Responsiveness of the Chinese version of the Oswestry disability index in patients with chronic low back pain

The Oswestry Disability Index (ODI) is one of the most widely used questionnaires that assess disability in patients with low back pain (LBP). Responsiveness is both an important psychometric property of an instrument and a key issue for clinicians when choosing suitable outcome measures. The objective of this study was to examine the responsiveness of the Chinese version of the ODI (ODI-Chinese) for subjects with chronic LBP following a physical therapy program. In total, 76 patients with chronic LBP completed the ODI-Chinese, a visual analog scale (VAS) of pain, and the Chinese version of Short Form-36 (SF-36) before and after treatment. All patients also completed a global perception of change Likert scale in condition after the program. The scale was collapsed to produce a dichotomous variable outcome, improved or non-improved. The responsiveness of the instruments was determined using the standardized response means (SRM) and receiver operating characteristics (ROC). After treatment, 56 patients considered themselves to be improved. The SRM of the ODI-Chinese was −1.2 in the improved group and −0.4 in the non-improved group. The area of the ROC curve for the ODI-Chinese was 0.77 (95% CI 0.66–0.89). Therefore, the Chinese version of the ODI is both responsive and appropriate for use in chronic LBP patients after conservative therapy.     

Can patients with low energy whiplash associated disorder develop low back pain?

800 consecutive claimant generated medicolegal reports were analysed for symptomatology of whiplash associated disorder (WAD) including the presence of mid and low back pain. We aimed to establish whether the two were linked and if so if there were correlations between accident vector and severity. We also aimed to establish if a low back injury could result from a vehicular accident in the absence of a neck injury. In addition we examined if occupant bracing and occupant neutral position at the time of the accident affected symptom patterns. We found that a claimed back injury following WAD was independent of both accident severity and accident vectors, approximately 40% claiming injury in low, medium and high violence groups and with rear, frontal and side impact. We established that it was unusual to have a back injury in the absence of a neck injury (18 out of 325, 5.5%) without a past medical history of back pain (72.2% of this group having previous back pain). Occupant bracing was not protective. We also showed that occupant neutral position was not protective against a back injury. We were surprised that patients with next to no car damage had the same incidence of back pain as those involved in more violent crashes when biomechanically unlikely. The complex biopsychosocial response and the relationship to constitutional factors are discussed. The literature concerning forces across the lumbar spine and possibilities of injury is reviewed.     

Oswestry功能障碍指数评定腰痛患者的可信性

目的 :探讨Oswestry功能障碍指数 (OswestrydisabilityIndex ,ODI)应用于腰痛患者评定的可信性。 方法 :住院拟手术的腰痛患者 2 2例 (男 13,女 9例 ) ,分为同一检查者重复评定 (A组 ) :10例 ,平均年龄 4 7 7岁 ;不同检查者重复评定 (B组 ) ,12例 ,平均年龄 36 6岁。用ODI对所有对象重复评定 ,平均间隔 3 0d。对两组患者的障碍指数进行Pearson相关分析。结果 :两组重复测试ODI的相关系数分别为 0 95 3和 0 912 ,相关性非常显著 (A组 :t =8 85 1,P <0 0 0 1;B组 :t=7 0 0 8,P <0 .0 1)。结论 :用ODI评定腰痛是稳定、可靠的 ,可作为腰痛患者是否需要手术或康复疗效评定的参考指标。     

2010年北京地区18岁及以上人群腰痛患病率研究

 目的 了解2010年北京地区18岁及以上人群腰痛患病现状。方法 研究设计为横断面研究,采用多阶段抽样方法,于2010年12月对北京地区18岁及以上的常住居民腰痛患病情况进行问卷调查,计算腰痛总患病率、地区和人群(性别、年龄)腰痛患病率。不同性别地区患病率的比较采用卡方检验;不同年龄腰痛患病率采用趋势卡方检验;年龄组内某几组年龄患病率的比较采用分割卡方检验。结果 3860例研究对象纳入分析。腰痛年患病率为26.09%(1007/3860)。腰痛时点患病率为6.11%(236/3860)。腰痛持续时间< 3个月的患病率为16.76%(647/3860);3~6个月的患病率为4.12%(159/3860);≥6个月的患病率为5.21%(201/3860)。男性患病率(23.03%)低于女性(28.83%);中心城区(20.88%)低于郊县城区(29.88%)和农村(27.54%);对于男性,郊县患病率最高(28.42%),农村次之(23.47%),中心城区最低(17.48%)。对于女性,郊县和农村的患病率均高于中心城区。年龄越高,患病率越高,55~岁组男性患病率最高,60~岁组女性患病率最高;中心城区和农村60~岁组患病率最高(34.43%和48.68%),郊区55~岁组最高(47.26%)。结论 北京地区18岁及以上人群腰痛年患病率、时点患病率较高,慢性腰痛更突出,且分布范围广,腰痛在北京地区处于流行状态;腰痛患病率存在郊县和农村地区较高,女性较高,随年龄增加而升高的分布特征。     

