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Study Design: A cost-effectiveness study was performed from the societal and health care perspectives.Objective: To evaluate the costs-effectiveness of lumbar fusion for chronic low back pain (CLBP) during a 2-year follow-up.Summary Of Background Data: A full economic evaluation comparing costs related to treatment effects in patients with CLBP is lacking.Patients and Methods: A total of 284 of 294 patients with CLBP for at least 2 years were randomized to either lumbar fusion or a nonsurgical control group. Costs for the health care sector (direct costs), and costs associated with production losses (indirect costs) were calculated. Societal total costs were identified as the sum of direct and indirect costs. Treatment effects were measured using patient global assessment of improvement, back pain (VAS), functional disability (Owestry), and return to work.Results: The societal total cost per patient (standard deviations) in the surgical group was significantly higher than in the nonsurgical group: Swedish kroner (SEK) 704,000 (254,000) vs. SEK 636,000 (208,000). The cost per patient for the health care sector was significantly higher for the surgical group, SEK 123,000 (60,100) vs. 65,200 (38,400) for the control group. All treatment effects were significantly better after surgery. The incremental cost-effectiveness ratio (ICER), illustrating the extra cost per extra effect unit gained by using fusion instead of nonsurgical treatment, were for improvement: SEK 2,600 (600-5,900), for back pain: SEK 5,200 (1,100-11,500), for Oswestry: SEK 11,300 (1,200-48,000), and for return to work: SEK 4,100 (100-21,400).Conclusion: For both the society and the health care sectors, the 2-year costs for lumbar fusion was significantly higher compared with nonsurgical treatment but all treatment effects were significantly in favor of surgery. The probability of lumbar fusion being cost-effective increased with the value put on extra effect units gained by using surgery. [ABSTRACT FROM AUTHOR]

Objectives: The major aim of this study was to investigate the quality of life [QOL] in a group of patients with chronic low back pain [CLBP] who were surgical candidates and to compare their QOL to patients with fibromyalgia [FMS] as well as to that of adults in the general population [GP]. A secondary aim was to determine whether any demographic, symptom, or psychological factors correlated with QOL. Methods:One hundred patients with CLBP selected for surgery, 99 patients with FMS and 268 randomly selected adults from the Swedish GP completed a questionnaire that included a nonhealth focused quality of life scale-the Quality of Life Scale-Swedish version [QOLS-S]. The GP group was separated into two subgroups-those with low back pain [LBP] and those without LBP. Results: The CLBP surgical candidates, FMS patients, and the GP subgroup with LBP had significantly lower quality of life than the GP subgroup without LBP. Differences between the three pain groups were not significant. The scores of the three pain groups deviated more from those of the GP subgroup without LBP on the QOLS-S physical health and activity items than they did on the items measuring family relationships or social activities. Of all the available predictive variables, only depression showed significant association with QOL. Conclusion: Persons with LBP, whether surgical candidates or in the GP suffer decreases in their QOL that are similar to FMS patients. Severity of depressive symptoms is most predictive of QOL. [ABSTRACT FROM AUTHOR]

Abstract Background The Quality of Life Scale (QOLS), developed originally by John Flanagan in the 1970's, has been adapted for use in chronic illness groups. Evidence for reliability and validity has been published over the years for both English and translations. This paper presents further evidence of construct validity for persons with chronic conditions as well as across two languages, and gender. Methods A sample of 1241 chronically ill and healthy adults from American and Swedish databases was used to generate factor analyses for both the 15-item original QOLS and the 16-item chronic illness adaptation. Results Analysis of the data suggested that the QOLS has three factors in the healthy sample and across chronic conditions, two languages and gender. Factors that could be labeled (1) Relationships and Material Well-Being, (2) Health and Functioning, and (3) Personal, Social and Community Commitment were identified. Conclusions The QOLS is a valid instrument for measuring domains of quality of life across diverse patient groups.

