mHealth Apps for the Self-Management of Low Back Pain: Systematic Search in App Stores and Content Analysis.

BACKGROUND: With the rapid development of mobile health (mHealth) technology, many health apps have been introduced to the commercial market for people with back pain conditions. However, little is known about their content, quality, approaches to care for low back pain (LBP), and associated risks of use. OBJECTIVE: The aims of this research were to (1) identify apps for the self-management of LBP currently on the market and (2) assess their quality, intervention content, theoretical approaches, and risk-related approaches. METHODS: The UK iTunes and Google Play stores were initially searched for apps related to the self-management of LBP in May 2022. A repeat search in June 2023 was conducted to ensure that any relevant new apps developed in the last year were incorporated into the review. A total of 3 keywords recommended by the Cochrane Back and Neck Group were used to search apps "low back pain," "back pain," and "lumbago." The quality of the apps was assessed by using the 5-point Mobile App Rating Scale (MARS). RESULTS: A total of 69 apps (25 iOS and 44 Android) met the inclusion criteria. These LBP self-management apps mainly provide recommendations on muscle stretching (n=51, 73.9%), muscle strengthening (n=42, 60.9%), core stability exercises (n=32, 46.4%), yoga (n=19, 27.5%), and information about LBP mechanisms (n=17, 24.6%). Most interventions (n=14, 78%) are consistent with the recommendations in the National Institute for Health and Care Excellence (NICE) guidelines. The mean (SD) MARS overall score of included apps was 2.4 (0.44) out of a possible 5 points. The functionality dimension was associated with the highest score (3.0), whereas the engagement and information dimension resulted in the lowest score (2.1). Regarding theoretical and risk-related approaches, 18 (26.1%) of the 69 apps reported the rate of intervention progression, 11 (15.9%) reported safety checks, only 1 (1.4%) reported personalization of care, and none reported the theoretical care model or the age group targeted. CONCLUSIONS: mHealth apps are potentially promising alternatives to help people manage their LBP; however, most of the LBP self-management apps were of poor quality and did not report the theoretical approaches to care and their associated risks. Although nearly all apps reviewed included a component of care listed in the NICE guidelines, the model of care delivery or embracement of care principles such as the application of a biopsychosocial model was unclear.

Cognitive functional therapy with or without movement sensor biofeedback versus usual care for chronic, disabling low back pain (RESTORE): a randomised, controlled, three-arm, parallel group, phase 3, clinical trial.

BACKGROUND: Low back pain is the leading cause of years lived with disability globally, but most interventions have only short-lasting, small to moderate effects. Cognitive functional therapy (CFT) is an individualised approach that targets unhelpful pain-related cognitions, emotions, and behaviours that contribute to pain and disability. Movement sensor biofeedback might enhance treatment effects. We aimed to compare the effectiveness and economic efficiency of CFT, delivered with or without movement sensor biofeedback, with usual care for patients with chronic, disabling low back pain. METHODS: RESTORE was a randomised, controlled, three-arm, parallel group, phase 3 trial, done in 20 primary care physiotherapy clinics in Australia. We recruited adults (aged ≥18 years) with low back pain lasting more than 3 months with at least moderate pain-related physical activity limitation. Exclusion criteria were serious spinal pathology (eg, fracture, infection, or cancer), any medical condition that prevented being physically active, being pregnant or having given birth within the previous 3 months, inadequate English literacy for the study's questionnaires and instructions, a skin allergy to hypoallergenic tape adhesives, surgery scheduled within 3 months, or an unwillingness to travel to trial sites. Participants were randomly assigned (1:1:1) via a centralised adaptive schedule to usual care, CFT only, or CFT plus biofeedback. The primary clinical outcome was activity limitation at 13 weeks, self-reported by participants using the 24-point Roland Morris Disability Questionnaire. The primary economic outcome was quality-adjusted life-years (QALYs). Participants in both interventions received up to seven treatment sessions over 12 weeks plus a booster session at 26 weeks. Physiotherapists and patients were not masked. This trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12618001396213. FINDINGS: Between Oct 23, 2018 and Aug 3, 2020, we assessed 1011 patients for eligibility. After excluding 519 (51·3%) ineligible patients, we randomly assigned 492 (48·7%) participants; 164 (33%) to CFT only, 163 (33%) to CFT plus biofeedback, and 165 (34%) to usual care. Both interventions were more effective than usual care (CFT only mean difference -4·6 [95% CI -5·9 to -3·4] and CFT plus biofeedback mean difference -4·6 [-5·8 to -3·3]) for activity limitation at 13 weeks (primary endpoint). Effect sizes were similar at 52 weeks. Both interventions were also more effective than usual care for QALYs, and much less costly in terms of societal costs (direct and indirect costs and productivity losses; -AU$5276 [-10 529 to -24) and -8211 (-12 923 to -3500). INTERPRETATION: CFT can produce large and sustained improvements for people with chronic disabling low back pain at considerably lower societal cost than that of usual care. FUNDING: Australian National Health and Medical Research Council and Curtin University.

