Diagnostic Screening for Lumbar Spinal Stenosis

Purpose: To develop a self-administered diagnostic screening questionnaire for lumbar spinal stenosis (LSS) consisting of items with high content validity and to investigate the diagnostic value of the questionnaire and the items.Patients and Methods: A self-reported diagnostic LSS screening questionnaire was developed based on items from the existing literature describing key symptoms of LSS. The screening questionnaire (index test) was to be tested in a cohort of patients with persistent lumbar and/or leg pain recruited from a Danish publicly funded outpatient secondary care spine clinic with clinicians performing the reference test. However, to avoid unnecessary collection of data if the screening questionnaire proved to be of limited value, a case-control design was incorporated into the cohort design including an interim analysis. Additional cases for the case-control study were recruited at two Danish publicly funded spine surgery departments. Prevalence, sensitivity, specificity and diagnostic odds ratio (OR) were calculated for each individual item, and AUC (area under the curve) was calculated to examine the performance of the full questionnaire.Results: A 13-item Danish questionnaire was developed and tested in 153 cases and 230 controls. The interim analysis was not in favour of continuing the cohort study, and therefore, only results from the case-control study are reported. There was a positive association for all items except the presence of back pain. However, the association was only moderate with ORs up to 3.3. When testing the performance of the whole questionnaire, an AUC of 0.72 was reached with a specificity of 20% for a fixed sensitivity of 95%.Conclusion: The items were associated with LSS and therefore have some potential to identify LSS patients. However, the association was not strong enough to provide sufficient accuracy for a diagnostic tool. Additional dimensions of symptoms of LSS need identification to obtain a reliable questionnaire for screening purposes

The effect of systematic functional assessment and immediate rehabilitation on physical performance in acutely admitted older adults with reduced functional performance: a randomised clinical trial

<p><b>Aims:</b> We hypothesised that a systematic functional assessment in a short stay unit at an emergency department (ED) and/or immediate rehabilitation after discharge will result in sustained or improved physical performance in comparison to a regimen in which neither of these interventions is offered.</p> <p><b>Methods:</b> A two-way factorial randomised clinical trial was completed in an ED and the primary sector. We enrolled 336 nonsurgical patients of 65 years or older, scoring eight or less in the 30-s chair stand test. The interventions were: 1) Usual assessment; 2) Usual rehabilitation; 3) A systematic functional assessment performed within 48 h of admission, in order to identify those with loss of functional mobility, or at risk thereof; and 4) Immediate rehabilitation initiated within five days after discharge. The primary outcome was the 30-s chair stand test three weeks after admission. Secondary outcome measures were Barthel, EQ-5D-3L, and length of stay (LOS).</p> <p><b>Results:</b> An intention-to-treat analysis showed no significant difference in the 30-s chair stand test score nor when analysed by groups or by intervention. The changes were approximately 1% when compared to the reference. No significant differences were found in the secondary outcomes. A per-protocol analysis showed that 99% had received assessment as assigned; however, the extent of mobilisation during hospitalisation was not disclosed. Of the patients, 48% were received the post-discharge rehabilitation they were assigned to.</p> <p><b>Conclusions:</b> Systematic functional assessment and immediate rehabilitation led to no significant differences in physical performance. The study was weakened by the incomplete implementation of mobilisation during hospitalisation and low adherence to protocol on immediate rehabilitation.Implications for rehabilitation</p><p>A systematic functional assessment within the first 48 h of hospital admission is suitable for the identification of older adults in need of post-discharge rehabilitation when compared to usual assessment.</p><p>To sustain physical performance in older adults <i>during acute hospitalisation</i>, further research focusing on mobilisation or physical activation is needed in older adults with a loss of functional mobility, or at risk thereof.</p><p>Further research focusing on physical activation during transition is needed to ameliorate tiredness and inactivity in older adults <i>after acute hospitalisation.</i></p><p></p> <p>A systematic functional assessment within the first 48 h of hospital admission is suitable for the identification of older adults in need of post-discharge rehabilitation when compared to usual assessment.</p> <p>To sustain physical performance in older adults <i>during acute hospitalisation</i>, further research focusing on mobilisation or physical activation is needed in older adults with a loss of functional mobility, or at risk thereof.</p> <p>Further research focusing on physical activation during transition is needed to ameliorate tiredness and inactivity in older adults <i>after acute hospitalisation.</i></p