Study design: A prospective study of 135 subjects with whiplash injury. Objectives: To identify factors predictive of prolonged disability following whiplash injury. Summary of background data: Although subjects with whiplash associated disorders lack demonstrable physical injury, many exhibit prolonged disability. Disability appears unrelated to the severity of the collision. Methods: 147 subjects with recent whiplash injury were interviewed for putative risk factors for disability. 135 were re-interviewed 12 months later to assess degree of duration of disability. Bivariate and multivariate analyses were undertaken to measure the association between putative risk factors and measures of outcome. Results: The bodily pain score and role emotional scores of the SF-36 health questionnaire showed a consistent significant positive association with better outcomes. After adjustment for bodily pain score and role emotional scores, consulting a lawyer was associated with less improvement in NPOS (p< 0.01) after one year, but there was no significant association with rate of return to work. The degree of damage to the vehicle was not a predictor of outcome. Conclusions: SF-36 scores for bodily pain and role emotional are useful means of identifying subjects at risk of prolonged disability. The findings support the implementation of an insurance system designed to minimise litigation

STUDY DESIGN: A prospective study of 135 subjects with whiplash injury. OBJECTIVES: To identify factors predictive of prolonged disability following whiplash injury. SUMMARY OF BACKGROUND DATA: Although subjects with whiplash associated disorders lack demonstrable physical injury, many exhibit prolonged disability. Disability appears unrelated to the severity of the collision. METHODS: 147 subjects with recent whiplash injury were interviewed for putative risk factors for disability. 135 were re-interviewed 12 months later to assess degree of duration of disability. Bi-variate and multi-variate analyses were undertaken to measure the association between putative risk factors and measures of outcome. RESULTS: The bodily pain score and role emotional scores of the SF-36 health questionnaire showed a consistent significant positive association with better outcomes. After adjustment for bodily pain score and role emotional scores, consulting a lawyer was associated with less improvement in NPOS (p< 0.01) after one year, but there was no significant association with rate of return to work. The degree of damage to the vehicle was not a predictor of outcome. CONCLUSIONS: SF-36 scores for bodily pain and role emotional are useful means of identifying subjects at risk of prolonged disability. The findings support the implementation of an insurance system designed to minimise litigation

Background. Disability is an important multifaceted construct. The aim of this study was to develop and evaluate a brief, generic self-reported disability questionnaire: the Universal Disability Index (UDI). Methods. Convenience sampling was used to collect general population data via an online survey. Data were randomly divided into training and validation subsets. The dimensionality and structure of eight UDI questionnaire items were evaluated using exploratory factor analysis (EFA, training subset) followed by confirmatory factor analysis (CFA, validation subset). To assess concurrent validity, the UDI summed score from the full dataset was compared to the Groningen Activity Restriction Scale (GARS) and the Graded Chronic Pain Scale (GCPS) disability scores. Internal consistency was also assessed. Results. 403 participants enrolled; 364 completed at least one UDI item. Three single-factor versions of the UDI were assessed (8-item, 7-item, and 6-item). All versions performed well during EFA and CFA (182 cases assigned to each), but none met the RMSEA (Root Mean Square Error of Approximation) criterion (≤ 0.08). All versions of the UDI had high internal consistency (Cronbach's α > 0.90) and were strongly correlated (Pearson's r > 0.7) with both GARS and GCPS disability scores, indicating concurrent validity. Conclusions. A brief, generic self-reported disability questionnaire was found to be valid and to possess good psychometric properties. The UDI has a single factor structure and either a 6-item, 7-item or 8-item version can be used to measure disability. For brevity and parsimony, the 6-item UDI is recommended, but further testing of all versions is warranted. Conflicts of interest. No conflicts of interest. Sources of funding. No funding obtained

