Renata Jabłońska

Depression, social factors, and pain perception before and after surgery for lumbar and cervical degenerative vertebral disc disease.

Objectives The purpose of this study was to evaluate the effects of psychosocial factors on pain levels and depression, before and after surgical treatment, in patients with degenerative lumbar and cervical vertebral disc disease. Patients and methods The study included 188 patients (98 women, 90 men) who were confirmed to have cervical or lumbar degenerative disc disease on magnetic resonance imaging, and who underwent a single microdiscectomy procedure, with no postoperative surgical complications. All patients completed two questionnaires before and after surgery – the Beck Depression Inventory scale (I–IV) and the Visual Analog Scale for pain (0–10). On hospital admission, all patients completed a social and demographic questionnaire. The first pain and depression questionnaire evaluations were performed on the day of hospital admission (n=188); the second on the day of hospital discharge, 7 days after surgery (n=188); and the third was 6 months after surgery (n=140). Results Patient ages ranged from 22 to 72 years, and 140 patients had lumbar disc disease (mean age, 42.7±10.99 years) and 44 had cervical disc disease (mean age, 48.9±7.85 years). Before surgery, symptoms of depression were present in 47.3% of the patients (11.7% cervical; 35.6% lumbar), at first postoperative evaluation in 25.1% of patients (7% cervical; 18.1% lumbar), and 6 months following surgery in 31.1% of patients (7.5% cervical; 23.6% lumbar). Patients with cervical disc disease who were unemployed had the highest incidence of depression before and after surgery (p=0.037). Patients with lumbar disc disease who had a primary level of education or work involving standing had the highest incidence of depression before and after surgery (p=0.368). Conclusion This study highlighted the association between social and demographic factors, pain perception, and depression that may persist despite surgical treatment for degenerative vertebral disc disease.

Measuring scales used for assessment of patients with traumatic brain injury: multicenter studies

Background Application of adequate numeric scales is essential for assessment of a patient’s condition. The scales most commonly used by the therapeutic team for assessment of a patient with traumatic brain injury (TBI) include deficit scales, functional scales, and scales assessing quality of life. The purpose of this study was to establish the relationships between the particular scales used for assessment of patients with TBI. Methods This multicenter study included 159 patients with TBI. The direct observation technique was used. Two measurements were made (at hospital admission and discharge) using standardized assessment scales, ie, the Glasgow Coma Scale (GCS), the Functional Capacity Scale (FCS), the Functional Index “Repty” (FIR), and the Glasgow Outcome Scale. Results Patients with mild impairment of consciousness were most numerous in the examined group at both admission and discharge, ie, 118 (78.8%) and 134 patients (89.3%), respectively. The mean score for functional capacity measured with the FCS was 34.41 points (71.7%) on the day of admission and 41.87 points (87.2%) on the day of discharge from hospital. A significant correlation was found between results obtained using the GCS and results on the FIR, on both the day of admission [R t(n-2) =7.612=0.530; P=0.00] and the day of discharge [R t(n-2) =8.998=0.595; P=0.00]. Further, a high correlation was found between the FCS and the FIR (rs= −0.854 on day of admission and rs= −0.840 on day of discharge). Conclusion The majority of examined patients had mild impairment of consciousness. A moderate correlation was found between the GCS and the scales assessing activities of daily living. A high correlation was found between FCS and FIR, which may result from the similarities between the analyzed tools in the scope of their construction and application.

