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A prospective study of the interrelationship between subjective and objective measures of disability before and 2 months after lumbar decompression surgery for disc herniation


Mannion, Anne F; Dvorak, Jiri; Müntener, Markus; Grob, Dieter (2005). A prospective study of the interrelationship between subjective and objective measures of disability before and 2 months after lumbar decompression surgery for disc herniation. European Spine Journal, 14(5):454-465.

Abstract

The value of range of motion (ROM) as an indicator of impairment associated with spinal problems, and in monitoring changes in response to treatment, is a controversial issue. The aim of this study was to examine the interrelationship between subjective disability (Roland-Morris scores) and objectively measured impairment (ROM), both before and in response to spinal decompression surgery, in an older group of patients with herniated lumbar disc (DH). Seventy-six individuals took part in the study: 33 patients (mean age 57years, SD 9years) presenting with DH and for whom decompression surgery was planned, and 43 controls (mean age 57years, SD 7years), with no history of back pain requiring medical treatment. In the patient group, pain intensity (leg and back; visual analog score), self-rated disability (Roland-Morris score), certain psychological attributes, and ROM of the spine (Spinal Mouse) were measured before and 2months after decompression surgery. In addition, the patients rated the success of surgery on a 1-5 Likert scale. The pain-free control group performed only the tests of spinal mobility. Before surgery, compared with matched controls, significantly lower values were observed in the DH patients for standing lumbar lordosis (p=0.01), and for range of flexion of the lumbar spine (ROFlumbar) (p=0.0006), but not of the hips (ROFhip) (p=0.14). Roland-Morris Disability scores correlated significantly with ROFlumbar (r=0.61, p=0.0002), but less well with ROFhip(r=0.43, p=0.01). Two months after surgery, there were significant reductions in back pain and leg pain (p=0.0001) and in Roland-Morris Disability scores (p=0.019). There was also a significant decrease in the group mean values for lumbar lordosis angle (i.e., a "flatter” spine after surgery, p=0.002) and ROFlumbar (p=0.038). ROFhip showed a (nonsignificant) tendency to increase (p=0.08) towards normal control values. As a result of these two opposing changes, the range of total trunk flexion showed no significant changes from pre-surgery to 2months post-surgery (p=0.60). On an individual basis, there was a highly significant relationship between the change in self-rated disability scores and the change in ROFlumbar, pre-surgery- to 2months post-surgery (r= −0.82; p<0.0001). Changes in ROFhip showed no such relationship (r= −0.30, p=0.10). The patients in the "poor” outcome group ("surgery didn't help”; 9%) had a significantly greater reduction in ROFlumbar post-surgery compared with the "good” outcome group ("surgery helped”; 91%) (p=0.04). In stepwise linear regression, the change in ROFlumbar was the only variable accounting for the change in self-rated disability pre-surgery to post-surgery (variables not included: pain intensity, psychological factors). The pivotal role of lumbar mobility in explaining disability emphasizes the importance of measuring lumbar and hip ranges of motion separately, as opposed to "global trunk motion.” In the patient group examined, the determination of lumbar spinal mobility provides a valid, objective measure of function, that shows differences from normal matched controls, that correlates well with self-rated disability, and the changes in which correlate extremely well with subjective changes in disability following surgery

Abstract

The value of range of motion (ROM) as an indicator of impairment associated with spinal problems, and in monitoring changes in response to treatment, is a controversial issue. The aim of this study was to examine the interrelationship between subjective disability (Roland-Morris scores) and objectively measured impairment (ROM), both before and in response to spinal decompression surgery, in an older group of patients with herniated lumbar disc (DH). Seventy-six individuals took part in the study: 33 patients (mean age 57years, SD 9years) presenting with DH and for whom decompression surgery was planned, and 43 controls (mean age 57years, SD 7years), with no history of back pain requiring medical treatment. In the patient group, pain intensity (leg and back; visual analog score), self-rated disability (Roland-Morris score), certain psychological attributes, and ROM of the spine (Spinal Mouse) were measured before and 2months after decompression surgery. In addition, the patients rated the success of surgery on a 1-5 Likert scale. The pain-free control group performed only the tests of spinal mobility. Before surgery, compared with matched controls, significantly lower values were observed in the DH patients for standing lumbar lordosis (p=0.01), and for range of flexion of the lumbar spine (ROFlumbar) (p=0.0006), but not of the hips (ROFhip) (p=0.14). Roland-Morris Disability scores correlated significantly with ROFlumbar (r=0.61, p=0.0002), but less well with ROFhip(r=0.43, p=0.01). Two months after surgery, there were significant reductions in back pain and leg pain (p=0.0001) and in Roland-Morris Disability scores (p=0.019). There was also a significant decrease in the group mean values for lumbar lordosis angle (i.e., a "flatter” spine after surgery, p=0.002) and ROFlumbar (p=0.038). ROFhip showed a (nonsignificant) tendency to increase (p=0.08) towards normal control values. As a result of these two opposing changes, the range of total trunk flexion showed no significant changes from pre-surgery to 2months post-surgery (p=0.60). On an individual basis, there was a highly significant relationship between the change in self-rated disability scores and the change in ROFlumbar, pre-surgery- to 2months post-surgery (r= −0.82; p<0.0001). Changes in ROFhip showed no such relationship (r= −0.30, p=0.10). The patients in the "poor” outcome group ("surgery didn't help”; 9%) had a significantly greater reduction in ROFlumbar post-surgery compared with the "good” outcome group ("surgery helped”; 91%) (p=0.04). In stepwise linear regression, the change in ROFlumbar was the only variable accounting for the change in self-rated disability pre-surgery to post-surgery (variables not included: pain intensity, psychological factors). The pivotal role of lumbar mobility in explaining disability emphasizes the importance of measuring lumbar and hip ranges of motion separately, as opposed to "global trunk motion.” In the patient group examined, the determination of lumbar spinal mobility provides a valid, objective measure of function, that shows differences from normal matched controls, that correlates well with self-rated disability, and the changes in which correlate extremely well with subjective changes in disability following surgery

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Item Type:Journal Article, refereed, original work
Communities & Collections:National licences > 142-005
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:1 June 2005
Deposited On:23 Oct 2018 15:09
Last Modified:17 Sep 2019 19:35
Publisher:Springer
ISSN:0940-6719
OA Status:Green
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1007/s00586-004-0787-0
Related URLs:https://www.swissbib.ch/Search/Results?lookfor=nationallicencespringer101007s0058600407870 (Library Catalogue)

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