Estimating EQ-5D values from the Neck Disability Index and numeric rating scales for neck and arm pain

2014 ◽  
Vol 21 (3) ◽  
pp. 394-399 ◽  
Author(s):  
Leah Y. Carreon ◽  
Kelly R. Bratcher ◽  
Nandita Das ◽  
Jacob B. Nienhuis ◽  
Steven D. Glassman

Object The Neck Disability Index (NDI) and numeric rating scales (0 to 10) for neck pain and arm pain are widely used cervical spine disease–specific measures. Recent studies have shown that there is a strong relationship between the SF-6D and the NDI such that using a simple linear regression allows for the estimation of an SF-6D value from the NDI alone. Due to ease of administration and scoring, the EQ-5D is increasingly being used as a measure of utility in the clinical setting. The purpose of this study is to determine if the EQ-5D values can be estimated from commonly available cervical spine disease–specific health-related quality of life measures, much like the SF-6D. Methods The EQ-5D, NDI, neck pain score, and arm pain score were prospectively collected in 3732 patients who presented to the authors' clinic with degenerative cervical spine disorders. Correlation coefficients for paired observations from multiple time points between the NDI, neck pain and arm pain scores, and EQ-5D were determined. Regression models were built to estimate the EQ-5D values from the NDI, neck pain, and arm pain scores. Results The mean age of the 3732 patients was 53.3 ± 12.2 years, and 43% were male. Correlations between the EQ-5D and the NDI, neck pain score, and arm pain score were statistically significant (p < 0.0001), with correlation coefficients of −0.77, −0.62, and −0.50, respectively. The regression equation 0.98947 + (−0.00705 × NDI) + (−0.00875 × arm pain score) + (−0.00877 × neck pain score) to predict EQ-5D had an R-square of 0.62 and a root mean square error (RMSE) of 0.146. The model using NDI alone had an R-square of 0.59 and a RMSE of 0.150. The model using the individual NDI items had an R-square of 0.46 and an RMSE of 0.172. The correlation coefficient between the observed and estimated EQ-5D scores was 0.79. There was no statistically significant difference between the actual EQ-5D score (0.603 ± 0.235) and the estimated EQ-5D score (0.603 ± 0.185) using the NDI, neck pain score, and arm pain score regression model. However, rounding off the coefficients to fewer than 5 decimal places produced less accurate results. Conclusions The regression model estimating the EQ-5D from the NDI, neck pain score, and arm pain score accounted for 60% of the variability of the EQ-5D with a relatively large RMSE. This regression model may not be sufficient to accurately or reliably estimate actual EQ-5D values.

2019 ◽  
Vol 4 (22;4) ◽  
pp. E295-E302
Author(s):  
Diab Fuad Hetta

Background: The atlantoaxial joint (AAJ) plays a pivotal role in the cervical spine motion. Unfortunately, it is the most common cervical spine joint that is affected in patients with rheumatoid arthritis. Inflammation of the AAJ results in neck disability, nerve root compression, and finally spinal cord compression. Objectives: We aim to evaluate the efficacy of intraarticular triamcinolone injection of the AAJ on neck pain and disability. Study Design: A prospective randomized, controlled clinical trial. Setting: An interventional pain unit in a tertiary center at a university hospital in Egypt. Methods: Sixty patients with rheumatoid arthritis complaining of AAJ arthritis were randomized into 2 groups. Group AAJI (n = 30) received AAJ injection with 1.0 mL of a mixture of 0.5 mL of bupivacaine 0.5% and 0.5 mL of 20 mg of triamcinolone, in addition to oral placebo tablets (2 tablets every 8 hours for one week). Group SS (n = 30) received systemic steroids, oral prednisolone tablets (5 mg, 2 tablets every 8 hours for one week), in addition to AAJ injection with 1.0 mL of a mixture of 0.5 mL of bupivacaine 0.5% and 0.5 mL of normal saline solution. The percentage of patients who showed ≥ 50% reduction of their visual analog scale (VAS) pain score (measured at 1, 2, and 3 months postoperatively), VAS pain score and neck disability index (NDI) (measured at 2, 4, 6, 8, and 12 weeks postoperatively), and the magnetic resonance imaging (MRI) changes of AAJ (assessed 4 weeks postoperatively) were all evaluated. Results: There was significant reduction in the percentage of patients who showed ≥ 50% reduction of their VAS pain score postoperatively in group AAJI compared with group SS at one month (75% vs. 46.45%; P = 0.033), 2 months (60.7% vs. 25%; P = 0.009), and 3 months (53.6% vs. 17.9%; P = 0.007). There was significant reduction in overall VAS and overall NDI in group AAJI compared with group SS (mean ± standard error) (41.5 ± 2.6 vs. 52.1 ± 2.6; P = 0.005) and (43.7 ± 3.1 vs. 52.4 ± 3.1; P = 0.040), respectively. Analysis of postoperative MRI findings revealed significant improvement of bone marrow edema in group AAJI (AAJI vs. SS) (71.4% vs. 42.9%; P = 0.033), also the synovial enhancement disappeared significantly in group AAJI compared with group SS, (16/22 [72.7%] vs. 10/23 [43.5%]; P = 0.026), moreover, there was a significant reduction in pannus size in group AAJI compared with group SS, (6/10 [60%] vs. 1/9 [11%]; P = 0.041). Limitations: The study follow-up period was limited to only 3 months. Conclusions: For acutely inflamed AAJ due to rheumatoid arthritis, AAJ steroid injection is a potential therapeutic option; it decreased cervical neck pain, improved neck mobility, and hastened recovery of the joint from an acute inflammatory stage. Key words: Rheumatoid arthritis, atlantoaxial joint injection


