| 1. |
- Brynhildsen, Jan, 1962-, et al.
(författare)
-
Is Hormone Replacement Therapy a Risk Factor for Low Back Pain Among Postmenopausal Women?
- 1998
-
Ingår i: Spine. - : Wolters Kluwer. - 0362-2436 .- 1528-1159. ; 23:7, s. 809-813
-
Tidskriftsartikel (refereegranskat)abstract
- Study Design: Cross-sectional study with two age cohorts.Objective: To assess whether women receiving hormone replacement therapy after menopause have a higher prevalence of back problems than women who do not receive such treatment.Background: Back pain is a common medical problem: throughout life and especially during pregnancy. Hormonal factors have been proposed as a possible contributor.Patients and Methods: A validated postal questionnaire was sent in early 1995 to all 1324 women of 55 years and 56 years of age residing in Linkoping, Sweden. This questionnaire included questions about current rent hormone replacement treatment, previous and current back problems, medical care for back problems, parity, exercise and smoking habits, and occupation.Results: The questionnaire was returned by 84.7% of the women. There was a significant, albeit weak, positive association between current use of hormone replacement treatment and low back pain. Previous back problems during pregnancy was a strong risk factor for current back pain, whereas neither current smoking nor regular physical exercise was a risk factor according to multiple logistic regression analysis. The interaction of smoking and an occupation involving heavy lifting significantly affected back pain.Conclusions: Women receiving hormone replacement treatment had a slightly, but significantly, higher prevalence of current back pain than nonusers (48% vs. 42%, respectively, P < 0.05), which could not be explained by differences in occupation, smoking habits, or current physical activity. Although the association be-tween hormone replacement therapy and back problems is weak and probably of minor clinical importance, it is speculated that hormonal effects on joints and ligaments may be involved.
|
|
| 2. |
- Elmose, Signe Forbech, et al.
(författare)
-
Magnetic Resonance Imaging Proxies for Segmental Instability in Degenerative Lumbar Spondylolisthesis Patients
- 2022
-
Ingår i: Spine. - : Wolters Kluwer. - 0362-2436 .- 1528-1159. ; 47:21, s. 1473-1482
-
Tidskriftsartikel (refereegranskat)abstract
- Study design: Retrospective cohort study.Objective: The aim was to investigate whether findings on magnetic resonance imaging (MRI) can be proxies (MRIPs) for segmental instability in patients with degenerative lumbar spinal stenosis (LSS) and/or degenerative spondylolisthesis (LDS) L4/L5.Background: LDS has a heterogeneous nature. Some patients have a dynamic component of segmental instability associated with LDS. Studies have shown that MRI can show signs of instability.Methods: Patients with LSS or LDS at L4/L5 undergoing decompressive surgery +/- fusion from 2010 to 2017, with preoperative standing lateral spine radiographs and supine lumbar MRI and enrolled in Danish national spine surgical database, DaneSpine. Instability defined as slip of >3 mm on radiographs. Patients divided into two groups based upon presence of instability. Outcome measures: radiograph: sagittal slip (mm). MRIPs for instability: sagittal slip >3 mm, facet joint angle (degrees), facet joint effusion (mm), disk height index (%), and presence of vacuum phenomena. Optimal thresholds for MRIPs was determined by receiver operating characteristic (ROC) curves and area under the curve (AUC). Logistic regression to investigate association between instability and MRIPs.Results: Two hundred thirty-two patients: 47 stable group and 185 unstable group. The two groups were comparable with regard to baseline patient-reported outcome measures. Thresholds for MRIPs: bilateral facet joint angle >= 46 degrees; bilateral facet effusion >= 1.5 mm and disk height index >= 13%. Logistic regression showed statistically significant association with MRIPs except vacuum phenomena, ROC curve AUC of 0.951. By absence of slip on MRI logistic regression showed statistically significant association between instability on radiograph and the remaining MRIPs, ROC curve AUC 0.757.Conclusion: Presence of MRIPs for instability showed statistically significant association with instability and excellent ability to predict instability on standing radiograph in LSS and LDS patients. Even in the absence of slip on MRI the MRIPs had a good ability to discriminate presence of instability.
|
|
| 3. |
|
|
| 4. |
- Linton, Steven J., et al.