The Questionnaire for Persons with a Transfemoral Amputation (Q-TFA) is a new self-report measure developed for nonelderly transfemoral amputees using a socket- or osseointegrated prosthesis to reflect use, mobility, problems, and global health, each in a separate score (0-100). This paper describes the initial measurement properties of the Q-TFA as completed by 156 persons with a transfemoral amputation using a socket prosthesis (67% male, 92% nonvascular cases, mean age 51 years). Criterion validity was determined by associations between scores of the Q-TFA and the Short-Form 36 (SF-36)-Item Health Survey. Reliability was assessed by retest (n = 48) and by determination of the internal consistency. Correlations between Q-TFA and SF-36-Item Health Survey scales matched hypothesized patterns. Intraclass correlations were between 0.89 and 0.97, and measurement error ranged from 10 to 19 points. Cronbach's alpha revealed good internal consistency, with no values less than 0.7. This study shows that the Q-TFA, applied to persons using a transfemoral socket prosthesis, has adequate initial validity and reliability. [ABSTRACT FROM AUTHOR]

Background: Patients surgically treated for lumbar spinal stenosis or cervical radiculopathy report improvement in approximately two out of three cases. Advancements in Machine Learning and the utility of large datasets have enabled the development of prognostic prediction models within spine surgery. This trial investigates if the use of the postoperative outcome prediction model, the Dialogue Support, can alter patient-reported outcome and satisfaction compared to current practice., Methods: This is a prospective, multicenter clinical trial. Patients referred to a spine clinic with cervical radiculopathy or lumbar spinal stenosis will be screened for eligibility. Participants will be assessed at baseline upon recruitment and at 12 months follow-up. The Dialogue Support will be used on all participants, and they will thereafter be placed into either a surgical or a non-surgical treatment arm, depending on the decision made between patient and surgeon. The surgical treatment group will be studied separately based on diagnosis of either cervical radiculopathy or lumbar spinal stenosis. Both the surgical and the non-surgical group will be compared to a retrospective matched control group retrieved from the Swespine register, on which the Dialogue Support has not been used. The primary outcome measure is global assessment regarding leg/arm pain in the surgical treatment group. Secondary outcome measures include patient satisfaction, Oswestry Disability Index (ODI), EQ-5D, and Numeric Rating Scales (NRS) for pain. In the non-surgical treatment group primary outcome measures are EQ-5D and mortality, as part of a selection bias analysis., Discussion: The findings of this study may provide evidence on whether the use of an advanced digital decision tool can alter patient-reported outcomes after surgery., Trial Registration: The trial was retrospectively registered at ClinicalTrials.gov on April 17th, 2023, NCT05817747., Protocol Version: 1., Trial Design: Clinical multicenter trial., (© 2024. The Author(s).)

Purpose: The Oswestry Disability Index (ODI) and the Neck Disability Index (NDI) scoring algorithms used by the Swedish spine register (Swespine) until April 2022 handled missing items somewhat differently than the original algorithms. The purpose of the current study was to evaluate possible differences in the ODI and NDI scores between the Swespine and the original scoring algorithms., Methods: Patients surgically treated for degenerative conditions of the lumbar or cervical spine between 2003-2019 (lumbar) and 2006-2019 (cervical) were identified in Swespine. Preoperative and 1-year postoperative ODI/NDI data were used to evaluate differences between the Swespine and the original ODI/NDI algorithms with adjustment for at most 1 or 2 missing items using mean imputation., Results: The preoperative as well as the 1-year postoperative ODI/NDI were approximately 1 unit out of 100 smaller for the Swespine algorithm, irrespective of adjustment model. The differences between preoperative and postoperative ODI/NDI scores were similar between the Swespine and the original scoring algorithms. There were occasional statistically significant differences between the preoperative-postoperative differences due to large sample sizes., Conclusions: The Swespine algorithms, used until April 2022, underestimated the ODI and NDI by approximately 1 out of 100 units compared with the original algorithms. In addition, there were no statistically significant differences between the original algorithms when adjusting for at most 1 or 2 missing items. The algorithm has now been changed, also for historical data., (© 2022. The Author(s).)

Infection has been proposed as a cause of back pain in individuals with Modic changes. This review summarises the knowledge on this topic in Scandinavia. A Norwegian randomized controlled trial could not replicate results in favor of antibiotic treatment for such patients. A Danish study demonstrated that patients with low back pain and Modic changes had similar physical disability-scores and less sick leave due to back pain than individuals without Modic changes at long-term follow-up (>10 years). A Swedish study displayed equal bacterial presence in discs of patients operated for lumbar disc herniation and in control patients, indicating that the presence of bacteria is caused by contamination during the surgical procedure and is not related to back pain.