2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 463.2-464
Author(s):  
A. Alawamy ◽  
M. Hassanien ◽  
E. Talaat ◽  
E. Kamel

Background:Rheumatoid arthritis is a common type of autoimmune arthritis characterized by chronic inflammation. Cervical spine is often affected specially in long lasting diseaseObjectives:Evaluate efficacy of Third occipital nerve Radiofrequency under fluoroscopic guidance to treat refractory cervicogenic headache in RA patients.Methods:The current study was revised and approved from the local ethical committee of Faculty of Medicine; Assiut University, then registered in the clinical trials under the number ofNCT03852355. Inclusion criteria included, Patients who fulfilled the American College of Rheumatology (ACR) (2010) criteria for RA and suffering from upper neck pain and/or headache due to bilateral 3rd occipital nerve involvement, excluding other local cervical spine pathologies was confirmed by MRI and previously failed conservative treatment for at least three months prior to enrollment. Sixty adult patients were randomly assigned to one of the two studied groups Group 1 (RF, n = 30), received bilateral Third occipital nerve Radiofrequency under fluoroscopic guidance or Group 2 (control group, n = 30), received oral prednisolone 10 mg/day. The two groups were then followed-up with neck disability index (NDI), nocturnal neck pain VAS score and headache score every two weeks for three months. Sleep disturbance, sleep disability index were reassessed six months post intervention. Post interventional assessment was done by pain physician who were kept blind to the grouping process.Results:Neck disability index (1ry outcome), Nocturnal pain VAS, and severity of headache showed significant differences during the whole post-interventional study period. The patients in RF group demonstrated significant improvement of pain in comparison to baseline value over the whole six months with p-value < 0.001 as regard to the fore-mentioned three parameters. On the other aspect, the control group patients showed significant improvement in comparison to its baseline value after the 2nd, 12th and 24th weeks only as follows: (0.001,0.003, 0.003 for the NDI) (p values of 0.02,0.01, 0.01 for the nocturnal pain VAS), (0.001 0.009, 0.005 for the headache VAS severity.Conclusion:Radiofrequency of 3rd occipital nerve is effective in treatment of refractory cervicogenic headache in RA.Disclosure of Interests: :None declared


Author(s):  
Kotteeswaran. K ◽  
Chiranjibi Kumar Nayak

Background: Cervical spine dysfunction is a cause of neck pain. The cause for it is believed to be a disorder (most likely malalignment) of the pain-sensitive facet joints (which may also be due to disc disruption). Dysfunction can also cause secondary muscle spasm, which can may lead to more pain and stiffness. Objective: To find the effectiveness of SNAGs and scapular strengthening exercises in the patients with chronic cervical dysfunction. To find the Neck disability index (NDI) score difference between the functional activities of experimental group and conventional treatment group. Methodology: According to inclusion and exclusion criteria a prior to the study, the principal researcher explained the procedures to all the subjects and inform consent obtained, 30 subjects taken through Random block design and numbering was done for all the subjects. All the odd numbers in one group and all the even numbers in another group are allocated by random table where each group had 15 subjects. The collected data was tabulated and analyzed using descriptive and inferential statistics. To all parameters mean and standard deviation (SD) were used. Paired t-test was used to analyze significant changes between pre-test and post-test measurements. Unpaired t-test was used to analyze significant changes between two groups. Result: rom statistical analysis made with the quantitative data revealed statistically significant difference between the Group A and Group B, and also within the group. The Posttest mean value of Neck Disability Index (NDI) in group A is 12.00 and in group B is 13.80. This shows that Neck Disability Index (NDI) in Group B disability value were comparatively more than Group A disability value, P<0.0001. Conclusion: This study shows better improvement in reducing cervical spine dysfunction (neck pain) by scapular strengthening exercise than resisted neck isometrics. Both the techniques can be used in clinical practice.


