Preferences and Avoidance of Sleeping Positions Among Patients With Chronic Low Back Pain: A Cross-Sectional Study.

Background Chronic low back pain (CLBP) is a common issue among the working-age population. Sleeping position may affect CLBP, with the prone position commonly suggested to be avoided. This study aims to examine the relationship between preferred and avoided sleeping positions and to explore the frequency of increased pain in various sleeping positions among patients with nonspecific CLBP and pain and disability levels. Methods This cross-sectional study included all adult patients referred for specialist consultation for CLBP at the outpatient clinic of the Central Hospital of Central Finland's spine department. Pain intensity was measured using a visual analog scale (VAS), and disability was assessed with the Oswestry Disability Index (ODI). Patients completed a questionnaire detailing the main sleeping positions and positions avoided due to low back pain (LBP). Results The study enrolled 375 consecutive patients, with a mean age of 51 ± 17 years; 64% (n=240) were female. The mean VAS score was 63 ± 24, and the mean Oswestry Index was 38 ± 18%. The majority of patients (87%, n=327) reported sleeping in a side-lying position, followed by supine (47%, n=176) and prone (22%, n=82) positions. A negative correlation was found between age and the preference for sleeping in the prone position. No significant gender differences in sleep positions were observed (p=0.69). Sleep was disturbed in 77% of patients (n=289) due to LBP, and 87% (n=327) reported difficulties due to LBP when getting up. Overall, 92% of participants (n=345) experienced difficulties sleeping or getting up in the morning due to LBP. Many patients avoided certain positions due to pain: 42% (n=157) avoided the prone position, 35% (n=131) the back, 15% (n=56) the left side, and 13% (n=49) the right side. Although the prone position was most commonly linked with pain, especially among women, our findings suggest that any sleeping position could potentially exacerbate pain in individuals with CLBP. Conclusions This study highlights the variability in how sleeping positions affect pain in patients with nonspecific CLBP. While the prone position is most frequently associated with increased pain, individual preferences and responses vary significantly, and often sidelying and supine positions provoke pain. The diversity in sleeping positions that exacerbate pain highlights the need for tailored advice in the management of patients with CLBP.

Trunk muscle activation of core stabilization exercises in subjects with and without chronic low back pain.

BACKGROUND: Weakness and atrophy in trunk muscles have been associated with chronic low back pain (CLBP). OBJECTIVE: This study aimed to identify isometric exercises resulting the highest trunk muscle activity for individuals with and without CLBP. METHODS: Fourteen males with CLBP and 15 healthy age-matched healthy subjects were recruited for this study. Muscle activity during maximal voluntary isometric contraction (MVIC) was measured for a comparative reference with surface electromyography (sEMG) from six trunk muscles. Thereafter maximum EMG amplitude values were measured during eleven trunk stability exercises. The maximal EMG activity in each exercise relative to the MVICs was analyzed using generalizing estimating equations (GEE) models with the unstructured correlation structure. RESULTS: The GEE models showed statistically significant differences in muscle activity between exercises within both groups (p< 0.001), with no significant differences between groups (p> 0.05). The highest muscle activity was achieved with the hip flexion machine for multifidus, side pull with a resistance band for lumbar extensors, side and single-arm cable pull exercises for thoracic extensors, rotary plank and the hip flexion machine for abdominal. CONCLUSION: This study found five isometric trunk exercises that exhibited highest muscle activity depending on muscle tested, with no significant difference between individuals with and without CLBP.

Neck-Shoulder Region Training for Chronic Headache in Women: A Randomized Controlled Trial.