Introduction. Patient reported outcome measures (PROMs) and psychological aspects of spinal conditions play an important role in its management. Disability benefit in the social welfare system is being closely scrutinized. The PHQ9 and GAD7 are used widely in general practice to aid assessment of depression and anxiety/somatization. To date, their use in the spinal surgery out patient setting has not been assessed. Materials and Method. Over a one-year period the senior author saw 516 new patients. Each patient completed a standard spinal assessment questionnaire consisting of several demographic/aetiological questions and PROMs (VAS back, VAS leg, ODI/NDI, PHQ9 and GAD7). An analysis of these scores was performed. Results. The mean age was 54 years with 237 males and 279 females. The mean VAS Neck/Back was 6.7, VAS Limb 6, ODI/NDI 48, PHQ9 12 and GAD7 8.7. The PHQ9 and GAD7 correlated strongly with the VAS and ODI/NDI scores (r=0.3–0.4, p<0.0001). The PHQ9 correlated strongly with the GAD7 (r=0.83, p<0.0001). 163 patients (31.6%) were receiving disability benefit. Disability benefit was strongly associated with increasing age, VAS, ODI/NDI, PHQ9 and GAD7 scores (p<0.0001). Patients receiving disability benefit have more concerns regarding their pain and worse PROMs. Similar findings were found in the subgroup of 81 patients with chronic degenerative low back pain. Conclusion. The PHQ9 and GAD7 scores appear to correlate well with the standard spinal disability assessment PROMs (VAS and ODI/NDI). Patients receiving disability benefit appear to have worse PROMs including worse measures of depression and anxiety/somatization

Background. Disability is an important multifaceted construct. Identifying sources of disability could help optimise patient care. The aim of this study was to test an approach that not only estimates severity of disability, but also identifies the source(s) of this disability. Methods. An online survey was used to collect data from a convenience sample, recruited via email and social media invitations. Two generic measures of disability, the 8-item Universal Disability Index (UDI8) and Groningen Activity Restriction Scale (GARS) were used to estimate the prevalence and severity of disability in this sample. Non-zero UDI8 item responses generated conditional sub-questions, in which participants could attribute their activity limitations to one or more sources (pain, fatigue, worry, mood, and other). This allowed for a decomposition of UDI8 scores into source components. Results. 403 participants enrolled; 334 completed all UDI8 and GARS items. Of these, 85.3% (285/334) reported at least one restricted activity via the UDI8, while 43.4% (145/334) reported some reduced independence via the GARS. Disability severity increased with age until approximately 40 years, after which it decreased gradually. Pain component scores were high in all individuals with higher and lower disability severity, whereas fatigue component scores were highest in individuals reporting higher disability severity. Worry, mood, and other component scores were not high at any level of disability severity. Conclusions. This approach should be used to identify the prevalence, severity and sources of disability in the general population and in specific patient groups. Conflicts of interest. No conflicts of interest. Sources of funding. No funding obtained

Chronic low back pain (CLBP) is the most common cause of disability worldwide, and lumbar spine fusion (LSF) is often chosen to treat pain caused by advanced degenerative disease when clinical treatment failed certain cases, the post-surgical outcomes are not what was expected. Several studies highlight how important are. In psychological variables during the postoperative spine surgery period. The aim of this study is to assess the role of preoperative depression on postoperative clinical outcomes. We included patients who underwent LSF since December 2021. Preoperative depression was assessed administering Beck Depression Inventory questionnaire (BDI). And pain and disability were evaluated at 1, 3, and 6 months, administering respectively Visual Analogic Scale (VAS) and Oswestry Disability Index (ODI). As statistical analysis Mann-Whitney test was performed. We included 46 patients, 20 female (43,5%) and 26 male (56,5%) with an average age of 64,2. The population was divided in two groups, fixing the BDI cut-off point at 10. Patients with BDI < 10 points (N=28) had normal mental health status, instead patients with BDI > 10 points (N=16) had depressive disorders. At 3 months patients with healthy mental status reported statistically significant reduction of pain (U = 372,5, p = .006) and improvement of disability but without statistical significancy (U = 318, p = 0,137). At 6 months patients without psychological disease reported statistically significant reduction of pain (U = 342, p = 0,039) and disability (U = 372,5, p = 0,006). This study demonstrates the correlation between pre-existing depressive state and poorer clinical outcomes after spine surgery. These results are consistent with the literature. Therefore, during the surgical decision making it is crucial to take psychological variables into account in order to predict the results after surgery and inform patients on the potential influence of mental status

