Background to the study:. The use of Patient Reported Outcome Measures (PROMs) to measure effectiveness of care, and supporting patient management is being advocated increasingly. PROMs data are often collected using hard copy questionnaires. New technology enables electronic PROM data collection. Purpose of the study:. To identify patient and practitioner perceived opportunities and challenges to implementing electronic PROM data capture as part of the process for developing a PROM phone and online app. Methods:. Interviews were undertaken with patients (N=18), and clinicians (N=46). Patients and clinicians were recruited through practice advertisement, in printed healthcare media, social media, and professional networks. Semi-structured interviews were used. Data were analysed using the Framework approach. Themes, sub-themes, and models were developed from the analysed data. Results:. Patient themes included relevance of data collection, data protection, and confidentiality. Practitioner themes included issues around patient engagement, and relevance to clinical practice. Overall patients were more enthusiastic than clinicians about using PROMs in practice. They welcomed the opportunity to provide feedback, and were prepared to use technology to achieve this. In contrast, clinicians reported concerns that patients would not want to complete PROMs, or may be unable to use electronic devices to achieve this. Other clinicians noted that this was a professional demand and part of reflective practice. Conclusion:. The patients' enthusiasm to contribute data and the clinicians' paternalistic views were contrasting and suggests a greater need for patient centred communication

Background

Embodiment- and distraction-based approaches to immersive virtual reality (IVR) show promise in treating persistent low back pain (PLBP). However, which approach is more effective is unclear. This study aims to evaluate the impact of distraction- and embodiment-based IVR on pain processing and patient-reported outcome measures in PLBP.

Background

PROMs have become an integral assessment tool of clinical effectiveness and patient satisfaction. To date, PROMs for lumbar discectomy are not an NHS requirement, although voluntary collection via the British Spine Registry is encouraged. Despite this, PROMs for day case microdiscectomy is scarcely reported. We present PROMs for day case microdiscectomy at Lancashire Teaching Hospitals.

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.

Aim

To develop a clinical core set of outcome measures that is accepted for relevance, feasibility and validity by stakeholders and useful for a) interaction between patient and professional, b) internal quality improvement, and c) external transparency in patients with NSLBP in primary care physical therapy.

Aim

Assess efficacy of caudal epidural injection with epidurogram with validated outcome measures.

Background. Depression, anxiety, catastrophising, and fear-avoidance beliefs are some of the so-called “yellow flags” that predict a poor outcome in back patients. Many surgeons have difficulty assessing yellow flags, perhaps due to the complexity of existing instruments and time constraints during consultations. We developed a brief tool to allow the systematic evaluation of core flags. Methods. Data from 4 questionnaires (ZUNG depression (N=399); Hospital Anxiety and Depression Scale (Anxiety-subscale) (N=308); Pain Catastrophising (N=766); Fear Avoidance Beliefs (N=736)) were analysed to identify the respective single item that best represented the full scale score. The 4 items formed the “Core Yellow Flags Index” (CYFI). 1'768 patients completed CYFI and a Core Outcome Measures Index (COMI) preoperatively, and COMI 3 and 12mo later (FU). Results. The individual flag items correlated with their corresponding full-length questionnaires: 0.71 (depression), 0.81 (catastrophising), 0.77 (anxiety), 0.83 (fear avoidance beliefs). Cronbach's α for the 4 items was 0.79. Structural equation modelling revealed that CYFI explained a unique proportion of the variance in COMI at 3 months' FU (β=0.23, p< 0.001) and also at 12 months FU (β=0.20, p< 0.001). Conclusion. The 4-item CYFI proved to be a simple, practicable tool for routinely assessing key psychological attributes in spine surgery patients; it made a relevant contribution in predicting postoperative outcome. CYFI's items were similar to those in the “STarTBack screening-tool”, used in primary care to predict back pain chronicity, further substantiating its validity. Its wider use may help improve the accuracy of predictive models derived using spine registry data. No conflicts of interest. No funding obtained

