Biomedical subjects

Karen Yamakawa

Publications and source records attributed to Karen Yamakawa.

9 recordsLinked to original sources

PubMed2006

The Spine Team Assessment for chronic back pain disability. Part 1: basic protocol and performance in 500 patients.

PURPOSE: For persons with chronic back pain disability, customized, effective, and efficient treatment depends on the initial assessment. Functional capacity evaluations and intake screenings for particular programs are not independent or goal-directed. This paper describes a standardized independent multidisciplinary assessment for treatment planning, and characteristic findings in a population of chronically disabled persons. METHODS: The Spine Team Assessment (STA), a (1/2)-day assessment including extensive intake information, evaluations by therapists and counselors, a team meeting with a physician, and a comprehensive report, was performed on 500 consecutive persons with chronic back pain. RESULTS: Representative findings included maximum cardiac performance of 5.33 (+/-4.08 SD) METS; Progressive Isoinertial Lifting Evaluation floor-to-waist of 36.4% (+/-23.9% of norms, and CESD depression scores of 24.7 (+/-13.5 SD). Fear and avoidance and poor physiologic effort were common. CONCLUSION: Deconditioning, psychosocial factors and functional deficits are common, complex, and variable among chronic back pain patients. This description of the STA provides a potentially reproducible standard for research into individualized treatment. The work provides benchmark data for independent multidisciplinary assessments.

Adult↗

PubMed2006

The Spine Team Assessment for chronic back pain disability. Part 2: team decision making and a preliminary outcome study.

PURPOSE: Back pain disability is complex, involving medical, physical, functional, social, and financial issues. This study aims to develop the first codified decision making process for individualized treatment planning. METHODS: In a multidisciplinary assessment protocol for chronic low back pain disability, the Spine Team Assessment (see Part I), a 'case law' qualitative approach to decision making began with a basic framework. Details were established over 103 cases at a community hospital. Through 500 more cases, a university spine program developed new exceptions, definitions, and rule clarifications. RESULTS: The final framework includes physical deconditioning, psychosocial factors, and potential for cure, with dozens of subcategories. Seventeen different combinations of therapy were recommended. Of 68 persons referred to one multidisciplinary treatment protocol, at 6 - 12 months the 17 completers had less work disability (31 vs. 62%, p = 0.032) and tended towards fewer subsequent diagnostic tests (17.6 vs. 34.7%) and less surgery (0 vs. 4). CONCLUSIONS: The data suggests that the process is complex, that customization did occur, and that at least one team decision led to better outcomes. While derived qualitatively, this decision-making tree provides a road map for less experienced teams and a precedent for researchers who wish to study individualized treatment.

Adult↗

PubMed2006

Assessment of the validity of masking in electrodiagnostic research.

OBJECTIVES: Performed by thousands of specialists and researched for >60 yrs, electrodiagnostic testing rates poorly in evidence-based guidelines in part because there are no valid masked research studies. This study assesses whether the electrodiagnostic examination can be adequately masked. DESIGN: Prospective, controlled, masked trial. A total of 150 persons aged 55-80 yrs, thought clinically to be asymptomatic (n = 32), with low back pain (n = 46), or with spinal stenosis (n = 63), underwent needle electromyography and nerve conduction studies by specialists in physical medicine and rehabilitation who were not permitted to ask any clinical information or to perform a formal examination. Examiners rated potential bias and recorded clues that might bias the examination. RESULTS: Examiners noted potential for bias in conversation in 17 and due to pain behavior in one. Half of these potential unmaskings pointed away from the correct clinical diagnosis, leaving potential for bias in <6% of the subjects. The clinical diagnosis had no relationship to electrodiagnostician rating of pain behavior in response to testing or repositioning, to limb atrophy, and to arthritis (P > 0.05 all instances). CONCLUSIONS: The electrodiagnostic examination can be successfully masked. This information will help future research in electrodiagnostics meet the criteria of evidence-based medicine.

Aged↗

PubMed2006

Changes in posture and perceived exertion in adolescents wearing backpacks with and without abdominal supports.