OBJECTIVES: We investigated whether a specific exercise program for the neck-shoulder region reduces headache intensity, frequency, and duration, and how it influences neck disability among women with chronic headache compared to a control group. DESIGN: Two-center randomized controlled trial. SUBJECTS: 116 working-age women. INTERVENTION: The exercise group (n = 57) performed a home-based program with six progressive exercise modules, over 6 months. The control group (n = 59) underwent six placebo-dosed transcutaneous electrical nerve stimulation sessions. Both groups performed stretching exercises. MAIN MEASURES: The primary outcome was pain intensity of headache, assessed using the Numeric Pain Rating Scale. Secondary outcomes were frequency and duration of weekly headaches, and neck disability assessed using the Neck Disability Index. Generalized linear mixed models were used. RESULTS: Mean pain intensity at baseline was 4.7 (95% CI 4.4 to 5.0) in the exercise group and 4.8 (4.5 to 5.1) in the control group. After 6 months the decrease was slight with no between-group difference. Headache frequency decreased from 4.5 (3.9 to 5.1) to 2.4 (1.8 to 3.0) days/week in the exercise group, and from 4.4 (3.6 to 5.1) to 3.0 (2.4 to 3.6) in the control group (between-group p = 0.017). Headache duration decreased in both groups, with no between-group difference. Greater improvement in the Neck Disability Index was found in the exercise group (between-group change -1.6 [95% CI -3.1 to -0.2] points). CONCLUSION: The progressive exercise program almost halved headache frequency. The exercise program could be recommended as one treatment option for women with chronic headache.

Comparison of magnetic resonance imaging findings among sciatica patients classified as centralizers or non-centralizers.

OBJECTIVE: To compare if the degenerative findings from MRI differ between the sciatica patients classified as centralizers (CEN) and non-centralizers (Non-CEN) according to the McKenzie Method of mechanical diagnosis and therapy. STUDY DESIGN: A cross-sectional study. METHODS: Patients (N = 100) referred to a spine clinic of a single tertiary hospital for specialist consultation for sciatica. The McKenzie-based assessment was performed by the mechanical diagnosis and therapy-trained physiotherapists. Clinical data and prevalence of lumbar MRI findings were compared between the groups. RESULTS: There was no significant difference in leg pain intensity between the groups. The Non-CEN had significantly more intense back pain, mean 56 (SD 30) and were more disabled 44 (SD 15) compared to the CEN mean 41 (SD 25) and mean 31 (11), measured with a visual analogue scale (0-100), and the Oswestry Disability Index (0-100), respectively. The CEN had more severe degenerative findings on MRI than the Non-CEN: vertebral end-plate changes were 63% and 43%; mean Pfirrmann's disc degeneration lumbar summary score was 12.8, and 10.6; and severity score of total damage was 12.0 and 10.1, respectively. There were differences neither in disc contour changes nor nerve root stenosis on MRI. CONCLUSIONS: Sciatica patients classified as non-centralizers had significantly more severe back pain, and were significantly more disabled than centralizers, who instead had more severe degenerative findings on MRI. Thus, classification to non-centralizers by the McKenzie method seems not predict higher incidence of degenerative findings on MRI compared to centralizers.

Psychometric Properties of the Scoliosis Research Society Questionnaire (Version 22r) Domains Among Adults With Spinal Deformity: A Rasch Measurement Theory Analysis.

OBJECTIVE: Adult spinal deformity (ASD) have lower health-related quality of life (HRQoL) compared to the general population. Applying Rasch measurement theory (RMT), this study tested the revised Scoliosis Research Society-22 (SRS-22r) HRQoL instrument among symptomatic adult patients with degenerative spinal disorders and varying degrees of ASD. METHODS: SRS-22r data from 637 outpatient spine clinic patients with degenerative spine conditions were investigated for unidimensionality, item/scale fit, differential item functioning (DIF), scale coverage/targeting, and person separation index (PSI) using RMT. RESULTS: Unidimensionality of the SRS-22r was not supported for either the total score or for 3 of its 5 domains. Item fit was acceptable for 11/22 items. The individual domains showed good coverage despite the degree of structural disorders. Ordered thresholds were achieved by merging response categories in some of the items. DIF towards age or sex was found in 11/22 items and in some domain items. The PSI exceeded 0.7 for the SRS-22r total score. CONCLUSION: The individual domain scores of the SRS-22r perform better than the total score providing good coverage and targeting among patients with ASD. Refinements of items and domains may improve the structural validity of the instrument to meet the criteria for measuring ASD patients, even when multidimensionality persists.

