European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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Reliable classification systems and clinical tests are sought for the care of patients with low back pain (LBP). The objectives of this clinical study were to evaluate inter-examiner reliability in the classification of patients with LBP, the influence of radiological findings on the classification and the reliability of some clinical tests. Two examiners independently assessed 50 outpatients with LBP. ⋯ The reliability of clinical tests was good (kappa>0.6) in 6 tests and moderate (kappa>0.4) in 12 tests. Good inter-examiner reliability was found for the SLR test, movement range and sensibility testing with spurs in dermatome areas. We conclude that the KWC for classifying patients with LBP seems to be a reliable classification system depending on a few key observations and that moderate and good inter-examiner reliability can be achieved in several clinical tests in the assessment of LBP.
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Over the past 10 years, a plethora of back-specific patient-orientated outcome measures have appeared in the literature. Standardisation has been advocated by an expert panel of researchers proposing a core set of instruments. Of the condition-specific questionnaires the Oswestry Disability Index (ODI) is recommended for use with low back pain (LBP) patients. ⋯ Longitudinal external construct validity showed moderate correlations (range 0.56-0.78). We conclude that the Danish version of the ODI is both a valid and reliable outcome instrument in two LBP patient populations. The ODI is probably most appropriate for use in SeS patients.
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In studies evaluating the efficacy of clinical interventions, it is of paramount importance that the functional outcome measures are responsive to clinically relevant change. Knowledge thereof is in fact essential for the choice of instrument in clinical trials and for clinical decision-making. This article endeavours to investigate the sensitivity, specificity and clinically significant improvement (responsiveness) of the Danish version of the Oswestry disability index (ODI) in two back pain populations. ⋯ A minimum clinically important change (MCID) from baseline score was established at 9 points (71%) for PrS patients and 8 points (27%) for SeS patients using ROC analyses. This was dependable on the baseline entry score with the MCID increasing with 5 points for every 10 points increase in the baseline score. We conclude that the Danish version of the ODI has comparable responsiveness to other commonly used functional status measures and is appropriate for use in low back pain patients receiving conservative care in both the primary and secondary sector.
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Several studies have suggested that psychosocial distress is an important predictor of negative outcome in lumbar spine surgery. Ozguler et al. [Spine 27:1783-1789, 2002, 18] described a classification tool for low back pain patients using the Dallas Pain Questionnaire (DPQ) which included a measure of distress. We wanted to evaluate the ability of this classification tool to predict the outcome in spinal fusion patients. ⋯ Variables found to predict high disability at follow-up were secondary degeneration Odds Ratio (OR) 1.61 (P=0.020), being retired/pensioned OR 3.48 (P<0.0005), age between 40-59 years OR 1.68 (P=0.011), belonging to group 3 OR 2.69 (P=0.003) or belonging to group 4 OR 5.53 (P<0.0005). The classification based on the DPQ were able to identify lumbar spinal fusion patients with a considerable amount of psychological distress in their symptomatology. Furthermore, the presence of distress, as determined by this classification, was a highly significant risk factor for inferior outcome.
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Comparative Study
Patient-based outcomes for the operative treatment of degenerative lumbar spinal stenosis.
A retrospective surgical case series was conducted using a condition-specific, patient-based outcomes assessment. ⋯ The results of this retrospective study indicate that operative decompression of the lumbar spine offers significant improvement for patients with DLSS. Although not all comparisons were statistically significant, there was a trend for DLLS patients aged less than 65 years with more severe pre-operative symptoms and physical function disturbances treated at one or two levels with a laminectomy and fusion to have the best outcomes.