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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The responsiveness of an instrument measuring health-related quality of life is an important indication of its construct validity. The SRS-22 Patient Questionnaire has become the most widely used patient-reported outcome instrument in the clinical evaluation of patients with idiopathic scoliosis. The responsiveness of the SRS-22 following surgical treatment in patients with idiopathic scoliosis has not been fully assessed. ⋯ As was expected, the MID values differed according to the calculation method used. In light of the fact that the MID-As for the function and mental health subscales are below the measurement error of the instrument, it seems preferable to use the MID-D values for determining subscale changes. If the purpose is to analyze sum score changes (either the raw or average values), the MID-A is preferable because it includes the patient's evaluation of the results of surgery.
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Bad Sobernheim Stress Questionnaire-Brace and Bad Sobernheim Stress Questionnaire-Deformity are relatively new tools aimed at facilitating the evaluation of long-term results of therapy in persons with idiopathic scoliosis undergoing conservative treatment. To use these tools properly in Poland, they must be translated into Polish and adapted to the Polish cultural settings. The process of cultural adaptation of the questionnaires was compliant with the guidelines of International Quality of Life Assessment (IQOLA) Project. ⋯ Internal consistency of BSSQ-Brace and BSSQ-Deformity was at the level of 0.80 and 0.87, whereas the value of the absolute stability factor was 0.82 and 0.88. Overall, the Polish versions of the BSSQ-Brace and BSSQ-Deformity Questionnaires are characterized by high values of internal consistency factor and absolute stability factor. Following the process of adaptation, the authors obtained a tool that is instrumental in clinical evaluations and complies with methodological criteria.
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Psychological factors have been found to be of major importance for the transition from acute to chronic low back pain (CLBP). Although some evidence has been provided that depressive symptoms occur secondarily to CLBP, psychological treatment modules that specifically address depressive symptoms are not yet included in German inpatient rehabilitation programs. In this study, a standard rehabilitation program for patients with CLBP and depressive symptoms was compared to a standard rehabilitation, into which a cognitive-behavioral management training of depressive symptoms was integrated. ⋯ Females benefited more in mental health than males. However, due to regression effects at the 12-month follow-up assessment, booster sessions are highly recommended. The results presented here support the notion that a more adequately tailored rehabilitation program seems to improve rehabilitation success and prevent further development of CLBP among this high-risk subpopulation.
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Understanding changes in patient-reported outcomes is indispensable for interpretation of results from clinical studies. As a consequence the term "minimal clinically important difference" (MCID) was coined in the late 1980s to ease classification of patients into improved, not changed or deteriorated. Several methodological categories have been developed determining the MCID, however, all are subject to weaknesses or biases reducing the validity of the reported MCID. ⋯ MCID(pre) was 4.5 larger for the ODI and 1.5 times larger for BQ and NRS(pain) compared to the MCID(post). Furthermore, MCID(pre) and patients post-treatment acceptable change was almost equal for the NRS(pain) but not for the ODI and BQ. In conclusion, chronic LBP patients have a reasonably realistic idea of an acceptable change in pain, but probably an overly optimistic view of changes in functional and psychological/affective domains before treatment begins.
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The aim of this study is to describe the outcome of surgical treatment for pediatric patients with forced vital capacity (FVC) <40% and severe vertebral deformity. Few studies have examined surgical treatment in these patients, who are considered to be at a high risk because of their pulmonary disease, and in whom preoperative tracheostomy is sometimes recommended. Inclusion criteria include FVC <40%, age <19 years and diagnosis of scoliosis. ⋯ After a follow-up of 30 months, FVC was 29% (13-50%). In conclusion, corrective scoliosis surgery in pediatric patients with severe restrictive lung disease is well tolerated, but the management of this population requires extensive experience with the vertebral surgery involved, and a multidisciplinary approach that includes pulmonologists, nutritionists and anesthesiologists. Currently, there is no indication for routine preoperative tracheostomy.