Lower thoracic spine extension mobility is associated with higher intensity of thoracic spine pain.

OBJECTIVES: To evaluate the association of thoracic spine (TS) posture and mobility with TS pain. METHODS: Participants with TS pain reported maximum, average, and night pain in TS area, and pain summary score was calculated. Upright and sitting TS postures were evaluated by inspection. TS posture and mobility (flexion and extension) were recorded using an inclinometer and a tape measure, respectively. Correlations between posture and mobility assessments were calculated using Spearman rank correlation, the association of TS posture and mobility with TS pain by logistic regression analysis. RESULTS: The participants' (n = 73, 52 females, age range 22-56) TS pain duration was 12 weeks on average. The correlations for measurements of TS posture and flexion mobility were higher than correlations of other TS measurements being between 0.53 and 0.82. Decreased extension mobility of the upper (from 1st to 6th TS segments; Th1-Th6) TS was associated with higher worst pain (OR 1.04, 95% CI 1.00-1.07) and whole TS with pain sum score (OR 1.05, 95% CI 1.01-1.08). Less kyphotic whole TS was associated with lower pain sum score (OR 0.96, 95% CI 0.92-1.00). Greater flexion mobility of upper and lower (Th6-Th12) TS were associated with lower pain sum score (OR 0.96, 95% CI 0.91-1.00, and OR 0.96, 95% CI 0.91-1.00, respectively). CONCLUSIONS: Reduced thoracic extension mobility was associated with higher pain scores and the greater flexion mobility with lower pain scores. Future research is warranted to evaluate if treatments geared toward TS extension mobility improvements would result in lower TS pain.

Associations of neck muscle strength and cervical spine mobility with future neck pain and disability: a prospective 16-year study.

BACKGROUND: Neck pain has been associated with weaker neck muscle strength and decreased cervical spine range of motion. However, whether neck muscle strength or cervical spine mobility predict later neck disability has not been demonstrated. In this 16-year prospective study, we investigated whether neck muscle strength and cervical spine mobility are associated with future neck pain and related disability in women pain-free at baseline. METHODS: Maximal isometric neck muscle strength and passive range of motion (PROM) of the cervical spine of 220 women (mean age 40, standard deviation (SD) 12 years) were measured at baseline between 2000 and 2002. We conducted a postal survey 16 years later to determine whether any subjects had experienced neck pain and related disability. Linear regression analysis adjusted for age and body mass index was used to determine to what extent baseline neck strength and PROM values were associated with future neck pain and related disability assessed using the Neck Disability Index (NDI). RESULTS: The regression analysis Beta coefficient remained below 0.1 for all the neck strength and PROM values, indicating no association between neck pain and related disability. Of the 149 (68%) responders, mean NDI was lowest (3.3, SD 3.8) in participants who had experienced no neck pain (n = 50), second lowest (7.7, SD 7.1) in those who had experienced occasional neck pain (n = 94), and highest (19.6, SD 22.0) in those who had experienced chronic neck pain (n = 5). CONCLUSIONS: This 16-year prospective study found no evidence for an association between either neck muscle strength or mobility and the occurrence in later life of neck pain and disability. Therefore, screening healthy subjects for weaker neck muscle strength or poorer cervical spine mobility cannot be recommended for preventive purposes.

Use of conservative therapy before and after surgery for carpal tunnel syndrome.

