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Source
Neuromodulation. 2013 Nov-Dec;16(6):506-13; discussion 513
Publication Type
Article
Author
Kaare Meier
Lone Nikolajsen
Morten Flink
Ronnie Simonsen
Ioanna Milidou
Troels Staehelin Jensen
Jens Christian Sørensen
Author Affiliation
Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark; Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark; Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark; ITmedico, Aarhus, Denmark; Perinatal Epidemiology Research Unit, Aarhus University Hospital, Aarhus, Denmark; and Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.
Source
Neuromodulation. 2013 Nov-Dec;16(6):506-13; discussion 513
Language
English
Publication Type
Article
Keywords
Analgesics - therapeutic use
Chronic Pain - therapy
Computer Security
Databases, Factual
Denmark
Employment
Humans
Internet
Neuralgia - drug therapy - therapy
Neurosurgical Procedures - adverse effects
Pain Measurement
Quality of Life
Questionnaires
Software
Spinal Cord Stimulation - adverse effects
Treatment Outcome
Abstract
?? Spinal cord stimulation (SCS) is increasingly gaining widespread use as a treatment for chronic pain. A widely used electronic registry could play a pivotal role in improving this complex and cost-?intensive treatment. We aimed to construct a comprehensive, universally available data base for SCS.
?? The design considerations behind a new online data base for SCS are presented; basic structure, technical issues, research applications, and future perspectives are described.
?? The Aarhus Neuromodulation Database covers core SCS treatment parameters, including procedure-?related details and complications, and features recording of key success parameters such as pain intensity, work status, and quality of life. It combines easy access to patient information with exhaustive data extraction options, and it can readily be adapted and expanded to suit different needs, including other neuromodulation treatment modalities.
?? We believe that the data base described in this article offers a powerful and versatile data collection tool suited for both clinicians and researchers in the field. The basic data base structure is immediately available on a no?-cost basis, and we invite our colleagues to make use of the data base as part of the efforts to further the field of neuromodulation.
PubMed ID
22882331 View in PubMed
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Acute management of traumatic spinal cord injury in a Greek and a Swedish region: a prospective, population-based study.

https://arctichealth.org/en/permalink/ahliterature146552
Source
Spinal Cord. 2010 Jun;48(6):477-82
Publication Type
Article
Date
Jun-2010
Author
A. Divanoglou
A. Seiger
R. Levi
Author Affiliation
Division of Neuro-rehabilitation, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden. anestis.divanoglou@ki.se
Source
Spinal Cord. 2010 Jun;48(6):477-82
Date
Jun-2010
Language
English
Publication Type
Article
Keywords
Community Health Planning
Greece - epidemiology
Humans
Neurologic Examination - methods
Prospective Studies
Retrospective Studies
Spinal Cord Injuries - diagnosis - epidemiology - etiology - therapy
Sweden - epidemiology
Treatment Outcome
Abstract
Prospective, population-based study. This paper is part of the Stockholm Thessaloniki Acute Traumatic Spinal Cord Injury Study (STATSCIS).
To characterize patient populations and to compare acute management after traumatic spinal cord injury (TSCI).
The Greater Thessaloniki region in Greece and the Greater Stockholm region in Sweden.
Inception cohorts with acute TSCI that were hospitalized during the study period, that is September 2006 to October 2007, were identified. Overall, 81 out of 87 cases consented to inclusion in Thessaloniki and 47 out of 49 in Stockholm. Data from Thessaloniki were collected through physical examinations, medical record reviews and communication with TSCI cases and medical teams. Data from Stockholm were retrieved from the Nordic Spinal Cord Injury Registry.
There were no significant differences between study groups with regard to core clinical characteristics. In contrast, there were significant differences in (1) transfer logistics from the scene of trauma to a tertiary-level hospital (number of intermediate admissions, modes of transportation and duration of transfer) and (2) acute key therapeutic interventions, that is, the use of mechanical ventilation (49% in Thessaloniki versus 20% in Stockholm), and performance of tracheostomy (36% in Thessaloniki versus 15% in Stockholm); spinal surgery was performed significantly more often and earlier in Stockholm than in Thessaloniki.
