To investigate whether the duration of pain has an influence on the clinical outcomes of patients with low back pain (LBP) managed through the North East of England Regional Back Pain and Radicular Pain Pathway (NERBPP). The NERBPP is a clinical pathway based upon NICE guidelines (2009) for LBP. Patients with LBP referred onto the NERBPP by their General Practitioner (GP) between May 2015 and January 2017 were included in this evaluation. Data from 635 patients, who provided pre and post data for pain (Numerical rating scale [NRS]), function (Oswestry Disability Index [ODI]) and quality-of-life (EuroQol [EQ5D]), were analysed using a series of covariate adjusted models in SPSS. Patients were categorised into four groups based upon pain duration: <3months, ≥3 to <6months, ≥6months to <12months, ≥12months.Aims
Patients and Methods
The BACK To Health programme is part of the wider North of England back pain and radicular pain pathway. The purpose of this programme is to provide a CPPP approach based on the NICE guidelines CG88 for those with back pain that has not responded to early management and simpler therapies. The purpose of this study is to present preliminary results of this programme. Referral onto the programme occurred through triage and treat practitioners or consultant clinics. A total of 44 patients were referred, with 31 attending the programme. The programme was delivered as a 3 week residential programme, with patients present 9am-5pm Monday to Thursday. A MDT provided an intense programme consisting of education, physical exercise, practical coping strategies and group discussion. The work has received ethical approval from the School of Health and Social Care Research Ethics and Governance committee at Teesside University.Background
Method
Healthcare interventions are under increasing scrutiny regarding cost-effectiveness and outcome measures have revolutionised clinical research. To identify all available outcome questionnaires designed for lowback, lumbar spine pathologies and to perform qualitative analysis of these questionnaires for their clinimetric properties. A comprehensive e-search on PUBMED & EMBASE for all available outcome measures and published review articles for lowback and lumbar spine pathologies was undertaken over a two month period (Nov-Dec 2009). Twenty-eight questionnaires were identified in total. These outcomes questionnaires were evaluated for clinimetric properties viz:- Validity (content, construct & criterion validity) Reliability (internal consistency & reproducibility) Responsiveness and scored on a scale of 0-6 points. Eight outcomes questionnaires had satisfied all clinimetric domains in methodological evaluation (score 6/6). Oswestry disability index (ODI) Roland-Morris disability questionnaire (RMDQ) Aberdeen lowback pain scale Extended Aberdeen spine pain scale Functional rating index Core lowback pain outcome measure Backpain functional scale Maine-Seattle back questionnaire. Sixteen of these questionnaires scored =5 when evaluated for clinimetric domains. RMDQ had the highest number of published and validated translations followed by ODI. Criterion validity was not tested for NASS-AAOS lumbar spine questionnaire. 32%(9/28) of the outcome instruments have undergone methodological evaluation for =3 clinimetric properties. Clinicians should be cautious when choosing appropriate validated outcome measures when evaluating therapeutic/surgical intervention. We suggest use of few validated outcome measures with high clinimetric scores (=5/6) to be made mandatory when reporting clinical results.
Surgery of the spine is associated with blood loss and frequently transfusion, with consequent risk of infection and reactions. It also costly, and puts a strain on national blood banks. A new blood salvage device works by ‘washing’ and centrifuging the blood lost during surgery; which can then be re-transfused into the patient. In a retrospective study 46 consecutive spinal surgeries with Cell Saver were compared with 39 matched surgeries without. Blood loss and units transfused was obtained from the transfusion database and the anaesthetic record. Average blood loss in the Cell saver group was 1382ml compared to 1405ml in the pre-Cell Saver group. Average allogenic transfusion was 1.30 units with cell saver compared to 2.78 units without. An average 2.3 units of lost blood were re-infused in the Cell Saver group. 26 (57%) of the Cell Saver group require no allogenic blood at all, whereas only 10 (26%) of patients in the pre-Cell Saver group had no transfusions. One unit of blood costs £130.52, and the Cell saver device costs £100 per patient. The average cost per patient in the Cell saver group was £270 (any transfusion plus cost of Cell Saver), compared to an average of £368.50 in the pre-Cell Saver group: a saving of £92.50. The Cell Saver decreased blood transfusions by 46% per patient and by 40% overall, a saving of £92.50 per patient. The number of patients receiving no allogenic blood increased by 31%.
It has previously been reported ( EMG data was recorded from 192 subjects across two years (initial contact, 12 months and 24 months). The data were analysed and the spectral half-widths calculated. The ICA method was then applied to the original raw data. As the power spectrum of ECG runs from 0-20Hz the resultant spectra were analysed to calculate which of them had the most signal energy below 20Hz. A high band pass filter was used to remove all signal data below 20Hz from this independent component. This method was chosen as there was signal data present in the chosen spectrum above 20Hz which would be EMG data. Removing data only below 20Hz preserved this EMG data. The components were then re-integrated and re-analysed to calculate the new half-widths. These new half-widths were compared with the originals to generate the results.Introduction
Methods
Previous work( EMG data was recorded from 192 subjects across two years (initial contact, 12 months and 24 months). The data were analysed and SCMs produced. The 30 second test data was split into 30 one second epochs. Colour values were scaled to the individual data set maximum and divided into 12 bands according to frequency strength at a particular point. Median Frequency values were calculated for each epoch and a line of best fit added to the colour map to further aid the diagnosis process. Maps with faulty recordings were excluded and 20 data sets from each group (BP and no BP) selected at random. Four observers were given only 5 minutes instruction and then asked to indicate whether they thought each map belonged to the LBP or no LBP group.Introduction
Methods