BACKGROUND: Conservative therapies are typically offered to individuals who experience mild or intermittent symptoms of carpal tunnel syndrome (CTS) or postoperatively to subjects who have undergone carpal tunnel release. Although long-term studies report mostly positive results for carpal tunnel release, knowledge on the need for conservative treatments following surgery is scarce. The aim of this retrospective cohort study was to examine the use of conservative therapies before and after carpal tunnel releasing surgery. METHODS: Of 528 patients who underwent carpal tunnel release surgery in the study hospital during the study period, 259 provided sufficiently completed questionnaires (response rate 49 %). The patients completed a questionnaire battery including a sociodemographic, medical history and symptom questionnaire, the Boston Carpal Tunnel Syndrome Questionnaire, 6-item CTS symptoms scale and EuroQoL 5D. Frequencies of conservative therapies pre- and postoperatively were calculated. Association between Pain VAS and satisfaction with treatment were examined in patient groups according to the use of conservative therapies. RESULTS: Of all patients, 41 (16 %) reported receiving only preoperative, 18 (7 %) reported receiving only postoperative, 157 (60 %) reported receiving both pre- and postoperative conservative therapies and 43 (17 %) did not receive any therapies. Preoperative use of conservative therapies was more common in females than males (82 % vs. 64 %; p = 0.002), but postoperatively no significant gender difference was observed. The patients who received conservative therapies were younger than non-users in both the preoperative (median age 59 vs. 66; p < 0.001) and postoperative (59 vs. 66; p = 0.04) phases. The patients reported high satisfaction with their treatment and simultaneous improvement in Pain VAS scores. Those receiving conservative therapies only preoperatively reported the highest satisfaction. CONCLUSIONS: While the use of conservative therapies decreased after surgery, a large proportion of the patients received these adjunct interventions. Patients reported high satisfaction with their treatment one year post surgery. Pain outcome seems to be closely related to satisfaction with treatment. LEVEL OF EVIDENCE: Level III.

Effect of biomechanical footwear on upper and lower leg muscle activity in comparison with knee brace and normal walking.

AIM: To evaluate the activity of knee stabilizing muscles while using custom-made biomechanical footwear (BF) and to compare it when walking barefoot and with a knee brace (Unloader®). METHODS: Seventeen healthy working-aged (mean age: 29 years; standard deviation: 8 years) individuals participated. The knee brace was worn on the right knee and BF in both legs. Surface electromyography (sEMG) data was recorded bilaterally from vastus medialis (VM), semitendinosus (ST), tibialis anterior (TA) and lateral gastrocnemius (LG) muscles during walking, and repeated-measures ANOVA with a post-hoc t-test was used to determine differences between the different walking modalities (barefoot, brace and BF). RESULTS: Averaged sEMG was significantly higher when walking with BF than barefoot or knee brace in the ST muscles, in the right LG, and left TA muscle. It was significantly lower when walking with the brace compared to barefoot in the right ST and LG muscles, and left TA muscle. Analysis of the ensemble-averaged sEMG profiles showed earlier activation of TA muscles when walking with BF compared to other walking modalities. CONCLUSION: BF produced greater activation in evaluated lower leg muscles compared to barefoot walking. Thus BF may have an exercise effect in rehabilitation and further studies about its effectiveness are warranted.

Rasch validation of the Depression Scale among patients with low back pain.

BACKGROUND: The Depression Scale (DEPS) is a commonly used screening tool for major depression in studies investigating low back pain, yet it has not been validated for patients with back-specific problems. OBJECTIVE: To assess the psychometric properties of the DEPS in patients with degenerative spinal disease. METHODS: Six hundred and thirty-seven patients with a degenerative spinal disease completed the DEPS instrument. The Rasch Measurement Theory was applied to analyze the measurement properties of the DEPS. The main hypothesis-driven approach was whether the DEPS would meet relevant psychometric criteria for assessing depressive symptoms among patients with degenerative spinal disease. RESULTS: The Mean (SD) DEPS score was 9.2 (6.6). Scale minimum or maximum points among participants were 2.4% and 0.8%, respectively. Cronbach's alpha for internal consistency was 0.92. Person Separation Index for reliability was 0.88. All items had ordered thresholds and seven of the 10 items had good item fit. Unidimensionality of the DEPS was supported (proportion of significant t-tests, 4.5%). CONCLUSIONS: This study supports the validity of the DEPS for screening depressive symptoms in patients with degenerative spinal disease.

