[Rehabilitation of patients after spinal surgery: effectiveness of nonthermal techniques of peloidotherapy]. / Reabilitatsiya patsientov posle operatsii na pozvonochnike: effektivnost' neteplovykh metodik peloidoterapii.

The problem of patients' rehabilitation after spinal surgery remains relevant. The use of therapeutic physical factors, both preformed and natural, including pelotherapy, is very important. The application of the latter requires to develop new techniques in this pathology, one of which is low temperature exposure. OBJECTIVE: To study the possibility and to assess the effectiveness of resource-saving nonthermal pelotherapy techniques in patients' rehabilitation, who underwent surgeries for intervertebral discs' herniation. MATERIAL AND METHODS: The number of patients equal 88, including 39 males and 49 females, after lumbar microdiscectomy, was examined in this study. The patients were divided into 3 groups. Control group (28 patients) received a basic rehabilitation complex (therapeutic gymnastics, massage, low-frequency magnetotherapy); the 1st study group (30 patients) - basic complex and procedures of thin layer applications with peat muds preparation (Tomed-applikat) at 20-24 °C; the 2nd study group (30 patients) - basic complex and procedures of fluctuoresis of 2% solution of peat mud Tomed-aqua preparation. RESULTS: There was a significant reduction of pain syndrome, recovery of sensitivity and motor activity, decrease of Oswestry index, characterizing the degree of vital activity disturbance, in patients of the study group compared to the control group after treatment. CONCLUSION: The inclusion of nonthermal resource-saving techniques of pelotherapy in rehabilitation complex of patients who underwent spinal surgery is effective and pathogenetically justified.

Associations between interim patient-reported outcome measures and functional status at discharge from rehabilitation for non-specific lumbar impairments.

PURPOSE: Identify impact of frequency and timing of interim Patient-Reported Outcome Measures (PROMs) assessments during episodes of care for rehabilitation services in outpatient clinical settings on functional status (FS) outcomes at discharge for patients with low back pain. METHODS: FS outcomes of patients who had no interim PROMs were compared to outcomes of six patient groups defined by interim timing (early, mid, late) and frequency (1, 2 or more). For each comparison, patients were matched using propensity score matching for variables known to be associated with FS outcomes and for episode duration (days) and number of visits. FS was assessed using the lumbar computerized adaptive test (LCAT) where scores range from 0 to 100 with higher scores representing better physical function. RESULTS: A sample of 140,336 patients was considered for matching (mean age = 58 [SD = 17] range 18-89; 60% females) with 83,101 patients (59%) having no interim PROMs. Patients who had only one interim PROM, administered during early (first 2 weeks), mid (weeks 3-4), or late (week 5 or later) timing, had 4.6, 2.7, and 1.0 additional FS score points at discharge compared to those without an interim PROM, respectively (p < 0.001). Having two or more interim PROMs was associated with an additional 1.2 FS points compared to having only one interim assessment, but only if the first interim was administered early. CONCLUSIONS: Optimal utilization of interim PROM assessment during clinical practice to enhance treatment outcomes was related to administering the first interim PROM within the first 2 weeks after the initial evaluation.

Perilesional photobiomodulation therapy and physical rehabilitation in post-operative recovery of dogs surgically treated for thoracolumbar disk extrusion.

BACKGROUND: Recent studies have reported contrasting results of the effects of laser therapy on post-operative intervertebral disk herniation, with a lack of evidence-based advantages of this modality within a rehabilitation protocol. The aim of this study was to report the clinical effects of photobiomodulation therapy within a post-operative rehabilitation protocol in dogs submitted to surgery for thoracolumbar disk extrusion. Twenty-four dogs were included in the study (12 dogs treated with laser therapy and rehabilitation protocol and 12 dogs treated with same rehabilitation protocol but without laser therapy). RESULTS: All dogs treated with laser therapy showed improved neurological status (Modified Frankel Score more than 3 within 30 days of physiotherapy starting) if deep nociception on admission was maintained (P = 0.04). However, Kaplan-Meier analysis did not show any statistical difference in time to regain ambulatory ability, although there was a tendency for a shorter mean time of 14.2 ± 8.55 days in the laser group versus 24 ± 18.49 days in the no laser group. CONCLUSIONS: The use of laser therapy in the post-operative rehabilitation of dogs affected by intervertebral disc extrusion and submitted to surgery for spinal decompression could help improve their neurological status.

