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Although decompression surgery for lumbar spinal canal stenosis (LSS) improves leg symptoms, low back pain (LBP), and disability, the factors related to the improvement of subjective disability have not been studied sufficiently. The purpose of the study was to clarify the relationship between subjective disability and objective physical function parameters. A total of 51 patients who underwent decompression were included and evaluated preoperatively and 6 and 12 months postoperatively. Patient-reported outcomes related to activity limitation due to LBP were evaluated using Roland–Morris disability questionnaire (RDQ) and VAS (Visual Analog Scale). Physical function was assessed using 6-min walk distance (6MWD) and trunk muscle strength. Univariate analysis and multivariable linear regression analysis were performed to identify significant factors for RDQ score change. The 6- and 12-month postoperative RDQ scores, VAS scores, and trunk extensor strength significantly improved relative to the preoperative values. In the univariate analysis, age, changes in VAS (LBP, leg pain, and numbness) scores, and change in 6MWD were associated with the RDQ score change (p < 0.05). Multivariable linear regression showed that 6MWD changes were significantly associated with RDQ score changes, explaining 41% of the variance in the RDQ score change. This study showed the change in 6MWD was significantly associated with the RDQ score change. Our results suggest that improving 6MWD may reduce disability in activities of daily living.

Treatment for lumbar spinal canal stenosis (LSCS) is mainly classified into conservative and surgical therapies. Among conservative therapies, pharmacological treatment is commonly prescribed for LSCS. Meanwhile, surgical treatment is the last option for LSCS. This study aimed to examine the impact of lumbar surgery on pharmacological treatment for patients with LSCS. Consecutive patients aged ≥ 40 years who underwent lumbar surgery for LSCS were identified. A total of 142 patients were retrospectively reviewed for preoperative and 6-month and 1-year postoperative LSCS medications. The results showed that the number of LSCS medications significantly decreased after lumbar surgery. The proportion of the patients taking non-steroidal anti-inflammatory drugs, pregabalin/mirogabalin, opioids, prostaglandin E1 analogs, and neurotropin was significantly decreased after lumbar surgery, but that of the patients taking mecobalamin, acetaminophen, and serotonin-noradrenalin reuptake inhibitors was not significantly changed. Additionally, around 15% of the participants showed an increase in LSCS medications even after lumbar surgery. Multivariable analysis revealed that individuals without improvements in walking ability (RR: 2.7, 95% CI: 1.3–5.9) or social life (RR: 2.3, 95% CI: 1.1–5.0) had a greater risk of a postoperative increase in LSCS medications. The study results may provide physicians with beneficial information on treatment for LSCS.

Study Design: Retrospective observational study. Objectives: There is no consensus to predict improvement of lower back pain (LBP) in lumbar spinal stenosis after decompression surgery. The aim of this study was to evaluate the improvement of LBP and analyze the preoperative predicting factors for residual LBP. Methods: We retrospectively reviewed 119 patients who underwent lumbar decompression surgery without fusion and had a minimum follow-up of 1 year. LBP was evaluated using the numerical rating scale (NRS), Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) LBP score, and Roland-Morris Disability Questionnaire (RMDQ). All patients were divided into LBP improved group (group I) and LBP residual group (group R) according to the NRS score. Radiographic images were examined preoperatively and at the final follow-up. We evaluated spinopelvic radiological parameters and analyzed the differences between group I and group R. Results: LBP was significantly improved after decompression surgery (LBP NRS, 5.7 vs 2.6, P < .001; JOABPEQ LBP score, 41.3 vs 79.6, P < .001; RMDQ, 10.3 vs 3.6, P < .001). Of 119 patients, 94 patients were allocated to group I and 25 was allocated to group R. There was significant difference in preoperative thoracolumbar kyphosis between group I and group R. Conclusions: Most cases of LBP in lumbar spinal stenosis were improved after decompression surgery without fusion. Preoperative thoracolumbar kyphosis predicted residual LBP after decompression surgery.

