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Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_4 | Pages 38 - 38
1 Jan 2013
Morsø L Albert H Kent P Manniche C Hill J
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Objective

The STarT Back Screening Tool (STarT) is a 9-item patient self-report questionnaire that classifies low back pain patients into low, medium or high risk of poor prognosis. When assessed by GPs, these subgroups can be used to triage patients into different evidence-based treatment pathways. The objective of this study was to translate the English version of STarT into Danish (STarT-dk) and test its discriminative validity.

Methods

Translation was performed using methods recommended by best practice translation guidelines. Psychometric validation of the discriminative ability was performed using the AUC statistic. The AUC was calculated for seven of the nine items where reference standards were available and compared with the original English version.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_I | Pages 55 - 55
1 Jan 2012
Mors⊘ L Kent P Albert HB
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Purpose of study and background

This study aimed to investigate if the PD-Q classification was predictive of outcomes at 3 and 12-months follow-up in LBP patients with associated leg pain.

Identification of clinically important subgroups and targeted treatment is believed to be important in low back pain (LBP) care. The PainDETECT Questionnaire (PD-Q) is designed to classify whether a person has neuropathic pain, based on their self-reported pain characteristics. However, it is unknown whether this classification is a prognostic factor and/or predicts treatment response.

Method and results

145 participants were recruited in secondary care. Inclusion criteria were 3-12 months LBP and leg pain. Baseline PD-Q scores classified participants into three groups (likely to have neuropathic pain, uncertain, unlikely) but did not affect treatment decisions. The outcome measures were LBP, leg pain, activity limitation and self-reported general health. Scores were compared between those with ‘likely’ neuropathic pain (neuropathic group) and ‘unlikely’ (non-neuropathic group), using Mann-Whitney, Friedman and Chi Square tests.

At baseline, the neuropathic group had worse scores on all outcome measures, and analgesic use, sick leave, sense of coherence and psychological profile (p=.000 to .044). At 3-months and 12-months both groups improved (p=.001 to .032). However, the groups remained different at each time point on all outcome measures (p=.000 to .033) except LBP (p=.054 to .214).


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_I | Pages 19 - 19
1 Jan 2012
Kent P Lauridsen HH
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Background and purpose

It is likely that the most common method for calculating a Roland Morris Disability Index (RMDQ) sum score is to simply ignore any unanswered questions. In contrast, the raw sum score on the Oswestry Disability Index (ODI) is converted to a 0-100 scale, with the advantage of allowing missing data to be accommodated by proportional recalculation. The aim of this study was to quantify the calculation error in RMDQ scores when one or more questions were unanswered and compare this with the error present when the ODI was scored in the same way.

Methods and results

The prevalence of unanswered RMDQ questions was measured in a research and a routine care setting. The accuracy of the RMDQ proportional recalculation method was measured using 311 fully completed RMDQ and matching ODI questionnaire sets. Raw sum scores were calculated, and questions systematically dropped. At each stage, sum scores were converted to a score on a 0-100 scale and the error calculated. Wilcoxon Tests were used to compare the magnitude of the error scores.

The prevalence of unanswered questions was 29.5% (RMDQ) in routine care, and 13.9% (ODI) and 20.3% (RMDQ) in a research project. Proportional recalculation was a more accurate method to calculate RMDQ sum scores than simply ignoring missing data.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_I | Pages 26 - 26
1 Jan 2012
Jensen T Kent P Karppinen J Sorensen J Niinimäki J Leboeuf-Yde C
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Purpose

By systematic literature review, to quantify the association between vertebral endplate signal changes (VESC) and non-specific low back pain (NSLBP).

Materials and methods

MEDLINE, EMBASE, and SveMED databases were searched for the period 1984 to June 2009. Articles were included which investigated the association between VESC and NSLBP and reported sufficient data to construct two-by-two tables. Articles on specific low back pain conditions were excluded. A standardised data collection and quality assessment were performed. To estimate the association between VESC and NSLBP, two-by-two tables were created and exact odds ratios were calculated with 95% confidence intervals (CI). Meta-analysis was performed on homogeneous studies.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_I | Pages 10 - 10
1 Jan 2012
Kent P Mj⊘sund HL Petersen DHD
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Purpose of study and background

This systematic review sought to determine the efficacy of such targeted treatment in adults with non-specific low back pain (NSLBP).