In a prospective observational study we compared the two-year outcome of lumbar fusion by a simple technique using translaminar screws (n = 57) with a more extensive method using transforaminal lumbar interbody fusion and pedicular screw fixation (n = 63) in consecutive patients with degenerative disease of the lumbar spine. Outcome was assessed using the validated multidimensional Core Outcome Measures Index. Blood loss and operating time were significantly lower in the translaminar screw group (p < 0.01). The complication rates were similar in each group (2% to 4%). In all, 91% of the patients returned their questionnaire at two-years. The groups did not differ in Core Outcome Measures Index score reduction, 3.6 (. sd. 2.5) (translaminar screws) vs 4.0 (. sd. 2.8) (transforaminal lumbar interbody fusion) (p = 0.39); ‘good’ global outcomes, 78% (translaminar screws) vs 78% (transforaminal lumbar interbody fusion) (p = 0.99) or satisfaction with treatment, 82% (translaminar screws) vs 86% (transforaminal lumbar interbody fusion) (p = 0.52). The two fusion techniques differed markedly in their extent and the cost of the implants, but were associated with almost identical patient-orientated outcomes. Extensive three-point stabilisation is not always required to achieve satisfactory patient-orientated results at two years

Background to the study. The use of Patient Reported Outcome Measures (PROMs) to measure effectiveness of care, and supporting patient management is being advocated increasingly. When evaluating outcome it is important to identify a PROM with good measurement properties. Purpose of the study. To review the measurement properties of the low back and neck versions of the Bournemouth Questionnaire. Methods. Bibliographic databases (e.g. EMBASE, MEDLINE, CINAHL and PsycInfo) were searched for articles evaluating the measurement properties of the Bournemouth Questionnaire. Articles were excluded that did not evaluate measurement properties of this instrument. The methodological quality of the studies selected was evaluated using the COSMIN checklist with the four point rating scale. Studies were rated as “excellent”, “good”, “fair” or “poor” based on completion of the checklist. Results. The initial search produced 6265 hits. A total of 13 studies were included in the final evaluation. Seven studies used the Bournemouth Questionnaire neck version, and six studies involved the back version. Cross-cultural translation was reported in six studies, reliability data were reported in eight studies, and responsiveness in ten studies. Conclusion. The review's findings suggest that the Bournemouth Questionnaire has suitable measurement properties for benchmarking practice in musculoskeletal settings. Conflicts of interest. None. Sources of funding. This study was sponsored by the National Council for Osteopathic Research (. www.ncor.org.uk. )

Background. Patient-rated measures are the gold standard for assessing spine surgery outcomes, but there is no consensus on the appropriate timing of follow-up. Journals often demand a minimum 2-year follow-up, but the indiscriminate application of this principle may not be warranted. We examined the course of change in patient outcomes up to 5 years postoperatively. Methods. The data from 3′334 consecutive patients (1′789 women, 1′545 men; aged 61±15 years) undergoing first-time surgery between 1.1.2005 and 31.12.2010 for differing lumbar degenerative disorders were evaluated. The Core Outcome Measures Index (COMI) was completed by 3′124 (94%) patients preoperatively, 3′164 (95%) at 3 months follow-up, 3′153 (95%) at 1 year, 3′112 (93%) at 2 years, and 2′897 (87%) at 5 years. 2′502 (75%) completed COMI at all five timepoints. Results. The COMI change-score from pre-op to 3 months follow-up correlated significantly with that from pre-op to 12 months (r=0.65;p<0.0001), 24 months (r=0.57;p<0.0001), and 5 years (r=0.51;p<0.0001). COMI decreased significantly from pre-op to 3 months (3.7-points), and from 3 months to 12 months (0.4-points), then levelled off up to 5 years (0.04–0.05 point-change). The course of change up to 12 months differed slightly depending on pathology/whether fusion was done. Conclusion. Stable COMI scores were seen from 1-year postoperatively onwards. As the early post-operative results appear to herald the long-term outcome, a ‘wait and see policy’ in patients with a poor initial outcome is not advocated. The insistence on a 2-year follow-up could result in a failure to intervene early to achieve better long-term outcomes. No conflicts of interest. No funding obtained

Aims

To determine the value of scoliosis surgery, it is necessary to evaluate outcomes in domains that matter to patients. Since randomized trials on adolescent idiopathic scoliosis (AIS) are scarce, prospective cohort studies with comparable outcome measures are important. To enhance comparison, a core set of patient-related outcome measures is available. The aim of this study was to evaluate the outcomes of AIS fusion surgery at two-year follow-up using the core outcomes set.