Further validation of the Scoliosis Research Society (SRS-30) questionnaire among adult patients with degenerative spinal disorder.

PURPOSE: The Scoliosis Research Society (SRS-30) questionnaire proved valid in measuring health-related quality of life (HRQoL) in adult patients with spinal deformity or degenerative disease. This study further assesses the validity of the SRS-30 by comparing its results with other HRQoL instruments, such as Oswestry disability index (ODI) and the RAND-36, among unselected adult patients with degenerative spinal disorder. MATERIALS AND METHODS: 628 consecutive patients completed the SRS-30, the ODI, the pain visual analog scale (VAS), and RAND-36 questionnaires. Using a 9 mm minimal important difference threshold of the VAS, patients were divided into three groups of symptom location: back pain (n = 226), lower extremity pain (n = 161), and combination of both (n = 241). Statistical and illustrative tests using beta coefficients, Rasch measurement analytics, and score distributions were used for analysis. RESULTS: The SRS-30 functioned well for all three subgroups. There were small differences in convergent validity of the SRS-30 compared to the ODI and the RAND-36 between the three subgroups. The SRS-30 performed similarly in different pain groups independent of age, gender, or deformity severity. The scale displayed good coverage and targeting for all three subgroups. CONCLUSIONS: The SRS-30 proved to provide valid HRQoL scores for all adult patients with degenerative spinal disorders. Implications for Rehabilitation Degenerative spinal conditions associated with spinal deformities are common in patients over 60 years. Low back pain is globally the leading cause of disability. The applicability of the Scoliosis Research Society (SRS-30) questionnaire has not been tested in relation to different pain origins. The SRS-30 proved to provide valid health-related quality of life assessment among patients with degenerative spinal disease independent of pain location. The SRS-30 questionnaire can be used to assess the level of disability and rehabilitation of patients with degenerative spinal disease.

Non-surgical and surgical treatments for rotator cuff disease: a pragmatic randomised clinical trial with 2-year follow-up after initial rehabilitation.

BACKGROUND: Rotator cuff disease (RCD) causes prolonged shoulder pain and disability in adults. RCD is a continuum ranging from tendinopathy to full-thickness tendon tear. Recent studies have shown that subacromial decompression and non-surgical treatments provide equivalent results in RCD without a full-thickness tendon lesion. However, the importance of surgery for full-thickness tendon tears remains unclear. METHODS: In a pragmatic, randomised, controlled trial, 417 patients with subacromial pain underwent 3-month initial rehabilitation and MRI arthrography (MRA) for the diagnosis of RCD. Of these, 190 shoulders remained symptomatic and were randomised to non-surgical or surgical treatments. The primary outcomes were the mean changes in the Visual Analogue Scale for pain and the Constant Murley Score for shoulder function at the 2-year follow-up. RESULTS: At the 2-year follow-up, both non-surgical and surgical treatments for RCD reduced pain and improved shoulder function. The scores differed between groups by 4 (95% CI -3 to 10, p=0.25) for pain and 3.4 (95% CI -0.4 to 7.1, p=0.077) for function. Among patients with full-thickness ruptures, the reduction in pain (13, 95% CI 5 to 22, p=0.002) and improvement in function (7.0, 95% CI 1.8 to 12.2, p=0.008) favoured surgery. CONCLUSIONS: Non-surgical and surgical treatments for RCD provided equivalent improvements in pain and function. Therefore, we recommend non-surgical treatment as the primary choice for patients with RCD. However, surgery yielded superior improvement in pain and function for full-thickness rotator cuff rupture. Therefore, rotator cuff repair may be suggested after failed non-surgical treatment. TRIAL REGISTRATION DETAILS: ClinicalTrials.gov, NCT00695981 and NCT00637013.

