Back related outcome assessment instruments

A literature review of the most widely used condition specific, self administered assessment questionnaires for low back pain had been undertaken. General and historic aspects, reliability, responsiveness and minimum clinically important difference, external validity, floor and ceiling effects, and available languages were analysed. These criteria, however, are only part of the consideration. Of similar importance are the content, wording of questions and answers in each of the six questionnaires and an analysis of the different score results. The issue of score bias is discussed and suggestions are given in order to increase the construct validity in the practical use of the individual questionnaire

Lückenbüßerinnen?: Weibliche Aushilfskräfte bei der Dresdner Straßenbahn im 1. Weltkrieg und die Heimkehr der Krieger

Die vorliegende Untersuchung soll dazu beitragen, die Stellung der erwerbstätigen Frau in der Kriegsgesellschaft der Jahre 1914 bis 1918 näher zu betrachten. Am Beispiel der Dresdner Straßenbahn lassen sich die Auswirkungen des Krieges auf die Lebens- und Arbeitswelt der bei der Straßenbahn angestellten Frauen gut nachvollziehen. Die Direktion der Dresdner Straßenbahn hatte sich zu Beginn der Mobilmachung im Ersten Weltkrieg mit umfassenden Veränderungen auseinander zu setzen. Ausgehend von den durch den Krieg erschwerten Arbeitsverhältnissen, die hauptsächlich durch den Personalmangel hervorgerufen wurden, soll im Folgenden untersucht werden, inwiefern Frauen zum Aushilfsdienst im Straßenbahnbetrieb eingesetzt wurden. Es wird um die Fragen gehen, zu welchem Zeitpunkt Frauen in den Straßenbahndienst eingestellt wurden und unter welchen Bedingungen die Einstellungen erfolgten. Daneben werden auftretende Probleme, insbesondere Vergehen gegen die Dienstvorschriften, beleuchtet. Ferner soll der Prozess der Wiedereinstellung von Kriegsteilnehmern und die damit einhergehende Entlassung der weiblichen Straßenbahnangestellten dargestellt werden. […

Predictive value of the Acute Low Back Pain Screening Questionnaire and the Örebro Musculoskeletal Pain Screening Questionnaire for persisting problems

Introduction: A small proportion of individuals with non-specific low back pain (NSLBP) develop persistent problems. Up to 80% of the total costs for NSLBP are owing to chronic NSLBP. Psychosocial factors have been described to be important in the transition from acute to chronic NSLBP. Guidelines recommend the use of the Acute Low Back Pain Screening Questionnaire (ALBPSQ) and the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) to identify individuals at risk of developing persistent problems, such as long-term absence of work, persistent restriction in function or persistent pain. These instruments can be used with a cutoff value, where patients with values above the threshold are further assessed with a more comprehensive examination. Methods: We systematically reviewed studies evaluating the accuracy of the ALBPSQ and ÖMPSQ to predict persistent problems. Results: The 13 included studies used different cutoff values for the screening questionnaires ranging from 68 to 147. The pooled sensitivity was 0.59 (0.43-0.74), while the pooled specificity was 0.77 (0.66-0.86). Heterogeneity (I 2) was 90.02% for sensitivity and 95.41% for specificity. Conclusion: Thus, we do not recommend the use of one cutoff value, but the use of a prediction model with all the individual item

Influence of High BMI on Functional Outcome After Total Hip Arthroplasty

Background: High body mass index (BMI) is associated with diseases of the hip joint and subsequent total hip arthroplasty (THA). Less is known about the effects of BMI on the functional postoperative status after THA in obese patients. The purpose of this study was therefore to quantify the role of high preoperative BMI on long-term pain status and functional outcome after THA. Methods: In a multi-center cohort, study data of 20,553 primary THAs (18,968 patients) and 43,562 postoperative clinical examinations were analyzed for a follow-up period of up to 15years. Patients were classified into three BMI groups (normal weight <25kg/m2, overweight 25 to <30kg/m2, and obese ≥30kg/m2), and pain status and functional outcome were compared accordingly. Results: High preoperative BMI is associated to an almost perfect dose-effect relationship with decreased ambulation during a follow-up period of 15years, but pain relief of THA is equally efficient for all BMI groups. Conclusion: Overweight and obesity are modifiable risk factors that may warrant physicians giving recommendations to patients before or after THA, to improve postoperative functional outcome qualit