Background Context. In the assessment and treatment of patients with chronic low back pain (CLBP) the bio- psycho-social model is used world wide. Psychological distress has been reported to have a strong relationship with self reported disability. The relationship between psychosocial distress measured with the SCL-90-R and self reported disability measured with the RMDQ has not been investigated. Purpose. To analyze the relationship between psychosocial distress measured with the Symptom Checklist-90-Revised (SCL-90-R) and self reported disability measured with the Roland Morris Disability Questionnaire (RMDQ) in patients with CLBP. Study design/Setting. This cross sectional study was performed in an outpatient pain rehabilitation setting. Patient sample. The study sample consisted of 152 patients with CLBP. Outcome measures. Scores on SCL-90-R and the RMDQ. Methods. All patients admitted for multidisciplinary treatment completed the SCL-90-R and RMDQ prior to treatment. Pearson’s correlation coefficients between SCL-90-R (Global Severity Index and subscales) and RMDQ were calculated. Results. Correlation coefficients between SCL-90-R (Global Severity Index and subscales) and RMDQ ranged from 0.18 to 0.31 (p< 0.05). Conclusion. The relationship between psychosocial distress measured with the SCL-90-R and self reported disability measured with the RMDQ in CLBP patients is weak. For clinical practice it is important to unravel the components and their suggested relationships in the bio-psycho-social model. This research has demonstrated that these relationships cannot be confirmed with the combined use of the SCL-90-R and the RMDQ. Further research is needed to determine which combination of instruments is most suitable to use in clinical practice, and to confirm or refute the suggested impact of psychosocial distress on self reported disability

Introduction. Functional deficits persist in a significant percentage of total hip arthroplasties (THA), leading to patient dissatisfaction. Spinal stenosis is a leading cause of chronic disability and lower extremity weakness. Although previous studies have evaluated the potential benefit of THA on back pain, none have reported the effects of spine disability on functional outcomes and patient satisfaction with THA. Methods. 244 primary THAs (233 patients) with minimum 2-year follow-up rated their satisfaction, return to activity, and standard hip outcomes using the Oxford Hip Score (OHS). History of lumbar spine pain, lumbar surgery, and daily activity limitations was documented and an Oswestry Disability Index (ODI) score was calculated. Results. 151 of 244 (62%) patients reported a history of back problems: 35 patients (14%) – history of lumbar surgery, 91 (37%) – daily low back pain, and 97 (40%) – back pain that limited activity. Patients with a history of back problems had lower OHS scores than those without, p=0.0001. Pain relief was reported by 93% versus resumption of activities in 82% of THA patients, p=0.025. Increasing spine disability, as determined by ODI, correlated with poor OHS, p<0.0001. Spine disability (ODI) was directly associated with patient dissatisfaction for pain relief (R=0.41, p<0.0001), return to activity (R=0.34, p<0.0001), and overall surgical results (ODI, R=0.38, p<0.0001) at 2 years after THA. Patient age, gender, and BMI were not associated with poor THA outcomes. Conclusions. The majority of THA patients have a history of lumbar spine problems. The Oswestry Spine Disability Index, which is the primary outcome measure of spinal disorders, correlated strongly with poor THA outcomes. Moderate and severe lumbar spine disability directly correlated with worse Oxford Hip Scores. Spine disability was directly associated with THA dissatisfaction

Background. The aim of the Groningen Spine Center (GSC) is to provide personalized and effective interventions to patients with spine-related disorders. The GSC comprises a multidisciplinary team to triage and treat patients most optimally. Aim. To investigate the patient reported clinical results of the treatments of the GSC during seven years of its existence. Patients and methods. The basis of this study is a natural cohort of all patients admitted to the GSC. Treatments existed of rehabilitation, surgery, anesthesiology, medication, referral to else, advice and self-management, or any combination of the above. Baseline characteristics, pain (Numeric Rating Scale; NRS), disability (Pain Disability Index; PDI) and quality of life (Euroqol 5-D;EQ5D) were obtained at baseline and discharge. Per calendar year, effects will be presented. Descriptive statistics, effect sizes and t-tests were calculated. Results are compared to the minimal clinically important change (MCIC) of the corresponding scales. Results. In total, 9.897 patients (43% male, mean age 49.2±16.1 yrs) were analyzed on T0, of whom 1.373 filled in a discharge questionnaire. All measures showed statistically significant changes (p<0.01), but for pain and disability mean changes were not always higher than the clinical important change. Effect sizes (d) for pain ranged between 0.44 and 1.01, for disability between 0.40 and 0.80, and for quality of life between 0.41 and 0.76. Conclusion. The Groningen Spine Center provides positive patient reported results over the past 7 years Effect sizes are moderate to high. The results are considered to be clinically important to patients. Non-response and regression to the mean may be sources for bias and should be topic for further research. No conflicts of interest. No funding obtained