OBJECTIVE: The goal was to examine whether backpacks with an abdominal support device improve posture and decrease exertion while walking among adolescents. DESIGN: Double-blinded trial, with 20 subjects, performed at a University Spine Center. On day 1, adolescents walked on a treadmill for 5 mins with photographic measurement of posture and responded to the Borg scale of perceived exertion before and after ambulation. On day 2, they repeated the trial four more times wearing a backpack randomly loaded with either 10% or 20% of body weight and with or without the Back Balancer abdominal support. Postural measures were recorded by a blinded observer. RESULTS: Postural changes (forward lean) wearing a backpack with abdominal support were significantly lower while carrying both 10% and 20% of body weight (P = 0.024 and P = 0.008, respectively) vs. no abdominal support. In addition, perceived exertion at 10% and 20% of body weight was significantly greater without abdominal support (P = 0.042 and P = 0.018, respectively). CONCLUSIONS: Forward lean and perceived exertion while wearing backpacks in adolescents can be significantly decreased with abdominal support. This may increase comfort and decrease complications, such as back pain, that may arise from backpack use.

Abdomen↗

PubMed2003

Alcohol use self report in chronic back pain--relationships to psychosocial factors, function performance, and medication use.

BACKGROUND CONTEXT: Alcohol consumption is a known risk factor for spinal disability, but there is no data on the relationship between reported alcohol consumption and behaviours in persons who are disabled. PURPOSE: To determine the interaction between reported alcohol consumption, physical performance, and medication use in this group. To determine psychosocial correlates of reported alcohol consumption in this group. METHODS: A retrospective review 147 men and 136 women with more than 3 months disability who underwent a multidisciplinary physical, functional and psychosocial Spine Team Assessment. Questions about alcohol consumption were related to outcome measures. RESULTS: None of the women reported more than 5 drinks/week. Ten men reported more than 12 drinks per week. These performed significantly better on the Progressive Isoinertial Lifting Evaluation (PILE) low lift and the Functional Assessment Screening Test (FAST) 5 minute twisting test, and trended towards better performance on all other tests (the PILE high lift, all 4 other FAST components, Sorenson trunk extension test, and bicycle ergometer submaximal stress test). They had less back pain disability (Quebec p = 0.061), but no difference in depression (CESD), pain (visual analog scale) or fear (Tampa). They used fewer Non-steroidal medications, but similar narcotic medications as the others. No significant differences in the SF-36 were noted. CONCLUSIONS: This first assessment of the relationship of alcohol consumption with back pain disability suggests that women with chronic back pain disability seldom report heavy alcohol consumption. Men with back pain disability who consume large amounts of alcohol have less physical disability despite similar pain. Despite potential interactions, heavy drinkers with pain do not use fewer narcotic analgesics than light drinkers.

Adult↗

PubMed2003

The effect of order of testing in functional performance in persons with and without chronic back pain.

Batteries of individually standardized physical and functional tests are commonly used to assess persons with chronic back pain disability. The order of testing may affect performance on later tests. One hundred and fifty patients with > 3 months of back pain disability underwent a multidisciplinary Spine Team Assessment involving Physical Therapy, Occupational Therapy, Pain Psychology, and Vocational Rehabilitation Counselor assessments at a university spine clinic. Seventeen back healthy volunteers performed the physical component of the assessment. For the volunteers the order of testing was randomized to OT tests first or PT test first, with 0.5 h rest between the tests. For patients the order of testing was arbitrarily set by an alternating schedule, with 1 h psychological testing between the two components. For both the patients and volunteers, among the 14 test components, there was no significant difference (p > 0.05) in performance with order of testing. This held true for the subgroup of patients who put out good cardiac effort. Volunteers performed better than patients on all individual tests (p < 0.001). Results suggest that the order of physical testing during a Spine Team Assessment does not affect test performance either in chronic low back disabled patients or in volunteers.

Adult↗

PubMed2002

The relation among spinal geometry on MRI, paraspinal electromyographic abnormalities, and age in persons referred for electrodiagnostic testing of low back symptoms.