SURGICAL AND POSTOPERATIVE TREATMENT OF INTERVERTEBRAL DISC DISEASE IN A MOUNTAIN COATI (NASUELLA OLIVACEA) USING BEHAVIORAL MANAGEMENT AND PHYSICAL THERAPY.

A captive 8-yr-old female mountain coati, Nasuella olivacea, presented with intermittent paresis of the pelvic limbs. The coati was anesthetized for radiographs, which showed mineralized discs in the thoracolumbar region. After 3 mo of daily prednisone, its condition further declined. Magnetic resonance imaging confirmed extradural disc herniation, spinal cord compression, and requirement for a left-sided hemilaminectomy. Postoperatively, the coati received prednisolone, gabapentin, tramadol, and clavamox. An established history of positive reinforcement training allowed caretakers to implement physical therapy walks and novel exercises designed for its condition. The coati showed improvement with appropriate proprioceptive positioning and improved balance. Intervertebral disc disease is common in dogs and cats, and although physical therapy is routinely implemented in recovering neurologic patients of those species, it is relatively new in zoologic medicine. This report highlights the benefits of behavioral management in postoperative management of nondomestic species.

Surgical versus non-operative treatment for lumbar disc herniation: a systematic review and meta-analysis.

OBJECTIVE: To investigate the effects of surgical versus non-operative treatment on the physical function and safety of patients with lumbar disc herniation. DATA SOURCES: PubMed, Cochrane Library, Embase, EBSCO, Web of Science, China National Knowledge Infrastructure and Chinese Biomedical Literature Database were searched from initiation to 15 May 2017. METHODS: Randomized controlled trials that evaluated surgical versus non-operative treatment for patients with lumbar disc herniation were selected. The primary outcomes were pain and side-effects. Secondary outcomes were function and health-related quality of life. A random effects model was used to calculate the pooled mean difference with 95% confidence interval. RESULTS: A total of 19 articles that involved 2272 participants met the inclusion criteria. Compared with non-operative treatment, surgical treatment was more effective in lowering pain (short term: mean difference = -0.94, 95% confidence interval = -1.87 to -0.00; midterm: mean difference = -1.59, 95% confidence interval = -2.24 to -9.94), improving function (midterm: mean difference = -7.84, 95% confidence interval = -14.00 to -1.68; long term: mean difference = -12.21, 95% confidence interval = -23.90 to -0.52) and quality of life. The 36-item Short-Form Health Survey for physical functions (short term: mean difference = 6.25, 95% confidence interval = 0.43 to 12.08) and bodily pain (short term: mean difference = 5.42, 95% confidence interval = 0.40 to 10.45) was also utilized. No significant difference was observed in adverse events (mean difference = 0.82, 95% confidence interval = 0.28 to 2.38). CONCLUSION: Low-quality evidence suggested that surgical treatment is more effective than non-operative treatment in improving physical functions; no significant difference was observed in adverse events. No firm recommendation can be made due to instability of the summarized data.

Influence of in-house rehabilitation on the postoperative outcome of dogs with intervertebral disk herniation.

OBJECTIVE: To determine the influence of in-house rehabilitation on the postoperative outcome of dogs with intervertebral disk herniation (IVDH). DESIGN: Retrospective cohort study. ANIMALS: Dogs (n = 248) under 20 kg of weight, with single site, thoracolumbar, Hansen Type I IVDH. PROCEDURES: Medical records of non-ambulatory dogs with IVDH treated via hemilaminectomy were reviewed. Dogs were classified in 2 groups depending on whether their postoperative management included an in-house rehabilitation program. Preoperative and sequential postoperative modified Frankel scores (MFSs) were recorded. Time to ambulation, time to normal conscious proprioception, final MFS, and complications were compared between the groups. RESULTS: More dogs returned to full neurologic function (final MFS of Grade 5) when in-house rehabilitation was included in the postoperative management (33% compared to 9%). Normal conscious proprioception and ambulation returned earlier in the control group (42 days and 14 days, respectively) compared to the group with rehabilitation (49 days and 28 days, respectively). The complication rate was higher in the control group (29%) compared with the group with rehabilitation (16%). CONCLUSIONS AND CLINICAL RELEVANCE: In-house rehabilitation should be included in the postoperative management in dogs after surgical treatment of IVDH to improve neurologic function and reduce postoperative complications.