Effectiveness of a short functional restoration program for patients with chronic low back pain: A cohort study of 193 patients

BackgroundFunctional restoration programs (FRPs) are integrative programs to improve function in chronic low back pain (cLBP). They are costly and time-consuming. The aim was to assess the effectiveness of a condensed FRP (CFRP) for patients with cLBP in professional activity.MethodsLongitudinal 3 months study of patients with cLBP in one tertiary care hospital, participating in a CFRP over 4 separate days. The primary outcome was the Oswestry Disability Index (ODI). Secondary outcomes included pain, quality of life (EQ5D), patient acceptable symptom state, presenteeism, absenteeism and psychological distress. Outcomes were compared using paired sample Student's t-test or Chi² between baseline and last follow-up. Logistic regression was used to identify factors associated with better response (improvement of ODI higher than 12.8).ResultsIn all, 193 patients were analysed, mean age 44.6 (standard deviation (SD) 10.4) years, mean cLBP duration 9.0 (SD 8.8) years. A small improvement was observed for ODI (mean difference −5.9, 95% confidence interval: −7.6, −4.1), as well as most other outcomes. Multivariate analysis showed an association between ODI improvement and higher duration of low back pain (odds ratio for 5 years: 1.41 (1.06,1.88)) and lower baseline back strength (Sorensen, odds ratio for 1 min: 0.54 [0.29,0.99]).ConclusionThis CFRP showed small effect to improve function, pain and other quality of life, in cLBP. Four-day programs may be an interesting option in cLBP patients still in professional activity for whom a long 1-month FRP is difficultly manageable. Further studies with randomized controlled designs are needed to confirm the benefits.     

Responsiveness of the Brazilian–Portuguese version of the Oswestry Disability Index in subjects with low back pain

When quality of life questionnaires are used as measures of treatment outcomes, it is essential to know how well these can respond to clinical changes. The objective of this study is to examine the responsiveness of the Brazilian–Portuguese version of the Oswestry Disability Index (ODI-Brazil) in subjects with chronic low back pain submitted to a physical therapy program. Thirty subjects with chronic low back pain completed the ODI-Brazil questionnaire, along with an 11-point pain visual analogue scale (Pain VAS), and the Brazilian–Portuguese version of Roland–Morris disability questionnaire before and after the program. All patients also completed a global perception of change Likert scale in condition after the program. This scale was collapsed to produce a dichotomous variable outcome: improved and non-improved. Responsiveness was determined using effect size statistics and receiver operating characteristic curve (ROC curve), with best cut-point analysis. The best change score cut-off was identified when equally balanced sensitivity and specificity was found, as an expression of the minimum clinically important difference (MCID). After treatment, 19 patients considered themselves improved. Both the effect size (0.37) and the area under the ROC curve (0.73) for ODI-Brazil score in relation to global outcome after program indicated that the ODI-Brazil showed responsiveness. The ROC curve for ODI-Brazil was distributed at the upper corners of the diagonal line, indicating that the questionnaire presents discriminative ability. The best cut-off point for ODI-Brazil was approximately 4.45 points (63.2% sensitivity, 81.8% specificity). The Brazilian–Portuguese version of ODI has comparable responsiveness to other commonly used functional status measures and is appropriate for use in chronic low back pain patients receiving conservative care.     

Management of facet joints osteoarthritis associated with chronic low back pain: A systematic review

IntroductionFacet joint injections (FJI) and medial branch blocks (MBB) can be employed for chronic low back pain (LBP) using different drugs such as corticosteroids, hyaluronic acid, sarapin and local anaesthetics. This systematic review compares the results of injections obtained with different compounds in the management LBP originating from facet joints.MethodsThe present systematic review was conducted according to the PRISMA statement. The literature search was performed in October 2020. All the randomized clinical trials concerning injection treatments for chronic LBP. Drugs rather than steroids, hyaluronic acid, anaesthetics and sarapin were not considered, as well as those reporting outcomes from combined treatments. The Oswestry Disability Index (ODI) and the numeric rating scale (NRS) were retrieved.ResultsData from 587 patients were retrieved. The mean follow-up was 12.4 ± 10.5 months. The mean age was 51.3 ± 9.6 years old. 57% (335/587) of patients were women. Steroids promoted a reduction of NRS by 28% (P < 0.0001) and an improvement of the ODI by 13.2% (P = 0.005), and local anaesthetics produced an improvement of the ODI by 9.8% (P < 0.0001). Sarapin resulted in a reduction of NRS by 44% (P = 0.04) and an improvement the ODI by 14.9% (P = 0.004); sarapin combined with steroids promoted a reduction of NRS by 47% (P = 0.04) and an improvement of the ODI by 11.7% (P = 0.001).ConclusionInjections for chronic LBP deriving from facet joints osteoarthritis are encouraging, especially when considering MBB.Level of evidenceI, systematic review of RCTs.     