Many clinicians and researchers believe that tailoring treatment to subgroups of NSLBP positively impacts on patient outcomes.

Method and results

MEDLINE, EMBASE, Current Contents, AMED, the Cochrane Central Register of Controlled Trials, reference list searching and citation tracking. Inclusion criteria were randomised controlled trials of targeted manual therapy and/or exercise for NSLPB that used trial designs capable of providing robust information on targeted treatment (treatment effect modification) for the outcomes of activity limitation and pain. Included trials needed to be hypothesis-testing studies published in English, Danish or Norwegian. Method quality was assessed using the Cochrane Back Review Group criteria.

Four high-quality trials of targeted manual therapy and/or exercise for NSLBP met the inclusion criteria. One study showed statistically significant effects for short-term outcomes using McKenzie directional preference-based exercise. Other included studies showed effects that might be clinically important in size but were not statistically significant with their samples sizes, as research into subgroups requires much larger sample sizes than traditional two-group trials.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 232 - 232
1 Mar 2010
Albert H Kent P Hansen J Soegaard H
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Background: The dermatomal drawings used in clinical practice are based on questionable experiments performed in the 1930s. Though widely used in the clinical practice to identify the level of nerve root irritation, this may not be a reliable practise.

Purpose: To identify the pain distribution and overlap of single level L4, L5 and S1nerve root irritation.

Methods: 187 patients with radicular pain to or below the knee made a precise drawing of their pain distribution and then underwent a MRI scan. Only patients identified as having a single level disc herniation were included in this study. Using computer software, the pain distribution of all people who had the same level nerve root irritation was made by layering their pain drawings. The darkest parts of these compound drawings was where most patients experienced pain.

Results: 89 patients were excluded due to tumour, depression or disc lesions on several levels. 98 patients with single level disc herniation were included.

There was wide overlap in the pain from each nerve root level, and these areas were much wider than shown on dermatome charts. In general, L4 nerve root pain tended to be anterior on the leg, L5 and S1 nerve root pain was on the posterior leg, with L5 root pain tending to be more lateral.

Conclusion: Pain distribution from the L4, L5, S1 nerve roots is not concordant with the sensory distribution of common dermatome charts. This might be due to the methods by which these dermatomes were constructed, or because sciatica is a complex pain experience.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 236 - 236
1 Mar 2010
Albert H Kent P Jensen J Dragsbæk L
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Background: Generalised joint hypermobility (GJH) has a prevalence of approximately 5% in the general population. There might be an association between GHJ and some low back pain. The Beighton Criteria are 9 tests that are widely used to diagnose GJH but it is time-consuming to perform all nine tests.

Purpose: To evaluate which of the nine Beighton tests is the most accurate as a screening test for GHJ. To investigate the relationship between hypermobility and age, gender, and ethnicity.

Methods: From the last 10 years archives at the Back Centre Funen 17,117 patient records were examined. All nine Beighton tests had been performed in 4,062 patients. Data on the nine Beighton tests and age, gender, and ethnicity were extracted.

Results: There was a selection bias in this clinical sample, as the prevalence of GJH was 14.6%. All tests showed an overall accuracy of > 85.2 % as single-item screening tests for GJH in low back pain patients. Extension of the dominant elbow > 10o was the most accurate screening test with an overall accuracy of 93.9 %, sensitivity 76.6 % specificity 96.9 %. There was a higher prevalence of GJH in women (22.8%) than men (3.8%) and in young patients (28.0%) than in older patients (2.5%). No difference in the prevalence of GJH was observed between the patients with Danish ethnicity and non-Danish ethnicity.

Conclusion: Extension of the dominant elbow > 10o was the single most accurate of the nine Beighton tests as a screening test for GJH in patients with low back pain.