The Impact of Multidisciplinary Approaches to Social Functioning on Surgical Outcomes After Surgery for Cervical Myelopathy.

STUDY DESIGN: Prospective cohort study. OBJECTIVE: To identify the effects of multidisciplinary approaches (MAs) to improve social functioning (SF) on 1-year surgical outcomes in patients with cervical myelopathy. SUMMARY OF BACKGROUND DATA: Despite significant improvement in cervical myelopathy, a patient's quality of life (QOL) sometimes does not improve postoperatively. A previous study revealed that SF, rather than myelopathy severity, correlated with QOL improvement after decompression surgery for cervical myelopathy. PATIENTS AND METHODS: This study compared two prospective cohorts in Japan. Patients who underwent cervical laminoplasty for cervical myelopathy from 2018 to 2020 were enrolled in the control cohort. Patients who underwent the same surgery with the same indications between 2020 and 2021 were enrolled in the MA cohort. Patients in the control cohort were treated with a standard care protocol, and those in the MA cohort were treated with a multidisciplinary protocol that focused on SF improvement. The changes in the total Japanese Orthopedic Association (JOA) score and in the domains of the JOA scores (upper limb function, lower limb function, upper limb sensory, and lower limb sensory) from preoperatively to 1 year postoperatively were compared between the control and MA cohorts using a mixed-effect model. RESULTS: The control and MA cohorts comprised 140 and 31 patients, respectively. The improvement in the JOA score was significantly better in the MA cohort than in the control cohort ( P = 0.040). In analyses of each JOA score domain, the improvement of upper limb function was significantly better in the MA cohort than in the control cohort ( P = 0.033). Similarly, the MA cohort demonstrated significantly higher patient-reported outcomes for upper extremity function than the control cohort ( P < 0.001). In addition, the self-care domain of QOL score at 1 year postoperatively was significantly higher in the MA cohort than in the control cohort ( P = 0.047). CONCLUSION: MAs to improve/rebuild a patient's SF were effective in improving cervical myelopathy and the self-care domain of QOL. This study is the first to demonstrate the effectiveness of postoperative MAs in patients with cervical myelopathy. LEVEL OF EVIDENCE: Level 3.

Postoperative Physical Therapy Program Focused on Low Back Pain Can Improve Treatment Satisfaction after Minimally Invasive Lumbar Decompression.

Patient satisfaction is crucial in pay-for-performance initiatives. To achieve further improvement in satisfaction, modifiable factors should be identified according to the surgery type. Using a prospective cohort, we compared the overall treatment satisfaction after microendoscopic lumbar decompression between patients treated postoperatively with a conventional physical therapy (PT) program (control; n = 100) and those treated with a PT program focused on low back pain (LBP) improvement (test; n = 100). Both programs included 40 min outpatient sessions, once per week for 3 months postoperatively. Adequate compliance was achieved in 92 and 84 patients in the control and test cohorts, respectively. There were no significant differences in background factors; however, the patient-reported pain score at 3 months postoperatively was significantly better, and treatment satisfaction was significantly higher in the test than in the control cohort (-0.02 ± 0.02 vs. -0.03 ± 0.03, p = 0.029; 70.2% vs. 55.4%, p = 0.045, respectively). In the multivariate logistic regression analysis, patients treated with the LBP program tended to be more satisfied than those treated with the conventional program, independent of age, sex, and diagnosis (adjusted odds ratio = 2.34, p = 0.012). Postoperative management with the LBP program could reduce pain more effectively and aid spine surgeons in achieving higher overall satisfaction after minimally invasive lumbar decompression, without additional pharmacological therapy.

Verification of Shoulder External Rotators Strength Measurement Using a Suspension Scale.

Background Of the shoulder external rotators, the infraspinatus and teres minor are the key muscles that contribute to the dynamic stability of the shoulder. It is crucial to properly measure the strength values to evaluate muscle function and training load for shoulder external rotators. A suspension scale (SPS) can measure the mass of the suspended object, and it may be possible to apply it to measure strength. However, the utility of strength measurements using an SPS has not been clarified in previous studies. In this study, we aimed to investigate the intra-rater reliability of measuring the strength of shoulder external rotators using an SPS and the relationship between strength measurement using an SPS and a handheld dynamometer (HHD). Methodology The participants were 10 healthy males with 20 shoulders (24.5 ± 2.5 years old; height = 172.8 ± 5.4 cm; weight = 69.6 ± 8.1 kg). Upper extremity strength was measured at 90° shoulder abduction, 90° external rotation, 0° horizontal adduction/abduction, 90° elbow flexion, and 0° forearm pronation/supination in the prone position. The isometric strength of shoulder external rotation was measured with the SPS and HHD, and one examiner measured the maximum strength value. The intra-rater reliability of the two methods using SPS and HHD was evaluated using the intraclass correlation coefficient (ICC1,2), standard error of measurement (SEM), minimum detectable change (MDC), and Bland-Altman analysis. The relationship between the SPS and HHD was calculated as the correlation coefficient between the strength values of SPS and HHD. Results The intra-rater reliability of the strength measurement of shoulder external rotators using SPS was ICC1,2 0.98 (95% confidence interval = 0.95-0.99), and SEM and MDC were 0.3 and 0.9, respectively. The measurements using SPS had no fixed and proportional biases. A significant positive correlation was observed between SPS and HHD (r = 0.94, p < 0.01). Conclusions The SPS is an alternative to the HHD for measuring the strength of shoulder external rotators. Thus, measuring the strength of shoulder external rotators using an SPS may be applied as a cost-effective and portable assessment method for shoulder function.