Mapping Lower-Limb Prosthesis Load Distributions Using a Low-Cost Pressure Measurement System.

Background: In the UK 55,000 people live with a major limb amputation. The prosthetic socket is problematic for users in relation to comfort and acceptance of the prosthesis; and is associated with the development of cysts and sores. Objectives: We have developed a prototype low-cost system combining low-profile pressure sensitive sensors with an inertial measurement unit to assess loading distribution within prosthetic sockets. The objective of this study was to determine the ability of this prototype to assess in-socket loading profiles of a person with an amputation during walking, with a view to understanding socket design and fit. Methods: The device was evaluated on four transtibial participants of various age and activity levels. The pressure sensors were embedded in the subject's sockets and an inertial measurement unit was attached to the posterior side of the socket. Measurements were taken during level walking in a gait lab. Results: The sensors were able to dynamically collect data, informing loading profiles within the socket which were in line with expected distributions for patellar-tendon-bearing and total-surface-bearing sockets. The patellar tendon bearing subject displayed loading predominately at the patellar tendon, tibial and lateral gastrocnemius regions. The total-surface bearing subjects indicated even load distribution throughout the socket except in one participant who presented with a large socket-foot misalignment. Conclusions: The sensors provided objective data showing the pressure distributions inside the prosthetic socket. The sensors were able to measure the pressure in the socket with sufficient accuracy to distinguish pressure regions that matched expected loading patterns. The information may be useful to aid fitting of complex residual limbs and for those with reduced sensation in their residual limb, alongside the subjective feedback from prosthesis users.

A Paradigm Shift in Assessment of Scientific Skills in Undergraduate Medical Education.

The General Medical Council's publication 'Outcomes for Graduates' places emphasis on doctors being able to integrate biomedical science, research and scholarship with clinical practice. In response, a new paradigm of assessment was introduced for the intercalated Bachelor of Science program at Imperial College School of Medicine in 2019. This innovative approach involves authentic "active learning" assessments analogous to tasks encountered in a research environment and intends to test a wider range of applied scientific skills than traditional examinations. Written assessments include a "Letter to the Editor", scientific abstract, and production of a lay summary. A clinical case study titled "Science in Context" presents a real or virtual patient, with evaluation of current and emerging evidence within that field. Another assessment emulates the academic publishing process: groups submit a literature review and engage in reciprocal peer review of another group's work. A rebuttal letter accompanies the final submission, detailing how feedback was addressed. Scientific presentation skills are developed through tasks including a research proposal pitch, discussion of therapies or diagnostics, or review of a paper. A data management assignment develops skills in hypothesis generation, performing analysis, and drawing conclusions. Finally, students conduct an original research project which is assessed via a written report in the format of a research paper and an oral presentation involving critical analysis of their project. We aspire to train clinicians who apply scientific principles to critique the evidence base of medical practice and possess the skillset to conduct high-quality research underpinned by the principles of best clinical and academic practice. Assessment drives learning, and active learning has been demonstrated to enhance academic performance and reduce attainment gaps in science education. We therefore believe this strategy will help to successfully shape our students as future scientists and scholars as well as clinical practitioners and professionals.

Assessment of chest wall movement following thoracotomy: a systematic review.