[The assessment of the impact of rehabilitation on the pain intensity level in patients with herniated nucleus pulposus of the intervertebral disc]. / Ocena wplywu rehabilitacji na poziom natezenia dolegliwosci bólowych u chorych z przepuklina jadra miazdzystego krazka miedzykregowego.

Back pain may be caused by many factors. In many cases it is difficult to unambiguously determine a cause of the pathology, which can involve various structures in the spine. In this paper we will discuss the symptoms associated with the degenerative changes of the intervertebral disc, which involve, among others, its bulging, dislocation and pressure on the surrounding structures. These problems require an adequate clinical and imaging diagnostics in order to implement an appropriate treatment. In the first place, it should be based on the conservative methods (such as: pharmacotherapy, rehabilitation and lifestyle changes). Only in the absence of improvement it is recommended to consider a surgical treatment. AIM: The aim of the study is to assess the impact of rehabilitation on the pain intensity level in patients with herniated nucleus pulposus of the intervertebral disc. MATERIALS AND METHODS: The study was performed in 46 patients (age range: 19-85), including 26 women and 20 men. On the basis of imaging, all patients showed the presence of a slipped disc with disc herniation. The patients were treated conservatively. For pain assessment was used the The Laitinen Modified Questionnaire Indicators of Pain and The Visual- Analogue Scale. The results were statistically analyzed. RESULTS: The results clearly demonstrate the analgesic efficacy of specialized rehabilitation in the spinal pain syndrome in a discopathy with a spinal disc herniation of an intervertebral disc. CONCLUSIONS: The rehabilitation of patients with a back pain due to the presence of herniated nucleus pulposus has a significant analgesic effect. In the case of a presence of the herniated nucleus pulposus, the rehabilitation should be considered in a first place. If no improvement, a possible surgery should be considered. An important element of a conservative treatment is an effective rehabilitation, which is of vital economic importance, because a therapy including surgery usually requires subsequent rehabilitation and is much more expensive.

Lumbar disc herniation surgery in children: outcome and gender differences.

INTRODUCTION: Lumbar disc herniation (LDH) in children is rare. Few studies have evaluated the outcome of surgery and none in a prospective study design. PURPOSE: To evaluate preoperative disability and postoperative outcome in children operated on for LDH. METHODS: Through a 10-year period, 74 children aged <18 years were included in SweSpine register for LDH with pre- and perioperative data registered, 48 with 1-year follow-up data. Demographics and outcome measurements were described according to the SweSpine protocol. RESULTS: All patients reported preoperatively severe impairment in terms of pain, quality of life and function, girls to a higher extent. Significant postoperative improvement was seen in all patients, leaving no patients dissatisfied with outcome. The PROMS were 1 year after surgery within normal ranges, but remained slightly lower for girls. CONCLUSION: Operative treatment of LDH in growing individuals leads to very good outcome with high degree of patient satisfaction.

Return to sport after open and microdiscectomy surgery versus conservative treatment for lumbar disc herniation: a systematic review with meta-analysis.