BackgroundLumbar paraspinal muscle (LPM) is important in spinal stabilization in patients with chronic low back pain (CLBP). However, the electrical properties of LPM in patients with CLBP remain unclear. Electrical impedance myography (EIM) is a novel and non-invasive technique that provides a simple quantitative evaluation of electrical properties of the LPM.PurposeThis study aimed to apply EIM to assess the electrical properties of the LPM between patients with CLBP and healthy control (HC).MethodsThirty participants (15 CLBP participants; 15 healthy controls) were enrolled in the study. Participants in the CLBP group were asked to complete the visual analog scale (VAS), Oswestry Disability Index (ODI), and Roland–Morris Disability Questionnaire (RDQ) to assess the pain intensity and disability in daily life. Independent sample t-tests were adopted to analyze the basic characteristics between the two groups. At 5, 50, 100, and 200 kHz current frequencies, the electrical properties were measured on each side of the LPM. The EIM parameters of resistance (R), reactance (X), phase angle (PA), and Z value were analyzed by one-way analysis of variance (ANOVA), with age as covariate. Spearman's rank correlation coefficient analysis was applied to explore the relationships between the questionnaires and the EIM parameters.ResultsThe R and Z values of bilateral LPM in the CLBP group were significantly larger than those in the HC group; the PA decreased and the X did not change at these four tested current frequencies. At 5 kHz, Z and R on the right side were non-significantly different between patients and HCs. Correlation analysis showed that at 50 kHz, ODI and RDQ scores correlated negatively with the R of the bilateral LPM (r = 0.523, r = 0.581, respectively; p < 0.05). RDQ scores correlated positively with the PA of the right LPM (r = 0.521, p < 0.05).ConclusionThe electrical properties of the bilateral LPM differed between CLBP participants and healthy individuals, regardless of the different frequencies used. These altered electrical properties of the LPM in the patients with CLBP correlated to some extent with disability in daily life.

Background: Lumbar spinal stenosis (LSS) is one of the important health problems in an aging society because it can significantly impair quality of life (QOL) and active daily living (ADL). However, the natural history or long-term change of LSS symptoms is still unclear. The purpose of this study was to clarify the 10-year course of lumbar spinal stenosis (LSS) symptoms in community-dwelling residents of more than 1000 people with prospective data collection. Methods: A total of 1149 subjects were analyzed for the time course of LSS symptoms for ten years. LSS symptoms were assessed using a questionnaire specially designed and validated to detect LSS symptoms without image information such as magnetic resonance imaging. Results: The prevalence of positive LSS symptoms was about 16% in the initial survey and 10-year follow-up. Of the subjects who were LSS positive at the initial survey, 40% showed positive LSS symptoms at follow-up and 60% switched to negative LSS symptoms. According to the multivariable logistic regression analysis, severe depression and positive LSS symptoms were extracted as predictors of the presence of LSS symptoms after a 10-year follow-up. Conclusion: The statistical predictor of the presence of LSS symptoms at 10 years was the presence of LSS symptoms at the initial survey; however, 60% of those who were positive for LSS symptoms at the initial survey were not determined to have LSS symptoms at the 10-year follow-up. This was the same result as at the 1-year and 6-year follow-up.

Background and Objectives: The current options for acute pain control of vertebral compression fracture include hard brace, vertebroplasty, early surgery, and analgesic injection. We hypothesize that the gray ramus communicans nerve block (GRNB) controls the acute pain experienced during vertebral compression fractures. This study assessed the time course of pain control after injection and evaluated the risk factors affecting pain control failure. Materials and methods: Sixty-three patients (24 male, 66.19 ± 15.17 y) with a thoracolumbar vertebral fracture at the T10-L5 spine, who presented to our hospital from November 2018 to October 2019, were included in this retrospective cohort study. GRNB was performed within 1 week of the trauma. The patients were followed up on days 3, 14, 30, 90, and 180 and assessed with the serial visual analog scale (VAS, resting and motion), Oswestry Low Back Disability (ODI) questionnaire, and Roland–Morris Disability Questionnaire (RDQ). The failure group was defined by the need for an additional block or cement injection after a single GRNB. The failure group’s risk factors, such as body mass index, initial thoracolumbar injury classification and severity score, Kummel’s disease, age, bone marrow density (BMD), and underlying disease, were analyzed. Results: The motion VAS score improved from preoperative to three months post-procedure, but the resting VAS was affected by the procedure for only three days. The quality of life index improved at postoperative six months. A lower BMD was the only risk that affected treatment failure in the logistic regression analysis (p = 0.0038). Conclusion: The effect of GRNB was maintained even at three months after trauma based on motion VAS results. The only risk factor identified for GRNB failure was lower BMD.

