Arabic-Translated Versions of Patient-Reported Outcome Measures Utilized in Spine Research: A Review of Validated Studies.

Patient-reported outcome measures (PROMs) are standardized tools commonly applied in research and healthcare appraisal. Most were developed in English and the cross-cultural adaptation (CCA) and validation of their translated versions remain topics of contemporary research appeal. This review aimed to identify the Arabic-translated PROMs that were utilized in spine research and to assess the methodological qualities of their studies. The PubMed database was searched, and all relevant publications were identified. The CCA and measurement properties were assessed using the guidelines described by Oliveria and Terwee respectively. Thirty studies that validated the Arabic versions of 26 PROMs were found suitable. The tools that had the highest total citation numbers were Neck Disability Index, Ronald-Morris Disability Questionnaire, Oswestry Disability Index, Fear Avoidance Beliefs Questionnaire, Scoliosis Research Society-22, Back Beliefs Questionnaire, Quebec Back Pain Disability Scale, and McGill Pain Questionnaire-Short Form. The Arabic versions of Short Form-36 (SF-36), Visual Analogue Scale (VAS), and EuroQol-5D (EQ-5D) were not included due to lack of validation in spine research. All the articles were published from 2007 to 2023 (median 2019) and their journal's impact factor and citation numbers were relatively modest (mean 2 and 6.5 respectively). Most patients had low back pain (19 articles), were recruited from physiotherapy and rehabilitation departments (18 articles) and came from the Kingdom of Saudi Arabia (12 articles). The quality of the CCA of the Arabic versions was rated good in forward translation, synthesis, back translation, and expert committee review but less so in pretesting and submission. The measurement properties of the studies were considered good quality in internal consistency, reliability, structural validity and cross-cultural validity but less so in content validity, error measurement, responsiveness and floor/ceiling effect. In conclusion, with a few exceptions, most of the widely utilized PROMs in spine research have validated Arabic versions. The methodological quality of the studies was good apart from a few shortages that could be improved upon by further research. Work should be done to address the validation of Arabic versions of SF-36, VAS and EQ-5D in spine research. PROMs are valuable in systematizing subjective outcomes. Their usage in research and clinical settings in any validated language should be highly encouraged.

Review of the Most Cited Patient-Reported Outcome Measure (PROM) Studies Published in the Neurospine Surgical Literature.

Patient-reported outcome measures (PROMs) are validated tools that are widely utilized in research and patient care. Their diversity, quality, and application remain matters of peak research interest. This article is a review of the PROMs that were utilized in high-impact publications in the neurospine surgical literature. The 50 most cited articles on the subject were selected and analysed. Most (42 articles) were published in spine journals and, in particular, in the journal Spine (Phila Pa 1976) (28 articles). A total of 34 PROMs were utilized, of which 24 were used only once in single studies. The four most common PROMs were Scoliosis Research Society-22 (SRS-22) (15 articles), Short Form-12 and Short Form-36 (SF-12 and SF-36) (11 articles), Ronald-Morris Disability Questionnaire (RMDQ) (nine articles), and Oswestry Disability Index (ODI) (five articles). Nineteen articles focused on validating translated versions of 11 PROMs to other languages. The languages that had the maximal number of tools translated to amongst the highly cited articles were Italian (six tools), Portuguese (four tools), German (three tools), and Japanese (three tools). The most common diagnoses and the PROMs used for them were back pain and cervical spine disorder (SF-12 and SF-36 (nine articles), RMDQ (eight articles), and ODI (five articles)), and idiopathic scoliosis (SRS-22) (14 articles)). The median (range) article citation number was 137 (78-675). The four most cited PROMs were SRS-22 (2,869), SF-12 and SF-36 (2,558), RMDQ (1,456), and ODI (852). Citation numbers were positively impacted by article age and participant number but not by tool type or clinical diagnosis. In conclusion, a wide range of PROMs was utilized in the 50 most cited publications in the neurospine surgical literature. The majority were disease-specific rather than generic and targeted particular spine pathology. Neurosurgical PROMs were under-represented amongst the most cited articles. Awareness of the PROMs used in high-impact studies may be helpful in tool selection in future research. PROMs are valuable in standardizing subjective outcomes. Their use in research and clinical settings in any validated language is highly encouraged.

