Responsiveness and minimal clinically important change of the Pain Disability Index in patients with chronic back pain

ABSTRACT: Study Design. Prospective cohort study.Objective. The objective of this study was to test the responsiveness and minimal clinically important change (MCIC) of the PDI in patients with Chronic Back Pain (CBP).Summary of background data. Treatment of patients with CBP is primarily focused on reduction of disability. For disability measurement, the Pain Disability Index (PDI) is a widely used questionnaire. There are, however, no data available on responsiveness and MCIC.Methods. 242 Patients with CBP were included in this study. Patients filled in the PDI at baseline and at discharge. The PDI consists of two subscales: one measuring voluntary activities and one measuring obligatory activities. PDI was anchored at two self-reported global perceived effect (GPE) scales for complaints and self-care, respectively. Responsiveness was considered sufficient when Area Under the Receiver Operating Characteristic Curve (AUC) was > 0.70. To test interpretability, change scores and MCIC were calculated. MCIC was tested by determination of optimal cut-off point of the ROC-curve and determination of specificity and sensitivity of the Optimal Cut off Point (OCP).Results. AUCs were 0.76 and 0.77 depending on the external criterion. The sub-scale obligatory activities did not meet the criteria for responsiveness (AUC 0.63-0.69). MCIC of the PDI was 9.5 points for GPE 'complaints' and 8.5 for GPE 'self-care'.Conclusion. The total score of the PDI as well as the subscale of voluntary activities are responsive. Partly because of floor effects, the subscale obligatory activities is not sufficiently responsive in patients with CBP. However, the responsiveness of this sub-scale in other patient groups should be further tested. In patients with CBP, change can be considered clinically important when PDI score has decreased 8.5 to 9.5 points

Clinimetric properties of the EuroQol-5D in patients with chronic low back pain

BACKGROUND CONTEXT: Clinimetric properties of the EuroQol-5D (EQ-5D) in patients with nonspecific chronic low back pain (CLBP) are largely unknown. PURPOSE: To study the criterion validity, responsiveness, and minimal clinically important change (MCIC) of EQ-5D in patients with CLBP. STUDY DESIGN: Prospective study design carried out in a multispecialist Spine Center in The Netherlands. PATIENT SAMPLE: One hundred fifty-one patients with CLBP. OUTCOME MEASURES: Quality of life (QOL) was measured with EQ-5D, consisting of two scales: one scale measuring QOL with five categorical questions and the other measuring health state on a visual analog scale (0-100). Criterion measures were disability, measured with the Pain Disability Index (PDI) and the Roland Morris Disability Questionnaire (RMDQ), and pain intensity, measured with a numeric rating scale (NRS). METHODS: Pearson correlation coefficients between the EQ-5D and RMDQ, PDI, and NRS were calculated to test the criterion validity. Correlations were interpreted based on predefined criteria. Responsiveness of the EQ-5D was calculated with area under the receiver operating characteristics (ROC) curve. Minimal clinically important change was calculated with the optimal cutoff point under the ROC curve, and sensitivity and specificity were also calculated. RESULTS: Correlations between EQ-5D and criterion measures ranged between 0.39 and 0.59 and were considered moderate to good. Areas under the ROC curve ranged from 0.59 to 0.72 depending on the external criterion and EQ-5D subscale. The MCIC was 0.03 points for the categorical scales of the EQ-5D and 10.5 points for the EQ-5D visual analog scale. CONCLUSIONS: The EQ-5D is a valid and responsive QOL scale in patients with CLBP

Operative treatment of anterior thoracic spinal cord herniation: three new cases and an individual patient data metaaAnalysis of 126 case reports

OBJECTIVE: Anterior thoracic spinal cord herniation is a rare cause of progressive myelopathy. Much has been speculated about the best operative treatment. However, no evidence in favor of any of the promoted techniques is available to date. Therefore, we decided to analyze treatment procedures and treatment outcomes of anterior thoracic spinal cord herniation to identify those factors that determine postoperative outcome. METHODS: An individual patient data meta-analysis was conducted, focusing on age, gender, vertebral segment of herniation, preoperative neurological status, operative interval, operative findings, operative techniques, intraoperative neurophysiological monitoring, postoperative imaging, neurological outcome and follow-up. Three cases from our own institution were added to the material collected. Bivariate analysis tests and multivariate logistic regression tests were used so as to define which variables were associated with outcome after surgical treatment of anterior thoracic spinal cord herniation. RESULTS: Brown-Sequard syndrome and release of the herniated spinal cord appeared to be strong independent factors, associated with favorable postoperative Outcome. Widening of the dura defect is associated with the highest prevalence of postoperative motor function improvement when compared with the application of an anterior dura patch (P < 0.036). CONCLUSION: Most patients with anterior thoracic spinal cord herniation require operative treatment because of progressive myelopathy. Patients with Brown-Sequard syndrome have a better prognosis with respect to postoperative motor function improvement, In this review, spinal cord release and subsequent widening of the dural defect were associated with the highest prevalence of motor function improvement. D-wave recording can be a very useful tool for the surgeon during operative treatment of this disorder,

Can patients with low back pain be satisfied with less than expected?

