Ewa Misterska

Polish adaptation of scoliosis research society-22 questionnaire.

Study Design. Polish adaptation of the original version of Scoliosis Research Society (SRS) instrument. Objective. The transcultural adaptation of SRS-22 and evaluation of its internal consistency. Summary of Background Data. High psychometric value of the SRS-22 Questionnaire has made it an effective evaluation instrument in clinically assessing the functional status of patients with adolescent idiopathic scoliosis. Methods. First, 2 translators translated the original version into Polish. Afterwards, the translators identified differences between the translations and produced a consensus version. In the third stage, 2 native English speakers produced back translations. Finally, a team of 2 orthopedic surgeons, translators, a statistician and a psychologist reviewed all the translations to produce a prefinal version. The questionnaire was administered to 60 girls at the age of 16.6, SD 2.0 with adolescent idiopathic scoliosis treated with the Cotrel–Dubousset method in Pediatric Orthopaedics and Traumatology Clinic in Poznań. Results. The internal consistency in the Polish version equaled 0.89 for the overall result and 0.81 for function, 0.81 for pain, 0.80 for mental health, 0.77 for self-image, and 0.69 for treatment satisfaction domains, respectively. Conclusion. The Polish version of SRS-22 is characterized by high internal consistency for all domains and for the overall score, which makes it an evaluation tool after surgical treatment compatible with the original SRS-22.

Cross-cultural adaptation of the Neck Disability Index and Copenhagen Neck Functional Disability Scale for patients with neck pain due to degenerative and discopathic disorders. Psychometric properties of the Polish versions.

BackgroundEven though there are several region-specific functional outcome questionnaires measuring neck disorders that have been developed in English-speaking countries, no Polish version has ever been validated. The purpose of our study was to translate, culturally adapt and validate the Neck Disability Index (NDI) and Copenhagen Neck Functional Disability Scale (CDS) for Polish-speaking patients with neck pain.MethodsThe translation was carried out according to the International Quality of Life Association (IQOLA) Project. Sixty patients were treated due to degenerative and discopathic disorders in the cervical spine filled out the NDI-PL and the CDS-PL. The pain level was evaluated using the Visual Analog Scale. The mean age of the assessed group was 47.1 years (SD 8.9). We used Cronbachs alpha to assess internal consistency. We assessed the test-retest reliability using the Intraclass Correlation Coefficients (ICCs). The Spearmans rank correlation coefficient (rS) was used to determine dependency between quantitative characteristics. The Mann-Whitney test was applied to determine dependency between quantitative and qualitative characteristics.ResultsThe Cronbachs alpha values were excellent for the NDI-PL in the test and in the retest (0.84, 0.85, respectively), and for the CDS-PL (0.90 in the test and in the retest). Intraclass Correlation Coefficients were excellent for the CDS-PL and NDI-PL and equalled 0.93 (95% CI from 0.89 to 0.95) and 0.87 (95% CI from 0.80 to 0.92), respectively The concurrent validity was good in the test and in the retest (rs = 0.42 p < 0.001; rs = 0.40 p = 0.002, respectively) for NDI-PL and for CDS-PL (rs = 0.42 p < 0.001; rs = 0.40 p = 0.001, respectively). The adapted questionnaires showed a strong inter-correlation both in the test (0.87 p < 0.001) and in the retest (0.79 p < 0.001).ConclusionsThe present versions of the NDI-PL and CDS-PL, the first to be published in Polish, have proven to be reliable and valid for patients with degenerative changes in the cervical spine. The NDI-PL and CDS-PL have excellent internal consistency and test-retest reliability, and good concurrent validity. The adapted questionnaires showed a strong inter-correlation both in the test and in the retest. No ceiling or floor effects were detected in the NDI-PL and CDS-PL. The NDI-PL and CDS-PL are comparable with other versions and can be recommended and used in international comparative studies.

Polish adaptation of Bad Sobernheim Stress Questionnaire-Brace and Bad Sobernheim Stress Questionnaire-Deformity

