Problem areas identified as important to older adults with lumbar spinal stenosis

Edwards, Todd C.; Lavallee, Danielle C.; Bauer, Zoya; Comstock, Bryan A.; Jarvik, Jeffrey G.; Patrick, Donald L.; Makris, Una E.; Friedly, Janna

doi:10.1016/j.spinee.2015.03.008

Cited by 28 publications

(26 citation statements)

References 38 publications

(23 reference statements)

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“…An indicator of treatment group was coded such that negative differences indicate greater improvement in the corticosteroid plus lidocaine group. Using the SIP weights assigned to the RDQ 14,15 and LESSER priority scores 22 for each item, we derived alternatively weighted RDQ scores for each patient and standardized each scale to a range from 0 to 24. We then re-assessed the effect of corticosteroids using each alternatively weighted RDQ in separate ANCOVA and qualitatively compared the resulting differences in both statistical significance and clinical importance.…”

Section: Discussionmentioning

confidence: 99%

“…22 The University of Washington's Institutional Review Board approved this study prior to contact with study participants.…”

Section: Methodsmentioning

confidence: 99%

“…In brief, study participants ≥ 50 years of age who reported low back and/or leg pain consistent with lumbar spinal stenosis were recruited for the LESSER prioritization study 22 from clinics in the University of Washington system (these participants were not part of the LESS trial) as well as senior centers, physical therapy clinics, and patient advocacy organizations in the Greater Seattle region. All participants signed informed consent and completed a brief questionnaire over the telephone at the time of screening on duration of pain symptoms, pain intensity, RDQ, treatment history, and demographics.…”

Section: Methodsmentioning

confidence: 99%

“…20-22 The experience of spinal stenosis may be different from other etiologies of back pain; symptoms of spinal stenosis may include lower extremity numbness/sensory changes, impairments in balance and weakness in addition to lower extremity pain and back pain. Leg pain is one of the most common symptoms of spinal stenosis.…”

Section: Introductionmentioning

confidence: 99%

“…Using structured individual sorting and ranking exercises and focus group discussions, we obtained patient-selected importance prioritizations of RDQ items. 22 …”

Section: Introductionmentioning

confidence: 99%

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Patient Priority Weighting of the Roland Morris Disability Questionnaire Does Not Change Results of the Lumbar Epidural Steroid Injections for Spinal Stenosis Trial

Makris

Edwards²,

Lavallee

et al. 2017

Spine

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Study Design Secondary analysis of Lumbar Epidural steroid injections for Spinal Stenosis randomized controlled trial data. Objective To re-evaluate whether outcomes for older adults receiving epidural steroid injections with or without corticosteroid improve after using patient-prioritized Roland-Morris Disability Questionnaire (RDQ) items. Summary of Background Data Epidural corticosteroid injections are commonly used to treat lumbar spinal stenosis symptoms, despite limited evidence for their effectiveness in clinical trials. It is unclear whether evaluating patient-prioritized outcomes would alter results of a large clinical trial. Methods Outcomes from the LESS trial were re-analyzed using RDQ, Sickness Impact Profile- SIP weights assigned to the RDQ items, and patient-prioritized RDQ items. Differences between corticosteroid+lidocaine versus lidocaine-alone groups and 95% confidence intervals (CI) were calculated using analysis of covariance with adjustment for baseline values of the RDQ and recruitment site. Results At 6 weeks, both the corticosteroid+lidocaine group and the lidocaine-alone group had improvement in the RDQ scores (RDQ, RDQ using SIP weights, patient-prioritized RDQ) as compared with baseline scores (corticosteroid+lidocaine: -4.2 points, -4.1 points, -4.2; lidocaine-alone: -3.1 points, -2.9 points, and -3.1 points, respectively). However, there was no significant between-group difference in the RDQ or patient-prioritized RDQ (average treatment effect -1.0 points, 95% CI -2.1 to 0.1, P = 0.07; -1.0 points, 95% CI -2.0 to 0.1, P = 0.08 respectively). While the between-group difference of RDQ using SIP weights was statistically significant (average treatment effect -1.1, 95% CI -2.2 to -0.1, P = 0.04), this was not clinically important. Conclusions Results of the LESS trial did not substantively differ based on re-analysis of data using RDQ with SIP weights or patient-prioritized RDQ outcomes. This provides additional evidence that epidural injection of corticosteroid+lidocaine offered minimal or no short-term benefit as compared with epidural injection of lidocaine-alone for older adults with lumbar spinal stenosis.

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Section: Discussionmentioning

confidence: 99%

“…22 The University of Washington's Institutional Review Board approved this study prior to contact with study participants.…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Using structured individual sorting and ranking exercises and focus group discussions, we obtained patient-selected importance prioritizations of RDQ items. 22 …”

Section: Introductionmentioning

confidence: 99%

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