Individualized quality of life in patients with low back pain: reliability and validity of the Patient Generated Index

Objective: To evaluate the reliability and validity of the improved version of the Patient Generated Index (PGI) in patients with low back pain. Methods: The PGI was administered to 90 patients attending care in 1 of 6 institutions in Norway and evaluated for reliability and validity. The questionnaire was given out to 61 patients for re-test purposes. Results: The PGI was completed correctly by 80 (88.9%) patients and, of the 61 patients responding to the re-test, 50 (82.0%) completed both surveys correctly. PGI scores were approximately normally distributed, with a median of 40 (range 80), where 100 is the best possible quality of life. There were no floor or ceiling effects. The 5 most frequently listed areas affecting quality of life were pain, sleep, stiffness, socializing and housework. The test-retest intraclass correlation coefficient was 0.73. The smallest detectable changes for individual and group purposes were 32.8 and 4.6, respectively. The correlations between PGI scores and other instrument scores followed a priori hypotheses of low to moderate correlations. Discussion: The PGI has evidence for reliability and validity in Norwegian patients with low back pain at the group level and may be considered for application in intervention studies when a comprehensive evaluation of quality of life is important. However, the smallest detectable change, of approximately 30 points, may be considered too large for individual purposes in clinical application

Comparison of the SF6D, the EQ5D, and the oswestry disability index in patients with chronic low back pain and degenerative disc disease

Background The need for cost effectiveness analyses in randomized controlled trials that compare treatment options is increasing. The selection of the optimal utility measure is important, and a central question is whether the two most commonly used indexes - the EuroQuol 5D (EQ5D) and the Short Form 6D (SF6D) – can be used interchangeably. The aim of the present study was to compare change scores of the EQ5D and SF6D utility indexes in terms of some important measurement properties. The psychometric properties of the two utility indexes were compared to a disease-specific instrument, the Oswestry Disability Index (ODI), in the setting of a randomized controlled trial for degenerative disc disease. Methods In a randomized controlled multicentre trial, 172 patients who had experienced low back pain for an average of 6 years were randomized to either treatment with an intensive back rehabilitation program or surgery to insert disc prostheses. Patients filled out the ODI, EQ5D, and SF-36 at baseline and two-year follow up. The utility indexes was compared with respect to measurement error, structural validity, criterion validity, responsiveness, and interpretability according to the COSMIN taxonomy. Results At follow up, 113 patients had change score values for all three instruments. The SF6D had better similarity with the disease-specific instrument (ODI) regarding sensitivity, specificity, and responsiveness. Measurement error was lower for the SF6D (0.056) compared to the EQ5D (0.155). The minimal important change score value was 0.031 for SF6D and 0.173 for EQ5D. The minimal detectable change score value at a 95% confidence level were 0.157 for SF6D and 0.429 for EQ5D, and the difference in mean change score values (SD) between them was 0.23 (0.29) and so exceeded the clinical significant change score value for both instruments. Analysis of psychometric properties indicated that the indexes are unidimensional when considered separately, but that they do not exactly measure the same underlying construct. Conclusions This study indicates that the difference in important measurement properties between EQ5D and SF6D is too large to consider them interchangeable. Since the similarity with the “gold standard” (the disease-specific instrument) was quite different, this could indicate that the choice of index should be determined by the diagnosis

Cost of Illness for Patients with Arthritis Receiving Multidisciplinary Rehabilitation Care

