Predictive value of the five-repetition sit-to-stand test for outcomes after surgery for lumbar disc herniation: prospective study.

OBJECTIVE: It is unknown whether presence of pre-operative objective functional impairment (OFI) can predict post-operative outcomes in patients with lumbar disc herniation (LDH). We aimed to determine whether pre-operative OFI measured by the five-repetition sit-to-stand test (5R-STS) could predict outcomes at 12-months post-discectomy. METHODS: Adult patients with LDH scheduled for surgery were prospectively recruited from a Dutch short-stay spinal clinic. The 5R-STS time and patient reported outcome measures (PROMs) including Oswestry Disability Index, Roland-Morris Disability Questionnaire, Visual Analogue Scale (VAS) for back and leg pain, EQ-5D-3L health-related quality of life, EQ5D-VAS and ability to work were recorded pre-operatively and at 12-months. A 5R-STS time cut-off of ≥ 10.5 s was used to determine OFI. Mann-Whitney and Chi-square tests were employed to determine significant differences in post-operative outcomes between groups stratified by presence of pre-operative OFI. RESULTS: We recruited 134 patients in a prospective study. Twelve-month follow-up was completed by 103 (76.8%) patients. Mean age was 53.2 ± 14.35 years and 50 (48.5%) patients were female. Pre-operatively, 53 (51.5%) patients had OFI and 50 (48.5%) did not. Post-operatively, patients with OFI experienced a significantly greater mean change (p < 0.001) across all PROMs compared to patients without OFI, except leg pain (p = 0.176). There were no significant differences in absolute PROMs between groups at 12-months (all p > 0.05). CONCLUSIONS: The presence of OFI based on 5R-STS time does not appear to decrease a patient's likelihood of experiencing satisfactory post-operative outcomes. The 5R-STS cannot predict how a patient with LDH will respond to surgery at 12-month follow-up.

Predictors of five-repetition sit-to-stand test performance in patients with lumbar degenerative disease.

BACKGROUND: The five-repetition sit-to-stand test (5R-STS) has recently been validated as an objective measure of functional impairment in patients with lumbar degenerative disease (LDD). Knowledge of factors influencing 5R-STS performance is useful to correct for confounders, create personalized adjusted test times, and potentially identify prognostic subgroups. We evaluate factors predicting the 5R-STS performance in patients with LDD. METHODS: Patients with LDD requiring surgery were included. Each participant performed the 5R-STS and completed a questionnaire that included their age, gender, weight, height, body mass index (BMI), smoking status, education level, employment type, ability to work, analgesic drug usage, history of previous spinal surgery, and EQ5D depression and anxiety domain. Surgical indication and index level of the spinal pathology were also recorded. Predictors of 5R-STS were identified through multivariable linear regression. RESULTS: The cohort consisted of 240 patients, 47.9% being female (mean age, 47.7 ± 13.6 years). In the final multivariable model incorporating confounders, height (regression coefficient (RC), 0.08; 95% confidence interval (CI), 0.003/0.16, p = 0.042) and being an active smoker (RC, 2.44; 95%CI, 0.56/4.32, p = 0.012) were significant predictors of worse 5R-STS performance. Full ability to work (RC, - 2.39; 95%CI, - 4.39/ - 0.39, p = 0.020) was associated with a better 5R-STS performance. Age, height, surgical indication, index level of pathology, history of previous spine surgery, history of pain, analgesic drug use, employment type, and severity of anxiety and depression symptoms demonstrated confounding effect on the 5R-STS time. CONCLUSIONS: Greater height, being an active smoker, and inability to work are significant predictors of worse 5R-STS performance in patients with LDD. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03303300 and NCT03321357.

Objective evaluation of the ``scratch collapse test'' for the diagnosis of carpal tunnel syndrome.