Despite largely similar core clinical characteristics, Stockholm and Thessaloniki cases underwent significantly different acute management, most probably to be attributed to adaptations to the differing regional approaches of care one following a systematic approach of SCI care and the other not.
PubMed ID
20029396 View in PubMed
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The artificial somato-autonomic reflex arch does not improve bowel function in subjects with spinal cord injury.

https://arctichealth.org/en/permalink/ahliterature273395
Source
Spinal Cord. 2015 Sep;53(9):705-10
Publication Type
Article
Date
Sep-2015
Author
M M Rasmussen
K. Krogh
D. Clemmensen
H. Tankisi
A. Fuglsang-Frederiksen
Y. Rawashdeh
H. Bluhme
P. Christensen
Source
Spinal Cord. 2015 Sep;53(9):705-10
Date
Sep-2015
Language
English
Publication Type
Article
Keywords
Anal Canal - physiopathology
Anastomosis, Surgical - methods
Colon - physiopathology - radionuclide imaging
Constipation - etiology - physiopathology
Contrast Media
Defecation - physiology
Denmark
Fecal Incontinence - etiology - physiopathology
Female
Follow-Up Studies
Humans
Male
Middle Aged
Neurogenic Bowel - etiology - physiopathology - radionuclide imaging - surgery
Neurologic Examination
Neurosurgical Procedures - adverse effects - methods
Pilot Projects
Rectum - physiopathology - radionuclide imaging
Reflex - physiology
Spinal Cord Injuries - complications - physiopathology - radionuclide imaging - surgery
Spinal Nerve Roots - physiopathology - surgery
Treatment Outcome
Abstract
Prospective cohort study.
Although introduced for neurogenic bladder dysfunction, it has been suggested that the artificial somato-autonomic reflex arch alleviates neurogenic bowel dysfunction (NBD). We aimed at evaluating the effects of the reflex arch on NBD.
Denmark.
Ten subjects with supraconal spinal cord injury (SCI) (nine males, median age 46 years) had an anastomosis created between the ventral part of the fifth lumbar or first sacral nerve root and the ventral part of the second sacral nerve root. Standardized assessment of segmental colorectal transit times with radiopaque markers, evaluation of scintigraphic assessed colorectal emptying upon defecation, scintigraphic assessment of colorectal transport during stimulation of the reflex arch, standard anorectal physiology tests and colorectal symptoms were performed at baseline and 18 months after surgery.
No significant change was observed in colorectal emptying upon defecation (median 31% of the rectosigmoid at baseline vs 75% at follow-up, P=0.50), no movement of colorectal contents was observed during stimulation of the reflex arch. Segmental colorectal transit times, anal sphincter pressures and rectal capacity did not change, and no change was seen in NBD score (median 13.5 (baseline) vs 12.5 (follow-up), P=0.51), St Marks fecal incontinence score (4.5 vs 5.0, P=0.36) and Cleveland constipation score (6.0 vs 8.0, P=0.75).
The artificial somato-autonomic reflex arch has no effect on bowel function in subjects with supraconal SCI.
PubMed ID
25917948 View in PubMed
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Association of myelopathy scores with cervical sagittal balance and normalized spinal cord volume: analysis of 56 preoperative cases from the AOSpine North America Myelopathy study.

https://arctichealth.org/en/permalink/ahliterature107913
Source
Spine (Phila Pa 1976). 2013 Oct 15;38(22 Suppl 1):S161-70
Publication Type
Article
Date
Oct-15-2013
Author
Justin S Smith
Virginie Lafage
Devon J Ryan
Christopher I Shaffrey
Frank J Schwab
Alpesh A Patel
Darrel S Brodke
Paul M Arnold
K Daniel Riew
Vincent C Traynelis
Kris Radcliff
Alexander R Vaccaro
Michael G Fehlings
Christopher P Ames
Author Affiliation
*Department of Neurosurgery, University of Virginia, Charlottesville †Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York ‡Department of Orthopaedic Surgery, Northwestern University, Chicago, IL §Department of Orthopaedic Surgery, University of Utah, Salt Lake City ¶Department of Neurosurgery, University of Kansas, Kansas City ?Department of Orthopaedic Surgery, Washington University, St Louis, MO **Department of Neurosurgery, Rush Medical Center, Chicago, IL ††Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA ‡‡Division of Neurosurgery and Spinal Program, University of Toronto, Toronto, Ontario, Canada; and §§Department of Neurological Surgery, University of California, San Francisco.