Purpose. To describe healthcare consumption and costs prior to, during, and after multidisciplinary rehabilitation due to arthritis. Methods. 306 patients (age 18–75 years) with arthritis scheduled for multidisciplinary rehabilitation care in 9 rehabilitation centres and 4 rheumatology hospital departments were included and followed for 6 months. Costs were estimated in Euros (€) for the total sample and five clinical subgroups. Results. Healthcare costs ranged from €3,033 to €91,336 and were significantly higher at hospital departments compared to rehabilitation centres: €9,722 (SD 5,406) and €4,250 (SD 1,040). While total costs prior to and after rehabilitation were stable for those receiving rehabilitation at a hospital, there was a significant increase in costs for those being at a rehabilitation centre. Total mean costs were more than doubled when including social costs: from €32,410 (95% CI 20,074–37,017) to €51,491 (95% CI 49,055–61,657). Conclusions. Healthcare and social costs for arthritis rehabilitation were substantial both before and after a rehabilitation stay. It is important to explore methods to reduce the length of rehabilitation stay and production loss connected to rehabilitation of patients with rheumatic disease

Multimodal physiotherapy may be no better than sham treatment for people with hip osteoarthritis

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Neck and shoulder pain in adolescents seldom occur alone: Results from the Norwegian Ungdata Survey

No previous studies have investigated the prevalence of co-occurring neck/shoulder pain, other musculoskeletal pain, headache and depressive symptoms in adolescents. This study aimed to describe the prevalence of isolated neck/shoulder pain and the co-occurrence of neck/shoulder pain with other musculoskeletal pain, headache and depressive symptoms in Norwegian adolescents. Methods: This is a cross-sectional study using data from the Norwegian Ungdata survey (2017–2019). Adolescents from almost all municipalities in Norway answered a comprehensive questionnaire, including physical complaints. We investigated the prevalence of self-reported neck/shoulder pain in isolation and neck/shoulder pain in combination with other musculoskeletal pain, headache and depressive symptoms. The results were presented with per cent and stratified by school level and sex. Results: In total, 253,968 adolescents (50% girls) participated in the study, of which 56.5% were from lower secondary school. The total prevalence of neck/shoulder pain was 24%, but only 5% reported isolated neck/shoulder pain. Among students reporting neck/shoulder pain, half of them also reported other musculoskeletal pain, and 50% of the boys and 70% of the girls reported co-occurring headache. Depressive symptoms were reported in 28% of the boys and 45% of the girls with neck/shoulder pain. Conclusion: Neck/shoulder pain in adolescents is seldom isolated, but seems to co-occur with headache, other musculoskeletal pain and depressive symptoms. Researchers and clinicians should keep a broader health perspective in mind when approaching adolescents with neck/shoulder pain. Significance: One in five adolescents reported neck/shoulder pain in this large population-based study of Norwegian adolescents. A majority of adolescents reported neck/shoulder pain in co-occurrence with other musculoskeletal pain, headache and depression. Researchers and clinicians should assess these comorbidities when assessing adolescents with neck/shoulder pain.publishedVersio

Translation and cultural adaptation of evidence-informed leaflets on the work-health interface: a pragmatic approach to cultural adaptation

Aim: Our aim was to translate and culturally adapt three evidence-informed leaflets on the work–health interface from English into Norwegian. Integral to this aim was the exploration of the quality and acceptability of each of the adapted leaflets to Norwegian-speaking stakeholders; general practitioners, people who deal with health issues in the workplace, and the general population. Background: Common health problems, such as musculoskeletal pain, account for most workdays lost and disability benefits in Norway. To facilitate return to work, it may be important to have access to evidence-informed information on the work–health interface for stakeholders involved in sickness absence processes. However, there is limited information material available in Norwegian that is tailored for the different stakeholders. Cultural adaptation is an emerging strategy for implementing health information across different populations and regions. Guidelines on cultural adaptation are not well-suited for translating and adapting evidence-informed health information material. Methods: We conducted a pragmatic cultural adaptation process informed by existing guidelines. Our conceptual framework for adaptation is situated between adaptation and translation and comprises appraisal, forward- and back-translation, review in multiple steps, sense checking, and re-designing using a transcreation approach. Using an online survey, we aimed to evaluate the overall quality, value, acceptability, and clarity of each of the adapted leaflets to a total of 30 end-users. Findings: We translated and culturally adapted three leaflets from English to Norwegian. Adapted leaflets were found to be clearly presented, acceptable, and valued by 45 Norwegian end-users. No differences in key concepts between original and back-translated leaflets emerged through the review process by the original author and forward translators. We used a pragmatic approach in this study that might be useful to others culturally adapting vidence-informed health information material.publishedVersio