Background:. Following lumbar spine surgery patients with a high BMI appear to have increased post-operative complications including surgical site infections (SSI), urinary complications, increased anaesthetic/operative time and a greater need for post-operative blood transfusion. There is no current evidence, however, analysing the effect of BMI on functional outcome. Purpose:. We aimed to analyse the effect of BMI on functional outcome following lumbar spine surgery. Study Design:. Retrospective Cohort Study. Patient Sample:. 131. Outcome Measures:. Outcome measures included mean post-operative Oswestry Disability Index (ODI) at six and twelve months, the incidence of SSI, mean operative time and the requirement for post-operative blood transfusion. Methods:. Patients that underwent lumbar spinal surgery between September 2010 and November 2013 were identified retrospectively and categorised into discectomy, decompression, fusion and revision is created. A BMI threshold of 30 was used to group patients as non-obese or obese. Univariate analysis was used to compare the effect of BMI on the above outcome measures. Results:. Post-operative complication rates were higher in the obese group in each category. However, there was no significant difference in the post-operative ODI at six ad twelve months post-operatively. Conclusions:. Increased BMI is related to increased post-operative complications but is not associated with a poorer functional outcome in the short to mid-term

Background to the study:. The use of Patient Reported Outcome Measures (PROMs) is being increasingly advocated but data are still being collected using paper systems. This is costly and environmentally challenging. New innovations are required to balance the challenges of capturing PROM data while considering budgets, and access to IT, and patient choice. Purpose of the study:. To develop and test a mobile phone and web app for collecting patient reported outcomes about musculoskeletal symptoms. Methods:. The content of the app was developed following qualitative work with patients and clinicians, and a review of measurement properties of different PROMs. Early versions of the app underwent α- and β-testing to identify issues with functionality. The PROM app was pilot-tested to assess feasibility, responsiveness, and test-retest reliability of the PROMs. The pilot version of the app contained demographic data, the Roland Morris Disability Questionnaire (RMDQ), the Bournemouth Questionnaire, and Visual Analogue Scale for pain. At follow-up additional questions exploring patient satisfaction and experience of care, plus a transition question were asked. Results:. A total of 517 patient codes were allocated. Completed datasets were gathered from patients (N=92) potentially indicating issues with acceptability and feasibility. Data analysis indicated good completion of questions. The RMDQ appeared to be largely redundant in this patient population and was removed in the final version of the app. Conclusion:. The app performed well when used by participants. Support is required for practitioners and patients to implement this electronic data capture system

Background. Low back pain (LBP) is widespread in all populations and is a worldwide health problem, which poses substantial challenges for clinical management. Individuals with LBP may reduce their symptoms by implementing self-managed at-home interventions. The theoretical design of the LumbaCurve™ promotes the principles of a passive gravity-assisted traction (PGAT) stretch of the lumbar and sacral region in order to reduce LBP. This study aimed to assess the clinical effectiveness of the LumbaCurve™ in the management of LBP when compared to a control group of standardised care. Methods. Following a screening form using Red Flags and STarT Back tools, 60 individuals with LBP were recruited to the 4-week intervention. Eligible participants completed a pre-intervention questionnaire and were randomly allocated to either ‘standardised care’ or ‘standardised care PLUS LumbaCurve™’ group. Intervention material was trialled for 4 weeks consecutively, followed by a post-intervention questionnaire. Pre and post assessments applied the Roland Morris Disability Questionnaire (RMDQ), Patient Reported Outcome Measures (PROMS). Results. Interim results suggested RMDQ values demonstrate a trend toward the classification of ‘definite improvement’ following standardised care plus LumbaCurve™ intervention. When comparing pre/post outcomes alone for the intervention of standardised care plus LumbaCurve™, significant reductions in RMDQ results occurred (p=.014). PROMS results reported a significant decrease (p=.015) in average pain rating when comparing interventions. Conclusion. Initial findings report that through a four week intervention programme, significant improvements in patient reported back pain levels are demonstrated following standardised care plus LumbaCurve™ intervention. This abstract has not been previously published in whole or substantial part and has not been previously presented at a national meeting. Conflicts of interest: No conflicts of interest. Sources of funding: Spark Ventures UK