PURPOSE: Evaluate the Scratch Collapse Test in an objective way, by replacing the subjective evaluation made by the physician with an objective evaluation measure, made with a digital dynamometer. METHODS: Observational study carried out, in 90 patients divided into three groups of 30 patients, taking into account the electromyographic study of the median nerve in the carpal tunnel (no alteration, moderate, severe).The external rotation of the shoulder was measured in four different situations (no scratch, scratch over the carpal tunnel, scratch in the dorsum of the wrist and scratch in the shoulder). RESULTS: There were no statistical differences in the result of the strength in any of the four different situations in patients without carpal tunnel of with moderate carpal tunnel syndrome. However, there were statistical differences between the basal measurement (without scratching) and the measurement after tunnel scratching in patients with severe carpal tunnel syndrome. But this statistical difference was only 0.08 kg in the average measure, and this difference is clinically undetectable and far for producing a real collapse of the external rotation of the shoulder. CONCLUSION: The Scratch Collapse Test is not a valid diagnostic exam for carpal tunnel syndrome if the strength is measured in an objective manner.

Measuring implanted patient response to tone pips.

BACKGROUND: An electrical potential not previously reported-electrical cochlear response (ECR)-observed only in implanted patients is described. Its amplitude and growth slope are a measurement of the stimulation achieved by a tone pip on the auditory nerve. The stimulation and recording system constructed for this purpose, the features of this potential obtained in a group of 43 children, and its possible clinical use are described. The ECR is obtained by averaging the EEG epochs acquired each time the cochlear implant (CI) processes a tone pip of known frequency and intensity when the patient is sleeping and using the CI in everyday mode. The ECR is sensitive to tone pip intensity level, microphone sensitivity, sound processor gain, dynamic range of electrical current, and responsiveness to electrical current of the auditory nerve portion involved with the electrode under test. It allows individual evaluation of intracochlear electrodes by choosing, one at the time, the central frequency of the electrode as the test tone pip frequency, so the ECR measurement due to a variable intensity tone pip allows to establish the suitability of the dynamic range of the electrode current. RESULTS: There is a difference in ECR measurements when patients are grouped based on their auditory behavior. The ECR slope and amplitude for the Sensitive group is 0.2 µV/dBHL and 10 µV at 50 dBHL compared with 0.04 µV/dBHL and 3 µV at 50dBHL for the Inconsistent group. The clinical cases show that adjusting the dynamic range of current based on the ECR improved the patient's auditory behavior. CONCLUSIONS: ECR can be recorded regardless of the artifact due to the electromyographic activity of the patient and the functioning of the CI. Its amplitude and growth slope versus the intensity of the stimulus differs between electrodes. The relationship between minimum ECR detection intensity level and auditory threshold suggests the possibility of estimating patient auditory thresholds this way. ECR does not depend on the subject's age, cooperation, or health status. It can be obtained at any time after implant surgery and the test procedure is the same regardless of device manufacturer.

Lying down looking down test: Evaluating patient suitability for small incision cataract surgery using assisted topical anesthesia.

Purpose: The objective of this study was to evaluate an OPD-based Lying down looking down (LDLD) test for the assessment of patient suitability for assisted topical anesthesia (ATA) during manual small incision cataract surgery (MSICS), and to compare it with assisted local anesthesia (ALA). Methods: The LDLD test was carried out during preoperative assessment of 250 consecutive patients. A standard LED torch was shined in patient's eye after pupil dilation, with the patient in lying down position, while simultaneously elevating the upper eyelid digitally. A positive test was indicated by the ability to maintain downward gaze and the lack of squeezing of eyes or withdrawal. Chi-square and Fisher's exact tests were used to assess the association between LDLD results and suitability for ATA. The positive predictive value and specificity of the test as an indicator of patient suitability for ATA were calculated. Complications (intra- and post-operative) and postoperative inflammation at day 1 and week 6 were compared between the ATA and ALA groups. Results: A total of 250 patients were included in the study, 138 in ALA group and 112 in ATA group. There were 109 males (43.6%) and 141 females (56.4%). Around 7.4% of LDLD- positive patients were converted to ALA during the surgery. Chi-square and Fisher's exact tests demonstrated a significant association of a positive LDLD test with successful ATA (P value 0.002). The positive predictive value and specificity of the test were 92.56% (95% CI86.87-95.9%) and 93.48% (95% CI87.98-96.97%), respectively. Intraoperative complications were similar in both the groups. Congestion and visually significant corneal edema were significantly less in ATA group. Conclusion: The LDLD is a simple, highly specific, OPD-based test to determine patient suitability for MSICS under ATA.