Anterior surgical treatment for cervical degenerative radiculopathy: a prediction model for non-success

Purpose By using data from the Norwegian Registry for Spine Surgery, we wanted to develop and validate prediction models for non-success in patients operated with anterior surgical techniques for cervical degenerative radiculopathy (CDR). Methods This is a multicentre longitudinal study of 2022 patients undergoing CDR surgery and followed for 12 months to fnd prognostic models for non-success in neck disability and arm pain using multivariable logistic regression analysis. Model performance was evaluated by area under the receiver operating characteristic curve (AUC) and a calibration test. Internal validation by bootstrapping re-sampling with 1000 repetitions was applied to correct for over-optimism. The clinical usefulness of the neck disability model was explored by developing a risk matrix for individual case examples. Results Thirty-eight percent of patients experienced non-success in neck disability and 35% in arm pain. Loss to follow-up was 35% for both groups. Predictors for non-success in neck disability were high physical demands in work, low level of education, pending litigation, previous neck surgery, long duration of arm pain, medium-to-high baseline disability score and presence of anxiety/depression. AUC was 0.78 (95% CI, 0.75, 0.82). For the arm pain model, all predictors for non-success in neck disability, except for anxiety/depression, were found to be signifcant in addition to foreign mother tongue, smoking and medium-to-high baseline arm pain. AUC was 0.68 (95% CI, 0.64, 0.72). Conclusion The neck disability model showed high discriminative performance, whereas the arm pain model was shown to be acceptable. Based upon the models, individualized risk estimates can be made and applied in shared decision-making with patients referred for surgical assessment

Can we define success criteria for lumbar disc surgery? Estimates for a substantial amount of improvement in core outcome measures

Background and purpose: A successful outcome after lumbar discectomy indicates a substantial improvement. To use the cutoffs for minimal clinically important difference (MCID) as success criteria has a large potential bias, simply because it is difficult to classify patients who report that they are “moderately improved”. We propose that the criteria for success should be defined by those who report that they are “completely recovered” or “much better”. Methods: A cohort of 692 patients were operated for lumbar disc herniation and followed for 1 year in the Norwegian Registry for Spine Surgery. The global perceived scale of change was used as an external criterion, and success was defined as those who reported that they were “completely recovered” or “much better”. Criteria for success for each of (1) the Oswestry disability index (ODI; score range 0–100 where 0 = no disability), (2) the numerical pain scale (NRS; range 0–10 where 0 = no pain) for back and leg pain, and (3) the Euroqol (EQ-5D; –0.6 to 1 where 1 = perfect health) were estimated by defining the optimal cutoff point on receiver operating characteristic curves. Results: The cutoff values for success for the mean change scores were 20 (ODI), 2.5 (NRS back), 3.5 (NRS leg), and 0.30 (EQ-5D). According to the cutoff estimates, the proportions of successful outcomes were 66% for the ODI and 67% for the NRS leg pain scale. Interpretation: The sensitivity/specificity values for the ODI and leg pain were acceptable, whereas they were very low for the EQ-5D. The cutoffs for success can be used as benchmarks when comparing data from different surgical units.publishedVersio

Complex return to work process – caseworkers’ experiences of facilitating return to work for individuals on sick leave due to musculoskeletal disorders

Musculoskeletal disorders (MSD) are the largest contributor to disability worldwide. In addition to burdening individuals, there are large socioeconomic costs involved. MSD accounts for a considerable use of health services, and for the greatest proportion of lost productivity in the workplace. In Norway, MSD are the most common cause of sickness absence and represent the largest health challenge for workers in terms of prevalence and cost measured in worse health and disability in addition to sickness absence.The study was founded by the Research Council of Norway (280431/GE).publishedVersio