Aim. To use Patient Reported Outcome Measures (PROMs) to determine the effectiveness of lumbar spinal surgery at a single UK institution. Methods. Consecutive patients who underwent lumbar spinal surgery (discectomies or decompressions) from 1 January 2011 to 13 March 2013 at a UK District General Hospital were assessed. The procedures were performed or supervised by a senior Consultant Orthopaedic spinal surgeon. All patients completed PROM questionnaires before and three months following surgery. These included Visual Analogue Scores (VAS), SF-12, Oswestry Disability Index (ODI) and Roland Morris Low Back Pain Questionnaire (RMQ). Results. A total of 230 patients had surgery. Of these, 189 (82%) completed both pre- and post-operative questionnaires. All PROMs showed improvement: VAS for constant back pain improved from 4.1 to 2.1 and exacerbations of back pain from 5.8 to 2.4. VAS for constant leg pain improved from 6.3 to 1.7 and for exacerbations of leg pain from 8.2 to 1.8. Mean ODI from 47 to 21; RMQ from13 to 5; and SF12-psychological and physical components increased by 7.2 and 12.4, respectively. Those patients with better psychological health pre-operatively, (high SF-12 score, >60 [n=14]) had a reduction in mean score (decrease of 3.2) post-operatively. However, those with poorer psychological health pre-operatively (low SF-12 score, <30 [n=18]) showed a marked improvement in mean score post-operatively (increase of 18.9). Conclusions. These results show that lumbar spinal surgery is safe and effective at a District General Hospital. Baseline psychological scores may help predict psychological outcomes following surgery. This warrants further prospective evaluation. This abstract has not been previously published in whole or substantial part nor has it been presented previously at a national meeting. Conflicts of interest: No conflicts of interest. Sources of funding: No funding obtained

Background. Recent studies show massage is effective in reducing back pain and heat and warmth during massage increases an individual's sense of wellbeing. The Ceragem V3 automatic thermal massage bed utilises principles of thermal massage to provide a therapeutic tool for individuals with conditions including diabetes and back pain. Though the brand is well known globally and has much anecdotal evidence, little research has been done on what effect the bed has on individuals with back pain. This study aims to assess subjective experience and function of participants with back pain when using the Ceragem V3. Methods & Results. Thirty-two participants (aged 35.2±9.9 years) with back pain (including sciatica) were recruited after screening using the Red Flags and STarT Back tools. The intervention comprised nine treatment sessions over three successive weeks using an automated thermal massage bed (Ceragem V3, Korea) in automatic mode. Body charts, Patient Reported Outcome Measures (PROM) and the Roland Morris Disability Questionnaire (RMDQ) were used to measure participant pain, stiffness, discomfort and disability levels pre and post intervention. Body chart analysis for pain location showed a significant reduction in reported pain in the thoracic and lumbosacral regions (p<0.01). PROMs showed a significant reduction in the number of days back pain was experienced (p<0.000) and clinically important reductions in back pain, stiffness and discomfort (p<0.000). There was also a significant reduction in RMDQ score (p=0.000). Conclusions. Initial findings demonstrate that through a three week intervention programme, individuals show a significant improvement in back pain, discomfort and stiffness

Objective. To assess the effectiveness of dynamic stabilisation as a treatment for discogenic pain compared to standard treatment of interbody fusion. Study Design & Subjects. All patients were referred for a 2 year back-pain management programme. Patients with continued pain following conservative treatment underwent discography & MRI. Patients with painful degenerate discs on the above investigations were selected. Patients underwent interbody fusion (PLIF/TLIF) or dynamic stabilisation. Mean follow-up was 24 months with a minimum follow-up of 12 months. Outcome Measures. All patients had pre-operative ODI and VAS scores. Patients were then sent further questionnaires at 6 month intervals. Results. The mean improvement in ODI following dynamic stabilisation was 20% (-20% → 56%), the mean improvement in the pain score was 2.4 (0→8). The mean improvement in ODI following interbody fusion was 11% (-14%→48%), the mean improvement in the pain score was 2.6 (-4→9). 10 patients in the dynamic stabilisation group had a greater than 20% improvement in ODI, 7 patients in the interbody fusion group had similar results. Conclusion. The above results demonstrate that dynamic stabilisation is at least as effective at treating discogenic pain as interbody fusion. The results however do question the validity of either interbody fusion (PLIF/TLIF) or dynamic stabilisation in the management of discogenic pain

