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Morphology and Hormones associated with Ovulation.
STUDY DESIGN Registry based repeated-measures psychometric validation of the Danish Oswestry Disability Index (ODI) OBJECTIVE. The goal was to use classical and modern psychometric validation methods to assess the measurement properties and the minimally clinical important difference (MCID) of the ODI in a Danish cohort of patients with chronic low back pain (LBP) being treated with spinal surgery. SUMMARY OF BACKGROUND DATA Scores for the ODI, EQ-5D, SF-36, leg pain, back pain, and a general rating of pain item from 800 patients with chronic LBP were extracted from the National Danish Spine Registry (DaneSpine) at baseline and 1-year post spine surgery. METHODS Confirmatory factor analysis (CFA) and item response theory (IRT) models were used to assess the psychometric properties of the ODI. MCID was also calculated based on generic legacy PROMs (EQ-5D and SF-36) and follow up pain scores. RESULTS While ODI did not fit a Rasch model, adequate fit to a CFA and a 2-parameter IRT model was found when accounting for differential item functioning (DIF) across diagnostic subgroups (degenerative spondylolisthesis, spondylosis, spinal stenosis, and herniated intervertebral disc). In addition, each group exhibited substantially different MCID values. CONCLUSION The Danish version of the ODI is valid and responsive, but only within each of the four major diagnosis subgroups degenerative spondylolisthesis, spondylosis, spinal stenosis, and herniated intervertebral disc.Level of Evidence - 2.STUDY DESIGN A multicenter retrospective case series OBJECTIVE. The purpose of this study was to compare the clinical outcomes of a surgical treatment for ASD in the United States (US) with those in Japan (JP) in a matched cohort. SUMMARY OF BACKGROUND DATA Surgical outcomes of thoracic-lumbar-sacral (TLS) spinal fusions in adult spinal deformity (ASD) patients who live in Asian countries are poorly understood. METHODS A total of 300 surgically treated ASDs of age > 50yr with the lowest instrumented vertebra at the pelvis and a minimum follow-up of 2y were consecutively included. Patients were propensity-score matched for age, gender, levels fused, and 2y postop sagittal spinal alignment. Demographic, surgical, and radiographic parameters were compared between the US and JP groups. RESULTS A total of 186 patients were matched by propensity score and were almost identical within these parameters age (US vs. JP 66 ± 8 vs. 65 ± 7y), gender (females 90 vs. 89%), levels fused (10 ± 3 vs. 10 ± 2), 2y C7SVA (5 ± 5 vs. 5 ± 4 cm), 2y PI-LL (9 ± 15° vs. 9 ± 15°), and 2y PT (25 ± 10° vs. 24 ± 10°). ODI scores and SRS-22 function and pain scores were similar at 2y between the US and JP groups (ODI 27 ± 19 vs. 28 ± 14%, p = .72; SRS-22 function 3.6 ± 0.9 vs. 3.6 ± 0.7, p = .54; SRS-22 pain 3.6 ± 1.0 vs. 3.8 ± 0.8, p = .11). However, significantly lower satisfaction was observed in JP than in the US (SRS-22 satisfaction 4.3 ± 0.9 vs. 4.0 ± 0.8, p  less then  .01). CONCLUSIONS Surgical treatment for ASD was similarly effective in patients in the US and in JP. However, satisfaction scores were lower in JP compared to the US. Differences in lifestyle and cultural expectations may impact patient satisfaction following ASD surgery. selleck products LEVEL OF EVIDENCE 3.STUDY DESIGN We performed a comprehensive search of Pubmed, MEDLINE, and EMBASE for all English-language studies of all levels of evidence pertaining to SPORT, in accordance with Preferred Reported Items for Systematic Reviews and Meta-analayses (PRISMA) guidelines. OBJECTIVE We aim to summarize the 10-year clinical outcomes of SPORT and its numerous follow-up studies for degenerative spondylolisthesis. SUMMARY OF BACKGROUND DATA The Spine Patient Outcomes Research Trial (SPORT) was a landmark randomized control trial including approximately 2,500 patients at 13 clinics across the country. SPORT compared surgical and nonoperative management of the three most common spinal pathologies. METHODS Keywords utilized in the literature search included SPORT, spine patient outcomes research trial, degenerative spondylolisthesis, and surgical outcomes. RESULTS The intent-to-treat analysis failed to show a significant difference between patients treated surgically as compared to those treated nonoperatively. However, asically, results of the as-treated analysis determined statically greater improvements in those patients with spondylolisthesis who were treated surgically as compared to those treated nonoperatively. LEVEL OF EVIDENCE 2.STUDY DESIGN Comparative effectiveness study OBJECTIVE. To evaluate factors leading to higher percentage of brace failures in a cohort of North American patients with AIS relative to their peers in Italy. SUMMARY OF BACKGROUND DATA Studies of bracing in USA have shown worse outcomes than studies from European centers, possibly due to sample characteristics or treatment approaches. METHODS Sample Braced patients, age 10-15, Risser less then 3, Cobb 20-40°, observed to Cobb ≥40° and/or ≥Risser 4 selected from prospective databases. Comparators Bracing per BrAIST (TLSO) and ISICO protocol (SPoRT braces with or without SEAS exercises). Baseline characteristics (sex, age, BMI, Risser, Cobb, curve type) and average hrs of brace wear/day. Differences in programs (e.g. SEAS, type of brace, weaning protocol) were captured by a variable named "SITE." OUTCOME Treatment failure (Cobb≥40 before Risser 4). STATISTICS Comparison of baseline characteristics, analyses of risk factors, treatment components and outcomes within and between cohorts using logistic regression. RESULTS 157 BrAIST and 81 ISICO subjects were included. Cohorts were similar at baseline but differed significantly in terms of average hrs of brace wear 18.31 in the ISICO vs. 11.76 in the BrAIST cohort. 12% of the ISICO and 39% of the BrAIST cohort had failed treatment. Age, Risser, Cobb and a thoracic apex predicted failure in both groups. SITE was related to failure (OR = 0.19), indicating lower odds of failure with ISICO vs BrAIST approach. With both SITE and wear time in the model, SITE loose significance. In the final model, the adjusted odds of failure were higher in boys (OR = 3.34), and those with lowest BMI (OR = 9.83); the odds increased with the Cobb angle (OR = 1.23), and decreased with age (OR = 0.41) and hours of wear (OR = 0.86). CONCLUSION Treatment at the ISICO resulted in a lower failure rate, primarily explained by longer average hours of brace wear. LEVEL OF EVIDENCE 3.
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