Wpływ umiejscowienia guza mózgu na wydolność funkcjonalną chorego

Introduction . The vast majority of lesions of the nervous system are located intra cranially. Their location in each brain structure results in the appearance of different deficits affecting the functional capacity of patients, and ultimately their quality of life. Aim . The aim of the study is to investigate the effect of tumor location on the functional capacity of patients with such tumors in the preoperative and postoperative periods. Material and Methods . Material includes 236 patients hospitalized in the Department of Neurosurgery 10th Military Hospital with Policlinic IP HCC Bydgoszcz. The research was approved by the Bioethics Committee at Collegium Medicum in Bydgoszcz (KB 222/2011). The analysis included 5 subgroups of patients taking into account the location of intracranial lesions in these patients. There were defined: a group of patients with tumors located in the temporal lobe (1), frontal lobe (2), parietal lobe (3), cerebral chamber (4), and cerebral lesions (5). The functional capacity was assessed by the KPS Scale (Karnofsky’s Performance Scale) (three times: on the day of admission to the Clinic, on the 5th and 30th day after the surgery) and by the GOS Scale (Glasgow’s Outcome Scale) (twice: on the 5th and 30th day following the surgery). Results . On the fifth day of the postoperative period, a statistically significant decrease in the functional capacity was observed in patients with tumors located in the cerebral, the extra cranial tumors, in the frontal and temporal lobes (p<0.05). In the postoperative period, significant increase in functioning was observed in patients with ventricular tumors cerebral and extra cranial (p<0.05). The final outcome of the treatment was improved on the 30th day in patients with extra cranial tumors (p<0.05). Conclusions . In the early postoperative period the functional capacity of most patients decreases, and the lowest functional capacity decline is observed in patients with parietal lobe tumors. 30 days after the surgery, the functionality of the patients increases, particularly with tumors located in the cerebral cortex as well as with extra cranial tumors. (JNNN 2017;6(2):66–72)

Ocena efektywności leczenia sanatoryjnego wpływająca na zmniejszenie dolegliwości bólowych odcinka lędźwiowego kręgosłupa

Introduction . Today, lumbar spine pain is a global problem, as one of the most common health problems in developing countries, including in Poland. One of the main problems of patients with back pain syndromes in the lumbar spine is pain. This disease may be classified as a direct cause of the limitation of physical, social, and professional activities. Aim . The aim of the study is to assess the impact of sanatorium treatment on the reduction of pain occurring in the pain syndromes of the lumbar spine. Material and Methods . The survey was conducted among 300 (100%) randomly selected patients, aged from 35 to 65 years. The study was conducted in sanatorium “The Wieniec-Zdroj spa”. The severity of pain in patients with diagnosed pain syndrome of lumbar spine was studied in two stages prior to and following sanatorium treatment using the Oswestry Disability Index Questionnaire. The tests were carried out after obtaining the approval of the Bioethics Committee of Kuyavian-Pomeranian Regional Medical Chamber in Torun (34/KB/2013) and the Medical Director of the institution where the study was conducted. Results . Analysis of selected components of the Oswestry Questionnaire for comparing the efficiency of patients before and after treatment allows for the assessment of pain intensity. Taking into account the intensity of pain and the use of painkillers it can be determined that after sanatorium treatment because of minor pain patients do not have to take pain medication 89 respondents (30%), 38 patients fewer. The surveyed also responded that painkillers completely/partially remove the pain more than twice as often after treatment. Conclusions . Sanatorium treatment affected pain in the lumbar spine. After therapy the pain decreased. The respondents stated that after the therapy applied, painkillers partially or completely removed the occurring pain. (JNNN 2016;5(3):99–103)

Ocena czynnościowa pacjentów w okresie leczenia neurochirurgicznego

Introduction . The interests of scientists, especially in the field of medicine and health science, contemplate the functional condition of patient in recent years. Proper functional capacity with good state of being and psychological attitude are the most important health indicators. Proper functional capacity is defined as the ability for independent performance and covering of basic vital needs, e.g. the control of the sphincter, nutrition, mobility and maintaining proper hygiene. The proper functional capacity of the whole system of vital activities means independence. Aim . The main aim of this study was the functional assessment of patients in the period of neurosurgical treatment. Material and Methods . The study included 415 patients hospitalized on neurosurgical wards. The functional capacity of patients was assessed twice (on the day of admission — Assessment 1 and on the day of discharge — Assessment 2). Functional capacity was analyzed using Functional Capacity Scale (FCS). The direct observation with measurement technique was used. The research proposal was approved by the bioethics committee. Results . On the day of admission, most of the patients (n=249; 60%), showed independence. Most of the independent patients were in the group of patients with tumors — 138 (83.6%), the second group were patients with brain aneurysm — 63 (63.0%) and the third group were patients with trauma — 48 (32.0%) (p 0.05). Conclusions . Most of the patients after neurosurgical treatment showed better functional capacity when compared with the period before it. Patients with brain tumors showed considerably better functional capacity on the day of admission when compared with patients with trauma or aneurysm. (JNNN 2016;5(2):46–52)

