with neurogenic intermittent claudication or lumbar radiculopathy with single- or two-level lumbar spinal stenosis with or without spondylolisthesis.OUTCOME MEASURESClinical outcomes were assessed using the visual analog scale (VAS) score for the back and leg pain, Oswestry Disability Index (ODI), and the Short Form-36 health survey Questionnaire (SF-36). Demographic data, operative data (total operation time, estimated blood loss, amount of surgical drain, postoperative transfusion, and length of hospital stay), and laboratory results (plasma hemoglobin, serum creatine phosphokinase, and C-reactive protein) were also evaluated. The fusion rate was assessed using the Bridwell interbody fusion grading system. Postoperative complications were also noted.METHODSPatients were divided into two groups: group A (BE-TLIF) and group B (MT-TLIF). The clinical outcomes, including VAS-Back and VAS-Leg, ODI, and SF-36 scores, were evaluated at 1 month, 6 months, and 1 year after surgery. Differences in demographics, operative data, and the laboratory and radiological results were assessed between the two groups. The fusion rate was assessed using standard standing lumbar radiographs and computed tomography scans conducted 1 year after surgery.RESULTSSeventy-nine patients were analyzed in this study, 47 from group A and 32 from group B. Demographic and operative data were comparable for both the groups. The VAS-Back and SF-36 scores were more significantly improved in group A than in group B at 1 month after surgery. However, there were no significant differences between groups for the mean VAS-Back, VAS-Leg, ODI, and SF-36 scores at 1year after the surgery. Although the total operation time was significantly longer in group A, the estimated blood loss and the amount of surgical drainage was significantly higher in group B (p < .001). There were no between-group differences for the fusion rate and postoperative complications.CONCLUSIONBoth BE-TLIF and MT-TLIF provided equivalent and favorable clinical outcomes and fusion rates. Further large-scale, randomized, controlled trials with long-term follow-ups are warranted.     

A new foot and ankle outcome score: Questionnaire based,subjective, Visual-Analogue-Scale,validated and computerized

Our purpose was to construct and validate a new score taking into consideration the flaws of existing scores.MethodsA new score named Visual-Analogue-Scale Foot and Ankle (VAS FA) with the following features was constructed: questionnaire based on 20 subjective questions, Visual-Analogue-Scale (VAS) based rating, computerized evaluation. The score was validated in 121 subjects. For validation, SF-36^® and Hannover Questionnaire (Q) were obtained and correlated with VAS FA.ResultsThe correlation VAS FA versus SF-36^® and Q (Pearson, all p-values <0.001, r ≥ 0.5) was sufficient for the total score and all score categories (pain, function, other complaints).The time needed for evaluating the scores was significantly lower for VAS FA than for SF-36^® and Q (Oneway-ANOVA, p < 0.001).ConclusionsThe introduced score is the first validated (on SF-36^®), subjective, VAS based outcome score for foot and ankle. The VAS FA is computerized which enables faster evaluation than SF-36^® or Q.     

Preoperative Zung depression scale predicts patient satisfaction independent of the extent of improvement after revision lumbar surgery

Background contextPatient satisfaction ratings are increasingly being used in health care as a proxy for quality and are becoming the focal point for several quality improvement initiatives. Affective disorders, such as depression, have been shown to influence patient-reported outcomes and self-interpretation of health status. We hypothesize that patient psychiatric profiles influence reported satisfaction with care, independent of surgical effectiveness.PurposeTo assess the predictive value of preoperative depression on patient satisfaction after revision surgery for same-level recurrent stenosis.Study designRetrospective cohort study.Patient sampleFifty-three patients undergoing a revision surgery for symptomatic same-level recurrent stenosis.Outcome measuresPatient-reported outcome measures were assessed using an outcomes questionnaire that included questions on health state values (EuroQol-5D [EQ-5D]), disability (Oswestry Disability Index [ODI]), pain (visual analog scale [VAS]), depression (Zung self-rating depression scale), and Short Form 12 (SF-12) physical and mental component scores (PCS and MCS). Patient satisfaction was dichotomized as either “YES” or “NO” on whether they were satisfied with their surgical outcome 2 years after the surgery.MethodsA total of fifty-three patients undergoing revision neural decompression and instrumented fusion for same-level recurrent stenosis-associated back and leg pain were included in this study. Preoperative Zung self-rating depression score (ZDS), education status, comorbidities, and postoperative satisfaction with surgical care and outcome was assessed for all patients. Baseline and 2-year VAS for leg pain (VAS-LP), VAS for low back pain (VAS-BP), ODI, SF-12 PCS and MCS, and health-state utility (EQ-5D) were assessed. Factors associated with patient satisfaction after surgery were assessed via multivariate logistic regression analysis.ResultsTwo years after surgery, a significant improvement was reported in all outcome measures: VAS-BP (5±2.94 vs. 9.28±1, p<.001), VAS-LP (3.43±2.95 vs. 9.5±0.93, p<.001), ODI (21.75±12.07 vs. 36.01±6, p<.001), SF-12 PCS (32.30±11.01 vs. 25.13±5.84, p<.001), SF-12 MCS (47.48±10.96 vs. 34.91±12.77, p<.001), EQ-5D (0.60±0.31 vs. 0.18±0.22, p<.001), and ZDS (37.52±11.98 vs. 49.90±10.88, p<.001). Independent of postoperative improvement in pain and disability (surgical effectiveness), increasing preoperative Zung depression score was significantly associated with patient dissatisfaction 2 years after revision lumbar surgery (Odds ratio=0.67 [confidence interval: 0.38, 0.87], p<.001).ConclusionsOur study suggests that independent of the surgical effectiveness, the extent of preoperative depression influences the reported patient satisfaction after revision lumbar surgery. Quality improvement initiatives using patient satisfaction as a proxy for quality should account for the patients' baseline depression as potential confounders.     