Background. Serious traumatic injury is a leading cause of death and disability globally, with the majority of survivors developing chronic pain. Methods. The aims of this study were to describe early predictors of poor long-term outcome for post-trauma pain. We conducted a prospective observational study, recruiting patients admitted to a Major Trauma Centre hospital in England within 14 days of their injuries, and followed them for 12 months. We defined a poor outcome as Chronic Pain Grade ≥ II and measured this at both 6-months and 12-months. A broad range of candidate predictors were used, including surrogates for pain mechanisms, quantitative sensory testing, and psychosocial factors. Univariate models were used to identify the strongest predictors of poor outcome, which were entered into multivariate models. Results. 124 eligible participants were recruited. At 6-months, 19 (23.2%) of 82 respondents reported a good outcome, whereas at 12-months 27 (61.4%) of 44 respondents reported a good outcome. The multivariate model for 6-months produced odds ratios for a unit increase in: number of fractures, 3.179 (0.52 to 19.61); average pain intensity, 1.611 (0.96 to 2.7); pain extent, 1.138 (0.92 to 1.41) and post-traumatic stress symptoms, 1.044 (0.10 to 1.10). At 12-months, equivalent values were: number of fractures, 1.653 (0.77 to 3.55); average pain intensity, 0.967 (0.67 to 1.40); pain extent, 1.062 (0.92 to 1.23) and post-traumatic stress symptoms, 1.025 (0.99 to 1.07). Conclusion. A poor long-term pain outcome from musculoskeletal traumatic injuries can be predicted by measures recorded within days of injury. Conflicts of interest: No conflicts of interest. Sources of funding: This study was funded by the National Institute for Health Research (NIHR) Surgical Reconstruction and Microbiology Research Centre (SRMRC)

Purpose. The purpose of this study was to investigate the difference in the level of pre- and 6 months post-operative objective and subjective measures of disability between patients with full-thickness rotator cuff tears and those with impingement syndrome/low grade partial thickness rotator cuff tears. Impact of age, gender, and job demands was taken into consideration. Methods. Standardised pre- and post-operative data were collected on consecutive patients who had undergone surgery related to rotator cuff pathology. A disease-specific disability measure, the Western Ontario Rotator Cuff (WORC) Index which explores five domains of physical symptoms – life style, work, sports, and emotions – was the primary outcome. Paired and independent non-parametric statistics and multivariable regression analysis were performed. Results. Three hundred and thirty patients (140 women and 190 men) with a mean age of 58 years (range, 21-82) met the inclusion criteria. Two hundred and fifteen (65%) patients had full-thickness rotator cuff tears and 115 (35%) had impingement or partial thickness rotator cuff tears. Patients with full-thickness tears complained of greater weakness and had a higher prevalence of a fall on an outstretched hand. They were significantly weaker in elevation both pre- (p=0.0002) and post-operatively (< 0.0001). Patients with impingement syndrome expressed more emotional disability both prior to (0.007) and after surgery (0.004). Both groups showed a statistically significant improvement in overall pain, disability and strength 6 months following surgery (p< 0.0001). Factors that affected emotional disability at both time points were job demands and age. Females were more emotionally disabled before surgery. Conclusion. Patients with impingement syndrome and less extensive tears tend to be more emotionally disabled due to their gender, age and work status/job demands. This needs to be considered when planning for return to work and other activities and when assessing treatment outcomes

Purpose and background. Lumbar spinal fusion (LSF) is frequently and increasingly used in lumbar degenerative disorders despite conflicting results and recommendations. Further understanding of patient outcomes after LSF is required to inform decisions regarding surgery and to improve post-surgery management. The objective was to evaluate the course of pain and disability in patients with degenerative disorders of the lumbar spine (spinal stenosis, spondylolisthesis, disc herniation, discogenic low back pain) after first-time LSF. Methods and results. A systematic review and meta-analysis of pain and disability outcomes in prospective cohort studies after first time LSF for degenerative disorders. Two independent researchers searched key databases, determined study eligibility, extracted data and assessed risk of bias (modified Quality in Prognostic Studies tool). A third reviewer mediated at each stage. N weighted pooled estimates were calculated. Twenty-five articles (n=1,777 participants) were included. 17 studies were at unclear risk of bias and 8 at high risk. Back pain (12 studies) decreased modestly and irregularly at follow-up intervals. The n weighted mean VAS back pain decreased from 65.4 (±3.3) pre-surgery to 22.2 (±3.1) at 23 months, but then 45.0 (±not reported; 2 studies at risk of bias) at 42 months. In contrast, leg pain (12 studies) improved substantially short and long-term. Disability (20 studies) improved steadily over time with the exception of the 42-months and 48-months intervals. Conclusion. The overall improvement of leg pain and disability after first-time LSF in degenerative disorders is promising in contrast to back pain outcomes. Further research is needed to analyse outcomes in patients of different diagnostic subgroups. Conflicts of interest. None. Sources of funding. None