Problem bólu kręgosłupa wśród pielęgniarek oddziałów neurologii i neurochirurgii

Introduction . In the occupational medicine back pain is treated as a paraoccupational disease, mainly related to specific professional groups. They include those employed in the sector of health care, who are at the highest risk of developing back pain, nurses in particular. Aim . Assessment of back pain occurrence among nurses and determining the factors affecting this condition. Material and Methods . The study group consisted of 76 nurses working in neurology and neurosurgery wards/clinics. The research methodology applied consisted of diagnostic survey method, and as the technique, a survey of our own design was used. The VAS Pain Scale was used. Statistical analysis was prepared in the program SPSS20. The statistical significance of differences was determined at a confidence level of p<0.05. Results . 98.7% of the surveyed nurses complain about back pain. The biggest group consisted of those with very severe pain (47.4%). At the same time in 80.26% of cases the pain was located in the lumbosacral section. Multiple comparisons showed that the level of pain intensity was higher in those working on the contract than in the personnel working on the basis of a contract of employment (p=0.045). The analysis showed no statistically significant differences in the level of pain intensity between respondents in different workplaces: Chi2 (2)=3.69; p=0.158. Conclusions . The vast majority of nurses complain about back pain, in most cases it is a very strong pain. This pain is determined by seniority, form of employment (contract) as well as by additional activities apart from of work in the ward. (JNNN 2016;5(3):84–91)

Assessment and Determinants of Spinal Pain in the Course of Disc Disorders Treated Surgically

Background Intervertebral disc disease is defined as a complex of structural changes in the aftermath of disorders of mutual elements, the structure of which form the discus intervertebralis and the spinal canal. The present work assessed pain in patients who were surgically treated due to spinal discopathy and analyzed factors that determine the condition. Material/Methods The research was carried on a group of 187 patients diagnosed with discopathy of the lumbosacral and cervical segment. The data are discussed in the context of medical records and the Visual Analogue Scale used for pain assessment. We used a prospective study plan with a 3-time assessment. Results The pain level observed among patients prior to the procedure (M=6.52) was higher than after 7 days (M=3.15) and 6 months from the operation (M= 3.45). The highest level of pain (M=6.88), with a relatively high consistency among the patients (SD=2.25), was observed in the case of left-side hernia (H=7.31; p=0.023). The influence of the analyzed factors on pain experience markedly increased by the third assessment (R2=0.14), and was strongly associated with the type of work performed by the patient. Conclusions Surgical operation significantly reduces pain in patients with disc disorders. The level of pain is predominantly affected by the location of the hernia and the type of work performed by the patient.

The Influence of Surgical Treatment on Reported Ailments and Neurological Status of Patients with Spine Discopathy

Introduction. Treatment of patients with spine discopathy is the subject of interest in numerous medical disciplines and includes non-invasive as well as invasive methods. Both therapeutic ways aim to resolve the disc-root conflict. The clinical picture and the incidence of neurological complications depend on the location of herniated nucleus pulposus. Aim. To determine the influence of surgical treatment on reported ailments and neurological status of patients with spine discopathy. Material and Methods. The study was conducted twice (before and after the surgery) among 188 patients treated surgically due to cervical or lumbosacral spine discopathy. The analysis included: clinical and intraoperative diagnosis, the level of operation, BMI, and neurological status: Laseque’s sign, muscle strength, pain, dysesthesia, sphincter disorders. The results were analyzed by means of Microsoft Excel spreadsheet and Statistica 6.0, assuming a significance level of p≤ 0.05. Results. While assessing pain, in the case of L-S discopathy, the majority of patients belonged to group III (34%) and group IV (33.5%). After the operation, 37.8% of patients were classified as group II; in cervical discopathy this percentage was 12.2%. The positive Laseque’s sign before the operation was observed in 68.1% of the subjects; after the surgery in 56%. Dysesthesia in the case of the upper discopathy occurred in 72.9% of the patients, after the surgery in 30.3% (p <0.05). Conclusions. Performed surgery significantly results in reducing pain in patients. The improvement was also noticed in neurological status. ( JNNN 2015;4(3):109–116)