STUDY DESIGN: A retrospective EMG study with blinded radiologic measurement was conducted. OBJECTIVE: To determine the relation among spinal measurements on MRI, paraspinal denervation, and age in patients referred for electrodiagnostic and radiologic evaluation of low back pain. SUMMARY OF BACKGROUND DATA: Spinal pathology, including disc herniation and spinal stenosis, can cause denervation of the paraspinal muscles. Various mechanisms including direct compression, inflammation, vascular compromise, and mechanical stretch of the posterior primary ramus may play a role in denervation. The relation between the amount of denervation and the size of the spinal canal can assist in understanding the pathophysiology of back pain. Since paraspinal denervation may increase with age in asymptomatic persons, age is an important covariable. METHODS: At a university hospital, 44 patients referred to undergo both electrodiagnostic evaluation and MRI for low back pain were studied. The study investigated the relation among the following: 1) axial MRI spinal measurements (canal transverse diameter, anteroposterior diameter, and area; thecal sac anteroposterior diameter and area; and the radiologist's overall impression at each level) and denervation measurements in terms of scores on the MiniPM, a quantified needle electromyographic measure of paraspinal denervation; 2) various models of multilevel spinal compression (smallest, smallest two, and average spinal levels for each measurement) and MiniPM scores; and 3) MRI spinal canal measurements and age. RESULTS: Although individual MRI measurements and combinations of measurements did not relate to MiniPM scores, the radiologist's impression was significantly related. The "smallest two" levels measurement had the strongest relation (r = 0.400; P < 0.007). Age related to the MiniPM scores (P = 0.004) and radiologic impression (P = 0.031). A regression suggested that MiniPM was an independent predictor of age. CONCLUSIONS: The radiologist's overall impression is more accurate than axial image measurements in predicting paraspinal denervation. A combination score of the smallest two levels is the most accurate, perhaps relating to the vascular pathophysiology of stenosis. There is more denervation with increasing age in this symptomatic population.

Age Factors↗

PubMed2002

The Spurling test and cervical radiculopathy.

STUDY DESIGN: A cross-sectional study design was used. OBJECTIVE: To determine the sensitivity and specificity of the Spurling test for cervical radiculopathy. SUMMARY OF BACKGROUND DATA: The Spurling test is an accepted physical examination test, but there is little data on its sensitivity or specificity. METHODS: From 1988 to 1993, 255 consecutive patients were referred for electrodiagnosis of upper extremity nerve disorders. A Spurling test administered before other testing was performed. The Spurling test was scored as positive if it caused pain or tingling that started in the shoulder and radiated distally to the elbow. After the electrodiagnostic examination, a score was given to each diagnosis in the differential diagnosis according to the likelihood of its presence. To determine the odds ratio, sensitivity, and specificity, chi2 analysis was used. Also, the percentage of subjects with positive results from the Spurling test was calculated for several nerve disease diagnoses. RESULTS: The Spurling test had a sensitivity of 6/20 (30%) and a specificity of 160/172 (93%). The results were positive in 16.6% of the normal group, in 3.4% of the group with nerve disorders other than a radiculopathy, in 25% of the group with an abnormality not consistent with any specific diagnosis group, in 37.5% of the group with possible radiculopathy, and in 40% of the group with certain radiculopathy. CONCLUSIONS: The Spurling test is not very sensitive, but it is specific for cervical radiculopathy diagnosed by electromyography. Therefore, it is not useful as a screening test, but it is clinically useful in helping to confirm a cervical radiculopathy.

Arm↗

PubMed2002

Concordance between rating of perceived exertion and function in persons with chronic, disabling back pain.

Rating of perceived exertion (RPE), or the Borg scale, has been shown to be positively associated with physiologic effort in individuals undergoing cardiovascular assessment. This study examined the correlations between cardiovascular performance, psychosocial factors, and the RPE scale among 50 persons with chronic pain undergoing multidisciplinary assessment. The results indicated a significant negative association between fitness outcome measures (maximum VO2 and endurance on bicycle), psychosocial measures, and age. With a mean maximum heart rate achieved on the exercise bicycle of 79.2% (SD = 8.3), there was no significant association between the highest rating of perceived exertion on the exercise bicycle test and percent of maximum heart rate. Percent of maximum heart rate was significantly related to self-reported pain and disability as well as age. These findings suggest that perceived exertion in this population is not highly correlated with physiologic effort, as other factors such as pain may influence effort ratings.

Adult↗