| 61. |
- Jensen, Irene B., et al.
(författare)
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Assessing the Needs of Patients in Pain: A Matter of Opinion?
- 2000
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Ingår i: Spine. - : LWW. - 0362-2436 .- 1528-1159. ; 25:21, s. 2816-2823
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Tidskriftsartikel (refereegranskat)abstract
- Study Design. A prospective cohort study including patients with nonspecific spinal pain was performed.Objectives. To investigate whether the use of expert judgment in routine practice can provide a basis for reliable decision making concerning the need for intervention in patients with spinal pain and their ability to benefit from treatment.Summary of Background Data. A wide range of instruments and techniques are used to assess and treat patients with spinal pain. Many instruments are used without being clinimetrically tested.Methods. A questionnaire concerning the patients’ need of treatment and their potential to assimilate it was sent to experts in the health care arena: physicians, physical therapists, social insurance officers. The experts included were those connected with patients participating in a larger outcome study. Two cohorts of patients (sample 1, n = 217; sample 2, n = 257) were followed for 6 and 12 months, during which time the patients’ health and work status were mapped.Results. No acceptable agreement was found between any of the experts’ ratings of patients’ needs and potential for rehabilitation. Logistic regression showed that the experts’ judgments were based almost solely on the age of the patient. The prediction analyses showed that the most consistent predictor of the patients’ status at the 6-month follow-up assessment was the patients’ own belief in the existence of effective treatments and their perceived ability for learning to cope with the condition.Conclusions. Expert judgment as exercised in routine practice cannot be used as basis for reliable decision making concerning the need of the patient with spinal pain for intervention and the patient’s ability to benefit from treatment.
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| 62. |
- Johnsson, Ragnar, et al.
(författare)
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Randomized radio stereometric study comparing osteogenic protein-1 (BMP-7) and autograft bone in human noninstrumented posterolateral lumbar fusion - 2002 Volvo Award in Clinical Studies
- 2002
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Ingår i: Spine. - : Ovid Technologies (Wolters Kluwer Health). - 0362-2436 .- 1528-1159. ; 27:23, s. 2654-2661
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Tidskriftsartikel (refereegranskat)abstract
- Study Design. Randomized efficacy trial comparing two types of noninstrumented posterolateral fusion between L5 and S1 in patients with L5 spondylolysis and vertebral slip less than 50%, as evaluated by radiosterometric analysis. Objective. To determine whether osteogenic protein-1 (BMP-7) in the OP-1 Implant yields better stabilizing bony fusion than autograft bone. Summary of Background Data. Animal studies of osteoinductive proteins in noninstrumented posterolateral fusions have shown high fusion rates. No similar conclusive study on humans has been performed. Methods. For this study, 20 patients were randomized to fusion with either OP-1 Implant or autograft bone from the iliac crest, 10 in each group. The patients were instructed to keep the trunk straight for 5 months after surgery with the aid of a soft lumbar brace. At surgery 0.8-mm metallic markers were positioned in L5 and the sacrum, enabling radiostereometric follow-up analysis during 1 year. The three-dimensional vertebral movements, as measured by radiostereometric analysis induced by positional change from supine posture to standing and sitting, were calculated with an accuracy of 0.5 to 0.7 mm and 0.5degrees to 2.0degrees. Conventional radiography was added. Results. No significant difference was noted between the radiostereometric and radiographic results of fusion with the OP-1 Implant and fusion with autograft bone. There was a significant relation between reduced vertebral movements and better bone formation. No adverse effects of the OP-1 Implant occurred. Persistent minor pain at the iliac crest was noticed in one patient. Conclusions. There was no significant difference between the two fusion versions. Thus, the OP-1 Implant did not yield better stabilizing bony fusion than autograft bone.
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| 63. |
- Jull, Gwendolen A, et al.
