Background and Objective: The influence of back pain on work status is normally implied from the severity of the functional limitations. The aim of this cross sectional study was to analyse whether functional assessment instruments correlate well with impact on work status.

Patients and Methods: 375 chronic low back pain patients attending back pain outpatient clinics of a University Hospital and a specialist rehabilitation centre over a period of one year were assessed. The three functional outcome scores measured were Oswestry Disability Index (ODI), Roland Morris disability questionnaire (RMQ) and Orebro Musculoskeletal Pain Questionnaire (OMPQ). The effect of back pain on patient’s work status was recorded in 6 options – work not affected, slightly affected, seriously affected, reduced number of hours, change job or give up job. The work status score was then correlated to the above three instrument values.

Results: There was good correlation among the three instrument values (rho > 0.70) suggesting they are interchangeable. However, there was only a modest correlation between the work status scale and the three functional scores; the rho values were 0.47 for OMPQ, 0.43 for ODI and 0.39 for RMQ. There was no influence of age, duration of pain or type of work on this correlation.

Conclusion: Back pain instruments (which measure pain and functional limitations) and work status are not interchangeable. The impact on work status cannot be implied from these functional scores and should be recorded as a separate outcome measure.

Aim: This study aimed at investigating the diagnostic value of local anaesthetic hip injection test to differentiate between hip and spinal pain in patients presenting with symptoms attributable to both hip and spine pathology.

Study design: Prospective cohort.

Materials and Methods: 48 patients with such diagnostic dilemma under one the care of one spinal surgeon in one centre were carefully selected. All patients had radiographs of the hip joint confirming varying degrees of osteoarthritis. Most of the patients also had different types of spinal imaging showing degenerative spinal changes. The hip injection test involved intraarticular injection of 0.5% Bupivacaine under strict aseptic precautions in a laminar airflow theatre under fluoroscopic control.

Results: 37 patients had a significant relief of pain to the injection. Of these, 33 (89%) underwent successful total hip replacement with relief of pain. The patients with a negative response to the test responded satisfactorily to treatment directed towards their spinal pathology. The sensitivity of this test is at least 97% and specificity 90%. These results are similar to those of previous studies on this topic.

Conclusion: Local anaesthetic hip injection test is a safe, inexpensive and reliable diagnostic tool in identifying the source of the pain in patients with attributable dual pathology.

Purpose: To establish the results of a three week functional restoration program in terms of commonly used surgical outcome measures

Method: 135 patients ( 57 male 78 female) undertook a three week functional restoration program consisting of hydrotherapy, gymnasium work, education and cognitive behavioral therapy. They completed pre-program standard questionnaires including the Oswestry Disability Index and the Roland Morris. Follow up was at an average of 26 months (std dev 7) The patient global assessment of worse, unchanged, better and much better were completed as well as the pre-program outcome measures.

Results: Oswestry; Roland Morris

Pre program 34 average: s.d. 158.8; s.d. 4.5

Post program 19 average: s.d. 174.3; s.d. 4.8

Patient Global assessment:

Much better 64; 47%

Excellent 62; 49.6%

Better: 52; 38%

Good: 43; 34.4%

Unchanged: 2; 9%

Fair: 16 ; 2.8%

Worse: 7; 5%

Poor: 4; 3.2%

Data on the impact upon work was available for 121 of the patients. Pre program 71 of the 121 had been seriously affected in the workplace. Work follow up was 79% and at follow up only 22 out of 96 were seriously affected in the workplace. A significant improvement.

43 had an injury at work, RTA or similar significant event, 89 did not. The ODI improved by 18 points in the attributable event group and 13 in the non event group. Similar results were found for the Roland score. There was no significant difference between the two groups.

Conclusion: A very favourable results in the treatment of chronic back pain can be achieved, despite including adverse patient groups. Over 80% of patients were in the ‘success’ treatment groups at follow up using the Scandinavian Spine stabilization study group global assessment tool. Surgeons, patients and health care purchasers need to be aware of what can occur with non surgical treatment.