Purpose. To examine measurement properties of four disability outcomes in patients with advanced osteoarthritis of the glenohumeral joint. Methods. This was a prospective longitudinal study of patients with advanced osteoarthritis of the glenohumeral joint who underwent a Total Shoulder Arthroplasty (TSA) and were followed for 6 months. Four measures [Western Ontario Osteoarthritis Shoulder (WOOS) Index, the American Shoulder and Elbow Surgeons (ASES) assessment, Constant-Murley score (CMS), and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH)] were completed 2-3 weeks before surgery and at 6 months after surgery. Results. Seventy-seven patients (average age: 66, range 35 to 86, 60% women, 40% men) participated in the study. The Cronbach's Coefficient Alpha of subjective measures was high at 0.91, 0.86, and 0.83 for WOOS, ASES, and QuickDASH respectively. All measures were able to discriminate between men and women's levels of disability at p< 0.05. Correlations between pre-operative scores were moderate (0.59 to -0.79) and slightly increased post-operatively (0.61 to -0.87). All measures were sensitive in detecting change in the disability status over a period of 6 months. Conclusion. All four disability measures were reliable and valid for use in patients with advanced osteoarthritis of the glenohumeral joint. Outcome measurement in busy clinics can be facilitated by choosing valid and reliable measures that have the advantage of simplicity for use by patients and clinicians. The consensus-based standards for selection of outcome measures have been developed for hip and knee arthritis and need to take place for the shoulder joint. Developing consensus by an international group of experts will improve consistency in using outcome measures in patients with shoulder problems

Personal injury claims following whiplash injury currently cost the British economy more than £3 billion a year, yet only a minority of patients have radiologically demonstrable pathology. Patients sustaining fractures of the cervical spine have been subjected to greater force and might reasonably be expected to have worse symptoms than those with whiplash injuries. Using the Neck Disability Index, we compared pain and functional disability in four groups of patients who had suffered cervical spine injuries. The four groups were: patients with stable cervical fractures treated conservatively, patients with unstable cervical fractures treated by internal fixation, patients with whiplash injuries seeking compensation, and patients with whiplash injuries not involved in litigation. After a mean follow-up of 3½ years, patients who had sustained cervical spine fractures had significantly lower levels of pain and disability than those who suffered whiplash injuries and were pursuing compensation (p< 0.01), but had similar level to those whiplash sufferers who had settled litigation or had never sought compensation. Functional recovery following neck injury is unrelated to the physical insult. The increased morbidity in whiplash patients is likely to be psychological and is associated with litigation

Summary. Data of 663 patients with three different pathologies were examined. We found that using patients with significant symptoms and functional difficulty in the opposite shoulder will not bias the results of observational studies if outcomes are based on routine disability measures such as ASES or Constant-Murley scores. Introduction. Recently, using patients with bilateral limb problems as independent cases has raised concerns in orthopaedic research due to violating the assumption of independence. If observations are too similar in characteristics, they become highly correlated which leads to lowering the variance and biasing the results. Type of pathology (impingement, cuff tear, osteoarthritis) and aging are expected to affect the incidence of bilateral shoulder complaints and should be considered when examining potential bias in this area. In addition, the impact of dominant side pathology has not been investigated primarily in patients with shoulder problems. The objectives of this study were: 1) to examine the incidence of bilateral shoulder complaints and pathology on the dominant side in patients with impingement syndrome, rotator cuff tear and osteoarthritis of the glenohumeral joint, 2) to explore the role of sex and age in developing bilateral shoulder complaints, and 3) to examine the impact of bilaterality and hand dominance on pre and one year post-operative disability. Patients and Methods. This study involved review of data of patients with a diagnosis of impingement syndrome, rotator cuff tears and osteoarthritis (OA) of the gleno-humeral joint who had undergone surgery and had returned for their one year follow-up. Two outcome measures were used; the American Shoulder & Elbow Surgeons (ASES) and the Constant Murley score (CMS). Results. Data of 663 patients (317 females; 269 impingement syndrome, 290 rotator cuff tear, 104 osteoarthritis) were included in the analysis. There was a difference in the incidence of bilateral symptoms in patients with different pathologies: osteoarthritis 46%, impingement 26%, and rotator cuff tears 23% (p<0.0001). The incidence of dominant side involvement was 70%, 68% and 50% in patients with rotator cuff tear, impingement syndrome and osteoarthritis (p=0.003). Neither bilaterality nor dominant arm pathology had a negative impact on disability (p>0.05). Discussion/Conclusion. Type of pathology and aging affect the incidence of bilateral shoulder symptoms. Rotator cuff related pathologies affect the dominant side more frequently. The most interesting finding of this study was related to lack of influence of bilateral symptoms or dominant side pathology on reported disability in three different pathology groups with different prevalence of disease