Bad Sobernheim Stress Questionnaire-Brace and Bad Sobernheim Stress Questionnaire-Deformity are relatively new tools aimed at facilitating the evaluation of long-term results of therapy in persons with idiopathic scoliosis undergoing conservative treatment. To use these tools properly in Poland, they must be translated into Polish and adapted to the Polish cultural settings. The process of cultural adaptation of the questionnaires was compliant with the guidelines of International Quality of Life Assessment (IQOLA) Project. In the first stage, two independent translators converted the originals into Polish. Stage two, consisted of a comparison of the originals and two translated versions. During that stage, the team of two translators and authors of the project identified differences in those translations and created a combination of the two. In the third stage, two independent translators, who were native speakers of German, translated the adjusted version of the Polish translation into the language of the original document. At the last stage, a commission composed of: specialists in orthopedics, translators, a statistician and a psychologist reviewed all translations and drafted a pre-final version of the questionnaires. Thirty-five adolescent girls with idiopathic scoliosis who were treated with Cheneau brace were subjected to the questionnaire assessment. All patients were treated in an out-patient setting by a specialist in orthopedics at the Chair and Clinic of Orthopedics and Traumatology. Median age of patients was 14.8 SD 1.5, median value of the Cobb’s angle was 27.8° SD 7.4. 48.6% of patients had thoracic scoliosis, 31.4% had thoracolumbar scoliosis, and 20% patients had lumbar scoliosis. Median results obtained by means of the Polish version of BSSQ-Brace and BSSQ-Deformity questionnaires were 17.9 SD 5.0 and 11.3 SD 4.7, respectively. Internal consistency of BSSQ-Brace and BSSQ-Deformity was at the level of 0.80 and 0.87, whereas the value of the absolute stability factor was 0.82 and 0.88. Overall, the Polish versions of the BSSQ-Brace and BSSQ-Deformity Questionnaires are characterized by high values of internal consistency factor and absolute stability factor. Following the process of adaptation, the authors obtained a tool that is instrumental in clinical evaluations and complies with methodological criteria.

Quebec Back Pain Disability Scale, Low Back Outcome Score and Revised Oswestry Low Back Pain Disability Scale for Patients With Low Back Pain Due to Degenerative Disc Disease: Evaluation of Polish Versions

Study Design. Evaluation and comparison of translated and culturally adapted self-reported measurements. Objective. The aim of this prospective study was to cross-culturally adapt the Polish versions of Revised Oswestry Disability Index (RODI-PL), Quebec Back Pain Disability Scale (QDS-PL), and the Low Back Outcome Score (LBOS-PL). Summary of Background Data. The application of instruments in English, which have undergone translation must be subjected to validation studies. Such studies are necessary above all for instruments that have been adapted to establish their value and usefulness in studies of patient populations where English is not the native language. Methods. The translation was carried out according to International Quality of Life Association (IQOLA) Project and consisted of the following stages: translation, synthesis of the translations, back translation, expert committee, and testing of the prefinal versions of questionnaires. Eighty-five consecutive patients with low back pain due to spinal disc herniation and degenerative changes completed the QDS-PL, RODI-PL, LBOS-PL, and a Visual Analogue Scale twice within 2-day intervals. Mean duration of LBP was 45.9 months SD 55.5. The evaluation of degenerative changes in the lumbar region was carried out according to the Modic scale. Twenty-nine patients were categorized at type I, 4 patients were registered as type II, and 52 patients were type III. Results. Cronbach &agr; values for the LBOS-PL equaled 0.77, for the RODI-PL 0.85, and 0.95 for the QDS-PL. Item-total correlation confirmed that all scales are internally consistent. Test-retest reliability was excellent for RODI-PL and QDS-PL, but poor for LBOS-PL (0.88, 0.93, and 0.34, respectively). All questionnaires were significantly intercorrelated. We identified the strongest correlation between QDS-PL and RODI-PL (0.823, P < 0.001). The statistically significant correlation was identified between the QDS-PL and Modic Classification (rS = 0.226 P = 0.038). Conclusion. QBPDS-PL and RODI-PL are reliable and valid. Furthermore, investigation of the psychometric properties of the LBOS-PL in different spinal conditions is required. There is a relation between the results of the QDS-PL, and different levels of advancement in degenerative disease of the lumbar spine, according to the Modic Classification.

Chronic pain coping styles in patients with herniated lumbar discs and coexisting spondylotic changes treated surgically: Considering clinical pain characteristics, degenerative changes, disability, mood disturbances, and beliefs about pain control

Background Pain catastrophizing, appraisals of pain control, styles of coping, and social support have been suggested to affect functioning in patients with low back pain. We investigated the relation of chronic pain coping strategies to psychological variables and clinical data, in patients treated surgically due to lumbar disc herniation and coexisting spondylotic changes. Material/Methods The average age of study participants (n=90) was 43.47 years (SD 10.21). Patients completed the Polish versions of the Chronic Pain Coping Inventory-42 (PL-CPCI-42), Beck Depression Inventory (BDI-PL), Coping Strategies Questionnaire (CSQ-PL), Beliefs about Pain Control Questionnaire (BPCQ-PL), and Roland-Morris Disability Questionnaire (RMQ-PL). Results In the PL-CPCI-42 results, resting, guarding and coping self-statements were frequently used as coping strategies (3.96 SD 1.97; 3.72 SD 1.72; 3.47 SD 2.02, respectively). In the CSQ-PL domains, catastrophizing and praying/hoping were frequently used as coping strategies (3.62 SD 1.19). The mean score obtained from the BDI-PL was 11.86 SD 7.23, and 12.70 SD 5.49 from the RMDQ-PL. BPCQ-PL results indicate that the highest score was in the subscale measuring beliefs that powerful others can control pain (4.36 SD 0.97). Exercise correlated significantly with beliefs about internal control of pain (rs=0.22). We identified associations between radiating pain and guarding (p=0.038) and between sports recreation and guarding (p=0.013) and task persistence (p=0.041). Conclusions Back pain characteristics, depressive mood, disability, and beliefs about personal control of pain are related to chronic LBP coping styles. Most of the variables related to advancement of degenerative changes were not associated with coping efforts.