Wykorzystanie skal w ocenie chorych z tętniakiem mózgu — doniesienia wstępne

Wstep. Krwawienie podpajeczynowkowe jest zespolem objawow, w ktorym dochodzi do krwawienia do przestrzeni plynowych mozgu, najcześciej z powodu peknietego tetniaka. Cel. Celem pracy byla ocena stanu chorych z krwawieniem podpajeczynowkowym z peknietego tetniaka z wykorzystaniem skal klinimetrycznych. Material i metody. Do grupy badawczej zakwalifikowano 15 pacjentow hospitalizowanych z powodu podejrzenia tetniaka mozgu. Dokonano oceny na podstawie skal: GCS, GOS, IB, FCS, VAS. Wyniki. Wyniki pomiarow w skali VAS przy przyjeciu wskazują, ze 60% nie odczuwa zadnych dolegliwości bolowych. Zaobserwowano korelacje dwustronną pomiedzy wynikiem FCS, a oceną IB w chwili przyjecia na oddzial p = 0,00; r = 0,970. Korelacja wystepuje pomiedzy FCS przy przyjeciu, a IB w dniu wypisu: p = 0,005; r = 0,685. Wnioski. Skala VAS nie ma mozliwości oceny natezenia dolegliwości bolowych u chorych ze znacznymi zaburzeniami świadomości. Ocena deficytu samoopieki podczas hospitalizacji w skali FCS jest bardziej precyzyjna od wyniku IB. Oceny wydolności funkcjonalnej w dniu wypisu nalezy dokonywac w IB pod warunkiem zakonczenia wzmozonej terapii. Problemy Pielegniarstwa 2015; 23 (2): 183–189

Zastosowanie Skali Wydolności Funkcjonalnej w ocenie pacjentów po urazach czaszkowo-mózgowych — badania wieloośrodkowe

Introduction . One of the most serious life and health hazards of a modern man are injuries, one of which is traumatic brain injury (TBI). Among functional scales that are most commonly used for the assessment of the condition of a patient after TBI we can distinguish the Modified Rankin Scale, Disability Rating Scale (DRS), Barthel Index, Functional Independence Measure (FIM), Glasgow Outcome Scale and Extended Glasgow Outcome Scale (GOSE). Aim . The main aim of this work was to present Functional Capacity Scale in the assessment of patients after traumatic brain injury. Material and Methods . In the multicenter studies, there were 159 patients examined. They were hospitalized in neurosurgical wards in Bydgoszcz, Lublin and Wroclaw due to traumatic brain injury. The research was based on twofold assessment (on the day of admission — assessment 1 and discharge — assessment 2) of the condition of a patient after traumatic brain injury with the use of standardized research tools such as Glasgow Coma Scale (GCS), Functional Capacity Scale (FCS) and Glasgow Outcome Scale (GOS). The method used was direct observation with measurement. Results . The average result of functional capacity in FCS was 34,41 points (71.7%) on the day of admission, and 41,87 points (87.2%) on the day of discharge. After analyzing the differences between the FCS results of men and women, there was no difference between gender groups that would be statistically significant (p>0.05) both on the day of admission and discharge. The age groups remained in statistically significant, low correlation with the results of FCS on the day of admission (R=0.261; p=0.001) and were on the edge of significance (R=0.140; p=0.088) on the day of discharge. The place of residence did not differentiate (p>0.05) the functional capacity assessed with FCS. The results of FCS remained in statistically significant correlation with GCS results (p<0.05) both on the day of admission and discharge and GOS (p=0.000) results on the day of discharge. Conclusions . The FCS scale, suggested for functional assessment of patients with traumatic brain injury, is a tool that appropriately recognizes the functional condition of a patient with traumatic brain injury. It substantially correlates with GCS and GOS, which denotes that its construction and prognostic features are accurate. (JNNN 2014;3(4):175–182)