BACKGROUND: Lumbar disc herniation has a prevalence of up to 58% in the athletic population. Lumbar discectomy is a common surgical procedure to alleviate pain and disability in athletes. We systematically reviewed the current clinical evidence regarding athlete return to sport (RTS) following lumbar discectomy compared to conservative treatment. METHODS: A computer-assisted literature search of MEDLINE, CINAHL, Web of Science, PEDro, OVID and PubMed databases (from inception to August 2015) was utilised using keywords related to lumbar disc herniation and surgery. The design of this systematic review was developed using the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Methodological quality of individual studies was assessed using the Downs and Black scale (0-16 points). RESULTS: The search strategy revealed 14 articles. Downs and Black quality scores were generally low with no articles in this review earning a high-quality rating, only 5 articles earning a moderate quality rating and 9 of the 14 articles earning a low-quality rating. The pooled RTS for surgical intervention of all included studies was 81% (95% CI 76% to 86%) with significant heterogeneity (I(2)=63.4%, p<0.001) although pooled estimates report only 59% RTS at same level. Pooled analysis showed no difference in RTS rate between surgical (84% (95% CI 77% to 90%)) and conservative intervention (76% (95% CI 56% to 92%); p=0.33). CONCLUSIONS: Studies comparing surgical versus conservative treatment found no significant difference between groups regarding RTS. Not all athletes that RTS return at the level of participation they performed at prior to surgery. Owing to the heterogeneity and low methodological quality of included studies, rates of RTS cannot be accurately determined.

Plasma disc decompression compared to physiotherapy for symptomatic contained lumbar disc herniation: A prospective randomized controlled trial.

INTRODUCTION: To evaluate clinical outcomes with PDD as compared with patients who underwent to standard physiotherapy intervention. MATERIAL AND METHODS: One-hundred-seventy-seven randomly assigned patients with primarily radicular pain associated with a single-level lumbar contained disc herniation were enrolled. Participants received either PDD (89 patients) or conservative physiotherapy care (88 patients). RESULTS: Patients in the PDD group had significantly greater reduction in leg pain scores and significantly improved VAS (p<0.001), Oswestry Disability Index (p<0.05), and 36-Item Short Form, than those in the physiotherapy group at 12 months. On subset analysis, patients achieved even better outcomes after PPD who: were younger, had a shorter period of radiculopathy, of male gender, and lower BMI. Patients with subacute pain reported better outcomes than those with chronic pain in the PDD group. CONCLUSIONS: Patient selection for PDD over physiotherapy favored younger patients who presented with a shorter period of pain symptoms and who had a more favorable body habitus.

Combined Use of High Radiofrequency Disk Ablation, Annulus Modulation, and Manual Nucleotomy in a Patient with Extruded Disk Herniation.

UNLABELLED: Different minimally invasive procedures are used to treat lumbar disk herniation. It is important to differentiate these techniques due to their specific effects and the disparate technical issues associated with each. This report describes a successful case involving the use of mechanical decompression in conjunction with radiofrequency ablation to treat a patient with pain and neurological deficits due to an extruded disk hernia. CASE REPORT: A 43-year-old male had magnetic resonance imaging (MRI) demonstrating an extruded disk herniation in the left foraminal region, compression at the left spinal nerve root, and obliteration of the left foraminal entrance of the L5-S1 distribution. In the operating room, sufficient disk material was removed using grasping forceps, and then, the Disc-FX system with a Trigger-Flex probe (Elliquence, Baldwin, NY, U.S.A.) was inserted. Modulation of the annulus was performed in bipolar hemo mode, and nucleus ablation was conducted in bipolar turbo mode within a 1.7-MHz frequency range. Among the available minimally invasive techniques, newly developed technologies may become important treatment options if they enable faster rehabilitation, lower rates of recurrence, shorter hospital stays, and reduced medical costs.

[Postoperative applications of the fast track technology in patients with herniated intervertebral discs of the lumbosacral spine]. / Primenenie tekhnologii bystrogo vosstanovleniya posle khirurgicheskikh vmeshatel'stv u patsientov s gryzhami mezhpozvonkovykh diskov poyasnichno-kresttsovogo otdela pozvonochnika.