Thoracotomy is a major cause of respiratory impairment, increasing the risk of postoperative pulmonary complications (PPC). Systems assessing ribcage kinematics may detect changes in chest expansion following thoracotomy and may thus aid in the development of patient-tailored chest physiotherapy. Hence, we aimed to identify studies assessing changes in chest wall movement following thoracotomy using objective measures. The Cochrane library, MEDLINE, EMBASE, Scopus and Web of Science databases were searched to find relevant articles providing an objective assessment of chest wall movement following thoracotomy. Methodological quality of included studies concerning chest wall movement following thoracotomy was assessed by use of QUADAS-2 tool. A total of 12 articles were included for the assessment of chest wall changes following thoracotomy using objective measures. Four studies measured changes in the cross-sectional area of the ribcage and abdomen using the respiratory inductive plethysmography (RIP), 1 study computed the chest wall compliance by monitoring the intra-pleural pressure, 3 studies measured changes in chest circumference with a simple tape measure and 4 articles performed a compartmental analysis of the chest wall volume by means of an optoelectronic plethysmography (OEP). There was no delay in the collection of data of the index test and reference standard, resulting in a low risk of bias for the flow and timing domain. Across all studies, participants underwent the same reference standard, resulting in a low risk of verification bias. Several objective measures were able to detect changes in chest wall displacement following thoracotomy and differed in the practical use and invasive nature. OEP allows a compartmental analysis of the chest wall volume. Hence, this system allows to assess chest wall movement changes following thoracotomy and the impact of different types of surgical approach. Furthermore, it could aid in the development of tailored physiotherapy.

Design and preliminary testing of a low-cost balance perturbation system for the evaluation of real life postural adjustment on public transport.

Balance recovery mechanisms are of paramount importance in situations like public transport where sudden loss of equilibrium can occur. These mechanisms can be altered by aging or pathological disorders. However it is almost impossible to investigate these phenomena in real-life conditions, and the safe environment of a laboratory is needed. This paper investigates how jerk perturbations in the transverse plane similar to those experienced on public transport can be simulated in a controlled manner. A platform capable of producing horizontal perturbations with a person standing on it was developed. Accuracy, repeatability, and load sensitivity of the system were assessed with repeated trials in all four directions of movement. Comparison between the destabilising effect experienced on public transport and the postural response to perturbations from the platform was also made by tracking acceleration of the centre of mass of four subjects in these two situations. Results show that balance perturbations representative of real-life situations, such as standing on public transport, can accurately and repeatedly be produced in a safe and controlled environment with a low-cost and low-maintenance system. Coupled to motion capture technology, the system can be used for pathology assessment and rehabilitation treatments.

RESTORE-Cognitive functional therapy with or without movement sensor biofeedback versus usual care for chronic, disabling low back pain: study protocol for a randomised controlled trial.

INTRODUCTION: Low back pain (LBP) is the leading cause of disability globally and its costs exceed those of cancer and diabetes combined. Recent evidence suggests that individualised cognitive and movement rehabilitation combined with lifestyle advice (cognitive functional therapy (CFT)) may produce larger and more sustained effects than traditional approaches, and movement sensor biofeedback may enhance outcomes. Therefore, this three-arm randomised controlled trial (RCT) aims to compare the clinical effectiveness and economic efficiency of individualised CFT delivered with or without movement sensor biofeedback, with usual care for patients with chronic, disabling LBP. METHODS AND ANALYSIS: Pragmatic, three-arm, randomised, parallel group, superiority RCT comparing usual care (n=164) with CFT (n=164) and CFT-plus-movement-sensor-biofeedback (n=164). Inclusion criteria include: adults with a current episode of LBP >3 months; sought primary care ≥6 weeks ago for this episode of LBP; average LBP intensity of ≥4 (0-10 scale); at least moderate pain-related interference with work or daily activities. The CFT-only and CFT-plus-movement-sensor-biofeedback participants will receive seven treatment sessions over 12 weeks plus a 'booster' session at 26 weeks. All participants will be assessed at baseline, 3, 6, 13, 26, 40 and 52 weeks. The primary outcome is pain-related physical activity limitation (Roland Morris Disability Questionnaire). Linear mixed models will be used to assess the effect of treatment on physical activity limitation across all time points, with the primary comparison being a formal test of adjusted mean differences between groups at 13 weeks. For the economic (cost-utility) analysis, the primary outcome of clinical effect will be quality-adjusted life years measured across the 12-month follow-up using the EuroQol EQ-5D-5L . ETHICS AND DISSEMINATION: Approved by Curtin University Human Research Ethics Committee (HRE2018-0062, 6 Feb 2018). Study findings will be disseminated through publication in peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (ACTRN12618001396213).

Rehabilitation following lumbar fusion surgery (REFS) a randomised controlled feasibility study.

