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EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE

Rivista di Medicina Fisica e Riabilitativa dopo Eventi Patologici


Official Journal of the Italian Society of Physical and Rehabilitation Medicine (SIMFER), European Society of Physical and Rehabilitation Medicine (ESPRM), European Union of Medical Specialists - Physical and Rehabilitation Medicine Section (UEMS-PRM), Mediterranean Forum of Physical and Rehabilitation Medicine (MFPRM), Hellenic Society of Physical and Rehabilitation Medicine (EEFIAP)
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European Journal of Physical and Rehabilitation Medicine 2010 Dicembre;46(4):497-503

lingua: Inglese

The development of a screening instrument to select patients at risk of residual complaints after lumbar disc surgery

Den Boer J. J. 1,2, Oostendorp R. A. B. 2,3,4, Evers A. W. M. 5, Beems T. 6, Borm G. F. 7, Munneke M. 1,2

1 Department of Rehabilitation, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands;
2 Research Centre of Allied Health Sciences, University Medical Centre Radboud, Nijmegen, the Netherlands;
3 Centre for Quality of Care Research (WOK), Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands;
4 Dutch Institute of Allied Health Care, Amersfoort, the Netherlands;
5 Department of Medical Psychology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands;
6 Department of Neurosurgery, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands;
7 Department of Epidemiology and Biostatistics, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands


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AIM: A considerable number of patients who undergo surgery for a lumbosacral radicular syndrome (LRS) continue to experience disability, pain, and loss of work capacity. The goal of the study is to develop a brief screening instrument to identify these patients at risk of residual complaints.
METHODS: In a prospective study of 277 patients, the predictors for the outcomes disability, pain, and loss of work capacity were investigated. The best predictive model was constructed using a stepwise selection procedure (forward selection), which calculates the discriminative power of the model. Based on the relationship between regression coefficients, a clinical prediction rule was derived that predicted the probability of residual complaints after surgery for LRS.
RESULTS: At 6 month follow-up 141 patients (51%) had residual complaints. The discriminative power of the instrument was .78 (AUC). The “Nijmegen Outcome of Lumbar Disc surgery Screening-instrument” (NOLDS) was based on the variables “lower education level”, “younger age”, “pain 3 days postoperatively”, “passive pain coping”, and “fear of movement/(re)injury”.
CONCLUSION: The results of the study are promising, showing that a brief clinical screening instrument can be used to identify patients at risk of residual complaints at 6 months after surgery for LRS. The early identification of patients at risk having residual complaints may make it possible to start tailored treatment early in the rehabilitation process.

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J.denboer@reval.umcn.nl