Use of the Pediatric Outcomes Data Collection Instrument to evaluate functional outcomes in arthrogryposis.

BACKGROUND: The Pediatric Outcomes Data Collection Instrument (PODCI) is a subjective measurement tool designed to provide a standardized method of assessing outcomes in pediatric musculoskeletal conditions. It has earlier been shown to be useful in several pediatric musculoskeletal conditions, but there is currently no widely accepted subjective outcome measurement tool for children with arthrogryposis. METHODS: The PODCI was administered to parents of 74 children diagnosed with amyoplasia. The score distributions were compared with values published earlier for children without musculoskeletal disorders. For those patients with repeated PODCI administrations over time, the initial score was compared with the most recent score. Comparisons were made using the Student t test. RESULTS: PODCI scores in children with amyoplasia were significantly lower than those for typically developing children in all 6 domains. The scores were also more normally distributed than those for typically developing children in all 6 domains. Over an average follow-up period of approximately 3 years, children with amyoplasia had a statistically significant increase in scores for upper extremity function, sports participation, and global functioning. CONCLUSIONS: These results show that the PODCI is useful in evaluating functional outcomes of children with amyoplasia, and is sensitive to change in function over time. The PODCI shows promise as a tool to evaluate long-term outcomes of surgical management in amyoplasia. LEVEL OF EVIDENCE: Diagnostic Study, Level III.

Preferences among five nicotine treatments based on information versus sampling.

Smokers' minimal exposure to nicotine replacement treatments (NRTs) may account for poor compliance and outcome with these treatments. This study tested effects of information versus sampling of NRTs on smokers' preferences and expectations. The study was a crossover comparing information-only (INF) with sampling (SMP) methods for five NRTs: gum (2 and 4 mg), lozenges (2 and 4 mg), and inhalers. Subjects were given computer-based presentations on NRTs (INF) and rated and ranked use variables (e.g., ease, sensory/ritual, perceived relief, embarrassment) and overall choice for "use to quit." After INF testing, subjects sampled each NRT (SMP) and again rated and ranked drugs. SMP was brief (4 min) to mimic potential use in practice. Results showed changes in perceptions and preferences post-SMP. NRT preferences shifted for overall "use to quit" (59%) and most use variables (43%-63%) post-SMP. Inhalers (generally top choice) showed a 20% drop in choice to quit (p<.04) and a 24% drop in anticipated "relief of withdrawal" (p<.04) post-SMP; 4-mg lozenge ratings increased for "relief of withdrawal" (p<.02). Ratings improved post-SMP for three of the five NRTs ("ease of use," p<.05) but were reduced overall for liking "sensory action" (p<.003) and reduced for all but 2-mg gum for "use to quit" (p<.03). Positive changes were seen in improved ratings of NRTs chosen post-SMP. Given that reactions to NRTs change with experience, sampling should allow for a more realistic choice of NRT (self-tailoring) and better compliance versus current trial-and-error methods.

Thoracolumbar deformity arthrodesis stopping at L5: fate of the L5-S1 disc, minimum 5-year follow-up.

STUDY DESIGN: A retrospective long-term follow-up study. OBJECTIVE: Evaluate the fate of L5-S1 disc analyzing subsequent disc degeneration and associated risk factors for degeneration at minimum 5-year follow-up (average 9-year follow-up). SUMMARY OF BACKGROUND DATA: Two previous studies reported the results of long deformity fusions terminating at L5 with minimum 2-year follow-up only. METHODS: Thirty-one consecutive patients with an average age of 45 years (range, 20-62 years) were fused from the thoracic spine to L5 and were evaluated at a mean follow-up of 9.4 years (range, 5-20.1 year). Patients were evaluated before surgery, after surgery, and latest follow-up with radiographs and Scoliosis Research Society Patient Questionnaire-24 scores. Disc degeneration using validated radiographic Weiner grades. Grade 0 to 1 discs were "healthy" and Grade 2 to 3 were degenerated. Patients with "healthy" discs preoperative that subsequently degenerated were designated subsequent advanced degeneration (SAD). RESULTS: Two out of 31 patients had preoperative advanced degeneration of the L5-S1 disc (Weiner grade 2-3). Three additional patients had an early revision to the sacrum secondary to sagittal imbalance not thought to be related to SAD. Twenty-six out of 31 patients were assessed as "healthy discs" preoperative (Weiner grade 0-1) and were evaluated for SAD. By latest follow-up, L5-S1 SAD developed in 18 of these 26 patients (69%). Risk factors for the development of SAD included long fusions extending into the upper thoracic spine down to L5 (P = 0.02) and having a circumferential lumbar fusion (P = 0.02). Although preoperative sagittal balance was not significantly different between the "healthy" and SAD group, sagittal balance at follow-up was: C7 plumb >5 cm in 67% of SAD patients and only 13% of "healthy" disc patients (P = 0.009). There was a trend toward inferior Scoliosis Research Society Patient Questionnaire-24 pain scores at follow-up in SAD patients (average score 4.1 vs. 3.4, P = 0.13). Eleven out of 30 patients (35%) had subsequent spinal surgery with 7 of 31 (23%) having extension of their fusion to the sacrum. An additional 6 of 31 (19%) were considered for extension to the sacrum but comorbidities precluded surgery (3 patients) or the patients declined further surgery (3 patients). CONCLUSION: Advanced L5-S1 DDD developed in 69% of deformity patients after long fusions to L5 with 5 to 15 year follow-up. SAD frequently results in significant positive sagittal balance at a minimum 5-year follow-up. Long fusions to the upper thoracic spine down to L5 and circumferential fusion may further promote subsequent L5-S1 disc degeneration.