PURPOSE: Following lumbar fusion surgery (LFS), 40% of patients are unsure/dissatisfied with their outcome. A prospective, single-centre, randomised, controlled trial was conducted to evaluate the feasibility (including clinical and economic impact) of a theoretically informed rehabilitation programme following LFS (REFS). METHODS: REFS was informed by an explicit theoretical framework and consisted of 10 consecutive weekly group rehabilitation sessions (education, low-tech cardiovascular, limb and spine strengthening exercises, and peer support). Participants were randomised to REFS or 'usual care.' Primary feasibility outcomes included recruitment and engagement. Secondary outcomes, collected preoperatively and 3, 6, and 12  months postoperatively, comprised the Oswestry disability index, European Quality of Life 5 dimensions score, pain self-efficacy questionnaire, hospital anxiety and depression scale and the aggregated functional performance time. Economic impact was evaluated with the Client Services Receipt Inventory. RESULTS: Fifty-two of 58 eligible participants were recruited, and engagement with REFS was > 95%. REFS participants achieved a clinically meaningful reduction in unadjusted mean short-term disability (- 13.27 ± 13.46), which was not observed in the 'usual care' group (- 2.42 ± 12.33). This was maintained in the longer term (- 14.72% ± 13.34 vs - 7.57 ± 13.91). Multilevel regression analyses, adjusted for body mass index, baseline depression, and smoking status reported a statistically significant short-term improvement in disability (p = 0.014) and pain self-efficacy (p = 0.007). REFS costs £275 per participant. CONCLUSIONS: Results suggest that REFS is feasible and potentially affordable for delivery in the National Health Service. It is associated with a clinically meaningful impact. A multicentre randomised controlled study to further elucidate these results is warranted. These slides can be retrieved under Electronic Supplementary Material.

A flexible wearable sensor for knee flexion assessment during gait.

BACKGROUND: Gait analysis plays an important role in the diagnosis and management of patients with movement disorders but it is usually performed within a laboratory. Recently interest has shifted towards the possibility of conducting gait assessments in everyday environments thus facilitating long-term monitoring. This is possible by using wearable technologies rather than laboratory based equipment. RESEARCH QUESTION: This study aims to validate a novel wearable sensor system's ability to measure peak knee sagittal angles during gait. METHODS: The proposed system comprises a flexible conductive polymer unit interfaced with a wireless acquisition node attached over the knee on a pair of leggings. Sixteen healthy volunteers participated to two gait assessments on separate occasions. Data was simultaneously collected from the novel sensor and a gold standard 10 camera motion capture system. The relationship between sensor signal and reference knee flexion angles was defined for each subject to allow the transformation of sensor voltage outputs to angular measures (degrees). The knee peak flexion angle from the sensor and reference system were compared by means of root mean square error (RMSE), absolute error, Bland-Altman plots and intra-class correlation coefficients (ICCs) to assess test-retest reliability. RESULTS: Comparisons of knee peak flexion angles calculated from the sensor and gold standard yielded an absolute error of 0.35(±2.9°) and RMSE of 1.2(±0.4)°. Good agreement was found between the two systems with the majority of data lying within the limits of agreement. The sensor demonstrated high test-retest reliability (ICCs>0.8). SIGNIFICANCE: These results show the ability of the sensor to monitor knee peak sagittal angles with small margins of error and in agreement with the gold standard system. The sensor has potential to be used in clinical settings as a discreet, unobtrusive wearable device allowing for long-term gait analysis.

Wearable technology for spine movement assessment: A systematic review.

Continuous monitoring of spine movement function could enhance our understanding of low back pain development. Wearable technologies have gained popularity as promising alternative to laboratory systems in allowing ambulatory movement analysis. This paper aims to review the state of art of current use of wearable technology to assess spine kinematics and kinetics. Four electronic databases and reference lists of relevant articles were searched to find studies employing wearable technologies to assess the spine in adults performing dynamic movements. Two reviewers independently identified relevant papers. Customised data extraction and quality appraisal form were developed to extrapolate key details and identify risk of biases of each study. Twenty-two articles were retrieved that met the inclusion criteria: 12 were deemed of medium quality (score 33.4-66.7%), and 10 of high quality (score >66.8%). The majority of articles (19/22) reported validation type studies. Only 6 reported data collection in real-life environments. Multiple sensors type were used: electrogoniometers (3/22), strain gauges based sensors (3/22), textile piezoresistive sensor (1/22) and accelerometers often used with gyroscopes and magnetometers (15/22). Two sensors units were mainly used and placing was commonly reported on the spine lumbar and sacral regions. The sensors were often wired to data transmitter/logger resulting in cumbersome systems. Outcomes were mostly reported relative to the lumbar segment and in the sagittal plane, including angles, range of motion, angular velocity, joint moments and forces. This review demonstrates the applicability of wearable technology to assess the spine, although this technique is still at an early stage of development.

A knee monitoring device and the preferences of patients living with osteoarthritis: a qualitative study.