Background. We have developed a LBP (low back pain) repository with IPD (individual patient data) from therapist-delivered intervention RCT's from various institutions, nationally and internationally (19 trials, 9328 patients). We will perform IPD meta-analyses to identify and determine the most effective and cost-effective treatments for subgroups of patients. Disability due to LBP is a key outcome of interest. However, there was no common disability measurement that was used in all the RCT's. We report here our assessment as to whether different disability measures are sufficiently comparable to allow pooling across trials. Method. We used data from seven trials (n = 5015 patients) that had at least two of the following measurements: RMDQ (Roland Morris Disability Questionnaire), MVK (Modified Von Korff disability score), physical component scale of SF-12/36, Patient Specific Functional Scale, and Hannover Functional Ability Questionnaire. Within each trial, the change score between baseline and short-term follow-up was computed. These change scores were then converted from one outcome measure to another with linear regression and ridge-reroughed linear models. They were also tested for correlation and responsiveness (the ability to detect changes in condition, measured by standardised response means). Conclusion. Most of the correlations between outcome measurements were high (>0.5), but responsiveness was often significantly different. Moreover, the accuracy of the conversions was poor, e.g. >40% of predictions from the conversion of RMDQ to MVK were incorrect by more than 10 points. The lack of agreement between different outcome measures suggests that conversion between different disability measurements is not recommended

The aim of this study was to assess the outcome of various modes of treatment for low back disorders in terms of eventual physical impairment and disability. Between 1998 and 2001 the author assessed for compensation purposes 135 adult men and women with low back disorders, following the bio-psychosocial approach described by Waddell. Grades of impairment and disability were compared in respect of various treatment categories, including non-surgical treatment, discectomy (single procedure), fusion (single procedure), single surgical procedure (any type), multiple surgical procedures (any type). The last category comprised patients with recognisable psychosocial features, regardless of treatment. Mean results for the different categories show considerable variation between patients. Although the results are not mathematically pure, there are certain clear trends. Non-surgical treatment gives the lowest impairment on the Wad-dell scale. A single surgical procedure, regardless of type, results in 56% greater physical impairment than non-surgical treatment. With multiple surgical procedures, impairment increases in proportion to the number of procedures. Patients with recognisable psychosocial features show proportionately more inappropriate symptoms and signs, regardless of treatment. Patients’ subjective sense of disability and distress is usually higher than their objectively assessed physical impairment