Source
Spine (Phila Pa 1976). 2013 Oct 15;38(22 Suppl 1):S161-70
Date
Oct-15-2013
Language
English
Publication Type
Article
Keywords
Adult
Aged
Canada
Cervical Vertebrae - radiography - surgery
Female
Humans
Kyphosis - radiography - surgery
Magnetic Resonance Imaging - methods
Male
Middle Aged
Preoperative Period
Prospective Studies
Quality of Life
Spinal Cord - radiography - surgery
Spinal Cord Diseases - radiography - surgery
Spondylosis - radiography - surgery
Treatment Outcome
United States
Abstract
Post hoc analysis of prospectively collected data.
Development of methods to determine in vivo spinal cord dimensions and application to correlate preoperative alignment, myelopathy, and health-related quality-of-life scores in patients with cervical spondylotic myelopathy (CSM).
CSM is the leading cause of spinal cord dysfunction. The association between cervical alignment, sagittal balance, and myelopathy has not been well characterized.
This was a post hoc analysis of the prospective, multicenter AOSpine North America CSM study. Inclusion criteria for this study required preoperative cervical magnetic resonance imaging (MRI) and neutral sagittal cervical radiography. Techniques for MRI assessment of spinal cord dimensions were developed. Correlations between imaging and health-related quality-of-life scores were assessed.
Fifty-six patients met inclusion criteria (mean age = 55.4 yr). The modified Japanese Orthopedic Association (mJOA) scores correlated with C2-C7 sagittal vertical axis (SVA) (r = -0.282, P = 0.035). Spinal cord volume correlated with cord length (r = 0.472, P
PubMed ID
23963001 View in PubMed
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Bladder management in persons with spinal cord lesion.

https://arctichealth.org/en/permalink/ahliterature178416
Source
Spinal Cord. 2004 Dec;42(12):694-8
Publication Type
Article
Date
Dec-2004
Author
A. Dahlberg
I. Perttilä
E. Wuokko
M. Ala-Opas
Author Affiliation
Käpylä Rehabilitation Centre, Finnish Association of People with Mobility Disabilities, Nordenskiöldinkatu 18B, PO Box 103, 00251 Helsinki, Finland.
Source
Spinal Cord. 2004 Dec;42(12):694-8
Date
Dec-2004
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Cross-Sectional Studies
Cystostomy - methods
Female
Finland
Follow-Up Studies
Humans
Injury Severity Score
Male
Middle Aged
Questionnaires
Risk factors
Severity of Illness Index
Spinal Cord Injuries - complications - diagnosis
Treatment Outcome
Urinary Bladder, Neurogenic - diagnosis - etiology - therapy
Urinary Catheterization - methods
Urinary Tract Infections - diagnosis - etiology - therapy
Urodynamics
Abstract
Cross-sectional clinical descriptive prevalence study.
To evaluate the methods of self-reported bladder management, the frequency of urinary tract infection (UTI) and subjective disturbance of bladder problems of all those individuals with traumatic spinal cord lesion (SCL) living in Helsinki area.
: Helsinki, Finland.
A total of 152 persons with SCL were found in the Helsinki area (546 000 inhabitants). A structured questionnaire was sent to all subjects and they were invited to a clinical visit.
The final study-group consisted of 129 (85%) subjects. They were defined into seven specific subgroups of bladder management: 14 (11%) subjects in the normal voiding group, 15 (12%) in the controlled voiding group, 16 (12%) in the clean intermittent catheterization (CIC) group, 30 (23%) in the mixed group, 31 (24%) in the suprapubic tapping group, 16 (12%) in the compression or straining group and seven (5%) in the catheter or conduit group. The frequency of UTI was highest in the mixed group. The bladder management was a biggest bother to the subjects in the compression or straining group.
This prevalence study assesses the self-reported bladder management methods in all the persons with traumatic SCL in the Helsinki area. The subjects who used CIC and other methods for bladder management had more problems than others. These subjects might manage better by using either CIC or suprapubic tapping as the only method for bladder emptying.