Five-Repetition Sit-to-Stand Test Performance in Healthy Individuals: Reference Values and Predictors From 2 Prospective Cohorts.

OBJECTIVE: The 5-repetition-sit-to-stand (5R-STS) test is an objective test of functional impairment- commonly used in various diseases, including lumbar degenerative disc diseases. It is used to measure the severity of disease and to monitor recovery. We aimed to evaluate reference values for the test, as well as factors predicting 5R-STS performance in healthy adults. METHODS: Healthy adults ( > 18 years of age) were recruited, and their 5R-STS time was measured. Their age, sex, weight, height, body mass index (BMI), smoking status, education level, work situation and EuroQOL-5D Healthy & Anxiety category were recorded. Linear regression analysis was employed to identify predictors of 5R-STS performance. RESULTS: We included 172 individuals with mean age of 39.4 ± 14.1 years and mean BMI of 24.0 ± 4.0 kg/m2. Females constituted 57%. Average 5R-STS time was 6.21 ± 1.92 seconds, with an upper limit of normal of 12.39 seconds. In a multivariable model, age (regression coefficient [RC], 0.07; 95% confidence interval [CI], 0.05/0.09; p < 0.001), male sex (RC, -0.87; 95% CI, -1.50 to -0.23; p = 0.008), BMI (RC, 0.40; 95% CI, 0.10-0.71; p = 0.010), height (RC, 0.13; 95% CI, 0.04-0.22; p = 0.006), and houseworker status (RC, -1.62; 95% CI, -2.93 to -0.32; p = 0.016) were significantly associated with 5R-STS time. Anxiety and depression did not influence performance significantly (RC, 0.82; 95% CI, -0.14 to 1.77; p = 0.097). CONCLUSION: The presented reference values can be applied as normative data for 5R-STS in healthy adults, and are necessary to judge what constitutes abnormal performance. We identified several significant factors associated with 5R-STS performance that may be used to calculate individualized expected test times.

Severity of Anosmia as an Early Symptom of COVID-19 Infection May Predict Lasting Loss of Smell.

Introduction: To evaluate the recovery rate of loss of smell (LOS) with objective olfactory testing in COVID-19 patients. Methods: Adults with confirmed COVID-19 and self-reported sudden LOS were prospectively recruited through a public call from the University of Mons (Belgium). Epidemiological and clinical data were collected using online patient-reported outcome questionnaires. Patients benefited from objective olfactory evaluation (Sniffin-Sticks-test) and were invited to attend for repeated evaluation until scores returned to normal levels. Results: From March 22 to May 22, 2020, 88 patients with sudden-onset LOS completed the evaluations. LOS developed after general symptoms in 44.6% of cases. Regarding objective evaluation, 22 patients (25.0%) recovered olfaction within 14 days following the onset of LOS. The smell function recovered between the 16th and the 70th day post-LOS in 48 patients (54.5%). At the time of final assessment at 2 months, 20.5% of patients (N = 18) had not achieved normal levels of olfactory function. Higher baseline severity of olfactory loss measured using Sniffin-Sticks was strongly predictive of persistent loss (p < 0.001). Conclusion: In the first 2 months, 79.5% of patients may expect to have complete recovery of their olfactory function. The severity of olfactory loss, as detected at the first Sniffin-Sticks-test, may predict the lack of mid-term recovery.

The five-repetition sit-to-stand test: evaluation of a simple and objective tool for the assessment of degenerative pathologies of the lumbar spine.