(författare)
-
Development of a short form of the Örebro musculoskeletal pain screening questionnaire
- 2011
-
Ingår i: Spine. - : Lippincott Williams & Wilkins. - 0362-2436 .- 1528-1159. ; 36:22, s. 1891-1895
-
Tidskriftsartikel (refereegranskat)abstract
- Study Design: A longitudinal design where the questionnaire was completed at a pre test and predictive ability evaluated with a one-year follow-up. A second sample was employed to provide a replication.Objective: The aim of the study was to validate a short form of the Örebro Musculoskeletal Pain ScreeningQuestionnaire: Summary of Background Data. Several studies demonstrate the research and clinical utility of the Örebro Musculoskeletal Pain Screening Questionnaire. Calls have been made for a shorter form that requires less time in administering.Methods: The short version was constructed by taking two items from each of the five factors shown to have predictive power. It was then tested against the long form in two samples of people with musculoskeletal pain where one reflects an occupational health care population (N = 324) and the other a primary care population (N = 183) thus providing a built-in replication. All participants completed the Örebro Musculoskeletal Pain Screening Questionnaire and were then followed over the course of a year to evaluate disability as measured by sick leave.Results: The correlation between the short and long forms was.91. The ROC curve was nearly identical for the long and short versions of the questionnaire (e.g. primary care sample:.84 versus.81; occupational sample:.72 versus.70). Of those who developed disability, a cutoff of 50 on the short version identified 85% in the occupational and 83% in the primary care samples which was nearly as good as the full version (92% respectively 83%).Conclusions: The short form of the Örebro Musculoskeletal Pain Screening Questionnaire is appropriate for clinical and research purposes since it is nearly as accurate as the longer version.
|
|
| 5. |
|
|
| 6. |
- Nerelius, Fredrik, 1985-, et al.
(författare)
-
Patient-reported Outcome after Surgical Evacuation of Postoperative Spinal Epidural Hematomas at One-year Follow-up
- 2024
-
Ingår i: Spine. - : Wolters Kluwer. - 0362-2436 .- 1528-1159. ; 49:10, s. 701-707
-
Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Retrospective analysis of prospectively collected data from the National Swedish Spine Register (Swespine).OBJECTIVE: To evaluate the effects of symptomatic spinal epidural hematoma (SSEH) requiring reoperation on one-year patient-reported outcome measures (PROMs) in a large cohort of patients treated surgically for lumbar spinal stenosis (LSS).SUMMARY OF BACKGROUND DATA: Studies exploring the outcomes of reoperations after SSEH are scarce and often lack validated outcome measures. As SSEH is considered a serious complication, understanding of the outcome following hematoma evacuation is important.MATERIALS AND METHODS: After retrieving data from 2007 to 2017 from Swespine, we included all patients with LSS without concomitant spondylolisthesis who were treated surgically with decompression without fusion. Patients with evacuated SSEH were identified in the registry. Back/leg pain numerical rating scales (NRS), the Oswestry Disability Index (ODI), and EQ VAS were used for outcome assessment. PROMs before and one-year after decompression surgery were compared between evacuated patients and all other patients. Multivariate linear regression was performed to determine if hematoma evacuation predicted inferior one-year PROM scores.RESULTS: A total of 113 patients with an evacuated SSEH were compared with 19527 patients with no evacuation. One-year after decompression surgery, both groups showed significant improvement in all PROMs. When comparing the two groups' one-year improvement there were no significant differences in any PROM. The proportion of patients achieving the minimum important change was not significantly different for any PROM. Multivariate linear regression found that hematoma evacuation significantly predicted inferior one-year ODI (β=4.35, P=0.043), but it was not a significant predictor of inferior NRS Back (β=0.50, P=0.105), NRS Leg (β=0.41, P=0.221), or EQ VAS (β=-1.97, P=0.470). CONCLUSIONS: A surgically evacuated SSEH does not affect outcome in terms of back/leg pain or health-related quality of life. Commonly used PROM surveys may not capture neurologic deficits associated with SSEH.
|
|
| 7. |
- Overmeer, Thomas, 1960-, et al.