Impact of the introduction of decoupled payments on functioning of the German land market: Country report of the EU tender Study on the functioning of land markets in those EU member states influenced by measures applied under the Common Agricultura

Against the background of the reform of the Common Agricultural Policy (CAP) in 2003 the following analysis, brings into focus the responses of the agricultural sector to decoupled subsidies. In particular it addresses the impact of the Single Payment Scheme (SPS) on land sales and rent prices and therefore on farm structure. It also aims to assess the extent to which the reform advances sound and sustainable agriculture and provides incentives for marketorientated farming practices. The study is based on the analysis of statistical data and expert surveys conducted in three selected regions. -- G E R M A N V E R S I O N: Die vorliegende Studie untersucht den Einfluss der 2003 im Zuge der Reform der Gemeinsamen Agrarpolitik (GAP) durchgeführten Entkopplung der Direktzahlungen auf den Agrarsektor in Deutschland. Besonderer Fokus der Analyse liegt auf der Auswirkung der einmaligen Zahlungen auf die Kauf- und Pachtpreise für das landwirtschaftlich genutzte Land. Des Weiteren wird die Förderung einer nachhaltigen und marktorientierten Landwirtschaft durch die GAP-Reform bewertet. Die Untersuchung basiert auf Auswertung statistischer Daten und auf Expertenbefragungen, welche in drei ausgewählten Bundesländern durchgeführt wurden.Land markets,midterm review,CAP,structural change,Bodenmärkte,Halbzeitbewertung,GAP,Strukturwandel

Influence of preoperative leg pain and radiculopathy on outcomes in mono-segmental lumbar total disc replacement: results from a nationwide registry

Purpose: Currently, many pre-conditions are regarded as relative or absolute contraindications for lumbar total disc replacement (TDR). Radiculopathy is one among them. In Switzerland it is left to the surgeon's discretion when to operate if he adheres to a list of pre-defined indications. Contraindications, however, are less clearly specified. We hypothesized that, the extent of pre-operative radiculopathy results in different benefits for patients treated with mono-segmental lumbar TDR. We used patient perceived leg pain and its correlation with physician recorded radiculopathy for creating the patient groups to be compared. Methods: The present study is based on the dataset of SWISSspine, a government mandated health technology assessment registry. Between March 2005 and April 2009, 577 patients underwent either mono- or bi-segmental lumbar TDR, which was documented in a prospective observational multicenter mode. A total of 416 cases with a mono-segmental procedure were included in the study. The data collection consisted of pre-operative and follow-up data (physician based) and clinical outcomes (NASS form, EQ-5D). A receiver operating characteristic (ROC) analysis was conducted with patients' self-indicated leg pain and the surgeon-based diagnosis "radiculopathy”, as marked on the case report forms. As a result, patients were divided into two groups according to the severity of leg pain. The two groups were compared with regard to the pre-operative patient characteristics and pre- and post-operative pain on Visual Analogue Scale (VAS) and quality of life using general linear modeling. Results: The optimal ROC model revealed a leg pain threshold of 40≤VAS>40 for the absence or the presence of "radiculopathy”. Demographics in the resulting two groups were well comparable. Applying this threshold, the mean pre-operative leg pain level was 16.5 points in group 1 and 68.1 points in group 2 (p<0.001). Back pain levels differed less with 63.6 points in group 1 and 72.6 in group 2 (p<0.001). Pre-operative quality of life showed considerable differences with an 0.44 EQ-5D score in group 1 and 0.29 in group 2 (p<0.001, possible score range −0.6 to 1). At a mean follow-up time of 8 months, group 1 showed a mean leg pain improvement of 3.6 points and group 2 of 41.1 points (p<0.001). Back pain relief was 35.6 and 39.1 points, respectively (p=0.27). EQ-5D score improvement was 0.27 in group 1 and 0.41 in group 2 (p=0.11). Conclusions: Patients labeled as having radiculopathy (group 2) do mostly have pre-operative leg pain levels≥40. Applying this threshold, the patients with pre-operative leg pain do also have more severe back pain and a considerably lower quality of life. Their net benefit from the lumbar TDR is higher and they do have similar post-operative back and leg pain levels as well as the quality of life as patients without pre-operative leg pain. Although randomized controlled trials are required to confirm these findings, they put leg pain and radiculopathy into perspective as absolute contraindications for TD

High incidence of medication documentation errors in a Swiss university hospital due to the handwritten prescription process