(författare)
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Toward optimal early management after whiplash injury to lessen the rate of transition to chronicity
- 2011
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Ingår i: Spine. - 0362-2436 .- 1528-1159. ; 36:25 Suppl, s. S335-S342
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Expert debate and synthesis of research to inform future management approaches for acute whiplash disorders.OBJECTIVE: To identify a research agenda toward improving outcomes for acute whiplash-injured individuals to lessen the incidence of transition to chronicity.SUMMARY OF BACKGROUND DATA: International figures are concordant, estimating that 50% of individuals recover from pain and disability within 3 to 6 months of a whiplash injury. The remainder report continuing symptoms up to 1 to 2 years or longer postinjury. As no management approach to date has improved recovery rates, new clinical/research directions are required for early management of whiplash-injured patients.METHODS: A group of multidisciplinary researchers critically debated evidence and current research concerning whiplash from biological, psychological, and social perspectives toward informing future research directions for management of acute whiplash.RESULTS: It was recognized that effective treatments for acute whiplash are constrained by a limited understanding of causes of whiplash-associated disorders. Acute whiplash presentations are heterogeneous leading to the proposal that a research priority was development of a triage system based on modifiable prognostic indicators and clinical features to better inform individualized early management decisions. Other priorities identified included researching effective early pain management for individuals presenting with moderate to high levels of pain; development of best education/information for acute whiplash; testing the efficacy of stratified and individualized rehabilitation, researching modes of delivery considering psychosocial modulators of pain and disability; and the timing, nature, and mode of delivery of cognitive-behavioral therapies. Directions were highlighted for future biomechanical research into injury prevention.CONCLUSION: The burden of whiplash injuries, the high rate of transition to chronicity, and evidence of limited effects of current management on transition rates demand new directions in evaluation and management. Several directions have been proposed for future research, which reflect the potential multifaceted dimensions of an acute whiplash disorder.
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| 64. |
- Karppinen, Jaro, et al.
(författare)
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Effects of tiaprofenic acid and indomethacin on proteoglycans in the degenerating porcine intervertebral disc.
- 1995
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Ingår i: Spine. - : Wolters Kluwer. - 0362-2436 .- 1528-1159. ; 20:10, s. 1170-1177
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Eighteen pigs were stabbed with a scalpel in the anterior part of the anulus fibrosus of a lumbar disc. After surgery, the pigs received either tiaprofenic acid or indomethacin daily, and a third group did not receive any medication.OBJECTIVES: Nonsteroidal anti-inflammatory agents are widely used in the treatment of low back patients, but their long-term effects on the matrix molecules in the degenerate disc are unknown.SUMMARY OF BACKGROUND DATA: Several in vitro and in vivo studies on articular cartilage have suggested that tiaprofenic acid may not have adverse effects on matrix metabolism, whereas indomethacin probably does.METHODS: Uronic acid, DNA, and water contents were determined from five different locations in each injured disc. Transport and incorporation of sulfate were examined by in vivo radioactive tracer analysis, and proteoglycan structures were analyzed by gel electrophoresis.RESULTS: Morphologically, there were no differences between the treatments. Tiaprofenic acid maintained a higher uronic acid content in the nucleus pulposus and outer anulus compared with that of the nonmedicated animals. Tiaprofenic acid decreased the incorporation of sulfate in the injured area and the water content at most sites. Indomethacin had no adverse effects compared with the nonmedicated group, and it increased water content in the posterior anulus fibrosus.CONCLUSIONS: Long-term administration of tiaprofenic acid and indomethacin did not have harmful effects on matrix metabolism after disc injury. On the contrary, tiaprofenic acid may slightly protect proteoglycans in the degenerating disc.
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| 65. |
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| 66. |
- Knutsson, Björn, et al.