Introduction. It is becoming increasingly more accepted that Patient Reported Outcome Measures (PROMs) should be used to assess surgical interventions. We report on a pilot study of a generic database with complete pre and post-operative data sets in a UK hospital. Method. 19 cases undergoing lumbar surgery in our institution were prospectively reviewed between January and August 2010. Pre and post–operative data assessing pain, back pain specific function, generic health, work disability and patient satisfaction were collected using a core outcome measures index, EuroQol EQ-5D and Oswestry Disability Index (ODI). Details of surgery and assessment of treatment outcome by the operating surgeon was also assessed. Results. There were 11 males and 8 females. 8 cases were coded as disc herniation, and 11 as spinal stenosis. Levels involved included L3/4 (4), L4/5 (8) and L5/S1 (6). ASA status was 1 (4/19), 2 (12/19) and 3 (3/19). The median operation time for all operations was between 1-2 hours and blood loss was under 500ml for all cases. Complications recorded were one dural tear and one wound infection. Post operatively the COMI score improved from 8.7 to 7 overall (p=0.028) and the leg pain score improved from 8 to 7 overall (p=0.009). The EQ-5D improved from 0.09 to 0.36. The ODI improved from 60 to 40 (p=0.03). Patients reported being satisfied in 73% of cases and the surgeon reported a good or excellent result in 65% of cases. Conclusion. The Spine Tango is an effective and user friendly tool for data collection. Data entry and extraction is easy. It is security enhanced and no Patient identifiable data (PID) is transferred outside the host institution. Data retrieval can be done online with clear-cut graphs and data tables or by downloading data and importing into a statistical package for more complex, analyses

Background. Minimally invasive surgery is an alternative therapeutic option for treating unstable spinal pathologies to reduce approach-related morbidity inherent to conventional open surgery. Objective. To compare the safety and therapeutic efficacy of percutaneous fixation to that of open posterior spinal stabilisation for instabilities of the thoraolumbar spine. Study Design. Comparison study of prospective historical cohort versus retrospective historical control at a tertiary care centre. Methods. Patients who underwent open or percutaneous posterior fixation for thoracic-lumbar instabilities secondary to metastasis, infection and acute trauma were included. Minimally access non traumatic instrumentation system (MANTIS) was used for percutaneous stabilisation. Outcome Measures. The differences in surgery-related parameters including operative time, blood loss, radiation exposure time, analgesia requirement, screw related problems and length of hospitalisation between the groups were analyzed. Results. There were a total of 50 patients with 25 in each group. There were no significant differences concerning age, sex, ASA, pathology causing instability, level and number of segments stabilised between the groups. There were significant differences between the MANTIS and open group in terms of blood loss (492 versus 925 ml, p<0.0001), post-op analgesia requirement (33 versus 45 mg/day of morphine, p<0.0004) and length of hospital stay for trauma sub-group of patients (6.2 versus 9.6 days, p< 0.0008). Average operative time of the MANTIS group was 190.2 minutes, not significantly longer to that of the conventional open group (183.84 minutes, p>0.05) Open group patients had less radiation exposure (average of 0.6 minutes) compared to MANTIS cohort (3.1 minutes). There were 2 patients with screw misplacements comprising one from each group that needing revision. Conclusion. Percutaneous spinal stabilisation using mini-invasive system is a good surgical therapeutic choice in thoracic-lumbar instabilities. It has the advantage of less trauma, quick recovery and shortened hospital stay with accuracy of screw placement as similar to those reported for other techniques. Indications and limitations of this technique must be carefully identified. Interest Statement. There was no commercial support or funding of any sort

This article reviews the current knowledge of the intervertebral disc (IVD) and its association with low back pain (LBP). The normal IVD is a largely avascular and aneural structure with a high water content, its nutrients mainly diffusing through the end plates. IVD degeneration occurs when its cells die or become dysfunctional, notably in an acidic environment. In the process of degeneration, the IVD becomes dehydrated and vascularised, and there is an ingrowth of nerves. Although not universally the case, the altered physiology of the IVD is believed to precede or be associated with many clinical symptoms or conditions including low back and/or lower limb pain, paraesthesia, spinal stenosis and disc herniation.

New treatment options have been developed in recent years. These include biological therapies and novel surgical techniques (such as total disc replacement), although many of these are still in their experimental phase. Central to developing further methods of treatment is the need for effective ways in which to assess patients and measure their outcomes. However, significant difficulties remain and it is therefore an appropriate time to be further investigating the scientific basis of and treatment of LBP.