(författare)
-
Do evidence-based guidelines have an impact in primary care? : A cross-sectional study of Swedish physicians and physiotherapists
- 2005
-
Ingår i: Spine. - : Lippincott Williams & Wilkins. - 0362-2436 .- 1528-1159. ; 30:1, s. 146-151
-
Tidskriftsartikel (refereegranskat)abstract
- Study Design. A cross-sectional study of physicians and physiotherapists in primary care. Objectives. To survey how familiar clinicians were with evidence-based guidelines for back pain and their opinion about their clinical usefulness and to compare self-reported practice behavior with the guidelines. Summary of Background Data. Guidelines, based on empirical evidence, are meant to ensure that patients get the most effective treatment. These evidence-based guidelines should steer clinical praxis, but clinicians may not read, let alone heed, them. Methods. Using a questionnaire, the authors surveyed all physicians and physiotherapists in primary health care in Örebro County, Sweden (N = 235). Results. Forty-two percent of the physicians and 37% of the physiotherapists were unfamiliar with the content of the guidelines, and 40% of the physicians and 25% of the physiotherapists were unfamiliar with the concept of 'red flags.' Less than half of the clinicians, 47%, were familiar both with the content of the guidelines and the concept of red flags. Their opinion about the guidelines showed that 54% of the physicians and 56% of the physiotherapists agreed that the guidelines were useful in clinical praxis. Concerning the self-reported practice behavior, the majority indicated that they followed the key points in the guidelines. Conclusions. A relatively large proportion of clinicians were unfamiliar with the content of evidence-based guidelines and/or with the concept of red flags. The process of implementing research into clinical practice is in need of an overhaul, and the impact of guidelines on clinical practice may be questioned.
|
|
| 8. |
- Sigmundsson, Freyr Gauti, 1972-, et al.
(författare)
-
Impact of pain on function and health related quality of life in lumbar spinal stenosis. A register study of 14,821 patients
- 2013
-
Ingår i: Spine. - : Lippincott Williams & Wilkins. - 0362-2436 .- 1528-1159. ; 38:15, s. E937-45
-
Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Descriptive register study.OBJECTIVE: To describe preoperative levels of leg and back pain in patients operated for lumbar spinal stenosis, and to obtain information on how 3 different pain constellations (back pain < leg pain, back pain > leg pain, back pain = leg pain) correlate to health related quality of life (HRQoL) and function in different morphological types of stenosis.SUMMARY OF BACKGROUND DATA: Degenerative lumbar spinal stenosis is considered a poorly defined clinical syndrome and knowledge of what uniquely characterizes the different morphological types of stenosis is lacking.METHODS: Using the Swedish Spine Register, we studied (1) the pain characteristics of patients with central spinal stenosis (CSS), lateral recess stenosis, and spinal stenosis with spondylolisthesis (2) how HRQoL and function correlate to leg and back pain.RESULTS: Grading leg pain higher than back pain was the most common pain constellation (49%) followed by grading back pain more than leg pain (39%). Twelve percent had the same intensity of leg and back pain. The type of stenosis grading the highest burden of back pain was spinal stenosis with spondylolisthesis (ratio = 0.93; [95% confidence interval, CI] = 0.92-0.95), followed by central spinal stenosis (ratio = 0.88; [95% CI] = 0.88-0.89). Lateral recess stenosis had the lowest burden of back pain (ratio = 0.85; [95% CI] = 0.83-0.87). The lowest HRQoL and function was found in spinal stenosis with spondylolisthesis (back pain = leg pain group) where 55% ([95% CI] = 50-59) of patients could not walk more than 100 m. Patients with lateral recess stenosis had better self-estimated walking distance.CONCLUSION: Back pain is generally experienced to a high extent by patients scheduled for spinal stenosis surgery. HRQoL and function are low preoperatively irrespective of whether back or leg pain is predominant. In this large patient material patients who grade their back and leg pain as likeworthy have significantly lower values for HRQoL and function compared to patients reporting predominant leg or back pain but the difference is not clinically relevant.
|
|
| 9. |
- Sigmundsson, Freyr Gauti, et al.