PubMed ID
15365573 View in PubMed
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Changes in epidemiology of acute spinal cord injury from 1947 to 1981.

https://arctichealth.org/en/permalink/ahliterature220371
Source
Surg Neurol. 1993 Sep;40(3):207-15
Publication Type
Article
Date
Sep-1993
Author
C H Tator
E G Duncan
V E Edmonds
L I Lapczak
D F Andrews
Author Affiliation
Spinal Cord Injury Treatment, Research and Prevention Centre, Toronto Hospital, Ontario, Canada.
Source
Surg Neurol. 1993 Sep;40(3):207-15
Date
Sep-1993
Language
English
Publication Type
Article
Keywords
Accidents
Acute Disease
Adolescent
Adult
Athletic Injuries - epidemiology
Child
Female
Humans
Intensive Care Units
Male
Middle Aged
Ontario - epidemiology
Severity of Illness Index
Spinal Cord Injuries - epidemiology - etiology - therapy
Treatment Outcome
Abstract
The aim of this study was to determine whether there have been epidemiologic changes in acute spinal cord injury. Two groups of patients injured in the same geographic area were compared: the first group of 351 patients was injured between 1947 and 1973; and the second group of 201 patients between 1974 and 1981. The results showed that there were indeed major epidemiologic changes in spinal cord injury between the two study periods. Most importantly, the more recently injured group were younger, arrived sooner, had less severe cord injuries, and higher frequencies of motor vehicle, and sports and recreational accidents, but fewer work-related injuries.
Notes
Comment In: Surg Neurol. 1994 Sep;42(3):2787940121
PubMed ID
8346474 View in PubMed
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Client-centred assessment and the identification of meaningful treatment goals for individuals with a spinal cord injury.

https://arctichealth.org/en/permalink/ahliterature181319
Source
Spinal Cord. 2004 May;42(5):302-7
Publication Type
Article
Date
May-2004
Author
C. Donnelly
J J Eng
J. Hall
L. Alford
R. Giachino
K. Norton
D S Kerr
Author Affiliation
Rehabilitation Research Laboratory, GF Strong Rehab Centre, and School of Rehabilitation Sciences, University of British Columbia, Vancouver, BC, Canada.
Source
Spinal Cord. 2004 May;42(5):302-7
Date
May-2004
Language
English
Publication Type
Article
Keywords
Activities of Daily Living - psychology
Adolescent
Adult
Aged
Aged, 80 and over
Canada
Disability Evaluation
Female
Goals
Humans
Leisure Activities - psychology
Male
Middle Aged
Outcome Assessment (Health Care)
Patient Satisfaction - statistics & numerical data
Quality of Life - psychology
Retrospective Studies
Self Care - statistics & numerical data
Sickness Impact Profile
Spinal Cord Injuries - psychology - rehabilitation
Treatment Outcome
Abstract
Retrospective analysis.
(1) Describe the self-care, productivity and leisure problems identified by individuals with a spinal cord injury (SCI) during rehabilitation, (2) describe the perceived level of satisfaction and performance with self-care, productivity and leisure activities following an SCI, (3) quantify the relationship between the Canadian occupational performance measure (COPM), a client-centred, individualized measure of function, and the functional independence measure (FIM).
Tertiary rehabilitation centre, spinal cord injury unit, GF Strong Rehabilitation Centre, Vancouver, Canada.
Health records from 41 individuals with an SCI admitted between 2000 and 2002 were reviewed. Information was obtained from assessments performed on admission and discharge. Self-care, productivity and leisure problems identified by individuals with an SCI were described and their perceived level of performance and satisfaction was calculated. The relationship between the COPM and the FIM was measured by the Pearson product correlation.