Structural validity of the Boston Carpal Tunnel Questionnaire and its short version, the 6-Item CTS symptoms scale: a Rasch analysis one year after surgery.

BACKGROUND: The Boston Carpal Tunnel Questionnaire (BCTQ) and its shorter version, the Six-Item Carpal Tunnel Symptoms Scale (CTS-6), are widely used for assessing function and/or symptoms in patients with carpal tunnel syndrome. This study examined the structural validity of the BCTQ and CTS-6 among patients who had undergone surgery for treatment of carpal tunnel syndrome. METHODS: The data for this cross-sectional analysis were obtained from 217 adult patients who had undergone carpal tunnel release surgery 1 year earlier. All patients completed the CTS-6, Symptom Severity Scale (SSS) and Functional Status Scale (FSS) of the BCTQ at 12 months after surgery. The Rasch Measurement Theory (RMT) was applied to investigate the unidimensionality, residual correlation, differential item functioning, scale coverage/targeting, and person separation of the CTS-6, SSS and FSS of the BCTQ. RESULTS: The FSS showed unidimensionality and good scale and item fit. All items showed ordered response category thresholds. Eight of the FSS items displayed differential item functioning favoring age or gender. The multidimensional structure of the CTS-6 was absorbed by creating a testlet for frequency of symptoms or testlets for pain and numbness. The testlets supported unidimensionality in the BCTQ SSS. One item in the CTS-6 and two items in the BCTQ SSS showed differential item functioning favoring age or gender. Four items in the BCTQ SSS and two items in the CTS-6 exhibited disordered response category thresholds. Merging of the relevant response categories led to ordered response category thresholds. The person separation indices were 0.73, 0.86 and 0.77 for the CTS-6, BCTQ SSS and FSS, respectively. CONCLUSIONS: Based on the RMT analysis, the CTS-6 has superior psychometric properties compared to the BCTQ SSS in surgically treated patients. The CTS-6 might be more accurate when separated into item sets measuring pain or numbness. The FSS of the BCTQ has acceptable construct validity, although gender differences at some ages were observed in responses.

Intra- and inter-rater reliability of thoracic spine mobility and posture assessments in subjects with thoracic spine pain.

BACKGROUND: The thoracic spine (TS) has been neglected in the study of the spine despite its essential role in the stability and posture of the entire spinal complex. Therefore, there is an inevitable need to investigate the reproducibility of different thoracic spinal posture measures used in subjects with TS pain. METHODS: Thirty-two subjects (16 females and 16 males, mean age 39 years) were evaluated by two physiotherapists on the same day to gauge inter-rater reliability and on two consecutive days to gauge intra-rater reliability. TS posture was assessed by observation, and thoracic spine mobility was measured by manual assessment of segmental flexion and extension mobility in a seated position. Additionally, posterior-to-anterior accessory mobility in a prone position was assessed manually. Moreover, cervicothoracic flexion in a seated position, thoracic posture, and thoracic flexion and extension mobility in a standing position were assessed with a tape measure, and flexion and extension mobility in a seated position and TS posture in seated and standing positions were measured with an inclinometer. The intraclass correlation coefficient (ICC), standard error of measurement (SEM), mean difference (MD), Bland-Altman (B&A) plot features and coefficient of repeatability (CR) were calculated. RESULTS: The mean and standard deviation (SD) of the duration of TS pain was 22 (SD 45) months, with the intensity of pain being rated at 27 (SD 21) mm on a visual analogue scale (VAS). Intra-rater reliability was very strong (ICC ≥ 0.80) for the evaluation of seated and standing upper TS posture, standing whole TS posture and seated lower TS posture with an inclinometer. Moreover, TS posture evaluation with a measuring tape, posture inspection in a seated position, and manual assessment of segmental extension were found to have very strong intra-rater reliability. Inter-rater reliability was very strong for inclinometer measurements of standing and seated upper TS posture as well as standing whole TS posture. CONCLUSION: Intra-rater reliability was higher than inter-rater reliability in most of the evaluated measurements. Overall, posture measurements with an inclinometer were more reliable than mobility measurements with the same instrument. The manual assessments can be used reliably when same evaluator performs the examination. TRIAL REGISTRATION: Clinical Trials, NCT01884818. Registered 24 June 2013, https://clinicaltrials.gov/ct2/show/NCT01884818?cond=thoracic+spine&cntry=FI&rank=1.

