The reliability of determining "leg dominant pain".

BACKGROUND CONTEXT: Patients with back dominant pain generally have a worse prognosis after spine surgery when compared with patients with leg dominant pain. Despite the importance of determining whether patients with lumbar spine pain have back or leg dominant pain as a predictor for success after decompression surgery, there are limited data on the reliability of methods for doing so. PURPOSE: To assess the test-retest reliability of a patient's ability to describe whether their lumbar spine pain is leg or back dominant using standardized questions. STUDY DESIGN/SETTING: Prospective, blinded, test-retest cohort study performed in an academic spinal surgery clinic. PATIENT SAMPLE: Consecutive patients presenting for consultation to one of three spinal surgeons for lumbar spine pain were enrolled. OUTCOME MEASURES: Eight questions to ascertain a patient's dominant location of pain, either back dominant or leg dominant, were identified from the literature and local experts. METHODS: These eight questions were administered in a test-retest format over two weeks. The test-retest reliability of these questions were assessed in a self-administered questionnaire format for one group of patients and by a trained interviewer in a second group. RESULTS: The test-retest reliability of each question ranged from substantial (eg, interviewer-administered percent question, weighted kappa=0.77) to slight (eg, self-administered pain diagram, weighted kappa=0.09). The Percent question was the most reliable in both groups (self-administered, interviewer). All questions in the interviewer-administered group were significantly (p<.001) more reliable than the self-administered group. Depending on the question, between 0% and 32% of patients provided a completely opposite response on test-retest. There was variability in prevalence of leg dominant pain, depending on which question was asked and there was no single question that identified all patients with leg dominant pain. CONCLUSION: A patient's ability to identify whether his or her lumbar spine pain is leg or back dominant may be unreliable and depends on which questions are asked, and also how they are asked. The Percent question is the most reliable method to determine the dominant location of pain. However, given the variability of responses and the generally poorer reliability of many specific questions, it is recommended that multiple methods be used to assess a patient's dominant location of pain.

The International Society for the Study of the Lumbar Spine: research trends over time and publication rates.

STUDY DESIGN AND OBJECTIVES: A retrospective review was conducted to assess trends in research selected for podium presentation at ISSLS. SUMMARY OF BACKGROUND DATA: Abstracts of past papers presented to ISSLS provide quantified documentation of trends in research as well as insight into future directions. METHODS: A systematic review of abstracts of research presented was performed. Graphical plots in each category of research and aspects of study quality were used to identify any trends. Univariate and multivariate logistical regression analyses were used to identify factors related to eventual publication. RESULTS: A total of 43% of selected papers focused on the disc, representing the single largest area of research. There is a linear trend over time toward increased selection of basic science papers and decreased clinical papers. Experimental research design is becoming more frequently selected. In 1978, over 80% of papers were purely descriptive. By 2002, 42% of papers were descriptive, whereas 40% incorporated an experimental design. However, over the past decade, there has been a linear increase in the proportion of randomized controlled trials among clinical papers compared with basic science or biomechanical papers. A total of 54% of all abstracts presented recently went on to publication. Independent factors that were associated with significantly (P < 0.05) higher publication rates included use of blinded or independent observers (84.6%), experimental design (68.4%), basic science or biomechanical papers (62.3%), and statistically positive result (61.8%). CONCLUSION: Overall, the type of research selected for presentation at ISSLS has improved over the years in regards to greater use of experimental and randomized study design. The eventual publication rates compare favorably to other research societies. Factors related to publication have been identified and should be considered in future research.