TOPICALITY: The fast track technology means a complex of targeted measures involving rational preoperative preparation, minimally invasive surgery, regional anesthesia and short-acting anesthetics, and early postoperative rehabilitation. Elucidating the possibility of applying the fast track technology in neurosurgery, in particular in spinal surgery, is extremely topical. This is associated with the epidemiological data and the fact that minimally invasive techniques used in neurosurgery are highly expensive. AIM: The study objective was implementation of the fast track technology and subsequent analysis of its use after surgery in patients with herniated intervertebral discs of the lumbosacral spine. MATERIAL AND METHODS: The fast track technology following spinal surgery was implemented at the Clinical Hospital of the Presidential Administration of the Russian Federation and the Neurosurgical Department of the Clinical Hospital № 1 of the Presidential Administration of the Russian Federation using an algorithm of technology application. The study included 48 patients who underwent surgical treatment for herniated intervertebral discs of the lumbosacral spine between January and July 2015. RESULTS: An analysis of pain severity using the Visual Analog Scale demonstrated a slight decrease (10%) in a group of patients who were subjected to the fast track technology, at discharge and at 1 month after surgery; there was no difference in longer follow-up. An analysis of the functional status using the Oswestry index and Roland-Morris scale demonstrated that patients of the study group had faster and more efficient recovery and an improvement of the functional activity by 20% (p<0.05) compared to those in the control group. An analysis of patient-reported assessment of treatment quality revealed that indicators, such as awareness and pain control, in the study group were highest and amounted to 95% and higher. An analysis of the hospital stay duration showed a decrease in the number of bed-days in an integrated group by 39%, which saved 34 bed-days. CONCLUSION: The fast track technology reduces the degree of surgical aggression, increases surgery safety, and decreases the number of intraoperative complications and hospital stay duration.

Impact of McKenzie Method Therapy Enriched by Muscular Energy Techniques on Subjective and Objective Parameters Related to Spine Function in Patients with Chronic Low Back Pain.

BACKGROUND: The high incidence and inconsistencies in diagnostic and therapeutic process of low back pain (LBP) stimulate the continuing search for more efficient treatment modalities. Integration of the information obtained with various therapeutic methods and a holistic approach to the patient seem to be associated with positive outcomes. The aim of this study was to analyze the efficacy of combined treatment with McKenzie method and Muscle Energy Technique (MET), and to compare it with the outcomes of treatment with McKenzie method or standard physiotherapy in specific chronic lumbar pain. MATERIAL AND METHODS: The study included 60 men and women with LBP (mean age 44 years). The patients were randomly assigned to 1 of 3 therapeutic groups, which were further treated with: 1) McKenzie method and MET, 2) McKenzie method alone, or 3) standard physiotherapy for 10 days. The extent of spinal movements (electrogoniometry), level of experienced pain (Visual Analogue Scale and Revised Oswestry Pain Questionnaire), and structure of the spinal discs (MRI) were examined prior to the intervention, immediately thereafter, and 3 months after the intervention. RESULTS: McKenzie method enriched with MET had the best therapeutic outcomes. The mobility of cervical, thoracic, and lumbar spine normalized at levels corresponding to 87.1%, 66.7%, and 95% of respective average normative values. Implementation of McKenzie method, both alone and combined with MET, was associated with a significant decrease in Oswestry Disability Index, significant alleviation of pain (VAS), and significantly reduced size of spinal disc herniation. CONCLUSIONS: The combined method can be effectively used in the treatment of chronic LBP.

Twelve-year follow-up of a randomized controlled trial of comprehensive physiotherapy following disc herniation operation.

OBJECTIVE: To evaluate the long-term effects of postoperative comprehensive physiotherapy starting one week after lumbar disc surgery. DESIGN: Twelve-year follow-up of a three-armed, randomized, controlled, single-blinded clinical trial. SETTING: Department of Physical Medicine & Rehabilitation. PARTICIPANTS: Of 111 patients following first-time, uncomplicated lumbar disc surgery who participated in the original study and completed the treatment originally allocated, 74 ((67%; 29 (73%) physiotherapy, 22 (58%) sham therapy, 23 (68%) no therapy) completed a 12-year follow-up examination. INTERVENTIONS: In the original study, patients had been randomly assigned to comprehensive physiotherapy, sham intervention (neck massage), or no therapy. MEASURES: Low Back Pain Rating Scale; best score 0, worst score 130 points). RESULTS: At 12 years after surgery, the group participating in comprehensive physiotherapy had significantly better functional outcomes, as rated on the Low Back Pain Rating Score, than the untreated group (mean difference: -13.2 (95% CI: (-25.4; -1.0)). Equally, there was a clinically relevant, non-significant difference between the sham therapy and no therapy (mean difference: -12.5 (95%CI: -26.1; 1.1)). Consequently, the Low Back Pain Rating Score outcome did not differ between physiotherapy and sham therapy (mean difference: -0.7 (95%CI: -14.2; 12.8)). CONCLUSIONS: Participating in a comprehensive physiotherapy program following lumbar disc surgery may be associated with better long-term health benefits over no intervention, but may not be superior to sham therapy.

