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Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_9 | Pages 38 - 38
1 Sep 2019
Sikkens D Broekema A Soer R Reneman M Groen R Kuijlen J
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Introduction

Degeneration of the cervical spine can lead to neurological symptoms that require surgical intervention. Often, an anterior cervical discectomy (ACD) with fusion is performed with interposition of a cage. However, a cage substantially increases health care costs. The polymer polymethylmethacrylate (PMMA) is an alternative to cages, associated with lower costs. The reported high-occurrence of non-fusion with PMMA is often seen as a drawback, but evidence for a correlation between radiological fusion and clinical outcome is absent. To investigate if the lower rate of fusion with PMMA has negative effects on long-term clinical outcome, we assessed the clinical results of ACD with PMMA as a intervertebral spacer with a 5–10 year follow-up.

Methods

A retrospective cohort study among all patients who underwent a mono-level ACD with PMMA for degenerative cervical disease, between 2007–2012, was performed. Patients filled out an online questionnaire, developed to assess clinical long-term outcome, complications and re-operation rates. The primary outcome measure was the Neck Disability Index (NDI), secondary outcome measures were re-operation and complication rates.


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_9 | Pages 2 - 2
1 Sep 2019
Nijeweme - d'Hollosy WO Poel M van Velsen L Groothuis-Oudshoorn C Hermens H Stegeman P Wolff A Reneman M Soer R
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Aims

Clinical decision support systems (CDSS) can support clinicians in selecting appropriate treatments for patients. The objective of this study was to examine if triaging patients with LBP to the most optimal treatment can be improved by using a data-driven approach with the help of machine learning as base of such a CDSS.

Methods

A clinical database of the Groningen Spine Center containing patient-reported data from 1546 patients with LBP was used. From this dataset, a training dataset with 354 features was labeled on eight different treatments actually received by these patients. With this dataset, models were trained. A test dataset with 50 cases judged on treatments by 4 experts in LBP triage was used to test these models with data not used to train the models. Prediction accuracy and average area under curve (AUC) were used as performance measures for the models.


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_9 | Pages 11 - 11
1 Sep 2019
Hallegraeff J Kan R van Trijffel E Reneman M
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Purpose and background

There is lacking evidence about the prognostic role of anxiety as prognostic in acute low back pain patients. The objective of this study was to determine whether patients with acute low back pain (ALBP) are at risk to develop chronic low back pain (CLBP) and pain-related disability after 12 weeks due to high anxiety levels.

Methods and results

An observational multi-centre study was conducted in primary physiotherapy care with measurements at baseline and at 12 weeks including known prognostic factors and psychological candidate predictors for CLBP. Two hundred and four participants completed both assessments of which 51 and 54 were classified as having less than 50% decrease in pain and pain-related disability, respectively. For pain, the final model contained higher pain intensity, longer pain duration, depression symptoms, and state anxiety with explained variance 0.30, sensitivity 0.74, specificity 0.82, Likelihood Ratio 4.1 (95% CI 2.0 to 6.1) and Area Under the Curve 0.78 (95% CI 0.70 to 0.85). For pain-related disability, trait anxiety, depression symptoms, and state anxiety contributed independently to the prediction with the model's explained variance of 0.19, sensitivity 0.78, specificity 0.78, Likelihood Ratio 3.0 (95% CI 2.0 to 4.5), and Area Under the Curve 0.73 (95% CI 0.65 to 0.81).


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_9 | Pages 31 - 31
1 Sep 2019
Broekema A Molenberg R Kuijlen J Groen R Reneman M Soer R
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Introduction

The Odom's criteria are, since 1958, a widely used 4-point rating scale for assessing the clinical outcome after cervical spine surgery. Surprisingly, the Odom's criteria have never been validated. The aim of this study was to investigate the reliability and validity of the Odom's criteria for the evaluation of surgical procedures of the cervical spine.

Methods

Patients with degenerative cervical spine disease were included and divided into two groups, based on their most predominant symptom: myelopathy or radiculopathy. Reliability was assessed with inter-rater and test-retest design using a quadratic weighted Kappa coefficient. Construct validity was assessed by means of hypothesis testing with related constructs. To evaluate if the Odom's criteria could act as a global perceived effect (GPE) scale, we assessed concurrent validity by comparing the areas under the curves (AUCs) of the receiver operating characteristic curves (ROCs) with both the Odom's criteria, as the GPE as an anchor.


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_9 | Pages 56 - 56
1 Sep 2019
Echeita JA Preuper HS Dekker R Reneman M
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Background and purposes

Central Sensitization (CS) may occur in patients with Chronic Low Back Pain (CLBP). Functional capacity these patients is limited. However, the association of CLBP with functioning assessed via lifting and aerobic capacity tests has been moderately explained and results are contradictory. Let alone pain response following strenuous exercise. Finally, whether CS is associated with either or both lifting and aerobic capacities is unknown.