多发性硬化患者的腰背痛危险因素分析

目的 :通过调查多发性硬化患者的肌肉骨骼疾病及腰背痛,试图找到相关的危险因素。方法 :选择我院确诊为多发性硬化并且EDSS评分在4~7分的患者进行研究。收集记录患者的病史、疼痛、肌肉骨骼疾病、肌力和下肢痉挛状态。结果:190例患者被纳入研究对象,平均年龄(54.9±9.2)岁,男61例,女129例,病程(19.3±9.9)年,EDSS 4~7分。52例为复发缓解型,45例为原发进展型,93例为继发进展型。最常见的肌肉骨骼疾病表现为:膝关节骨关节炎(15例),爪状趾(13例),膝关节过伸(12例)。腰背痛患者共79例,在进展型患者中则更高(继发进展型:OR=2.958,P=0.007 9;原发进展型:OR=2.629,P=0.039 8)。EDSS量表中出现视觉功能障碍的患者,则出现腰背痛的概率越大(OR=1.411,P=0.012 4)),男性患者较女性患者腰背痛少(OR=0.306,P=0.001 4)。结论 :进展型及出现了视觉功能障碍的多发性硬化患者拥有更高的腰背痛风险。     

Relationship between psychological factors and performance-based and self-reported disability in chronic low back pain

Cross sectional study, performed in an outpatient university based pain rehabilitation setting. To analyze the relationship between psychological factors (psychosocial distress, depression, self efficacy, self-esteem, fear of movement, pain cognitions and coping reactions) and performance-based and self-reported disability, as measured with a Functional Capacity Evaluation (FCE) and the Roland Morris Disability Questionnaire (RMDQ), in patients with chronic low back pain (CLBP). It has been suggested that a strong relationship exists between psychological factors and disability in patients with CLBP. In former research disability was often measured by self-report and seldom performance-based. Study sample consisted of 92 patients with CLBP admitted for multidisciplinary rehabilitation. Prior to treatment, all patients completed questionnaires to measure psychological factors and self-reported disability, and performed an FCE to measure performance-based disability. Correlation coefficients between psychological variables and FCE and self-reported disability were calculated. Multivariate linear regression analyses were performed with self-reported or performance based disability measures as outcome variables, and psychological measures as predictor variables. Out of 42 relations analyzed, 5 were statistically significant. This concerned one significant correlation between kinesiophobia and a subtest of FCE, and four correlations between psychological factors and RMDQ. No correlation was significant after the Bonferroni correction was applied (P < 0.001). The strength of significant correlations ranged from r = −0.33 to r = 0.25. The multivariate analysis revealed that psychological variables measured in this study could explain 19% of the variance of self-reported disability, with kinesiophobia being the only psychological variable that contributed significantly. The suggested strong relationship between psychological factors and performance-based and self-reported disability could not be confirmed in this study. This may implicate that the relationship between psychological factors and disability in patients with CLBP is not as unambiguous as suggested.     

Selective changes in multifidus dimensions in patients with chronic low back pain

Summary This study of 52 patients (27 men) with recent (18 months) or chronic (>18 months) low back and unilateral radicular pain symptoms was undertaken to investigate whether wasting of the paraspinal muscle components is generalised or selective. During the patients' routine computed tomographic lumbar spinal scans a standardised transaxial view was obtained along the upper end-plate of the L4 vertebra, and the cross-sectional areas of the paraspinal muscles and their components, multifidus and erector spinae, estimated. Irrespective of whether the symptoms were recent or chronic, multifidus dimensions were significantly greater on the side ipsilateral to the radicular pain symptoms. The results indicate selective changes of multifidus in these patients and possibly reflect an adaptive response by this muscle, such as to an increased role in stabilising the lumbar spine in the face of overall paraspinal muscle atrophy. Present address: Royal Hospital and Home, Putney, West Hill, London SW15 3SW, UK     