(författare)
-
Preoperative Pain Pattern Predicts Surgical Outcome more than Type of Surgery in Patients With Central Spinal Stenosis Without Concomitant Spondylolisthesis: A Register Study of 9,051 Patients.
- 2014
-
Ingår i: Spine. - : Lippincott Williams & Wilkins. - 0362-2436 .- 1528-1159. ; 39:3, s. 199-210
-
Tidskriftsartikel (refereegranskat)abstract
- Study Design. A register cohort study.Objective. To evaluate outcome of surgery for lumbar spinal stenosis without concomitant degenerative spondylolisthesis according to predominance of pain and to analyze the role of spinal fusion in conjunction with decompression in patients with predominant back or leg pain.Summary of Background Data. Predominance of back pain is associated with inferior outcome of surgery for central spinal stenosis (CSS). It is unknown if adding spinal fusion improves outcomes.Methods. In a register study of 9,051 patients we studied outcome of surgery in terms of back and leg pain (VAS), function (the Oswestry disability index and self-estimated walking distance), health-related quality of life (SF-36 and EQ-5D), and patient satisfaction. Outcome was analyzed for 4 groups at 1 and 2 year follow up; preop back pain ≥ leg pain and decompression, preop back pain ≥ leg pain and decompression and fusion, preop back pain < leg pain and decompression, preop back pain < decompression and fusion.Results. Patients with concomitant fusion were younger and had higher back pain and ODI scores and lower preoperative EQ-5D. Predominant back pain was associated with inferior outcome in terms of pain, health-related quality of life and function. Patients most often satisfied (69%) were patients with back pain < leg pain treated with decompression and fusion and the least satisfied group was patients with back pain ≥ leg pain treated with decompression (54%). Fusion was associated with higher EQ-5D at 1-year follow up for patients with predominant back pain up but was also associated with increased leg pain at 2- year follow up in patients with predominant leg pain. Patients with predominant back pain experienced small gains in the physical component summary with fusion.Conclusion. Predominance of back pain is associated with inferior outcome. Adding spinal fusion improves unadjusted outcome but the benefit is small and not clinically significant and generally disappears in the adjusted analysis.
|
|
| 10. |
- Svensson, Elisabeth, 1942-, et al.
(författare)
-
The balanced inventory for spinal disorders : the validity of a disease specific questionnaire for evaluation of outcomes in patients with various spinal disorders
- 2009
-
Ingår i: Spine. - 0362-2436 .- 1528-1159. ; 34:18, s. 1976-1983
-
Tidskriftsartikel (refereegranskat)abstract
- Study Design. A prospective validation study. Objective. To validate the Balanced Inventory for Spinal Disorders (BIS), a questionnaire concerning the extent to which pain affects perceived physical health, social life, mental health, and quality of life. The operational definitions of the items and the verbal descriptive scales were compared with corresponding items in the Short-Form 36 (SF-36), European Quality of Life Scale (EQ), and Oswestry Disability Index (ODI). Summary of Background Data. In validation studies, scales that intend to measure the same variable are compared. Methods. The SF-36, EQ, ODI, and the BIS were filled in by 101 patients before surgical treatment. The comparisons were analyzed by statistical methods that take account of the nonmetric properties of ordered categorical data to obtain reliable results. The level of order-consistency between BIS and comparing items, when present, was calculated. The Spearman rank-order correlation coefficient was also calculated. Results. In the paired comparisons between the BIS pain scales and the other pain scales about 80% units more pairs were ordered than disordered, and the disorder was explained by the discriminating ability of the BIS back and leg pain items. The BIS and ODI items of limitation in walking were comparable, and the assessments of social limitations on the questionnaires were consistent; the disordered pairs being explained by different coverage of activities in the items. The assessments of physical and mental health on BIS were disordered, with the responses in SF-36 in favor of the BIS type of scale categories. The few items and response categories in the EQ did not discriminate the assessments. Conclusion. The BIS assessments can be regarded as being a valid disease-specific questionnaire that provides interpretable information regarding the impact of back end leg pain on well-defined physical, social and mental aspects, and on the quality of life.
|
|