OBJECTIVE: Recently, objective functional tests have generated interest since they can supplement an objective dimension to clinical assessment. The five-repetition sit-to-stand (5R-STS) test is a quick and objective tool that tests movements frequently used in everyday life. The aim of this prospective study was to evaluate the validity and reliability of the 5R-STS test in patients with degenerative pathologies of the lumbar spine. METHODS: Patients and healthy volunteers completed the standardized 5R-STS, Roland-Morris Disability Questionnaire (RMDQ), Oswestry Disability Index (ODI), visual analog scale (VAS) for back and leg pain, and EQ-5D for health-related quality of life (HRQOL). To assess convergent validity, the 5R-STS test times were correlated with these questionnaires. RESULTS: Overall, 157 patients and 80 volunteers were enrolled. Direct correlation with RMDQ (r = 0.49), ODI (r = 0.44), and VAS for back pain (r = 0.31) and indirect correlation with the EQ-5D index (r = -0.41) were observed (p < 0.001). The 5R-STS test showed no correlation with VAS for leg pain and EQ-5D VAS (p > 0.05). In 119 individuals, the 5R-STS test demonstrated excellent test-retest reliability with an intraclass correlation coefficient of 0.98. The upper limit of normal, distinguishing patients with and without objective functional impairment, was identified as 10.35 seconds. A severity stratification classified patients with test times of 10.5-15.2, 15.3-22.0, or greater than 22.0 seconds as having mild, moderate, or severe functional impairment, respectively. CONCLUSIONS: The 5R-STS test is a simple and effective tool to describe objective functional impairment. A patient able to perform the test in 10.4 seconds can be considered to have no relevant objective functional impairment. Clinical trial registration no.: NCT03303300 (clinicaltrials.gov).

The Subjective and Objective Evaluations of Autonomic Nervous System Function in Stroke Patients

OBJECTIVE: To evaluate autonomic function in stroke patients and to explore the relationship between patient's subjective symptoms and the results of objective tests regarding autonomic dysfunction. METHOD: Twenty stroke patients and 27 controls were recruited. Autonomic function was accessed by subjective checklist and by objective tests such as sympathetic skin response (SSR) and blood pressure (BP) response to positional change and to sustained hand-grip. Motor function was classified using the Brunnstrom stages: Group 1, stage 1 and 2; Group 2, stage 3 and 4; Group 3, stage 5 and 6. RESULTS: Seventy percent of patients had subjective changes in autonomic function after stroke. 50% and 65.5% of patients revealed autonomic insufficiency by BP responsetests and SSR, respectively. More than half of the patients who didn't have any subjective changes in autonomic function revealed autonomic insufficiency by objective tests. Group 1 of Brunnstrom stage in upper extremity showed significantly longer SSR latencies (p<0.05) and lower amplitudes than the controls (p<0.05). Group 1 and 2 of Brunnstrom stage in lower extremity showed significantly longer SSR latencies (p<0.05) and lower amplitudes than the controls (p<0.05). CONCLUSION: Although stroke patients don't complain any subjective symptoms of autonomic dysfunction, they need to undergo objective autonomic function evaluations such as SSR and BP responses.

Objective olfactory function test through analysis of human Q-EEG changes / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Increased industrialization and the changing environment have caused complex olfactory problems in the modern population, and the need for an objective evaluation of such problems has thus come to our attention. In this study, we used the human Q-EEG (Bio-Logic, Brain Atlas III) equipment to evaluate olfactory fuction, and tried to lay out a basis for an objective test of olfactory function in humans. MATERIALS AND METHODS: Twenty normosmic adults and ten anosmic patients were studied by the human Q-EEG equipment. EEG changes were analyzed by a nonparametric test (Mann-Whitney test, p<0.05). A mixture of S-D alcohol, benzophenol, BHT (benzyl hydroxy toluene), water, and fragrance were used as an odorant. The odorant was applied to the one third anterior of the inferior turbinate using a small piece of filter paper soaked in the odorant. RESULTS: During odorant stimulation, the Q-EEG analyzer showed that the delta band (0-3.5 Hz) decreased in the whole brain region, while the alpha band (8-11.5 Hz) increased in the bilateral temporal region in the normosmic patients. There was no Q-EEG changes in the anosmic patients. CONCLUSION: It is suggested that human Q-EEG analysis may provide the basis for the development of an objective test of olfactory function in humans.