Introduction: Estimates of low back pain prevalence show that low back pain is a common problem particularly in western countries. But the extent to which low back pain causes true disability and not just nuisance pain casts doubt of the utility of these estimates. No studies have been performed in Australia to study both the prevalence and disability associated with low back pain in the population. Accordingly, the objectives of this study were to determine the prevalence ranges and retrospective one year incidence of low back pain together with any related disability in Australian adults. Methods: A survey was mailed to a stratified random sample of 3000 Australian adults selected from the Electoral Roll. There was a 69% response rate. Demographic variables of respondents were compared with those of the Australian population taken from Census data. Selective response bias was investigated using wave analysis. A range of prevalence data were derived as was a disability score using the Chronic Pain Grade Questionnaire. 1. (CPG). The CPG has demonstrated reliability and validity in measuring pain and disability in postal surveys. 2. Prevalence and disability estimates were variously standardised using gender, age and marital status. Results: There was little variation between the sample and the Australian adult population. There was no significant selective response bias found. The sample point prevalence was estimated at 25.5% (95% CI, 23.6–27.5), six-months prevalence was 64.6% (95% CI, 62.6–66.8) and lifetime prevalence was 79.2%, (95% CI, 77.3–80.9). The retrospective one year incidence was 8.0% (95% CI, 6.9–9.3). In the previous six months period 42.6% (95% CI, 40.4–44.8) of the adult population had experienced low intensity pain and low disability from it. Another 10.9% (95% CI, 9.6–12.3) had experienced high intensity pain, but still low disability from this pain. However, 10.5% (95% CI, 9.2–11.9) had experienced high disability low back pain. The mean time-off from usual activities in the past six months for this group was 1.6 months (95% CI, 1.3–1.9), the median was 18 days. There was no gender difference for a high disability rating or time-off. Conclusion: Low back pain is a very common problem in the Australian adult population, yet most of this is low intensity and low disability pain. Nevertheless, over 10% had been disabled by low back pain in the past six months and it required significant time off from usual activities

Acute recurrent LBP is prevalent within western society and is recognised as a predictor of chronic LBP related disability. Despite this, predictors of disability, in subjects with acute recurrent LBP, have not yet been explored. This study aimed to examine the association between variables of pain, psychology and disability, in acute recurrent LBP, and establish which of these measures best predicts LBP related disability. The study was of prospective design employing regression analysis. A battery of questionnaires and a series of functional tests were obtained from 47 subjects, with acute recurrent LBP, at assessment and on conclusion of treatment. Measures of pain (VAS), psychology (CSQ, TSK, MSPQ, ZDS) and disability (step ups, stand ups, walking test, RMDQ) were employed. The criterion measure for resultant disability was the Roland Morris Disability Questionnaire. The characteristics of the sample were found to typify that of an acute, rather than chronic, LBP population. Pain was found to correlate with all other variables and a relationship was demonstrated between subjective disability and psychological variables. The relationship between psychological variables and objective disability however, was less clear. Forty four percent of the residual disability was explained by initial scores of the Visual Analogue Pain Scale, the Modified Somatic Perceptions Questionnaire and the Roland Morris Disability Questionnaire. Fifty six percent of the resultant disability remains unexplained by the variables explored in this study. It was concluded that subjects at risk of chronic LBP related disability might be identified at assessment by the initial levels of , anxiety and subjective disability

Long term outcomes of distal radius fractures have rarely been studied prospectively and do not traditionally extend past 1–2 years following treatment. The purpose of this study was to describe the long term patient-rated pain and disability of patients after a distal radius fracture and to also determine the differences in patient reported pain and disability after one year following injury and at the long term follow-up. Patients who had previously participated in a prospective study, where baseline and standardised one year follow-up were performed following a distal radius fracture were contact to participate in this long term follow-up (LTFU) study. Eligible cases that consented agreed to evaluation which included being sent a package in the mail contain a letter of information and questionnaire. Baseline demographic data including age and sex, as well as date of fracture, mechanism of fall and attending physician information was obtained for all participating subjects. Patient rated pain and disability was measured at baseline, one year and at long-term follow-up using the Patient Rated Wrist Evaluation (PRWE). Patients were categorised as having had a worse outcome (compared to one year follow-up PRWE scores) if their LTFU PRWE score increased by 5 points, having no change in status (if their score changed by four or less points) or improved if their LTFU PRWE score decreased by 5 or more points. Sixty-five patients (17 male, 48 female) with an average age of 57 years at the time of injury and 67 years at follow-up were included in the study. The mean length of follow-up was 10.7 (± 5.8) years (range: 3–19 years). Overall, 85% of patients reported having no change or had less patient-reported pain and disability (PRWE) at their long-term follow-up compared to their one year PRWE scores. As well, one year PRWE scores were found to be predictive (20.2%) of the variability in long term PRWE score (p=0.001). This study provided data on a cohort of prospectively followed patients with a distal radius fracture, approximately 10 years after injury. This data may be useful to clinicians and therapists who are interested in determining the long term effects of this frequently occurring upper extremity fracture. The results of this study indicate that after 10 years following a distal radius fracture, 85% of patients will have good outcomes. The results of this study also indicate that majority of cases, if patients have a low amount of pain and disability at one year, then these outcomes will also be true approximately 10 years later