Enhanced rehabilitation guidance after arthroscopic capsulolabral repair of the shoulder: a randomized controlled trial.

OBJECTIVE: To compare the effects of a 12-month home-based exercise program to usual care in patients after arthroscopic capsulolabral repair of the shoulder. DESIGN: Randomized controlled trial. SETTING: Outpatient physical and rehabilitation medicine clinic. SUBJECTS: Forty-five patients (mean age: 35 years; standard deviation (SD): 10 years) who underwent arthroscopic capsulolabral repair due to labral lesion were randomized into an exercise group (EG) or a control group (CG). INTERVENTION: The EG received a 12-month home-based additional exercise program with four physiotherapy follow-up visits, while the CG received standard postoperative exercise instructions. MAIN MEASURES: Self-reported shoulder disability was assessed with the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) and quality of life with the Short-Form (SF)-36 Health Survey. The function of the operated shoulder was evaluated with strength and range of motion measurements. RESULTS: No between-group differences were observed in any of the outcomes at the follow-up. Mean ASES score improved by 16 (95% confidence interval (CI): 10-23) points from the baseline 78 (SD: 17) in the EG and 13 (95% CI: 7-19) points from the baseline 79 (SD: 17) in the CG. Both groups achieved a significant improvement in the dimensions of Physical Functioning, Role-Physical, and Bodily Pain of the SF-36 and in every aspect of strength and range of motion measures. In EG, exercise adherence was moderate (52%) during the first six months and poor (22%) during the last six months. CONCLUSION: Home-based additional exercises with four outpatient follow-up visits did not improve outcome after arthroscopic capsular repair of the shoulder.

Assessment of Construct Validity of the Oswestry Disability Index and the Scoliosis Research Society-30 Questionnaire (SRS-30) in Patients With Degenerative Spinal Disease.

STUDY DESIGN: Observational cohort study. OBJECTIVES: To measure and compare the structural validity of the Oswestry Disability Index (ODI) and the Scoliosis Research Society-30 (SRS-30) questionnaire in an adult population with prolonged degenerative thoracolumbar disease. SUMMARY OF BACKGROUND DATA: The ODI and the SRS-30 are commonly used patient-reported outcome instruments to assess back-specific disability and symptoms related to scoliosis. Still, these instruments have not been validated for degenerative spinal disease with different stages of deformity. METHODS: Altogether, 637 consecutive adult patients with degenerative spinal pathologies were included. The patients completed the ODI (version 2.0), the 23 preoperative items of the SRS-30, a general health survey, the Kasari Frequency Intensity Time (FIT) index, the Depression Scale (DEPS), the RAND-36, and visual analog scales for leg and back pain instruments. Psychometric statistical and illustrative analyses were conducted. Deformity groups were analyzed to assess how well the two instruments reflect deformity-related back problems. RESULTS: Both instruments reflected good coverage and targeting. Correlation between the ODI and the SRS-30 was high (r = 0.70; p < .001). Both measures could distinguish between different general health states. The SRS-30 strongly reflected mental state and social well-being. The SRS-30 was less sensitive for pain and function. Furthermore, the principal component of pain/function explained more variance in the SRS-30 compared with the ODI score. The ODI was more sensitive for variance of disability among different age and deformity groups. CONCLUSIONS: Both the ODI and the the SRS-30 provide valid scores in evaluating health-related quality of life and/or level of disability among patients with prolonged degenerative thoracolumbar disease. The ODI has slightly higher correlation with physical functioning. The SRS-30 seems to be better when evaluating the emotional and psychological functions. LEVEL OF EVIDENCE: Level III.