Author(s):  
MA MacLean ◽  
A Dakson ◽  
F Xavier ◽  
SD Christie ◽  
C Investigators

Background: Many studies have demonstrated improved arm pain (AP) following surgery for degenerative cervical radiculopathy (DCR); however, axial neck pain (NP) is generally not felt to improve. The purpose of this study was to determine whether surgery for DCR improves NP. Methods: A ambispective cohort study of the Canadian Spine Outcomes Research Network (CSORN) registry for patients who received 1-level, 2-level, 3-level ADCF (anterior cervical discectomy and fusion) or cervical disc arthroplasty (CDA) for DCR. Outcomes: 12-month post-operative Visual Analogue Scale for NP (VAS-NP), Neck Disability Index (NDI), VAS for AP (VAS-AP), Short-Form Physical Health Composite Scale (SF36-PCS), and Mental Health Composite Scale (SF36-MCS). Results: We identified 603 patients with DCR. CDA patients were the youngest (ANOVA; p<0.001). Patients reported similar pre-operative AP, NP, disability, and health-related quality of life, regardless of procedure (ANOVA; all P>0.05). All procedures offered a statistically significant reduction in VAS-NP, VAS-AP, and NDI (ANOVA; all P<0.001). Mean change from baseline in NP, AP, and disability, were similar across procedures. At 12 months, mean reduction in VAS-AP, VAS-NP, and NDI exceeded minimal clinically important differences for nearly all procedures. Conclusions: Patients undergoing surgery for DCR can expect a clinically significant, approximate 50% reduction in NP, AP, and neck-related disability.


2013 ◽  
Vol 13 (9) ◽  
pp. S40
Author(s):  
Leah Y. Carreon ◽  
Kelly R. Bratcher ◽  
Nandita Das ◽  
Jacob Nienhuis ◽  
Steven D. Glassman

Spine ◽  
2011 ◽  
Vol 36 (6) ◽  
pp. 490-494 ◽  
Author(s):  
Leah Y. Carreon ◽  
Paul A. Anderson ◽  
Christine M. McDonough ◽  
Mladen Djurasovic ◽  
Steven D. Glassman

2018 ◽  
Vol 100-B (9) ◽  
pp. 1201-1207 ◽  
Author(s):  
N. Kirzner ◽  
G. Etherington ◽  
L. Ton ◽  
P. Chan ◽  
E. Paul ◽  
...  

Aims The purpose of this retrospective study was to investigate the clinical relevance of increased facet joint distraction as a result of anterior cervical decompression and fusion (ACDF) for trauma. Patients and Methods A total of 155 patients (130 men, 25 women. Mean age 42.7 years; 16 to 87) who had undergone ACDF between 1 January 2001 and 1 January 2016 were included in the study. Outcome measures included the Neck Disability Index (NDI) and visual analogue scale (VAS) for pain. Lateral cervical spine radiographs taken in the immediate postoperative period were reviewed to compare the interfacet distance of the operated segment with those of the facet joints above and below. Results There was a statistically significant relationship between greater facet distraction and increased NDI and VAS pain scores. This was further confirmed by Spearman correlation, which showed evidence of a moderate correlation between both NDI score and facet joint distraction (Spearman correlation coefficient 0.34; p < 0.001) and VAS score and facet distraction (Spearman correlation coefficient 0.52; p < 0.001). Furthermore, there was a discernible transition point between outcome scores. Significantly worse outcomes, in terms of both NDI scores (17.8 vs 8.2; p < 0.001) and VAS scores (4.5 vs 1.3; p < 0.001), were seen with facet distraction of 3 mm or more. Patients who went on to have a posterior fusion also had increased NDI and VAS scores, independent of facet distraction. Conclusion After undergoing ACDF for the treatment of cervical spine injury, patients with facet joint distraction of 3 mm or more have worse NDI and VAS pain scores. Cite this article: Bone Joint J 2018;100-B:1201–7.