OBJECTIVES: To identify perspective of patients with osteoarthritis, in particular design requirements and mode of use, of wearable technology to support the rehabilitation pathway. This study is part of a user-centred design approach adopted to develop a rehabilitation tool for patients with osteoarthritis. DESIGN: Qualitative study using a focus group approach; data management via a thematic analysis of patients' responses. PARTICIPANTS: 21 patients with osteoarthritis (age range 45-65 years) participated in 1 of the 4 focus groups. Recruitment continued until data saturation. SETTING: The study was conducted in a university setting. RESULTS: Main determinants of user acceptance of a wearable technology were appearance and comfort during use. Patients were supportive of the use of wearable technologies during rehabilitation and could recognise their benefit as monitors for their progress, incentives to adhere to exercise, and tools for more informed interaction with clinicians. CONCLUSIONS: This paper should encourage adoption and development of wearable technology to support rehabilitation of patients with osteoarthritis. It is pivotal that technological development takes into account patients' views in that it should be small, light, discrete, not 'appear medical' or challenge the identity of the user. Derived data should be available to patients and clinicians. Furthermore, wearable technologies should be developed to operate in two modes: for exercise guidance and assessment only, and for unobtrusive everyday monitoring. The information obtained from this study should guide the design of new technologies and support their use in clinical practice.

Use of wearable technology for performance assessment: a validation study.

The prevalence of osteoarthritis is increasing globally but current compliance with rehabilitation remains poor. This study explores whether wearable sensors can be used to provide objective measures of performance with a view to using them as motivators to aid compliance to osteoarthritis rehabilitation. More specifically, the use of a novel attachable wearable sensor integrated into clothing and inertial measurement units located in two different positions, at the waist and thigh pocket, was investigated. Fourteen healthy volunteers were asked to complete exercises adapted from a knee osteoarthritis rehabilitation programme whilst wearing the three sensors including five times sit-to-stand test, treadmill walking at slow, preferred and fast speeds. The performances of the three sensors were validated against a motion capture system and an instrumented treadmill. The systems showed a high correlation (r(2) > 0.7) and agreement (mean difference range: -0.02-0.03 m, 0.005-0.68 s) with gold standards. The novel attachable wearable sensor was able to monitor exercise tasks as well as the inertial measurement units (ICC > 0.95). Results also suggested that a functional placement (e.g., situated in a pocket) is a valid position for performance monitoring. This study shows the potential use of wearable technologies for assessing subject performance during exercise and suggests functional solutions to enhance acceptance.

Function after spinal treatment, exercise, and rehabilitation: cost-effectiveness analysis based on a randomized controlled trial.

STUDY DESIGN: Cost-effectiveness analysis alongside a factorial randomized controlled trial. OBJECTIVE: To assess the cost-effectiveness of a rehabilitation program and/or an education booklet each compared with usual care for the postoperative management of patients undergoing discectomy or lateral nerve root decompression surgery. SUMMARY OF BACKGROUND DATA: There is little knowledge about the cost-effectiveness of postoperative management of patients after spinal surgery. METHODS: A total of 338 patients were recruited into the study between June 2005 and March 2009. Patients were randomized to rehabilitation only, booklet only, rehabilitation plus booklet, or usual care only. Interactions between booklet and rehabilitation were nonsignificant; hence, we compare booklet versus no booklet and rehabilitation versus no rehabilitation. We adopt an English National Health Service and personal social services perspective. Data on outcomes and costs are based on patient level data from the trial. A 1-year time horizon was used. Outcomes were measured in terms of quality-adjusted life years. Health-related quality of life was reported by patients using the EuroQol-5D (EQ-5D). A comprehensive range of health service contacts were included in the cost analysis. RESULTS: There were no significant differences in costs or outcomes associated with either intervention. Mean incremental costs and mean quality-adjusted life years gained per patient of booklet versus no booklet were -£87 (95% CI: -£1221 to £1047) and -0.023 (95% CI: -0.068 to 0.023), respectively. Figures for rehabilitation versus no rehabilitation were £160 (95% CI: -£984 to £1304) and 0.002 (95% CI: -0.044 to 0.048), respectively. Neither intervention was cost-effective when compared with the threshold range commonly used to judge whether or not an intervention is cost-effective in the English National Health Service. CONCLUSION: Cost-effectiveness evidence does not support use of booklet over no booklet or rehabilitation over no rehabilitation for the postoperative management of patients after spinal surgery.

Direct, quantitative clinical assessment of hand function: usefulness and reproducibility.