Contribution of Saudi Neurosurgeons to the International Neurosurgical Literature: a Bibliometric Analysis of Trends Over the Last Three Decades.

This review is a bibliometric analysis of the contribution of neurosurgeons from the Kingdom of Saudi Arabia (KSA) to the international neurosurgical literature over the last three decades. The study aimed at determining changes in publication trends over time and assessing the impact of these changes on citation numbers. All publications in the PubMed-indexed neurosurgical journals that were authored by at least one Saudi neurosurgeon were selected. The articles were divided into two study groups according to publication year whether during the last decade (2011- 2020) or the previous two decades (1991- 2010). Changes in publication trends were determined by comparing the bibliometric characteristics of the articles in both groups. The impact of the changes on citation numbers was assessed by correlating the annual citation rates for the articles with their bibliometric qualities. A total of 352 publications were suitable for the review (200 articles published during 2011- 2020, and 152 during 1991- 2010). Temporal changes in the publishing journals and first authors' centres and regions were observed. The articles that were published in the last decade were associated with a significantly higher annual publication rate, a greater number of authors, centres, and countries, and a larger sample size compared to those published in the previous two decades. They also had a lower percentage of Saudi total and first authorship as well as a smaller proportion of case reports. The annual citation rate was significantly impacted by the duration from publication, sample size, and study type during both study periods. However, only during the last decade, the annual citation rate was positively influenced by the journal's impact factor, number of authors, centres, countries, and percentage of Saudi authorship. We conclude that KSA neurosurgeons' contribution to international neurosurgical journals had increased considerably over the last decade. The publications were authored by neurosurgeons from a wider range of centres and regions than in the past. A bigger portion of publications had become more multi-authored, multi-centred, and multi-national as well as reported larger sample sizes and lesser rates of case reports. The changes in publication trends correlated positively with the articles' annual citation rates. The findings could be considered encouraging.

Regional Variation in the Neurosurgical Workforce in Saudi Arabia.

OBJECTIVES: To highlight the disparity in the regional distribution of neurosurgical workforce in the Kingdom of Saudi Arabia (KSA) and to correlate the provision of neurosurgeons across the regions with several parameters. METHODS:  The 13 administrative emirates of provinces in KSA were grouped into five geographical regions (central, western, eastern, southern, and northern). The density of neurosurgeons was calculated for each region. The distribution of neurosurgeons across the regions was correlated with several parameters using Pearson coefficient test. RESULTS:  This study examined 238 neurosurgeons working in 85 neurosurgical centers in KSA. The regional median (range) density of neurosurgeons was 7.1 (3.1-10.2) per million population and 9.3 (2.3-23.3) per thousand square kilometer area. The regional provision of neurosurgeons correlated significantly with the distribution of KSA-national (p=0.031), KSA-certified (p=0.0004), Government Hospitals (GHs) (p=0.0012), and private hospitals (PHs) (p=0.0359) funded neurosurgeons. The regional allocation of neurosurgeons also correlated positively with the distribution of the total neurosurgical centers (p=0.048), the PHs centers (p=0.0057) but not the GHs centers (p=0.3296). Furthermore, a mismatch was observed between the regional distribution of the neurosurgical workforce and the provision of neurosurgeons according to their GHs' sub-divisions, regional population, and area. CONCLUSIONS:  The regional distribution of neurosurgeons in KSA was uneven. The density of neurosurgeons was the lowest in the southern and northern regions. There was disparity in the number of neurosurgeons employed by the various GHs' sub-divisions and in the allocation of GHs' neurosurgical centers across the regions. Easy access to quality neurosurgical care is imperative. Policy makers should take this into consideration in the future planning of regional neurosurgical services in KSA.

Predictors of citation rates for research publications in Neurosciences.