汉译Roland-Morris功能障碍调查表评估下腰痛患者的可靠性

目的:探讨应用汉译Roland-Morris功能障碍调查表评定下腰痛患者的可靠性。方法:将Roland-Morris功能障碍调查表按一定的要求翻译成中文调查表(CRMDQ),对48例住院拟手术的下腰痛患者(男30例,女18例;年龄26～73岁,平均38.5岁),用CRMDQ、中文版Oswestry功能障碍指数(CODI)、视觉模拟评分(VAS)先后进行两次测试,间隔期2d,检测CRMDQ的可重复性;对门诊158例下腰痛患者在就诊时行CRMDQ、CODI、VAS测试,对CRMDQ与CODI、VAS测试结果进行Spearman秩相关分析。结果:CRMDQ具有良好的可重复性(r=0.945,P<0.01);在CRMDQ有效性测试中,与CODI、VAS比较显示出显著的相关性(CRMDQ-CODI:r=0.386;CRMDQ-VAS:r=0.478,P<0.05)。结论:CRMDQ测试具有良好的可重复性和有效性,可用于对下腰痛患者的功能障碍评估。     

椎间盘源性腰痛髓核成形术

髓核成形术是近些年提出或完善的治疗椎间盘源性腰痛的新型治疗方式.本文着重介绍了椎间盘源性腰痛髓核成形术的产生、手术适应证和禁忌证、技术方法、术后处理、临床疗效及治疗体会.     

国外急性腰痛的治疗进展

急性腰痛为临床常见病,也称单纯性或非特异性急性腰痛.其病因主要为机械性外力损害,如搬提重物、扭转腰部,或长时间坐位,操作振动性工具等.损害部位以腰部软组织为主,如肌肉、筋膜、韧带、关节囊,还包括椎间关节及骶髂关节的损伤;椎间盘纤维环可能发生不全撕裂,但不伴有髓核向椎管内的突出,破裂椎间盘的渗出物可能造成神经根的炎性反应.急性发病及外伤史对诊断有意义.腰部或骶髂关节处可见弥漫性或局限性压痛,腰椎活动可能引发腰痛;腰痛可放射至臀部及下肢,但多在膝关节水平以上.损伤组织的痉挛可使患者呈被动的僵直体位,不能做屈或伸的运动[1].腰椎的放射学检查对诊断通常无帮助,仅作为排除性方法以区分出腰椎的骨折、肿瘤、脊柱滑脱等[2].……     

Patterns of sick-leave and health outcomes in injured workers with back pain

Little is known about the sick-leave experiences of workers who make a workers’ compensation claim for back pain. Our objective is to describe the 1-year patterns of sick-leave and the health outcomes of a cohort of workers who make a workers’ compensation claim for back pain. We studied a cohort of 1,831 workers from five large US firms who made incident workers’ compensation claims for back pain between January 1, 1999 and June 30, 2002. Injured workers were interviewed 1 month (n = 1,321), 6 months (n = 810) and 1 year (n = 462) following the onset of their pain. We described the course of back pain using four patterns of sick-leave: (1) no sick-leave, (2) returned to worked and stayed, (3) multiple episodes of sick-leave and (4) not yet returned to work. We described the health outcomes as back and/or leg pain intensity, functional limitations and health-related quality of life. We analyzed data from participants who completed all follow-up interviews (n = 457) to compute the probabilities of transition between patterns of sick-leave. A significant proportion of workers experienced multiple episodes of sick-leave (30.2%; 95% CI 25.0–35.1) during the 1-year follow-up. The proportion of workers who did not report sick-leave declined from 42.4% (95% CI 39.0–46.1) at 1 month to 33.6% (28.0–38.7) at 1 year. One year after the injury, 2.9% (1.6–4.9) of workers had not yet returned to work. Workers who did not report sick-leave and those who returned and stayed at work reported better health outcomes than workers who experienced multiple episodes of sick-leave or workers who had not returned to work. Almost a third of workers with an incident episode of back pain experience recurrent spells of work absenteeism during the following year. Our data suggest that stable patterns of sick-leave are associated with better health.     

Recent advances in the treatment of low back pain

Summary There is at the present time an epidemic of low back pain in the industrialized countries. Although the exact origin of such pain is still unknown, there is increasing awareness that the outcome is usually favourable. Only some 10% of those suffering an acute episode of back pain are incapacitated for more than 6 weeks. The causes of long standing back pain are being identified in an increasing number of patients. They include anatomical and pathological disturbances in the motion segment as well as psychological, social and political causes. There are numerous factors which influence the pathophysiology of the motion segment. The degree of loading has been successfully measured and delineated for various postures and exercises, including those at work. The nutritional pathways to the disc have been established and the effect of various external factors measured. Movement is good for the disc and the importance of continuous passive motion for the healing of diseased or injured connective tissues is now established. Activation of large muscle groups increases the production of the body's pain reducing encephalins. Early diagnosis and early mobilisation of the patient should be of benefit, and long term bed rest and inactivity must be prevented. Fewer cases will need operation in the future. Improved imaging techniques and better methods of operation and fixation will help those few who have a definite pathological lesion amenable to surgery.Current trends lecture SICOT 1984