2011 ◽  
Vol 14 (2) ◽  
pp. 244-249 ◽  
Author(s):  
Joseph B. Stachniak ◽  
Jeffrey D. Diebner ◽  
Estee S. Brunk ◽  
Shelley M. Speed

Object The goal of this study was to demonstrate the incidence of fusion and soft-tissue swelling in multilevel anterior cervical discectomies and fusions (ACDFs) using polyetheretherketone (PEEK) spacers with recombinant human bone morphogenetic protein–2 (rhBMP-2) impregnated in a Type I collagen sponge and titanium plates. Methods A single surgeon performed 30 multilevel ACDFs using PEEK spacers with an rhBMP-2 impregnated collagen sponge (0.4 ml, or the equivalent of 0.6 mg rhBMP-2). Soft-tissue swelling was assessed using cervical spine radiographs on postoperative Day 1 and at 2, 6, and 10 weeks and 6 months after surgery. Incidence of dysphagia was assessed with the Cervical Spine Research Society Swallowing–Quality of Life tool. Clinical success was evaluated with the Neck Disability Index, neck pain scores, and arm pain scores. Final fusion was assessed with CT by an independent neuroradiologist. Results Patients were followed for 6 months unless they had an incomplete fusion; those patients were reassessed at 9 months. Twenty-four patients underwent 2-level ACDFs and 6 underwent 3-level ACDFs were performed on patients with the following risk factors for pseudarthrosis: smoking (33%), diabetes (13%), and obesity (body mass index ≥ 30 [43%]). Seventeen percent of the patients had multiple risk factors. Soft-tissue swelling peaked at 2 weeks regardless of level of surgery or number of levels treated surgically and decreased to near preoperative levels by 6 months. At 2 weeks, Swallowing–Quality of Life evaluation showed 19% of patients frequently choking on food, 4.8% frequently choking when drinking, and 47.6% with frequent food sticking in the throat. Scores continued to improve, and at 6 months, 0% had frequent choking on food, 6.7% had frequent difficulty drinking, and 6.7% had frequent food sticking in the throat. The Neck Disability Index, neck pain, and arm pain scores all improved progressively over 6 months. Incidence of fusion was 95% at 6 months and 100% at 9 months. There were no rehospitalizations or reoperations for soft-tissue swelling or dysphagia. Conclusions Multilevel ACDF procedures using PEEK grafts and rhBMP-2 can be performed safely in patients with multiple risk factors for pseudarthrosis with excellent fusion outcomes.


2021 ◽  
Vol 9 (66) ◽  
pp. 15310-15318
Author(s):  
Shankar Khedkar ◽  
Pooja Sharma

Purpose of present research was to study the effect of 6 weeks Greeva Sanchalan on Cervical Spine Health or work-related neck pain among male IT professionals. Quasi Pre-test Post-test Non-Equivalent research design used to achieve this objective. Non-Probability based Judgemental Sampling Technique, was used to screen samples from 2 different IT firms from Pune city, who were falling under the criteria of using laptop/desktop/computer for ≥5hours/day, between 30-50years of age group, experiencing neck pain/stiffness and were willing to participate in study. Neck Disability Index Questionnaire (NDI) includes 10 measuring sections such as neck pain, personal care, headache, lifting, reading, concentration, sleeping, work, driving, and recreation was used to collecting data. Using ABBA method, total selected 26 IT professionals, were divided into two groups, i.e., experimental (n=13) and control group (n=13). 6 weeks Greeva Sanchalan intervention was developed and implemented to experimental group’s IT professionals only. After 6 weeks, post-test NDI scores were collected for all 26 IT professionals. NDI pre and post test scores were statistically analysed through Descriptive and Inferential statistics using SPSS software. Mean of pre and post NDI scores for experimental group was 7.92 (±1.89) and 5.62 (±1.26) respectively. Similarly Mean of pre and post NDI scores for control group was 7.54 (±2.44) and 7.77 (± 2.98) respectively. On comparing the Mean of pre and post NDI scores with Neck Disability Index standard norms, all 26 IT professionals were falling within mild neck disability category. Mean of change in performance for experimental and control group’s IT professionals were 2.31 (±2.06) and 0.23 (±1.74) respectively. Calculated mean difference of change in performance was 2.54 for 26 IT professionals. Calculated t-value was 3.40(24) at 0.05 significance level (p=0.002; p less than 0.05). According to statistical outcome, 6 weeks Greeva Sanchalan intervention benefitted in reducing neck pain/stiffness related to work among IT professionals, which relieved muscular tension of neck-shoulder region. It improves range of motion (CROM) of cervical pivot joint along with regaining neck muscles flexibility, which also strengthens neck muscles.


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