Self-care goals were identified most frequently (79%) followed by productivity (12%) and leisure (9%) goals. The top three problems identified by individuals with an SCI were functional mobility (including transfers and wheelchair use), dressing and grooming. A fair relationship was found between the COPM and the FIM (r between 0.351 and 0.514, P
Notes
Cites: J Rehabil Res Dev. 2001 Nov-Dec;38(6):655-6011767973
Cites: Lancet. 2002 Feb 2;359(9304):417-2511844532
Cites: J Rehabil Med. 2002 Jan;34(1):5-1111900262
Cites: Can J Occup Ther. 2002 Apr;69(2):84-9411977872
Cites: Spinal Cord. 2003 Jan;41(1):44-5212494320
Cites: Adv Clin Rehabil. 1987;1:6-183503663
Cites: Am J Occup Ther. 1993 Apr;47(4):298-3018322870
Cites: Phys Ther. 1994 Jul;74(7):614-28; discussion 628-98016194
Cites: Can J Occup Ther. 1994 Oct;61(4):191-710137673
Cites: Scand J Rehabil Med. 1994 Sep;26(3):115-97801060
Cites: Am J Occup Ther. 1995 Mar;49(3):214-207741154
Cites: Am J Occup Ther. 1995 May;49(5):428-367598158
Cites: Spinal Cord. 1996 Sep;34(9):531-58883187
Cites: Int J Rehabil Res. 1997 Sep;20(3):303-139331579
Cites: Md State Med J. 1965 Feb;14:61-514258950
Cites: Arch Phys Med Rehabil. 1999 Nov;80(11):1471-610569443
PubMed ID
14993893 View in PubMed
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The clinical significance of spinal cord injuries in patients older than 60 years of age.

https://arctichealth.org/en/permalink/ahliterature174460
Source
Acta Neurol Scand. 2005 Jul;112(1):42-7
Publication Type
Article
Date
Jul-2005
Author
E M Hagen
J A Aarli
M. Gronning
Author Affiliation
Department of Clinical Medicine, Section for Neurology, University of Bergen and Haukeland University Hospital, Bergen, Norway. ellen.merete.hagen@helse-bergen.no
Source
Acta Neurol Scand. 2005 Jul;112(1):42-7
Date
Jul-2005
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Cervical Vertebrae - injuries - pathology
Comorbidity
Dislocations - epidemiology - pathology
Female
Hospitalization - statistics & numerical data
Humans
Intervertebral Disc Displacement - epidemiology - pathology
Magnetic Resonance Imaging
Male
Middle Aged
Norway
Risk factors
Spinal Cord - pathology - physiopathology
Spinal Cord Injuries - epidemiology - pathology - rehabilitation
Spinal Fractures - epidemiology - pathology
Spinal Stenosis - epidemiology - pathology
Treatment Outcome
Abstract
To study the causes and the rehabilitation outcome of traumatic spinal cord injury (SCI) in patients older than 60 years at the time of injury.
Forty-four patients were included.
The American Spinal Injury Association Motor Impairment Scale on admission and at discharge and the Functional Independence Measure Motor subscale at discharge were calculated retrospectively according to the patient records. The causes of injury and treatment were obtained. The MRI-scans in patients with cervical injuries during the last 5 years were evaluated.
Thirty-four patients (77%) were injured after falling from a height, 24 with cervical lesions. Thirty-five patients (80%) had incomplete lesions and they had the best outcome with regard to functional level. MR images of 15 patients with cervical lesions revealed preexisting cervical stenosis in 80%.
A high proportion of the patients had a cervical spinal stenosis and incomplete SCI; most of them regained good function.
PubMed ID
15932355 View in PubMed
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Complications in acute phase hospitalization of traumatic spinal cord injury: does surgical timing matter?

https://arctichealth.org/en/permalink/ahliterature116181
Source
J Trauma Acute Care Surg. 2013 Mar;74(3):849-54
Publication Type
Article
Date
Mar-2013
Author
Étienne Bourassa-Moreau
Jean-Marc Mac-Thiong
Debbie Ehrmann Feldman
Cynthia Thompson
Stefan Parent
Author Affiliation
Faculty of Medicine, University of Montreal, Montreal, Canada. etienne.bourassamoreau@gmail.com
Source
J Trauma Acute Care Surg. 2013 Mar;74(3):849-54
Date
Mar-2013
Language
English
Publication Type
Article
Keywords
Adult
Cervical Vertebrae - injuries - surgery
Decompression, Surgical - methods
Female
Hospitalization - statistics & numerical data
Humans
Incidence
Injury Severity Score
Male
Middle Aged
Pneumonia - epidemiology - etiology
Prognosis
Quebec - epidemiology
Retrospective Studies
Spinal Cord Injuries - complications - diagnosis - surgery
Time Factors
Treatment Outcome
Abstract
Optimal timing of surgery after a traumatic spinal cord injury (SCI) is one of the most controversial subjects in spine surgery. We assessed the relationship between surgical timing and the occurrence of nonneurologic postoperative complications during acute hospital stay for patients with a traumatic SCI.