STUDY DESIGN A prospective cohort study within care as usual. OBJECTIVE 1. To explore the psychometric properties of a baseline disability questionnaire designed to collect patients expectation. 2. To analyse relationships between satisfaction with care and treatment success in patients with CLBP. 3. To determine the chances of being satisfied with the received care in absence of treatment success. SUMMARY OF BACKGROUND DATA There is a lack of evidence on determinants of treatment satisfaction in patients with chronic low back pain (CLBP), specifically the role of patient's expectation of disability reduction after treatment. METHODS Treatment expectation was measured with questions inspired by the Pain Disability Index (PDI) at baseline. Treatment success was considered if disability at the end of therapy was lower than, or equal to pre-treatment expectation. An exploratory factor analysis was performed on the new questionnaire. Binary logistic regression models were used to analyse how much variance of satisfaction with care was explained by treatment success, pain disability at baseline, gender, age, duration of complaints and pain intensity. The Odds Ratio (OR) of being satisfied when treatment was successful was calculated. RESULTS 609 patients were included. The factor structure of the PDI-expectancy (PDI-E) had optimal fit with a one factor structure. There were low correlations between the expected and baseline disability, pain intensity, and duration of pain. Correlation between treatment success and satisfaction with care was low (χ2 = 0.13; p <0.01). Treatment success had a low contribution to satisfaction with care. Of all participating patients, 51.4% were satisfied with care even when treatment was not successful. The OR for being satisfied was 2.42 when treatment was successful compared to when treatment was not successful. CONCLUSION The PDI-E is internally consistent. Pre-treatment expectation contributes uniquely but slightly to satisfaction with care; patients whose treatment was considered successful have 1.38 - 4.24 times higher chance of being satisfied at the end of treatment. Even when treatment was not successful, 51.4% of the patients with CLBP are satisfied with care. LEVEL OF EVIDENCE 2

Reference Values of the Pain Disability Index in Patients With Painful Musculoskeletal and Spinal Disorders: A Cross-national Study

Study Design. Cross-sectional study. Objective. To examine reference data for the Pain Disability Index (PDI) in Dutch and Canadian patient samples with a variety of musculoskeletal pain disorders and to test which potential factors are independently associated with the PDI score. Summary of Background Data. The PDI is a widely used generic instrument for measuring disability related to pain. It is unknown whether patients with spinal and other musculoskeletal diagnoses have different levels of disability when scored on the PDI. Methods. Patients were referred to secondary and tertiary care centers in the Netherlands and Alberta, Canada, between 2009 and 2013. All patients filled out a baseline questionnaire including demographics and the PDI. After first consultation with a medical doctor, diagnoses were set by the medical specialist. Univariate general linear models were used to examine correlations between PDI scores and age, sex, country of residence, diagnosis, and work status. Results. In total 6997 patients were included in this study: 1302 Canadian and 5695 Dutch patients. Mean PDI score of the total group was 37.8 +/- 14.2. Reference values are presented and clustered into the following diagnostic groups: spinal nerve and intervertebral disc disorders; nonspecific back pain; rheumatic soft-tissue pain (widespread pain or fibromyalgia); spinal stenosis; and whiplash-associated disorder. The PDI score was significantly and relevantly associated with pain intensity (. 2 explained variance from 20% to 25%), but not relevantly associated with age, sex, country of residence, and diagnostic group (eta(2) Conclusion. Reference values of the PDI are presented. Patient ratings of disability on the PDI are relevantly associated with pain intensity and work status, but not with nationality or diagnostic group. Only minimal differences were identified between the various musculoskeletal diagnoses included

Prediction of Quality of Life and Survival After Surgery for Symptomatic Spinal Metastases: A Multicenter Cohort Study to Determine Suitability for Surgical Treatment

Scientific Assessment and Innovation in Neurosurgical Treatment Strategie

Rapid improvements in pain and quality of life are sustained after surgery for spinal metastases in a large prospective cohort

Introduction Metastatic spinal cancer is a common condition that may lead to spinal instability, pain and paralysis. In the 1980s, surgery was discouraged because results showed worse neurological outcomes and pain compared with radiotherapy alone. However, with the advent of modern imaging and spinal stabilisation techniques, the role of surgery has regained centre stage, though few studies have assessed quality of life and functional outcomes after surgery. Objective We investigated whether surgery provides sustained improvement in quality of life and pain relief for patients with symptomatic spinal metastases by analysing the largest reported surgical series of patients with epidural spinal metastases. Methods A prospective cohort study of 922 consecutive patients with spinal metastases who underwent surgery, from the Global Spine Tumour Study Group database. Pre- and post-operative EQ-5D quality of life, visual analogue pain score, Karnofsky physical functioning score, complication rates and survival were recorded. Results Quality of life (EQ-5D), VAS pain score and Karnofsky physical functioning score improved rapidly after surgery and these improvements were sustained in those patients who survived up to 2 years after surgery. In specialised spine centres, the technical intra-operative complication rate of surgery was low, however almost a quarter of patients experienced post-operative systemic adverse events. Conclusion Surgical treatment for spinal metastases produces rapid pain relief, maintains ambulation and improves good quality of life. However, as a group, patients with cancer are vulnerable to post-operative systemic complications, hence the importance of appropriate patient selection.Scientific Assessment and Innovation in Neurosurgical Treatment Strategie

Loss of Local Tumor Control After Index Surgery for Spinal Metastases: A Prospective Cohort Study

Scientific Assessment and Innovation in Neurosurgical Treatment Strategie

A novel risk calculator to predict outcome after surgery for symptomatic spinal metastases; use of a large prospective patient database to personalise surgical management

Scientific Assessment and Innovation in Neurosurgical Treatment Strategie