Background Data: Spondylolysis is the main identifiable cause of low back pain in children and adolescents. The fifth lumbar vertebra (L5) is the most common site for spondylolysis. The cause of spondylolysis in these patients is attributed to repetitive stress of the pars interarticularis with subsequent microfracture;it is believed that an inherited genetic pars weakness can make an individual more susceptible to spondylolysis.There are varieties of surgical techniques in the treatment of spondylolisthesis whether the traditional surgical fusion and instrumental fixation or the direct pars repair if no evident slippage, disc degeneration or canal stenosis. Purpose: Evaluations of the efficacy of pars repair as regard bony fusion, preservation of motion segment with no adjacent level disease. Patients and Methods: our study was conducted on10 patients with diagnosed isthmic spondylolysis.Three males and seven females were operated (between 2016- 2018) by direct pars repair using smile face shaped rod technique (V shaped rod technique) with insertion of iliac crest bone graft at the site of the defect bilaterally to enhance bony fusion at the fracture site. Age less than 30years, Weight less than 80kg, back pain not responding to conservative treatment. No slippage or less than 2mm, healthy disc space not degenerated, no disc herniation or canal stenosis, no previous disc operation, preserved sagittal balance and lumber lordosis. Results: All cases were assessed clinically and radiologically over one year to assess the improvement in back pain using RMQ and to assess bony fusion radiologically through PXR and CT lumbosacral spine. Good outcome was achieved in seven cases (70% of patients) with significant improvement in back pain and RMQ. Two cases (20% of patients) had fair outcome with occasional back pain occur with sports and strenuous activities. 1 case (10% of patients) had poor out come as the patient exposed to back trauma that lead to fracture of the L5 screw and operated again for traditional surgery with 4 screws, 2 rods and cage placemen. Par bony fusion was sound in all cases except one patient that was subjected to direct back trauma 3 months following surgery and had one screw fracture, that required redo surgery with formal fixation using 4 screws, 2 rods and intervertebral cage Conclusion: Direct pars repair can provide good functional outcomes in young adult patients with isthmic spondylolysis.

Background Substantial investment has gone into research on the efficacy and effectiveness of pharmaceutical and nonpharmacologic interventions for chronic pain. However, synthesizing this extensive literature is challenging because of differences in the outcome measures used in studies of similar or competing interventions. The absence of a common metric makes it difficult to replicate findings, pool data from multiple studies, resolve conflicting conclusions, or reach consensus when interpreting findings. Methods This study has a seven-member Advisory Council of chronic pain experts. Preliminary analyses will be performed on data from several large existing datasets; intermediate analyses will be performed using primary data collected from Amazon’s Mechanical Turk (MTurk); and cross-validation will use primary data collected from a nationally-representative, probability-based panel. Target sample size for both primary datasets is 1500. The three study aims are as follows: Aim 1 will develop and evaluate links between the 29-item Patient-Reported Outcomes Measurement Information System (PROMIS®-29) and legacy measures used for chronic pain such as the Roland-Morris Disability Questionnaire (RMDQ) and the Oswestry Disability Index (ODI). We will assess the best method of score linking and create crosswalk tables. Aim 2 will evaluate and refine the Impact Stratification Score (ISS) based on 9 PROMIS-29 items and proposed by the NIH Research Task Force on chronic low back pain. We will evaluate the ISS in terms of other indicators of condition severity and patient prognosis and outcomes and identify cut-points to stratify chronic pain patients into subgroups. Aim 3 will evaluate the strengths and limitations of MTurk as a data collection platform for estimating chronic pain by comparing its data to other data sources. Discussion The accomplishment of Aims 1 and 2 will allow direct comparison of results across past and future studies of chronic pain. These comparisons will help us to understand different results from seemingly similar studies, and to determine the relative effectiveness of all pharmaceutical and nonpharmacologic interventions for chronic pain across different trials. Aim 3 findings will provide valuable information to researchers about the pros and cons of using the MTurk platform for research-based data collection. Trial registration ClinicalTrials.gov: NCT04426812; June 10, 2020.