A retrospective cohort study was performed in a single institution. Four hundred thirty-one cases of traumatic SCI were reviewed, and postoperative complications were recorded from the medical charts. Patients were compared using two different surgical timing cutoffs (24 hours and 72 hours). Logistic regression analyses were modeled for complication occurrence. The effect of surgical timing on complication rate was adjusted for potential confounding variables such as the level of injury, American Spinal Injury Association (ASIA) grade, Injury Severity Score (ISS), age, sex, Charlson Comorbidity Index, and Surgical Invasiveness Index.
Patients operated on earlier were younger, had less comorbidity, had a higher ISS, and were more likely to have a cervical lesion and a complete injury (ASIA A). A reduction in the global rate of complications as well as in the rate of pneumonias and pressure ulcers were predicted by surgery performed earlier than 72 hours and 24 hours. Increasing age, more severe ASIA grade, and cervical lesion as well as increased Charlson Comorbidity Index, ISS, and SII were also statistically related to the occurrence of complications.
This study showed that a shorter surgical delay after a traumatic SCI decreases the rate of complications during the acute phase hospitalization. We suggest that patients with traumatic SCI should be promptly operated on earlier than 24 hours following the injury to reduce complications while optimizing neurologic recovery. If medical or practical reasons preclude timing less than 24 hours, efforts should still be made to perform surgery earlier than 72 hours following the SCI.
Prognostic study, level III; therapeutic/care management study, level IV.
PubMed ID
23425747 View in PubMed
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Contribution of nonspinal comorbidity to low back pain outcomes.

https://arctichealth.org/en/permalink/ahliterature166932
Source
Clin J Pain. 2006 Nov-Dec;22(9):765-9
Publication Type
Article
Author
Greg McIntosh
Hamilton Hall
Christina Boyle
Author Affiliation
CBI Health (Canadian Back Institute) Research Department, University of Toronto, Toronto, Ontario, Canada. gmcintosh@cbi.ca
Source
Clin J Pain. 2006 Nov-Dec;22(9):765-9
Language
English
Publication Type
Article
Keywords
Adult
Age Distribution
Canada - epidemiology
Comorbidity
Female
Humans
Incidence
Low Back Pain - diagnosis - epidemiology - therapy
Male
Middle Aged
Outcome Assessment (Health Care) - methods
Prognosis
Risk Assessment - methods
Risk factors
Sex Distribution
Spinal Cord Injuries - diagnosis - epidemiology - therapy
Treatment Outcome
Abstract
To determine the involvement of comorbidity to outcomes in a cohort of acute mechanical low back pain patients.
Incident low back pain cases (n=7077) in the acute or subacute phase assessed between January 1, 1999 and December 31, 2001 were included. Patients were categorized into 1 of 2 groups on the basis of their current medical history: (1) those with at least 1 of 7 medical histories considered (Comorbidity Group, n=539), or (2) those with only low back pain (Back Pain Group, n=6538). Main outcome measures were: change in perceived function and visual analog scale (VAS) pain rating from initial assessment to discharge, and total number of treatment days.
There were no baseline statistically significant differences in VAS pain rating, questionnaire score, or symptom duration between groups. Odds ratios (ORs) were adjusted to reflect age and sex differences between groups. Logistic regression analysis revealed no statistically significant difference for change in functional score (OR=1.002) between groups; there were marginal differences in change in VAS pain rating (OR=1.08) and total number of treatment days (OR=1.006). chi analysis revealed no statistically significant differences in medication use, global pain rating, or pain control ability posttreatment, between groups.
Significant ORs were barely greater than 1.00 and were likely the result of the large sample size. The clinical course for comorbid patients, who may seem more complicated at the start of treatment, is just as favorable.
PubMed ID
17057557 View in PubMed
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53 records – page 1 of 6.