(författare)
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Body mass index and risk for clinical lumbar spinal stenosis : a cohort study
- 2015
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Ingår i: Spine. - : Wolters Kluwer. - 0362-2436 .- 1528-1159. ; 40:18, s. 1451-1456
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Tidskriftsartikel (refereegranskat)abstract
- STRUCTURED ABSTRACT: Study Design. A prospective cohort study that used a Swedish nationwide occupational surveillance program for construction workers (period of registration from 1971-1992). In all, 364 467 participants (mean age at baseline 34 years) were included in the study.OBJECTIVE: To determine whether overweight and obesity are associated with a higher risk of lumbar spinal stenosis (LSS).SUMMARY OF BACKGROUND DATA: During recent decades, LSS has become the most common indication for spine surgery, a change that coincides with a higher prevalence of obesity.METHODS: A diagnosis of LSS was collected through individual linkage to the Swedish National Patient Register through December 31, 2011. Poisson regression models were employed to estimate multivariable-adjusted incidence rate ratios (IRRs) for LSS.RESULTS: At baseline, 65% had normal weight (BMI 18.5 to 24.99 kg/m), 29% were overweight (BMI 25 to 29.99 kg/m), 5% were obese (BMI≥30 kg/m) and 2% were underweight (BMI<18.5 kg/m). During 11,190,944 person-years of follow-up, with a mean of 31 years, 2381 participants were diagnosed with LSS. Compared with normal weight individuals, obese workers had an IRR of 2.18 (95% confidence interval (CI), 1.87 to 2.53) for LSS and overweight workers had an IRR of 1.68 (95% CI, 1.54 to 1.83). Workers who were underweight halved their risk of LSS (IRR 0.52, 95% CI 0.30 to 0.90).CONCLUSION: Obese and overweight persons are at a higher risk of developing LSS. Further, our results indicate that obesity might be a novel explanation for the increased number of patients with clinical LSS.
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| 67. |
- Knutsson, Björn, et al.
(författare)
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Obese patients report modest weight loss after surgery for lumbar spinal stenosis : a study from the Swedish spine register
- 2014
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Ingår i: Spine. - 0362-2436 .- 1528-1159. ; 39:20, s. 1725-1730
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN:SWESPINE, the Swedish Spine Register, was used for this cohort study.OBJECTIVE:Our primary aim was to determine weight change in obese patients after surgery for lumbar spinal stenosis (LSS). Our secondary aim was to study any possible associations between weight loss after surgery and improvement in patient-related outcome measures (PROMs).SUMMARY OF BACKGROUND DATA:Only meager evidence is available as to how surgery for LSS affects weight and whether weight loss is associated with improvement in PROMs after surgery for LSS.METHODS:All obese patients who underwent surgery for LSS from January 1, 2006 through June 30, 2008 with a completed 2-year follow-up in SWESPINE were included. Data for weight were collected before surgery and then 1 and 2 years after surgery. The cohort was divided into 3 subclasses (weight stable, weight loss, or weight gain).RESULTS:Totally, 538 obese patients were enrolled. Mean weight loss was 1.9 kg (95% confidence interval, 1.5-2.3) 1 year after surgery and 2.0 kg (95% confidence interval, 1.5-2.4) after 2 years after surgery. Only 8% of the patients reported a clinically important weight loss (≥10%). No significant differences in PROMs were observed. The weight-stable group reported a mean improvement of 0.22 (standard deviation, 0.36) in EQ-5D, 14 (18) units in the Oswestry Disability Index, 18 (33) units in back pain (visual analogue scale), and 23 (36) units in leg pain (visual analogue scale). The corresponding changes in the weight-loss group were 0.23 (0.35) in EuroQol 5D, 15 (19) in Oswestry Disability Index, 27 (29) in back pain, and 31 (36) in leg pain.CONCLUSION:Modest weight loss was reported 1 and 2 years postsurgery; a small proportion (8%) of these patients reported a clinically important weight loss at the 2-year follow-up. The weight loss was unrelated to changes in PROMs.LEVEL OF EVIDENCE:3.
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| 68. |
- Knutsson, Björn, et al.