Chronic low back pain (LBP) is a common condition and is generally treated using non-steroidal anti-inflammatory drug (NSAID); however, chronic NSAID use can decrease renal function. Tramadol, a weak opioid agonist, may improve chronic LBP and disability, while avoiding adverse effects such as gastrointestinal and renal toxicity. However, few studies have evaluated the short-term efficacy of opioids in Asian patients with chronic LBP. In this study, 24 patients with chronic LBP unresponsive to NSAIDs (10 men, 14 women; mean age, 65.1 ± 12.1 years) were prescribed tramadol/acetaminophen (37.5 mg/325 mg; four tablets daily) for 1 month. Then, the following parameters were assessed at baseline and after 1 week and 1 month of treatment: leg pain and LBP (Visual Analog Score [VAS]); activity of daily life (Roland-Morris Disability Questionnaire [RDQ]); and disability (Oswestry Disability Index [ODI]). Leg pain resolved within 1 week (p = 0.00093); however, LBP was relieved only at 1 month (p = 0.00034). The mean RDQ (p = 0.015) and ODI (p = 0.0032) scores were improved at 1 month. A total 41.6% of patients reported nausea and floating sensation beginning tramadol/acetaminophen treatment, and 12.5% (four patients) discontinued treatment as a result. LBP did not improve in 25% of patients administered tramadol/acetaminophen. Because this was an observational study, rather than a comparative study, further investigation is needed to evaluate the long-term efficacy of tramadol/acetaminophen in elderly patients with chronic LBP unresponsive to NSAIDs.

Study Design:Prospective longitudinal validation studyObjective:To translate and cross-culturally adapt the Oswestry Disability Index (ODI) to the Tamil language (ODI-T), and to evaluate its reliability and construct validity.Summary of Background Data:ODI is widely used as a disease specific questionnaire in back pain patients to evaluate pain and disability. A thorough literature search revealed that the Tamil version of the ODI has not been previously published.Methods:The ODI was translated and cross-culturally adapted to the Tamil language according to established guidelines. 30 subjects (16 women and 14 men) with a mean age of 42.7 years (S.D. 13.6; Range 22 - 69) with low back pain were recruited to assess the psychometric properties of the ODI-T Questionnaire. Patients completed the ODI-T, Roland-Morris disability questionnaire (RMDQ), VAS-pain and VAS-disability at baseline and 24-72 hours from the baseline visit.Results:The ODI-T displayed a high degree of internal consistency, with a Cronbach's alpha of 0.92. The test-retest reliability was high (n=30) with an ICC of 0.92 (95% CI, 0.84 to 0.96) and a mean re-test difference of 2.6 points lower on re-test. The ODI-T scores exhibited a strong correlation with the RMDQ scores (r = 0.82) pConclusion:The Tamil version of the ODI Questionnaire is a valid and reliable tool that can be used to measure subjective outcomes of pain and disability in Tamil speaking patients with low back pain.

Context and Aim: The assessment of severity of low back pain includes subjective questionnaires to quantify the impact on routine life. The objective of current study was to correlate various quality of life (QOL) scores to the clinical outcome measured as improvement in Visual Analog Score (VAS) after interventional treatment. Subjects and Methods: Fifty-one consecutive chronic low backache patients were assessed for pain intensity using VAS, revised Oswestry Disability Index (ODI), Quebec's, Roland–Morris disability questionnaire (RMDQ), and depression score at presentation. All subjects received interventional therapy complemented with physiotherapy; changes in scores were evaluated at 2 weekly intervals till 12 weeks. Type of Study: Prospective, observational, cohort study. Results: All scores depicted highly significant statistical improvement over baseline scores (P < 0.001). The Pearson correlation of VAS with rest of the scores showed that all variables correlate well with VAS at various time periods till 3 months. However, the best outcome predictor for VAS in QOL scores was Oswestry score as well as depression score which had an additive predictive effect. Among the QOL scores best intercorrelation was found with ODI and RMDQ scores at baseline as well as at all treatment follow-ups. Interpretation and Conclusion: ODI and depression score closely parallel trends of reduction in VAS indicating that these scores may be the best outcome predictor after interventional treatment of pain. Among QOL scores ODI and RMDQ evaluated in the current study record comparable degree of physical incapacity; the exception is Quebec's score.