Brace and deformity-related stress level in females with adolescent idiopathic scoliosis based on the Bad Sobernheim Stress Questionnaires

Summary Background Psychopathological symptoms occur more often in chronically ill patients than in healthy populations. The aim of this study was to analyze the associations between different types of treatment and stress levels. Material/Methods The study group consisted of 69 females, of whom 35 were treated conservatively with a Cheneau brace; the other 34 subjects were treated operatively and, after correction of scoliosis with thoracoplasty, wore a brace for 12 weeks during the postoperative period. Patients completed the Polish versions of the Bad Sobernheim Stress Questionnaire-Deformity and the Bad Sobernheim Stress Questionnaire-Brace. Results Patients who were treated surgically felt a moderate level of stress connected with wearing the brace and with body deformation. The group treated conservatively felt moderate stress connected with wearing the brace, but a low level of stress in relation to body deformation. The groups differed significantly statistically in the level of stress felt regarding body deformation (p=0.004). In the group treated conservatively, the correlation between the level of stress, the age at which treatment was initiated, and degree of apical translation proved to be significant. Conclusions Patients treated surgically in comparison with patients treated conservatively report higher stress levels connected with body deformation. A higher level of stress depends on the degree of trunk deformation on the frontal plane; stress is also higher in patients who begin conservative treatment at a later age.

Co‑culture of human nucleus pulposus cells with multipotent mesenchymal stromal cells from human bone marrow reveals formation of tunnelling nanotubes

Degeneration of the intervertebral disc (IVD) is the main cause of age-related damage of spinal tissues. Using multipotent mesenchymal stromal cells (MSCs) regenerative medicine intends to restore the IVD components of annulus fibrosus (AF) and nucleus pulposus (NP). In the present study NP cells (NPCs) and MSCs obtained from adolescent patients suffering from scoliosis were used. IVDs and vertebrae were obtained during surgery and subsequently processed in order to establish cultures of NPCs and MSCs. The two cell types were co-cultured in 1-µm pore size insert system (indirect co-culture) or on one surface (direct co-culture). Prior to co-culture in these systems one of the cell types was stained by lipophilic fluorescent dye DiD (red). The results demonstrated that regardless of the cell type, the flow of DiD from stained to non-stained cells was more efficient in the direct co-culture in comparison with the insert system. Moreover, in the direct system the DiD flow was more efficient from MSCs towards NPCs compared with that in the opposite direction. These data indicated that the membrane interchange between the two cell types was asymmetric. To discriminate the subpopulation of cells that underwent membrane interchange, cells were double stained with DiD and DiO (green). In the first part of the experiment NPCs were stained by DiO and MSCs by DiD. In the second, NPCs were stained by DiD and MSCs by DiO. The cells were co-cultured in the direct system for 8 days and subsequently analyzed by flow cytometry and confocal microscopy. This analysis revealed that >50% of cells were stained by the DiO and DiD dyes. NPCs and MSCs formed structures similar to tunnelling nanotubes (TnT). In conclusion, the formation of TnT-like structures is able to promote, phenotypic changes during the direct co-culture of NPCs with MSCs.

Kinesiophobia in Pre-Operative Patients with Cervical Discopathy and Coexisting Degenerative Changes in Relation to Pain-Related Variables, Psychological State and Sports Activity

Background No research group has ever investigated the level of kinesiophobia in a well defined group of preoperative patients treated due to cervical discopathy and degenerative spine disease, confirmed by X-ray and magnetic resonance imaging (MRI) examinations. We aimed to investigate the degree of kinesiophobia and the differences in pain-related and psychosocial characteristics between patients with high and low levels of kinesiophobia, in relation to factors commonly associated with neck pain. Material/Methods Sixty-five consecutive patients with cervical discopathy and coexisting degenerative changes were assessed pre-surgically. The mean pain duration was 31.7 SD 34.0 months. Patients completed the Polish versions of the Tampa Scale for Kinesiophobia (TSK-PL) on 2 occasions, and the following once: Neck Disability Index (NDI-PL), State-Trait Anxiety Inventory (STAI-PL), Coping Strategies Questionnaire (CSQ-PL), and the Visual Analogue Scale (VAS-PL). Results A high level of kinesiophobia was indicated in 81.5% and 87.7% of patients in first and second completion, respectively. Patients with high and low kinesiophobia differ in regards to the recreation section of NDI-PL (p=0.012), gender (p=0.043), and sports activity (p=0.024). Correlations were identified between TSK-PL and marital status (p=0.023) and sports activity (p=0.024). Conclusions Kinesiophobia levels are higher in patients with chronic cervical pain before surgical treatment. Fear of movement tends to be higher in women and among patients avoiding sports recreation before surgical treatment. Although sports activity and socio-demographic data are predictors of kinesiophobia, psychological, pain-related, and clinical data are not. These findings should be considered when planning rehabilitation after surgical treatment of cervical discopathy and coexisting degenerative changes.

