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1.
Spine Deform ; 5(4): 225-230, 2017 07.
Article in English | MEDLINE | ID: mdl-28622896

ABSTRACT

STUDY DESIGN: Cross-sectional. OBJECTIVE: To examine the relationships between spine morphology, spine flexibility, and idiopathic scoliosis. BACKGROUND: Girls have a higher incidence of clinically significant scoliosis than boys, along with smaller vertebrae and greater flexibility. Based on biomechanical modeling, we hypothesized that smaller vertebral width relative to intervertebral disc (IVD) height would be associated with both greater lateral flexibility of the spine and with idiopathic scoliosis. METHODS: Magnetic resonance imaging was used to measure IVD height, vertebral width, and paraspinous musculature in 22 girls with mild and moderate idiopathic scoliosis and 29 girls without scoliosis ages 9-13 years. Clinical measurement of maximum lateral bending was also performed in the girls without scoliosis. A simple biomechanical model was used to estimate bending angle from the ratio of IVD height to vertebral half-width for L1-L4. The average ratio (Ravg) and calculated total bending angle (αtot) for L1-L4 were compared to the clinical measurements of lateral bending flexibility in the control group. These measures were also compared between the scoliosis and control groups. RESULTS: There was a significant positive relationship between clinical flexibility and both Ravg (p = .041) and αtot (p = .042) adjusting for skeletal age, height, body mass index, and paraspinous muscle area as covariates. The ratio was significantly higher (Ravg = 0.45 vs. 0.38, p < .0001) and the bending angle was significantly greater (αtot = 107° vs. 89°, p < .0001) for girls with scoliosis compared with controls. CONCLUSION: These results suggest that differences in spine morphology and corresponding changes in spine flexibility may be related to idiopathic scoliosis. If these relationships can be corroborated in larger prospective studies, these easily measured morphologic traits may contribute to a better understanding of the etiology of idiopathic scoliosis and an improved ability to predict scoliosis progression. LEVEL OF EVIDENCE: Level III.


Subject(s)
Biomechanical Phenomena/physiology , Intervertebral Disc/diagnostic imaging , Lumbar Vertebrae/diagnostic imaging , Range of Motion, Articular/physiology , Scoliosis/diagnostic imaging , Spine/diagnostic imaging , Adolescent , Age Determination by Skeleton/instrumentation , Body Mass Index , Child , Cross-Sectional Studies , Female , Humans , Incidence , Intervertebral Disc/pathology , Lumbar Vertebrae/abnormalities , Magnetic Resonance Imaging/methods , Male , Scoliosis/epidemiology , Scoliosis/physiopathology , Spine/anatomy & histology
2.
J Occup Environ Med ; 57 Suppl 3: S36-42, 2015 Mar.
Article in English | MEDLINE | ID: mdl-25741613

ABSTRACT

OBJECTIVE: The federal workers' compensation program includes under a single employer five commonly encountered roles and responsibilities-injured patient, clinical provider, third-party administrator, adjudicator, and insurer. Data within the Veterans Health Administration (VHA) provide a unique opportunity to apply a simple model of health care quality improvement, exploring interactions between structures, processes, and outcomes. METHODS: A facility survey identified reporting structures, levels of education and training, policies and processes, tool availability and use, and perceptions of role adherence. Administrative data included process and outcome metrics, including short-term disability, long-term disability, and lost time cases. RESULTS: Improved collaboration between clinical and administrative staff within VHA and with the Department of Labor was associated with improved performance. CONCLUSIONS: Applying a clinical quality improvement model clarifies roles, expectations, and likely relationships for improved program management.


Subject(s)
Outcome and Process Assessment, Health Care , Quality Improvement/organization & administration , United States Department of Veterans Affairs/organization & administration , United States Department of Veterans Affairs/statistics & numerical data , Workers' Compensation/organization & administration , Workers' Compensation/statistics & numerical data , Cooperative Behavior , Federal Government , Humans , Models, Organizational , Professional Role , Program Evaluation , United States , Workers' Compensation/standards
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