The aims of this study were; 1) to develop the final version of the Korean Roland-Morris Disability Questionnaire (RDQ), and 2) to compare the responsiveness between the RDQ and the Oswestry Disability Index (ODI) scores in patients having low back pain. The psychometric properties of the final Korean RDQ were evaluated in 221 patients. Among them, 30 patients were reliability tested. Validity was evaluated using an 11-point numerical rating scale (NRS) and the Korean ODI. The receiver operating characteristic (ROC) curve analysis of the RDQ and the ODI was compared in 54 patients with lumbar zygapophyseal (facet) joint pain. There was a moderate relationship between the RDQ and NRS (r = 0.59, P < 0.01) and a strongly positive correlation between the RDQ and the ODI (r = 0.76, P < 0.001). The Korean RDQ with the higher area under the ROC curve showed a better overall responsive performance than did the ODI in patients with lumbar facet joint pain after medial branch radiofrequency neurotomy (P < 0.01). The results of the study present the final version of the Korean RDQ is valid for assessing functional status in a Korean population with chronic low back pain.

Lumbago is one of the most prevalent symptoms in patients with osteoporotic vertebral fracture. Roland-Morris Disability Questionnaire (RDQ) is a quality of life (QOL) questionnaire targeted for evaluating lumbago. Although total score is the usual way of analysis, we have tried to make more use of it by subscale analysis. Forty-four osteoporotic patients were evaluated for their QOL using RDQ and SF-8; a widely accepted generic (non disease-specific) QOL questionnaire. Subscales and summary scores of SF-8 were significantly lower than Japanese norm. Patients with fracture had significantly lower scores including RDQ. Multiple regression analysis has shown that total score of RDQ was significantly contributed by bodily pain as well as other subscales of SF-8. Principal component analysis has revealed that RDQ consists of two components representing general, and mental or social aspect of lumbago. Defining the component structure and determining the procedure to obtain the subscales would make the most use of RDQ, and contribute to the better evaluation of patients with lumbago.

Purpose: Functional status measures are currently not widely used in South Africa to facilitate clinical decision-making or document treatment outcomes for patients with low back pain (LBP). This study investigated the internal consistency and clinical utility of a back-specific functional status measure, the Roland Morris Disability Questionnaire (RMDQ), and determined its ability to confirm the need for spinal fusion surgery. Method: Aretrospective, descriptive design was used with 42 patients with chronic mechanical low back pain who consulted a private Orthopaedic surgeon in Cape Town over a one year period. All patients completed the RMDQ prior to their consultation. On completion of the medical examination, a rating for surgery was determined for each patient. The completed questionnaires were analysed using Statistical Package for the Social Sciences (SPSS). Results: The mean RMDQ score was 8.6 (N=42; median=9.0; range=2-21). Cronbach’s alpha showed a high internal consistency between items (.92). A categorical principal component analysis (CATPCA) identified two distinct dimensions in the RMDQ. Item reduction improved the internal consistency and thus the construct validity of the RMDQ. There was a low correlation between the surgeon’s rating for surgery and RMDQ scores (r=.40; P