Psychometric properties of the Polish language version of the chronic pain coping inventory-42 for patients treated surgically due to herniated lumbar discs and spondylotic changes.

Background The development of a pain-management program tailored to the specific needs of patients with chronic low back pain (CLBP) requires the proper assessment of psychosocial factors affecting each individual. The Chronic Pain Coping Inventory-42 (CPCI-42) refers to coping strategies, which are commonly defined as the cognitive and behavioral techniques an individual may resort to in stressful or demanding situations. Evidence from a number of sources suggests that differences in pain coping strategies may significantly affect how an individual deals with chronic pain. We aimed to adapt the CPCI-42 to Polish cultural conditions (PL-CPCI-42) and then verify its psychometric properties based on a group of patients treated surgically due to herniated lumbar discs and coexisting spondylotic changes. Material/Methods The average age of the study participants (n=90) was 43.47 years (SD 10.21). The average duration of chronic low back pain (CLBP) was 49.37 months (SD 64.71). Lumbosacral spine X-rays and magnetic resonance imaging scans were performed and all patients completed the PL-CPCI-42 and the Polish versions of the Numeric Pain Rating Scale (NPRS-PL) twice. Internal consistency of the PL-CPCI-42, floor and ceiling effects, test-retest reliability, and criterion validity were analyzed. Results Resting, guarding, and coping self-statements were frequently used as coping strategies both in the test and in the retest, in contrast to relaxation and exercise/stretch. The NPRS-PL result was 5.70 cm in the test and 5.66 in the retest. Cronbach’s alpha values were recorded for the asking for assistance, coping self-statements, and seeking social support domains (0.83, 0.80, 0.83, respectively). Test-retest reliability of the PL-CPCI-42 varied from 0.53 (relaxation domain) to 0.84 (asking for assistance and coping self-statements domains). Conclusions The present study provides evidence of the validity of the PL-CPCI-42 and supports its usefulness in assessing chronic pain coping strategies, which are especially important to pain adjustment and in the creation of multidisciplinary pain management programs for patients with severe CLBP.

A longitudinal study of alexithymia in relation to physical activity in adolescent females with scoliosis subjected to cheneau brace treatment: preliminary report.

Study Design. A longitudinal pilot study of changes in levels of alexithymia among females with adolescent idiopathic scoliosis (AIS) under brace treatment. Objective. To investigate the prevalence of alexithymia and to evaluate changes in alexithymia levels among female patients with AIS treated with a Cheneau brace, in comparison with healthy female adolescents. Summary of Background Data. Alexithymia is a personality trait incorporating the following core characteristics: difficulty in identifying and describing feelings, difficulty in distinguishing between feelings and the physical sensation of emotional arousal, limited imaginal processes, and an externally oriented cognitive style. Alexithymia can be common among adolescents and young adults with severe idiopathic scoliosis. Methods. Thirty-six female patients with AIS, aged 13.4 years (standard deviation [SD], 1.7) at the beginning of the study, completed the Polish version of the Toronto Alexithymia Scale-26 (TAS-26). The second and third evaluations took place at 6 and 12 months, respectively, after the beginning of the study. Thirty-six healthy female controls were also included. Results. The mean TAS-26 total score was 63.4 (SD, 9.3), 59.5 (SD, 12.1), and 59.6 (SD, 12.5) during the first, second, and last patient evaluation, whereas in healthy females 60.0 (SD, 10.9). With regard to the TAS-26 total score, results differed significantly between the first and the second (P = 0.007) and between the first and the third patient evaluation (P = 0.007). Regression analysis revealed that during the second and third patient evaluation, duration of recreational sports activity had a statistically significant (P = 0.029 and P = 0.005, respectively) influence on the probability of females reporting no alexithymia. Conclusion. The prevalence of alexithymia in healthy female controls is the same as in patients with scoliosis subjected to underarm brace treatment. Statistically significant changes with regard to TAS-26 total score and externally oriented thinking domain were found in patient sample. Physical activity in females with AIS treated nonoperatively coexists with lower scores in the TAS-26. Level of Evidence: 2