Endplate defects,not the severity of spinal stenosis,contribute to low back pain in patients with lumbar spinal stenosis

BACKGROUND CONTEXTIt is controversial whether lumbar spinal stenosis (LSS) itself contributes to low back pain (LBP). Lower truncal skeletal muscle mass, spinopelvic malalignment, intervertebral disc degeneration, and endplate abnormalities are thought to be related to LBP. However, whether these factors cause LBP in patients with LSS is unclear.PURPOSETo identify factors associated with LBP in patients with LSS.STUDY DESIGN/SETTINGCross-sectional design.PATIENT SAMPLEA total of 260 patients (119 men and 141 women, average age 72.8 years) with neurogenic claudication caused by LSS, as confirmed by magnetic resonance imaging (MRI).OUTCOME MEASURESRatings of LBP, buttock and leg pain, and numbness on a numerical rating scale (NRS), 36-Item Short Form Survey (SF-36) scores, muscle mass measured by bioelectrical impedance analysis, and radiographic measurements including slippage and lumbopelvic alignment. The severity of LSS, endplate defects, Modic endplate changes, intervertebral disc degeneration, and facet joint osteoarthritis were assessed on MRI.METHODSThe presence of LBP was defined as an NRS score ≥3. The demographic data, patient-reported outcomes, and radiological and MRI findings were compared between patients with and without LBP. Multivariate logistic regression analysis was used to identify the factors that were independently associated with the presence of LBP.RESULTSThere were significant differences between patients with and without LBP for buttock and leg pain and numbness on the NRS, general health on the SF-36, presence of endplate defects, presence of Modic changes, disc degeneration grading, and disc height grading (all p < .05). Multivariate logistic regression analysis showed significant associations between LBP and diabetes (OR 2.43; 95% CI 1.07–5.53), buttock and leg numbness on the NRS (OR 1.34; 95% CI 1.17–1.52), general health on the SF-36 (OR 0.97; 95% CI 0.95–0.99), and the presence of erosive endplate defects (OR 3.04; 95% CI 1.51–6.11) (all p < .05).CONCLUSIONSThese results suggest that LBP in patients with LSS should be carefully assessed not only for spinal stenosis but also clinical factors and endplate defects.     

Back pain in surgically treated degenerative lumbar spondylolisthesis: what can we tell our patients?

Summary of background dataSurgery for degenerative lumbar spondylolisthesis (DLS) has traditionally been indicated for patients with neurogenic claudication. Surgery improves patients’ disability and lower extremity symptoms, but less is known about the impact on back pain.ObjectiveTo evaluate changes in back pain after surgery and identify factors associated with these changes in surgically-treated DLS.Study designRetrospective review of prospectively collected data.MethodsThere were 486 consecutive patients with surgically-treated DLS who were enrolled in the Canadian Spine Outcomes Research Network prospective registry and identified for this study. Patients had demographic data, clinical information, disability (Oswestry Disability Index), and back pain rating scores collected prospectively at baseline, and 12 months follow-upResultsOf the 486 DLS patients, 376 (77.3%) were successfully followed at 12 months. Mean age at baseline was 66.7 (standard deviation [SD] 9.2) years old, and 63% were female. Back pain improved significantly at 12 months, compared with baseline (p<.001). Improvement in Numeric Rating Scale (NRS)-back pain ratings was on average 2.97 (SD 2.5) points at one year and clinically significant improvement in back pain was observed in 75% of patients (minimal clinically important difference (MCID) NRS-Pain 1.2 points). Multivariable logistic regression revealed five factors associated with meeting MCID NRS-back pain at 12 month follow up: higher baseline back pain, better baseline physical function (higher SF-12 Physical Component Score), symptoms duration less than 1 to 2 years, and having no intraoperative adverse events.ConclusionsBack pain improved significantly for patients treated surgically for DLS at 1-year follow-up.     

