William Hollingworth

The Longitudinal Assessment of Imaging and Disability of the Back (LAIDBack) Study: baseline data.

Study Design. Prospective cohort study of randomly selected Veterans Affairs (VA) outpatients. Objective. To determine the prevalence of magnetic resonance imaging (MRI) findings in the lumbar spine among persons without current low back pain or sciatica and to examine which findings are related to age or previous back symptoms. Summary of Background Information. Previous studies of patients without low back pain have not explored the possible association of various MRI findings to past symptoms. Methods. We randomly selected an age-stratified sample of subjects without low back pain in the past 4 months from clinics at a VA hospital. We collected information on demographics, comorbidity, functional status, and quality of life. MR images were obtained using a standardized protocol through each of the five lumbar disc levels. Results. Of 148 subjects, 69 (46%) had never experienced low back pain. There were 123 subjects (83%) with moderate to severe desiccation of one or more discs, 95 (64%) with one or more bulging discs, and 83 (56%) with loss of disc height. Forty-eight subjects (32%) had at least one disc protrusion and 9 (6%) had one or more disc extrusions. Conclusion. Many MR imaging findings have a high prevalence in subjects without low back pain. These findings are therefore of limited diagnostic use. The less common findings of moderate or severe central stenosis, root compression, and extrusions are likely to be diagnostically and clinically relevant.

Measuring changes in quality of life following magnetic resonance imaging of the knee: SF-36, EuroQol© or Rosser index?

Evidence suggests that magnetic resonance imaging (MRI) allows accurate diagnosis of meniscal and ligamentous injuries of the knee. However the link between improved diagnosis through MRI and improved patient quality of life (QOL) has yet to be shown. Previous studies almed at establishing this link have found no significant improvements in health related quality of life (HRQOL) as measured by the Rosser classification and index. This paper presents the results of three HRQOL questionnaires (SF-36, Rosser and EuroQol©) used to measure health change in 332 patients referred for MRI of the knee. Before imaging, patients reported poorer HRQOL than the general population on two of the three questionnaires (SF-36 and EuroQol©). The same two questionnaires recorded significant improvements in patient health at six months, although patients health had not yet reached that experienced in the general population. There was evidence to suggest that the index values attached to the Rosser classification made it unresponsive in this group of patients, which may have predisposed the null results of previous studies of the influence of MRI on HRQOL. Some evidence is provided to suggest that the EurolQol© may be less responsive in assessing change in health status than the SF-36.

Self reported health status and magnetic resonance imaging findings in patients with low back pain.

Abstract The authors present a prospective study of quality of life (SF-36) and MRI findings in patients with low back pain (LBP). Disc herniation and nerve root compression contribute to LBP and poor quality of life. However, significant proportions of asymptomatic subjects have disc herniation and neural compromise. Little is known about the influence of disc abnormalities and neural compression on quality of life in symptomatic patients. The purpose of this study was to assess the relationship between the extent of disc abnormality, neural impingement and quality of life. A total of 317 consecutive patients with LBP referred for MRI completed an SF-36 health status questionnaire immediately before imaging and again 6 months later. Patients were grouped according to the most extensive disc abnormality and any neural compromise reported at MRI. The relationship between symptoms, radiological signs and SF-36 scores was assessed. Eighty percent (255/317) and 65% (205/317) of patients completed the initial and 6-month SF-36, respectively. Thirty-six percent of patients (115/317) had one or more herniated discs and 44% (140/317) had neural impingement. There was little relationship between the extent of disc abnormality and quality of life. Patients with radiological evidence of neural impingement reported better general health (P < 0.01). SF-36 scores improved at 6 months in four dimensions, but general health deteriorated (P < 0.01). Patients with neural impingement had improved pain scores at 6 months (P < 0.05). The study results showed that the pain and dysfunction caused by disc herniation and neural compromise are not sufficiently distinct from other causes of back pain to be distinguished by the SF-36. Whilst neural compromise may be the best radiological feature distinguishing patients who may benefit from intervention, it cannot predict quality of life deficits in the diffuse group of patients with LBP.

Comparison of Directly Elicited Preferences to Preferences Derived from the SF-36 in Adults with Asthma:

Introduction. Algorithms have been developed that estimate preferences from the Short Form 36 (SF-36). The objective of this study was to compare SF-36-derived preferences to directly elicited preferences. Methods. The authors used data from a clinical trial of adult asthmatics to derive preferences from the SF-36 and compare those to visual analog scale (VAS) values and the Asthma Quality-of-Life Questionnaire (AQLQ). Results. The differences between VAS and derived preferences ranged from -0.066 to 0.024 at baseline and 0.006 to 0.107 at the end of follow-up. All measures improved from baseline (P < 0.001); however, derived preferences un- derestimated change (0.066 to 0.131) compared to the VAS (0.173) (P < 0.001), which could affect economic evaluations. Correlations between preferences and the AQLQ ranged from 0.56 to 0.70 at baseline (P < 0.001) and 0.53to 0.70 for changes from baseline (P < 0.001). Conclusions. The derivation methods produce valid and responsive measures of patient preference. However, derived preferences differ from one another and directly elicited VAS preferences.

The cost of treating hip fractures in the twenty-first century: short report.

ConclusionThe reported steep rise in the age-specific incidence of fractured neck of femur may now have abated; however, the overall incidence will rise further as Englands population continues to age. This rise in volume, combined with the increasing age and frailty of those fracturing their hips, will have major resource implications. Unless beds can be provided, major initiatives will be required to prevent fracture, improve treatment, and provide for community care.

Quality of life assessments in the evaluation of magnetic resonance imaging

Health technology assessments incorporating measurement of quality of life are becoming increasingly common. In the evaluation of magnetic resonance imaging (MRI), the most widely used quality of life instrument has been the Rosser classification. The theoretical basis for incorporating such a measure in the evaluation of imaging technology is considered and several studies using this instrument are reviewed. Despite the obvious technical advances of MRI and its influence on clinical management, it has proved difficult to demonstrate that the use of this expensive new imaging technique contributes to improvement in health-related quality of life. Some reasons why the expected improvement has not been demonstrated are discussed, as are the quality of life instruments which may be appropriate in this setting.