Early multimodal rehabilitation following lumbar disc surgery: a randomised clinical trial comparing the effects of two exercise programmes on clinical outcome and lumbar multifidus muscle function.

BACKGROUND: The optimal components of postoperative exercise programmes following single-level lumbar discectomy have not been identified. Facilitating lumbar multifidus (LM) function after discectomy may improve postoperative recovery. The aim of this study was to compare the clinical and muscle function outcomes of patients randomised to receive early multimodal rehabilitation following lumbar discectomy consisting of exercises targeting specific trunk muscles including the LM or general trunk exercises. METHODS: We included participants aged 18 to 60 years who were scheduled to undergo single-level lumbar discectomy. After two postoperative weeks, participants were randomly assigned to receive an 8-week multimodal exercise programme including either general or specific trunk exercises. The primary outcome was pain-related disability (Oswestry Index). Secondary outcomes included low back and leg pain intensity (0-10 numeric pain rating scale), global change, sciatica frequency, sciatica bothersomeness and LM function measured with real-time ultrasound imaging. Treatment effects 10 weeks and 6 months after surgery were estimated with linear mixed models. RESULTS: 61 participants were randomised to receive a general trunk (n=32) or specific (n=29) exercise programme. There were no between-group differences in clinical or muscle function outcomes. Participants in both groups experienced improvements in most outcome measures. CONCLUSIONS: Following lumbar discectomy, multimodal rehabilitation programmes comprising specific or general trunk exercises have similar effects on clinical and muscle function outcomes. Local factors such as the individual patient characteristics identified by specific assessment findings, clinician expertise and patient preferences should direct therapy selection when considering the types of exercises tested in this trial for inclusion in rehabilitation programmes following lumbar disc surgery.

Transforaminal epidural steroid injections followed by mechanical diagnosis and therapy to prevent surgery for lumbar disc herniation.

STUDY DESIGN: Prospective cohort study. OBJECTIVE: To report the clinical course of patients with MRI-confirmed lumbar disc herniation-related radicular noncentralizing pain who received transforaminal epidural steroid injections (TESIs) and mechanical diagnosis and therapy (MDT). SUMMARY OF BACKGROUND DATA: Noncentralizing symptoms in patients with lumbar disc herniation are associated with poor outcome. Commonly used treatments for these patients include TESIs and MDT. No study has evaluated the outcome of combining both strategies. METHODS: Consecutive candidates for herniated lumbar disc surgery with noncentralizing chronic pain were eligible. Patients received TESIs followed by MDT. The primary outcomes were pain severity in the leg, disability (Roland-Morris Disability Questionnaire for Sciatica), and global perceived effect (GPE). Outcomes were measured at baseline, discharge, and 12 months. Linear mixed-models and McNemar's tests were used to analyze outcome data. RESULTS: Sixty-nine patients receive TESIs. After TESIs, symptoms were resolved completely in 11 patients (16%). In these patients, symptom resolution was maintained at 12 months. A second subgroup of 32 patients (46%) reported significantly less pain after TESIs and showed centralization with MDT reassessment (significant reductions in leg pain and disability [P < 0.001]) and a satisfaction rate of 90% at 12 months. A third subgroup of 11 patients (16%) reported significantly less pain after TESIs but still showed noncentralization with MDT reassessment (significant reductions in leg pain and disability [P < 0.05] and a satisfaction rate of 50% at 12 months). A fourth subgroup of 15 patients (22%) did not respond on TESIs and received an operative intervention. CONCLUSION: The results indicate that a course of TESIs followed by MDT may be able to avoid surgery in a substantial proportion of candidates for herniated lumbar disc surgery.