OBJECTIVES: To identify the predictors of citation rates for research publication in Neurosciences. METHODS: All original articles including meta-analyses (MAs) and systematic reviews (SRs) that were published in Neurosciences during 2011 to 2019 were reviewed. The impact of several predictors on citation rates was assessed using correlation coefficient and mean difference tests. RESULTS: This study examined 231 articles. The mean article citation number was 11.6. The correlation analysis showed a significant association between citation rates and duration from publication in years (p<0.0001), sample size (p<0.0001), study design (p=0.0353), and level of evidence (LOE) (p=0.03). The comparative analysis showed significantly more citations for articles that were published 6-10 years ago (p<0.0001), had a sample size >91 (p=0.0359), were randomized controlled trials (p=0.0353), MAs and SRs (p<0.0001), and level of evidence (LOE)-I (p=0.0004). Retrospective case series had significantly lower citations. The higher and lower citation numbers for publications from Iran and rehabilitation, respectively, may have been influenced by the duration from publication. CONCLUSION: The most significant predictors of citation rates for Neurosciences publications were the age of articles, population size, study design, and LOE. Awareness of the predictors of citation rates may help researchers enhance the academic impact of their work.

Predictors of Citation Rates in High-Impact Glioblastoma Clinical Trials.

Clinical trials are at the top of research study designs and tend to attract high citation numbers. Glioblastoma multiforme (GBM) is a multidisciplinary disease that continues to be the subject of peak research interest. In general, the literature relating to the predictors of citation rates in clinical trials remains limited. This review aims to identify the factors that influence citation numbers in high-impact GBM clinical trials. The 100 most cited GBM trials of any phase published from 1975 to 2019 were selected and reviewed. The primary analysis correlated citation numbers of articles with various trial and publication-related predictors using the Pearson correlation coefficient. The secondary analysis compared the mean citation numbers for different subgroups using the mean difference test. The median (range) citation number for the selected 100 trials was 349 (135-16,384). The primary analysis showed a significant correlation between citation numbers of articles and the study population (P = 0.024), trial phase (I-III) (P = 0.0427), and the impact factor (IF) of the journal (P < 0.0001). The secondary analysis demonstrated significantly higher mean citation numbers in all trials with the following features: study population ≥115 (P = 0.0208), phase III (P = 0.0372), treatment protocol including radiotherapy (P = 0.0189), temozolomide (TMZ) therapy (P = 0.0343), IF of the journal ≥14.9 (P = 0.02), and general medical journals (P = 0.28). We conclude that the most significant predictors of citation rates in high-impact GBM trials were the study population, trial phase, and journal's IF. The treatment protocol was a positive predictor when it included the currently widely accepted treatment modalities (radiotherapy and TZM). Randomization, age of publication, as well as the numbers of arms, authors, centers, countries, and references were not significant predictors. Increasing awareness of the factors that could affect citations may help researchers undertaking clinical trials to enhance the academic impact of their work.

Attrition and Success Rates in the Saudi Board of Neurosurgery: Analysis of 115 Consecutive Residents Who Started Training From 2001 to 2014.

Objectives At present, the literature lacks data on the outcome of neurosurgery training programs in the Middle East. In this study we aim to assess the attrition, completion of training and success rates in the Saudi Board of Neurosurgery (SBNS). Methods A cohort of 115 trainees who started SBNS training during 2001-2014 was reviewed. The outcome was the rate of attrition, completion of training, and success in the final examination of the SBNS. Results Attrition rate was 29% (14% to neurosurgery training elsewhere and 15% to non-neurosurgery). Completion of training rate was 71%. Success in the final examination rate was 74% (60% on the first attempt). Attrition rate was significantly influenced by being sponsored by University Hospitals. Success rate was impacted positively by being sponsored by King Fahad Medical City and negatively by Ministry of Health Hospitals. Trainees who started during 2011-2014 had a significantly better success rate in the final examination. Conclusions SBNS attrition rate was high due to access to training opportunities abroad, particularly for university-sponsored trainees. Success rate in the final examination was considered comparable to some other neurosurgical qualifications. The first attempt pass rate was significantly impacted by being sponsored by certain hospitals. Factors contributing to attrition and failure should be identified and addressed during the selection process and during training.