Assessment of generic health-related quality of life in patients with intermittent claudication.

OBJECTIVES: to measure quality of life in patients with intermittent claudication and evaluate the ability of patients and vascular surgeons to make a similar assessment. DESIGN, MATERIALS AND METHODS: in this prospective study patients with intermittent claudication attending two vascular clinics were asked to complete a generic health-related quality of life instrument (MOS SF-36). Patient quality of life and vascular surgeons' assessment of patient quality of life were further evaluated using a single question/adjectival scale response combination. RESULTS: patients' self-assessment of their quality of life correlated better with the SF-36 score than did the surgeons' assessment. There was little correlation between the surgeons' and patients' own assessment of quality of life. The surgeons differed significantly from each other in their assessments. Claudicants had lower SF-36 scores than population norms in pain and physical aspects of quality of life. CONCLUSIONS: claudicants have worse quality of life than the general population, with pain and physical limitations being the most important domains. Surgeons predict the quality of life of claudicating patients less accurately than patients do themselves, and may differ from their colleagues in such assessments. Objective quality of life assessment in claudicants should be undertaken before treatment is decided.     

Pain affects health-related quality of life in kidney transplant recipients

BACKGROUND: Chronic pain is prevalent in end-stage renal disease patients undergoing chronic hemodialysis. We do not fully know the intensity of chronic pain experienced by kidney recipients in comparison to those on chronic hemodialysis and healthy controls. Moreover, the effect of chronic pain on kidney recipients' health-related quality of life (HRQoL) is yet to be comprehensively addressed. We designed this study to find an answer to these questions. METHODS: In this case control study, we studied 205 kidney recipients, 69 hemodialysis patients, and 100 healthy controls, who were matched for age, sex, monthly family income, and educational level. The patients were evaluated for the intensity of chronic pain by Visual Analogue Scale (VAS). HRQoL was measured with Short Form 36 (SF-36) in the kidney recipients. Chronic pain intensity was compared in the study groups, and in the kidney recipients the correlation between SF-36 subscores and severity of pain was assessed. RESULTS: Severity of pain in the kidney recipients was lower than the hemodialysis patients, but more than the healthy controls (P=.001). The VAS pain score negatively correlated with the scores of SF- 36 total (r=-.329, P=01), mental health (r=-.190, P=07), physical health (r=-.275, P=.001), physical function (r=-.339, P=.001), role limitation due to physical problems (r=-.478, P=.001), role limitation due to emotional problems (r=-.326, P=.001), and bodily pain (r=-.894, P=.001). DISCUSSION: The intensity of chronic pain experienced by the kidney recipients is less than that experienced by patients under chronic hemodialysis, but higher than healthy subjects. Focusing on chronic pain as a cause of post-renal transplantation morbidity is expected to improve post-renal transplantation quality of life.     

SF-36 health status of workers compensation cases with spinal disorders.

BACKGROUND CONTEXT: Poorer outcomes of treatment are reported in patients with spinal disorders who receive workers compensation. The reason for their suboptimal outcomes is unclear. No study has examined the relationship between workers compensation and the Short Form Health Survey (SF-36) health status of patients with spinal disorders. PURPOSE: To compare the self-perceived health status of spinal disorder patients receiving workers compensation with those not receiving workers compensation. STUDY DESIGN/SETTING: A cross-sectional study on 18,389 patients who were evaluated in the 28 centers comprising the National Spine Network. PATIENT SAMPLE: The study data were derived from patients when first evaluated for back or neck pain between January 1998 and April 2000. OUTCOME MEASURES: The outcome measures used were the eight individual and two component scores of the SF-36. METHODS: All first-visit patients enrolled in the National Spine Network from January 1998 to April 2000 were reviewed. Eight individual scores and two component scores of the SF-36 were compared. RESULTS: Of the 18,389 patients, 1,535 (8%) were receiving workers compensation. Bivariate analyses showed all eight individual scores, and two summary scores of the SF-36 were significantly lower (p<.0001) in patients receiving workers compensation. After controlling for confounding covariates, workers compensation status was a significant predictor of lower SF-36 scores for General Health (p<.0001), Physical Functioning (p<.0001), Role Physical (p<.01), Social Functioning (p<.05), and Mental Health (p<.05). CONCLUSIONS: Workers compensation status is associated with poorer physical and mental health of patients with spinal disorders. Because the workers compensation group is younger, has a shorter duration of symptoms, and fewer comorbid medical problems, the lower SF-36 scores most likely reflect psychological factors and not ill health per se. The lower SF-36 scores may also reflect premorbid personality differences in the workers compensation patients, compared with those not receiving workers compensation. SF-36 is a validated tool that can be used to objectively identify the patient at risk for delayed recovery. Future treatment protocols should pay special attention to improve the health-related quality of life, especially general health and physical functioning of spinal patients receiving workers compensation.     