BACKGROUND: Medication errors have been reported to be a leading cause of death in hospitalized patients. In this study we focused on identifying and quantifying errors in the handwritten drug ordering and dispensing documentation processes which could possibly lead to adverse drug events. METHODS: We studied 1,934 ordered agents (165 consecutive patients) retrospectively for medication documentation errors. Errors were categorized into: Prescribing errors, transcription errors and administration documentation errors on the nurses' medication lists. The legibility of prescriptions was analyzed to explore its possible influence on the error rate in the documentation process. RESULTS: Documentation errors occurred in 65 of 1,934 prescribed agents (3.5%). The incidence of patient charts showing at least one error was 43%. Prescribing errors were found 39 times (37%), transcription errors 56 times (53%), and administration documentation errors 10 times (10%). The handwriting readability was rated as good in 2%, moderate in 42%, bad in 52%, and unreadable in 4%. CONCLUSIONS: This study revealed a high incidence of documentation errors in the traditional handwritten prescription process. Most errors occurred when prescriptions were transcribed into the patients' chart. The readability of the handwritten prescriptions was generally bad. Replacing the traditional handwritten documentation process with information technology could potentially improve the safety in the medication process

The International Documentation and Evaluation System IDES: a single center observational case series for development of an ankle prosthesis documentation questionnaire and study of its feasibility and face validity

ABSTRACT: BACKGROUND: The number of implanted total ankle replacements is increasing and most articles present short- and mid-term results. Comparison of outcomes is difficult because of inconsistent terminology and different use of parameters. MATERIALS AND METHODS: We created a module for total ankle prostheses in the framework of the International Documentation and Evaluation System (IDES). Content development was conducted with an iterative process based on a single surgeon series of 74 HINTEGRA(c) total ankle replacements and expert opinions. RESULTS: The IDES ankle module comprises three forms A, B and C for recording of primary (A), revision (B) and followup (C) procedures. 74 primary interventions, 28 revisions and 92 followups could be documented in detail with the final version of the questionnaires. CONCLUSION: The IDES-forms facilitate a structured and standardized data collection for total ankle arthroplasties. Implemented on the academic MEMdoc portal http://www.memdoc.org of the University of Bern, all registered users can make use of IDES in its online or paper based versions

Benchmarking in the SWISSspine Registry: results of 52 Dynardi lumbar total disc replacements compared with the data pool of 431 other lumbar disc prostheses

The SWISSspine registry is the first mandatory registry of its kind in the history of Swiss orthopaedics and it follows the principle of "coverage with evidence development”. Its goal is the generation of evidence for a decision by the Swiss federal office of health about reimbursement of the concerned technologies and treatments by the basic health insurance of Switzerland. Recently, developed and clinically implemented, the Dynardi total disc arthroplasty (TDA) accounted for 10% of the implanted lumbar TDAs in the registry. We compared the outcomes of patients treated with Dynardi to those of the recipients of the other TDAs in the registry. Between March 2005 and October 2009, 483 patients with single-level TDA were documented in the registry. The 52 patients with a single Dynardi lumbar disc prosthesis implanted by two surgeons (CE and OS) were compared to the 431 patients who received one of the other prostheses. Data were collected in a prospective, observational multicenter mode. Surgery, implant, 3-month, 1-year, and 2-year follow-up forms as well as comorbidity, NASS and EQ-5D questionnaires were collected. For statistical analyses, the Wilcoxon signed-rank test and chi-square test were used. Multivariate regression analyses were also performed. Significant and clinically relevant reduction of low back pain and leg pain as well as improvement in quality of life was seen in both groups (P<0.001 postop vs. preop). There were no inter-group differences regarding postoperative pain levels, intraoperative and follow-up complications or revision procedures with a new hospitalization. However, significantly more Dynardi patients achieved a minimum clinically relevant low back pain alleviation of 18 VAS points and a quality of life improvement of 0.25 EQ-5D points. The patients with Dynardi prosthesis showed a similar outcome to patients receiving the other TDAs in terms of postoperative low back and leg pain, complications, and revision procedures. A higher likelihood for achieving a minimum clinically relevant improvement of low back pain and quality of life in Dynardi patients was observed. This difference might be due to the large number of surgeons using other TDAs compared to only two surgeons using the Dynardi TDA, with corresponding variations in patient selection, patient-physician interaction and other factors, which cannot be assessed in a registry stud