Methods of assessing functional impairment in arthritic hands include pain assessments and disability scoring scales which are subjective, variable over time and fail to take account of the patients' need to adapt to deformities. The aim of this study was to evaluate measures of functional strength and joint motion in the assessment of the rheumatoid (RA) and osteoarthritic (OA) hand. Ten control subjects, ten RA and ten OA patients were recruited for the study. All underwent pain and disability scoring and functional assessment of the hand using measures of pinch/grip strength and range of joint motion (ROM). Functional assessments including ROM analyses at interphalangeal (IP), metacarpophalangeal (MCP) and wrist joints along with pinch/grip strength clearly discriminated between patient groups (RA vs. OA MCP ROM P<0.0001), pain and disability scales were unable to. In the RA there were demonstrable relationships between ROM measurements and disability (R2=0.31) as well as disease duration (R2=0.37). Intra-patient measures of strength were robust whereas inter-patient comparisons showed variability. In conclusion, pinch/grip strength and ROM are clinically reproducible assessments that may more accurately reflect functional impairment associated with arthritis.

The assessment of intersegmental motion and pelvic tilt in elite oarsmen.

UNLABELLED: Low back pain (LBP) is a common problem in elite oarsmen. The relevance of spinal and pelvic flexibility to good rowing technique and the incidence of LBP is unclear. PURPOSE: The aim of this study was to investigate patterns of spinal and pelvic mobility in a group of elite oarsmen with and without a history of LBP. METHODS: Twenty elite oarsmen were recruited into this study, including nine with no history of spinal problems, four with a current spinal problem, and the remainder with a history of LBP. Subjects were scanned using an interventional magnetic resonance imaging (MRI) scanner. Four key stages of the rowing stroke were simulated within the scanner, and sagittal images of the lumbar spine and sacrum were obtained. From these images intersegmental motion was determined along with the angle of lordosis and position of the lumbar spine and sacrum. RESULTS: Different mobility trends were seen; oarsmen with no history of LBP demonstrated the greatest mobility in their lower lumbar regions (at the L5/S1 level in the catch position 7.5 degrees +/-1.3 in normals; 4.8 degrees +/-1.2 in previous LBP groups; and 2.8 degrees +/-5.5 in current LBP group) and the lowest rotation of their pelvis (level in the catch position 13.9 degrees +/-11.2 in normals; 16.1 degrees +/-6.8 in previous back pain groups; and 15.2 degrees +/-11.2 in current back pain group). In contrast, those with either current or previous LBP presented with a hypomobility of their spine which appeared to be compensated for by increased pelvic rotation. CONCLUSIONS: Marked differences were observed in the motion characteristics of these 3 groups of oarsmen. At present it is not known if these changes are causative or effect.

The evaluation of the surgical management of nerve root compression in patients with low back pain: Part 1: the assessment of outcome.

STUDY DESIGN: This was a prospective study investigating the outcome of decompression surgery using validated measures of outcome. OBJECTIVES: To investigate the outcome of lumbar decompressive surgery in the initial postoperative year period in terms of function, disability, general health, and psychological well-being. SUMMARY OF BACKGROUND DATA: The majority of studies investigating the outcome of lumbar decompression surgery have been retrospective and have not used validated measures of outcome. This limits their interpretation and usefulness. METHODS: Eighty-four patients undergoing lumbar spinal stenosis surgery were recruited into this study. Patients were assessed by use of validated measures of outcome including the Oswestry Disability Index and the Short Form SF-36 General Health Questionnaire before surgery and 6 weeks, 6 months, and 1 year after surgery. RESULTS: A significant reduction in pain (P < 0.001) was observed at the 6-week postoperative stage; this did not change at the subsequent assessment stages. Only some of the SF-36 categories were sensitive to change. The subcategories that were sensitive to change were physical function (P < 0.05), bodily pain (P < 0.001), and social function (P < 0.05). Improvements were observed in these categories at the 6-week and 6-month reviews. A gradual reduction in the Oswestry Disability Index was observed with time, with changes principally being observed between the 6-week and 6-month review and the 6-week and 1-year review stages (P < 0.05). Minimal changes were observed in the psychological assessments with time. The outcome of surgery could not be predicted reliably from psychological, functional, or pain measures. CONCLUSIONS: The visual analogue pain scales, the Oswestry Disability Index, and certain categories of the SF-36 Questionnaire, namely bodily pain and physical and social function, appeared to be the most sensitive outcome measures, with significant improvements occurring at the 6-week and 6-month reviews.