To analyze the relationship between CS, and lifting and aerobic capacities in patients with CLBP.

To describe pain response to strenuous exercise in patients with CLBP.

Methods

Cross-sectional observational study. CS, lifting and aerobic capacities, and pain response were respectively measured with Central Sensitization Inventory (CSI), floor-to-waist lifting test, Cardiopulmonary Exercise Test (CPET), and Pain response questionnaire.

Statistical analyses:

Stepwise-forward multiple regression with lifting and aerobic capacities (dependent), CSI (independent), physical, work- and disability-related characteristics (covariates);

Paired t-test of pain response before CPET pain to immediately and 24h after, and correlation of the changes with CSI.


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_9 | Pages 59 - 59
1 Sep 2019
Speijer L Soer R Reneman M Stegeman P Dutmer A
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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.


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_9 | Pages 49 - 49
1 Sep 2019
Beemster T van Velzen J van Bennekom C Reneman M Frings-Dresen M
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Purpose

The aim of this study was to explore the usefulness and feasibility of comprehensive vocational rehabilitation (C-VR) and less comprehensive vocational rehabilitation (LC-VR) for workers on sick leave due to CMP, from the perspective of patients, professionals, and managers.

Methods

Semi-structured interviews were held with patients, professionals, and managers. Using topic lists, interviewees were questioned about barriers to and facilitators of the usefulness and feasibility of C-VR and LC-VR. All interviews were transcribed verbatim. Data were analyzed by systematic text condensation using thematic analysis.


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_9 | Pages 28 - 28
1 Sep 2019
Soer R Buwalda N Mireau J Coppes M Wolff A Preuper HS Reneman M
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Aims

The aims of this study were to investigate whether 1) multispecialist tertiary intervention for complex spinal pain lead to reductions in spine-related healthcare costs and 2) baseline characteristics are related to health care consuming costs.

Patients and methods

A cost study in a natural prospective cohort was carried out to investigate healthcare data of patients admitted to the Groningen Spine Center (GSC) ranging from two years prior to referral until two year after discharge. GSC intervention consisted of a multi-professional and -specialist based diagnosis and treatment. Patients (18 and 80 years) were included, suffering from specific as well as multifactorial spinal pain. Clinical data was merged with Health Care Insurance data and included questionnaires on demographics, work, pain, disability, quality of life and psychosocial functioning. Univariable (paired sample t-tests) and multivariable analyses (pooled OLS Regression and fixed effects models) were carried out.


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_9 | Pages 60 - 60
1 Sep 2019
Stegeman P Speijer L Hamelink J Sterken M Soer R Wolff A Preuper HS Reneman M Nijeweme - d'Hollosy WO
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Aims

The aim of this study was to investigate the agreement of physician assistants (PAs) in the triaging of patients with Low Back Pain (LBP) based on self-reported data.

Patients and methods

A cross sectional vignette study among four PAs was carried out. Vignettes (cases) were constructed including 26 factors that can be self-reported, identified in literature that have predictive value in treatment outcomes (for example red flags indicating serious underlying conditions and yellow flags indicating psychosocial factors). All vignettes were randomly assigned to the PAs who should determine what intervention would be most optimal to the patient (rehabilitation, injections, medications, surgery, primary care psychology, primary care physical therapy). PAs were allowed to advise more than one intervention. Per vignette, 3 PAs were assigned randomly to advise on intervention. Fleish kappas were calculated to determine the interrater reliability.


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_9 | Pages 33 - 33
1 Sep 2019
Dutmer A Reneman M Wolff A Soer R Preuper HS
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Introduction

A minority of patients with chronic low back pain (CLBP) account for a majority of disability and costs. This subgroup has potentially most to gain from effective treatment. The Groningen Spine Cohort will provide a 10-year prospective insight into the burden of CLBP for patients referred to multispecialty tertiary spine care in the Netherlands. This study reports first baseline results.

Objective

To study the personal and societal impact of CLBP in patients visiting the UMCG tertiary spine center.


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_2 | Pages 20 - 20
1 Feb 2015
McCluskey S de Vries H Reneman M Brooks J Brouwer S
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Background

Emerging research has indicated that ‘significant others’ (spouses/relatives) may have important influences on continued work participation for individuals with chronic non-specific musculoskeletal pain (CMP). In order to expand on this novel area of research, data from studies conducted in The Netherlands and the UK were assimilated.

Method

In both studies, worker and significant other perceptions of pain self-efficacy, perceived partner responses to pain, pain catastrophizing, and contribution to work participation were explored in relation to the worker's CMP. In the Netherlands, questionnaire data were collected from workers with CMP and their significant others (n=103), and in the UK, in-depth semi-structured interviews were conducted (n=10). Appropriate quantitative and qualitative analysis techniques were applied.