How is recovery from low back pain measured? A systematic review of the literature

Kamper, Steven J.; Stanton, Tasha R.; Williams, Christopher M; Maher, Christopher G.; Hush, Julia M.

doi:10.1007/s00586-010-1477-8

Cited by 61 publications

(58 citation statements)

References 97 publications

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“…The kappa value among four raters using five categories is slightly lower than earlier reported in a cross section of 1-year postoperative controls [4]. This may reflect different prevalence and bias indices in the two populations [22]. Difference in observer training was a less likely explanation, as agreement rates were not consistently higher for consultants and confidence intervals were robust in either simplified categorization.…”

Section: Discussioncontrasting

confidence: 59%

Interobserver agreement in fusion status assessment after instrumental desis of the lower lumbar spine using 64-slice multidetector computed tomography: impact of observer experience

et al. 2012

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Purpose Persistent lower back pain after instrumental posterolateral desis may arise from incomplete fusion. We investigate the impact of experience on interobserver agreement in fusion estimation. Methods Four independent observers, two residents and two musculoskeletal radiologists, reviewed dedicated lumbar 64-MDCT scans and scored vertebral levels 1-5 after Glassman's grades, 1: solid bilateral fusion, 2: solid unilateral fusion, 3: partial bilateral fusion, 4: partial unilateral fusion, 5: non-fusion. We investigated two simplifying dichotomizations, solid bilateral fusion (Glassman 1) versus all others and uni-or bilateral fusion (Glassman 1-2) versus partial or non-fusion. Results Thirty-six patients with 61 operated lumbar levels were included. Interobserver agreement rates for four observers using Glassman's system were fair (kappa 0.32), either dichotomization showed moderate agreement (kappa 0.53 and 0.59). Observer pairs had comparable prevalence adjusted interobserver agreement rates (residents: PABAK 0.67 and 0.54; consultants: PABAK 0.57 and 0.71). Conclusions Difference in observer experience seems of minor impact.

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Section: Discussioncontrasting

confidence: 59%

Interobserver agreement in fusion status assessment after instrumental desis of the lower lumbar spine using 64-slice multidetector computed tomography: impact of observer experience

et al. 2012

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“…[63][64][65] Although there are well-established standard packages of outcome measures, endorsed by expert groups, the theoretical underpinning of these is poor and they may not capture those outcomes that are important to individuals. 63,66 It is of note that neither of these consensus exercises included input from patients and the decision about which outcomes should be measured in LBP trials was from a consensus of clinicians and researchers.…”

Section: Measurement Of Outcomementioning

confidence: 99%

“…Stage 1 requires the respondents to list up to five important areas of life affected by their LBP. This is facilitated by the provision of a 'trigger list' generated for the target condition: 134 a 17-item trigger list was created, informed by qualitative evidence of the impact of LBP, 63,64,140,141 items included in widely used LBP-specific measures 63,65 and recent application of the PGI in a Norwegian LBP population 113 (Box 9).…”

Section: Patient Generated Indexmentioning

confidence: 99%

Facet joint injections for people with persistent non-specific low back pain (Facet Injection Study): a feasibility study for a randomised controlled trial

Ellard

Underwood

Achana

et al. 2017

Health Technol Assess

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BackgroundThe National Institute for Health and Care Excellence (NICE) 2009 guidelines for persistent low back pain (LBP) do not recommend the injection of therapeutic substances into the back as a treatment for LBP because of the absence of evidence for their effectiveness. This feasibility study aimed to provide a stable platform that could be used to evaluate a randomised controlled trial (RCT) on the clinical effectiveness and cost-effectiveness of intra-articular facet joint injections (FJIs) when added to normal care.ObjectivesTo explore the feasibility of running a RCT to test the hypothesis that, for people with suspected facet joint back pain, adding the option of intra-articular FJIs (local anaesthetic and corticosteroids) to best usual non-invasive care is clinically effective and cost-effective.DesignThe trial was a mixed design. The RCT pilot protocol development involved literature reviews and a consensus conference followed by a randomised pilot study with an embedded mixed-methods process evaluation.SettingFive NHS acute trusts in England.ParticipantsParticipants were patients aged ≥ 18 years with moderately troublesome LBP present (> 6 months), who had failed previous conservative treatment and who had suspected facet joint pain. The study aimed to recruit 150 participants (approximately 30 per site). Participants were randomised sequentially by a remote service to FJIs combined with ‘best usual care’ (BUC) or BUC alone.InterventionsAll participants were to receive six sessions of a bespoke BUC rehabilitation package. Those randomised into the intervention arm were, in addition, given FJIs with local anaesthetic and steroids (at up to six injection sites). Randomisation occurred at the end of the first BUC session.Main outcome measuresProcess and clinical outcomes. Clinical outcomes included a measurement of level of pain on a scale from 0 to 10, which was collected daily and then weekly via text messaging (or through a written diary). Questionnaire follow-up was at 3 months.ResultsFifty-two stakeholders attended the consensus meeting. Agreement informed several statistical questions and three design considerations: diagnosis, the process of FJI and the BUC package and informing the design for the randomised pilot study. Recruitment started on 26 June 2015 and was terminated by the funder (as a result of poor recruitment) on 11 December 2015. In total, 26 participants were randomised. Process data illuminate some of the reasons for recruitment problems but also show that trial processes after enrolment ran smoothly. No between-group analysis was carried out. All pain-related outcomes show the expected improvement between baseline and follow-up. The mean total cost of the overall treatment package (injection £419.22 and BUC £264.00) was estimated at £683.22 per participant. This is similar to a NHS tariff cost for a course of FJIs of £686.84.LimitationsPoor recruitment was a limiting factor.ConclusionsThis feasibility study achieved consensus on the main challenges in a trial of FJIs for people with persistent non-specific low back pain.Future workFurther work is needed to test recruitment from alternative clinical situations.Trial registrationEudraCT 2014-000682-50 and Current Controlled Trials ISRCTN93184143.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 30. See the NIHR Journals Library website for further project information.

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“…Reyndar er athyglisvert að ekki er til ákveðin skilgreining á bata hryggvandamála, sem torveldar jafnvel samanburð milli framskyggnra rannsókna. 34 Áhugavert vaeri að endurtaka rannsókn sem þessa með staerra úrtaki og gjarnan framskyggnu rannsóknarsniði til að fylgjast með þróun á notkun segulómskoðunar vegna bakverkja á landinu öllu, auk kostnað-argreiningar, meðferðar og bata fólks með bakverki. Þessi fyrsta rannsókn á notkun segulómskoðunar við greiningu bakverkja hérlendis gefur vísbendingar um að segulómun sé talsvert notuð við greiningu þeirra.…”

Section: Umraeðaunclassified

Segulómun við greiningu lendahryggsverkja: Nýting, samband við einkenni og áhrif á meðferð

Svanbergsson¹,

Ingvarsson²,

Arnardóttir³

2017

LBL

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How is recovery from low back pain measured? A systematic review of the literature

Abstract: Recovery is commonly used as an outcome measure in low back pain (LBP) research. There is, how-

Cited by 61 publications

References 97 publications

Interobserver agreement in fusion status assessment after instrumental desis of the lower lumbar spine using 64-slice multidetector computed tomography: impact of observer experience

Interobserver agreement in fusion status assessment after instrumental desis of the lower lumbar spine using 64-slice multidetector computed tomography: impact of observer experience

Facet joint injections for people with persistent non-specific low back pain (Facet Injection Study): a feasibility study for a randomised controlled trial

Segulómun við greiningu lendahryggsverkja: Nýting, samband við einkenni og áhrif á meðferð

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