Placebo Effect of Sham Spine Procedures in Chronic Low Back Pain: A Systematic Review.

BACKGROUND: The literature lacks information about the characteristics of the placebo effect following sham spine procedures for chronic low back pain. We aim to evaluate the effect using pain score data from the sham arms of published trials. METHODS: Relevant trials were selected and reviewed. Baseline and post-procedure pain scores were collected. Each follow up pain score was considered an episode and compared to its baseline for significance. Patients and episodes were pooled and analyzed using three parameters: patient reported outcome measures (PROMs) (Oswestry Disability Index [ODI], Visual Analog Scale [VAS], Numerical Rating Scale [NRS] and Short Form-36 [SF]), anatomical targets (disc, facet, sacroiliac joint [SIJ], ramus communicans nerve [RCN], basivertebral nerve [BVN], and caudal) and follow up periods (early: 0-2, intermediate: >2-4 and late: >4-6) in months. The percentage of pooled patients in the episodes that had significant reduction in pain scores was termed placebo effect. The outcome was defining the magnitude of the placebo effect and determining if it was influenced by the three parameters. RESULTS: Seventeen studies that reported 535 patients and 55 pain scoring episodes were considered eligible. Significant reduction in pain scores was reported in 21 episodes. The overall placebo effect among the patients during the studied period was 53.2%. The rate ranged according to PROMs from 42.4% to 72.1%, anatomical targets from 11.1% to 100% and follow up periods from 47.9% to 59%. The placebo effect differed significantly between the various domains in the three parameters. CONCLUSION: Placebo effect was observed in nearly half of the patients during the first 6 months following a sham spine procedure. The effect was influenced by utilized PROMs, anatomical target and follow up period. The findings should be considered in the design of new sham spine procedure trials. Further research is required to delineate the effect of bias on the findings.

Impact of country self citation on the ranking of the top 50 countries in clinical neurology.

OBJECTIVES: To examine the factors that influence country self-citation rate (SCR) in clinical neurology and to assess the impact of self-citation on the ranking of the top 50 countries. METHODS: SCImago Journal & Country Rank was used to collect data for the 50 most cited countries in clinical neurology during 1996-2019. Country SCR was correlated with several productivity parameters and examined statistically. Countries that dropped in their ranking after the exclusion of self-citations were identified. RESULTS: The median (range) country SCR for the 50 most cited countries was 11.3%.(5.3%- 47%). Country SCR correlated significantly with total citable documents and total cites numbers and rankings. The exclusion of self-citations led to a drop in the ranking of 8(16%) countries only. No significant difference between the total and net total cites rankings was observed. CONCLUSIONS: Self-citation can be appropriate and reflect an expansion on earlier research. Highly cited productive countries tend to have high country SCR. Excluding self-citations had minimal impact on the ranking of the top 50 countries. Our findings indicate that self-citation is unlikely to influence country standing amongst the top 50 and does not support the argument for eliminating self-citations from citation-based metrics. A more globalization through international collaboration in research is encouraged.

De novo Craniopharyngioma of the Fourth Ventricle: Case Report and Review of Literature.

Craniopharyngiomas usually involve the sella and suprasellar space. Their occurrence in the posterior fossa without extension to the suprasellar region is uncommon with only 16 cases reported in the literature. We report a case of a primary posterior fossa craniopharyngioma that was managed by complete excision with a good recovery. Our case was unique in that the craniopharyngioma occurred in the fourth ventricle and extended downward to the level of C1, a manifestation that was reported only twice in the past. The literature on the topic is reviewed.

Impact of country-specific characteristics on scientific productivity in clinical neurology research.