Trunk Muscle Strength After Lumbar Spine Fusion: A 12-Month Follow-up.

OBJECTIVE: The aim of this study was to investigate changes in trunk muscle strength 12 months after lumbar spine fusion (LSF) compared to preoperative strength. METHODS: A total of 194 patients (mean±standard deviation [SD] age, 61±21 years) who underwent LSF participated in this prospective longitudinal study. Physical measurements of the participants were made before surgery and 12 months postoperatively. Isometric trunk extension and flexion strength was measured using a strain-gauge dynamometer in the standing position. Strength changes were calculated. Regression analysis was performed to explore which factors predicted strength levels at 12 months postoperatively. RESULTS: The preoperative mean±SD extension strength was 205±144 N, which increased to 258±142 N (p<0.001) at the 12-month follow-up. Flexion strength increased from 295±172 N to 364±164 N (p<0.001). The preoperative extension/flexion strength ratio was 0.75±0.38 and remained similar (0.73±0.26) at 12 months postoperatively (p=0.39). CONCLUSION: Although trunk muscle strength increased by 26% for extension and 23% for flexion at the 12-month postoperative follow-up, both values remained objectively low. In addition, flexion strength remained higher than extension strength, which indicates an imbalance between those muscle groups. Age, severe back pain, and low trunk muscle strength before surgery predicted low trunk muscle strength at 1 year after spinal fusion.

Spinopelvic Parameters and Sagittal Alignment of Symptomatic Degenerative Adult Spinal Disorder Patients With 6 Lumbar Vertebrae.

STUDY DESIGN: This was a cross-sectional, observational study. OBJECTIVE: The main objectives of this study were to observe the prevalence of a true L6 among patients with symptomatic adult spinal degeneration, and to evaluate similarities of their radiographic spinopelvic parameters to L5 patients. SUMMARY OF BACKGROUND DATA: Spinopelvic parameter values used for diagnosis and surgical planning are different between individuals with 5 or 6 lumbar vertebrae. The difference has not been studied in patients with symptomatic spinal degenerative conditions. MATERIALS AND METHODS: A total of 775 consecutive symptomatic patients with degenerative spinal disorders were classified as having 5 or 6 lumbar vertebrae in full spine radiographs. Pelvic incidence minus lumbar lordosis (PI-LL), sagittal vertical axis (SVA), pelvic tilt, and T1 pelvic angle were measured in 3 groups: sacral (L5 and L6s) and L6 upper endplate (L6e). Oswestry Disability Index (ODI) was obtained. RESULTS: In total, 715 (92.3%) patients had L5 and 60 (7.7%) had L6. LL values were comparable between the L5 and L6s (P=0.355) and SVA between all groups (P=0.869). Only SVA had excellent concordance correlation (ρc=0.91) between the L6s and L6e groups. PI-LL had significantly different values (P<0.001 all groups) and distributions between L5 and L6s (P=0.038), and L6s and L6e (P<0.001) groups. In patients with severe disability (ODI>40%) the parameters that deteriorate with increasing degeneration (pelvic tilt, T1 pelvic angle, SVA, LL, PI-LL) were not significantly different between L5 and L6s groups unlike patients with ODI<40% while PI remained similarly different (P<0.001). PI and LL had a multivariate relationship in L6 patients computable as regression model equation: PI (sacrum)=-0.92×LL (L6e)+0.91×LL (sacrum) +1.11×PI (L6e)+10.81 (R=0.88). CONCULSIONS: L6 variant is fairly common. The radiographic L6 parameters were different from L5 except for SVA and values of patients with severe disability measured from sacrum. PI and LL have a mathematic relationship in L6 patients. The cutoff values for radiographic modifiers need further studies combining radiology and clinical outcome. LEVEL OF EVIDENCE: Level III.