Preoperative psychological factors affecting surgical satisfaction of elderly patients with lumbar spinal stenosis

ObjectiveThe objective of this observational study was to investigate the effects of preoperative psychological factors on short-term patient satisfaction with surgery in elderly patients with lumbar spinal stenosis (LSS).MethodsSurgery was performed on 90 elderly patients with clinically and radiologically defined LSS: mean age at surgery, 73 years; 46 men and 44 women. Patients completed questionnaires before surgery and 1 year postoperatively. They used a self-administered the Roland Morris Disability Questionnaire (RDQ), the Japanese Orthopaedic Association Back Pain Questionnaire (JOABPEQ), MOS 36-Item Short-Form Health Survey (SF-36), and satisfaction for surgery (VAS) were completed. At baseline, psychological factors were assessed using the Self-Rating Questionnaire for Depression (SRQ-D), Hospital Anxiety and Depression scale (HADS), Pain Catastrophizing Scale (PCS), Pain Anxiety Symptoms Scale-20, and Brief Scale for Psychiatric Problems in Orthopaedic Patients (BS-POP). At follow-up, patient satisfaction was evaluated using 2 items: (1) satisfaction with surgery and (2) Would you undergo the same surgery again?.ResultsSatisfaction item 1 correlated negatively with the VAS for low back pain, leg pain, numbness, JOABPEQ social life disturbance score, SF-36 physical function score, and HADS anxiety score (p < 0.05). Satisfaction 2 correlated negatively with age at surgery, VAS of leg pain, PCS magnification score, and BS-POP score (p < 0.05). Multiple regression analysis showed significant associations between satisfaction 1 and SF-36 physical function and HADS anxiety scores, and between satisfaction 2 and PCS magnification score (p < 0.05).Statistical analysisThe preoperative factors independently associated with surgical satisfaction were analyzed utilizing Speaman’s rank correlation coefficient and multiple regression analysis.ConclusionPhysical function and anxiety were identified as preoperative factors that affected patient satisfaction with surgery. Preoperative assessment of psychological factors and interventions for anxiety may help improve patient satisfaction after surgery for LSS.     

Does Total Hip or Knee Arthroplasty Have an Effect on the Patients’ Functional or Behavioral Outcome and Health-Related Quality of Life of the Affected Partners?

BackgroundSpouses are the primary caregivers of patients living with osteoarthritis (OA). Little is known about how the quality of life (QoL) of OA patients’ partners change after total joint replacement surgery (TJR).MethodsPreoperative health status and 12-month postoperative outcomes were evaluated and compared in 24 couples using the Short-Form 36 (SF-36), knee or hip specific Osteoarthritis Outcome Score (OOS) and accelerometry for the assessment of habitual physical activity (PA) and sedentary behavior (SB). Correlations between the changes in the patients’ OOS subscales scores, habitual activity, and their partners’ SF-36 scores were calculated.ResultsFollowing TJR the patients’ OOS subscale scores showed positive changes (P < .001). The SF-36 physical component summary (PCS) score improved (P < .001), while the mental component summary (MCS) score as well as PA and SB remained unchanged (P ≥ .093). Their partners’ PCS, MCS, and SB did not change (P ≥ .286), whereas the PA even decreased (P = .027). Correlation analyses showed positive results for the changes in the patients’ OOS subscale pain and the changes in their partners’ MCS (r = 0.355, P = .048) as well as the changes in the patients’ OOS subscale activities of daily living and the changes in the PCS of their partners (r = 0.406, P = .027). In contrast to the results described above, changes in the patients’ PA were negatively correlated with changes in their partners’ PCS (r = ?0.389, P = .033).ConclusionTJR has a positive influence on QoL but not the habitual activity of OA patients. Their partners, on the other hand, show no changes in QoL and even a slight decrease in habitual activity.