Outcomes of conservative treatment for ruptured lumbar disc herniation.

The authors set up a prospective study of the effect of conservative treatment on a ruptured lumbar disc herniation in 89 patients, between June 2008 and June 2010. Seventy-two patients (81%) improved, while the other 17 (19%) needed surgery. The JOA score (best possible result: 29) was found to be significantly improved in the 72 patients of the conservative group, at 1 month, 3 months, 6 months, 1 year and 2 years (t-test: p < 0.001). At final follow-up, after 2 years, 84.7% of the patients in the conservative group had a good or excellent result. However, if the 17 surgical cases were included, this proportion dropped to 68.5%. The volume of the protrusion decreased significantly in the 72 patients of the conservative group: from 1422.52 +/- 539.10 mm3 to 102735 +/- 585.51 mm3 (paired t-test: p < 0.001). There was a definite correlation, in the conservative group, between the final resorption rate on the one hand and the percentage of combined excellent and good results on the other hand (72 cases; Spearman rank correlation coefficient: r 0.01 = 0.470, p < 0.001).

The Canadian Occupational Performance Measure's semi-structured interview: its applicability to lumbar spinal fusion patients. A prospective randomized clinical study.

BACKGROUND: Although lumbar spinal fusion has been performed for more than 70 years, few studies have examined rehabilitation strategies for spinal fusion patients, and there is only sparse information about the patient's activity level after surgery. The Canadian Occupational Performance Measure (COPM) is a standardized semi-structured interview, developed to identify patients' problems in relation to activities of daily living (ADL). The COPM has neither been examined in a randomised clinical study nor employed in relation to lumbar spinal fusion patients. We aimed to examine whether or not the use of the semi-structured interview COPM during in-hospital rehabilitation could: (1) identify more ADL-related problems of importance to the patients after discharge from the hospital, (2) enhance the patients' ADL performance after discharge from hospital METHOD: Eighty-seven patients undergoing a lumbar spinal fusion caused by degenerative diseases were randomly assigned to either use of the COPM or to standard treatment. RESULTS AND CONCLUSION: Use of the COPM during hospitalization helped in identifying more ADL problems encountered by patients during the first 3 months post-discharge period as COPM served to identify more treatment goals and plans of action. Use of the COPM had no impact on the patients' ADL performance, and the difference is so small that COPM may be of little clinical consequence.

An outcome measure of functionality and pain in patients with lumbar disc herniation: a validation study of the Japanese Orthopedic Association (JOA) score.

BACKGROUND: Lumbar disc hernia (LDH) is a common cause of low back pain and radicular leg pain. The Japanese Orthopedic Association (JOA) score is a very short instrument for measuring functionality and pain in these patients. This study aimed to translate and validate the JOA score for use in Iran. METHODS: This was a prospective clinical validation study. Translation of the English version of the questionnaire was performed in accordance with published guidelines. A sample of patients with LDH was asked to respond to the questionnaire at two points in time--at preoperative and postoperative (6 months follow-up) assessments. To test reliability, the internal consistency was assessed by use of Cronbach's alpha coefficient. Validity was evaluated by use of known-groups comparison. RESULTS: A total of 117 patients with LDH were entered into the study. The mean age of patients was 45 (SD = 11) and Cronbach's alpha coefficients for the JOA score at the preoperative and postoperative assessments were 0.67 and 0.81, respectively. Validity as performed by known-groups analysis also showed the result was satisfactory. The instrument discriminated well between sub-groups of patients who differed in age and in a standard predictive measure of lumbar disc surgery (the Finneson-Cooper score). CONCLUSIONS: In general, the Iranian version of the JOA score performed well and the findings suggest that it is a reliable and valid measure of functionality and pain among LDH patients.