(författare)
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Obesity Is Associated With Inferior Results After Surgery for Lumbar Spinal Stenosis : A Study of 2633 Patients from the Swedish Spine Register
- 2013
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Ingår i: Spine. - 0362-2436 .- 1528-1159. ; 38:5, s. 435-441
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Tidskriftsartikel (refereegranskat)abstract
- Study DesignA cohort study based on the Swedish Spine Register.ObjectiveTo determine the association between body mass index (BMI) and outcome of lumbar spine surgery for spinal stenosis.Summary of Background DataSeveral small studies have sought to evaluate the importance of obesity in relation to results after surgery for lumbar spinal stenosis (LSS) but the findings are inconsistent and relatively weak.MethodsAll patients who underwent surgery for LSS from January 1, 2006 to June 30, 2008 with a completed 2-year follow-up in the Swedish Spine Register were included. Logistic regression was used to assess the association between BMI and different outcomes.ResultsOf 2633 patients enrolled, 819 (31%) were normal weight, 1208 (46%) overweight and 606 (23%) obese. On average, all three BMI groups achieved significant improvements after surgery. A higher BMI, however, was associated with greater odds of dissatisfaction after surgery and inferior results at the 2-year follow-up. After adjusting for differences in baseline characteristics, the obese group demonstrated inferior function and quality of life (QoL) as measured by the Oswestry Disability Index (ODI) and the EuroQol group (EQ-5D), respectively. At the 2-year follow-up, obese patients had a mean ODI of 33 (95% confidence interval [CI], 31-34) and mean EQ-5D of 0.56 (95% CI, 0.54-0.59) compared with a mean ODI of 25 (95% CI 24-26) and mean EQ-5D of 0.64 (95% CI, 0.62-0.66) in the normal weight group. When compared with the normal weight patients, the adjusted odds ratio (OR) for dissatisfaction was 1.73 in the obese group (95% CI 1.36-2.19). Differences between the normal weight and overweight group were modest and therefore could not be considered clinically relevant.ConclusionObese patients achieved significant pain reduction, better walking ability and improved QoL after surgical treatment for LSS. Nevertheless, obesity was associated with a higher degree of dissatisfaction and poorer outcomes after surgery for LSS.
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| 69. |
- Kristiansson, Per, et al.
(författare)
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Back pain during pregnancy : a prospective study
- 1996
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Ingår i: Spine. - : Ovid Technologies (Wolters Kluwer Health). - 0362-2436 .- 1528-1159. ; 21:6, s. 702-709
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN:A longitudinal, prospective, observational, cohort study.OBJECTIVES:To describe the natural history of back pain occurring during pregnancy and immediately after delivery.SUMMARY OF BACKGROUND DATA:Back pain during pregnancy is a frequent clinical problem even during the early stages of pregnancy. The cause is unclear.METHODS:A cohort of 200 consecutive women attending an antenatal clinic were followed throughout pregnancy with repeated measurements of back pain and possible determinants by questionnaires and physical examinations.RESULTS:Seventy-six percent reported back pain at some time during pregnancy. Sixty-one percent reported onset during the present pregnancy. In this group, the prevalence rate increased to 48% until the 24th week and then remained stable and declined to 9.4% after delivery. The reported pain intensity increased by pain duration. The pain score correlated closely to self-rated disability and days of sickness benefit.CONCLUSIONS:Back pain during pregnancy is a common complaint. The 30% with the highest pain score reported great difficulties with normal activities. The back pain started early in pregnancy and increased over time. Young women had more pain than older women. Back pain starting during pregnancy may be a special entity and may have another origin than back pain not related to pregnancy.
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| 70. |
- Kristiansson, Per, et al.
(författare)
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Discriminatory power of tests applied in back pain during pregnancy
- 1996
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Ingår i: Spine. - 0362-2436 .- 1528-1159. ; 21:20, s. 2337-2344
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGNA longitudinal, prospective, observational cohort study.OBJECTIVESTo assess the relationship between clinical back status and reported pain locations during and after pregnancy.SUMMARY OF BACKGROUND DATABack pain during pregnancy is a frequent clinical occurrence, even during the early stages of pregnancy. The cause is unclear. There are few data describing the results of a general physical examination of the back during pregnancy and there are no data on serial examinations. Such data could provide information about what structures cause the pain, which might have implications for the choice of treatment.METHODSA cohort of 200 consecutive women attending an antenatal clinic was observed throughout the pregnancy terms, and repeated measurements of back pain and its possible determinants were taken using questionnaires and physical examinations in a standardized way, including a series of tests of configuration, mobility, and pain provocation.RESULTSPain provocation tests were better at discriminating among women who reported back pain from women who reported no back pain from tests of configuration or mobility. The discriminatory power of the tests was better in the lower part of the spine than in the upper part. The best discrimination was achieved by combining some of the tests.CONCLUSIONSThe results indicate that not one but several pain-releasing structures may be involved. These are probably the various pelvic ligaments, which may form a functional unit. These findings may have therapeutic implications.
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