MANAGING MISSING SCORES ON THE ROLAND MORRIS DISABILITY QUESTIONNAIRE Peter Kenta and Henrik Hein Lauridsenb aBack Research Centre and bInstitute of Sports Science and Clinical Biomechanics, University of Southern DenmarkBackgroundThere is no standard method to calculate Roland Morris Disability Questionnaire (RMDQ) sum scores when one or more questions have not been answered. However, missing data are common on the RMDQ and the current options are: calculate a sum score regardless of unanswered questions, reject all data containing unanswered questions, or to impute scores. Other questionnaires, such as the Oswestry Disability Index (Oswestry) convert their raw score into a standardized score out of 100. An advantage of this method is that it allows missing data to be accommodated by proportional recalculation. For example, if 17 questions had been answered ’yes’ on a RMDQ questionnaire containing 23 yes/no questions, a raw sum score of 17 would be a standardized score of 74/100 if all 23 questions were answered (17/23 x 100/23). However, the raw sum score of 17 would be proportionally recalculated to a standardized score of 85/100 if 3 questions had not been answered (17/20 x 100/20). Quantification of the measurement error introduced when using this method would allow determination of whether it is a valid strategy.The aim of this study was to quantify the measurement error in RMDQ (standardized) scores when one or more questions were unanswered and to compare this with the measurement error present when the Oswestry was scored in the same way.Methods· For each of 311 fully completed RMDQ23 questionnaires from people seeking primary or secondary care, a sum score was calculated and standardized to a 100-point scale.· Using random number generation, questions were systematically dropped from each person’s raw scores and the standardized score was proportionally recalculated. This process was repeated until 6 questions had been dropped from each person’s questionnaire.· The error (absolute and percentage) introduced by each level of dropped question was calculated for each person’s score. The absolute error was the number of standardized RMDQ points that the proportionally recalculated score varied from the original standardized score. The percentage error was the absolute error expressed as a proportion of the original standardized score.· This process was repeated using the Oswestry scores from the same people.Results· The mean standardized score for the RMDQ23 was 49/100 (SD25, range 4-91) and for the Oswestry was 37/100 (SD13, range 3-74).· The absolute error from a RMDQ23 standardized score ranged from a mean of 2 (SD2, range 0-9) when 1 question was dropped to a mean of 4 (SD3, range 0-20) when 6 questions were dropped.· The proportional error from a RMDQ23 standardized score ranged from a mean of 6.6% (SD5.8%, range 0.0%-38.3%) when 1 question was dropped to a mean of 13.9% (SD15.9%, range 0.4%-100.0%) when 6 questions were dropped.· These results were equal to or less than those found when dropping the same number of questions from the Oswestry. ConclusionsThe practice of expressing RMDQ scores as a standardized score allows missing data to be accommodated by proportional recalculation and is as valid for the RMDQ23 as it is for the Oswestry.

There is a paucity of locally developed functional status measures to assess the disability of patients with low back pain. This study sought to adapt a well-known disability measure with good psychometric properties for local use. A Hong Kong Chinese version of the Roland-Morris Disability Questionnaire (RMDQ-HK) was produced by forward and backward translations of the original questionnaire. The reliability, validity and responsiveness of the RMDQ-HK were examined in 112 patients with low back pain attending 11 physiotherapy outpatient departments of the Hong Kong Hospital Authority. Item analysis showed that all except one item had satisfactory discriminative ability. The test-retest reliability of the RMDQ-HK was 0.94 (intraclass correlation coefficient, ICC[1,1]; 95% confidence interval, CI, 0.90-0.97). Its internal consistency was 0.86 (Kuder-Richardson 20 coefficient; 95% CI, 0.82-0.89). A change of 4 RMDQ-HK points with 95% CI indicated a true change rather than random variation. The standardized response mean of the RMDQ-HK was 1.22. Using a criterion of at least 70% improvement in overall condition for clinically important change from treatment commencement to discharge, change scores of 3, 6 and 9 RMDQ-HK points were considered clinically important for patients initially with mild (RMDQ-HK, 0-8), moderate (RMDQ-HK, 9-16) and high (RMDQ-HK, 17-24) severity, respectively. However, there was little correlation between mean change in RMDQ-HK score and global rating of change in overall condition at discharge (rs = −0.22, p = 0.02). Greater correlation was obtained between the mean change score of pain rating and the global rating of change (rs = −0.44, p < 0.001). Patients might have based the rating of their change in overall condition at discharge more on change in pain intensity than on change in functional disability. Overall, the test-retest reliability, internal consistency and responsiveness of the RMDQ-HK were high. Further investigations of the content validity and construct validity of the RMDQ-HK are recommended.