OBJECTIVES: The objective of this study was to identify the top 50 countries in the world in clinical neurology research and to use their data to assess the impact of a number of country-specific characteristics on scientific productivity in clinical neurology. METHODS: The SCImago Journal & Country Rank (SCR) web site was used to identify the top 50 countries in the world based on their total documents in clinical neurology. Using their data 5 country-specific characteristics and 6 productivity indicators (total documents, total cites, h-index, citable documents, self-cites and citations per document) were correlated and examined statistically. RESULTS: The number of universities in the world top 500 and the number of clinical neurology journals enlisted in SCR correlated significantly with each of the 6 indicators. The gross domestic product (GDP) per capita and the percentage of GDP spent on research and development (R & D) correlated significantly with 3 and 4 out of the 6 indicators respectively. The population size did not correlate significantly with any of the 6 indicators. CONCLUSIONS: The number of universities in the world top 500 and the number of clinical neurology journals enlisted in SCR appear to have a strong impact on scientific productivity. GDP per capita and spending on R & D appear to have a moderate impact on productivity that is influenced by the indicator used. Furthermore, population size appears to have no significant impact on productivity in clinical neurology research.

Survey of h-index for neurosurgeons in Saudi Arabia.

OBJECTIVE: To calculate the h-index for neurosurgeons in the Kingdom of Saudi Arabia (KSA), and to assess its association with a number of features relating to neurosurgical practice in KSA. METHODS: The h-index for 84 neurosurgeons that worked in KSA during 1990-2013 was evaluated using Google Scholar during the period September to October 2014. The correlation between the h-index and a number of neurosurgeon and neurosurgical center characteristics was determined and examined statistically. RESULTS: The median h-index was 2.5 (range 0-33) and the mean was 5.04. The h-index was significantly higher for neurosurgeons who obtained their certification before 2001 and those working at the King Faisal Specialist Hospital, Riyadh, KSA. The h-index was also higher, but without reaching significance, for non-Saudi neurosurgeons, those with international certification and those working at the university hospitals. Additionally, the h-index was significantly lower for neurosurgeons working in the Ministry of Health hospitals. CONCLUSION: Application of the h-index to KSA neurosurgeons revealed a significant correlation with the duration after certification and with certain centers. Evaluation of the h-index should be included in the consideration for academic positions in KSA. Saudi neurosurgeons should be encouraged to publish in journals with high impact factor.

Efficacy of intraoperative epidural steroids in lumbar discectomy: a systematic review.

BACKGROUND: This study is a descriptive review of the literature aimed at examining the efficacy of the use of intraoperative epidural steroids in lumbar disc surgery, a matter that remains controversial. METHODS: The relevant clinical trials were selected from databases and reviewed. The methodological quality of each included study was assessed and graded for perceived risk of bias. All the documented significant and non-significant findings were collected. Our outcome targets were reduction in postoperative pain scores, consumption of analgesia, duration of hospital stay and no increase in complication rates. The variation in the timing of postoperative pain assessments necessitated grouping the outcome into three postoperative stages; early: 0 to 2 weeks, intermediate: more than 2 weeks to 2 months and late: more than 2 months to 1 year. RESULTS: Sixteen trials that were published from 1990 to 2012 were eligible. At least one significant reduction in pain score was reported in nine of the eleven trials that examined pain in the early stage, in four of the seven trials that examined pain in the intermediate stage and in two of the eight trials that examined pain in the late stage. Seven of the nine trials that looked at consumption of postoperative analgesia reported significant reduction while six of the ten trails that examined the duration of hospital stay reported significant reduction. None of the trials reported a significant increase of steroid-related complications. CONCLUSIONS: There is relatively strong evidence that intraoperative epidural steroids are effective in reducing pain in the early stage and reducing consumption of analgesia. There is also relatively strong evidence that they are ineffective in reducing pain in the late stage and in reducing duration of hospital stay. The evidence for their effectiveness in reducing pain in the intermediate stage is considered relatively weak. The heterogeneity between the trials makes it difficult to make undisputed conclusions and it indicates the need for a large multicenter trial with validated outcome measures that are recorded at fixed time intervals.