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PubMed1994

The impact of patient adherence on health outcomes for patients with chronic disease in the Medical Outcomes Study.

The association between adherence to medical recommendations and health outcomes (physical, role, and social functioning, energy/fatigue, pain, emotional well-being, general health perceptions, diastolic blood pressure, and glycohemoglobin) was examined in a 4-year longitudinal, observational study of 2125 adult patients with chronic medical conditions (hypertension, diabetes, recent myocardial infarction, congestive heart failure) and/or depression. Change score models were evaluated, controlling for disease and comorbidity. Patient adherence was associated minimally with improvement in health outcomes in this study. Only 11 of 132 comparisons showed statistically significant positive effects of adherence on health outcomes. We conclude that the relationship between adherence and health outcomes is much more complex than has often been assumed.

Adult↗

PubMed2006

Prevalence, predictors, and outcomes of patients with non-ST-segment elevation myocardial infarction and insignificant coronary artery disease: results from the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA Guidelines (CRUSADE) initiative.

BACKGROUND: Unlike ST-segment elevation myocardial infarction, the degree of stenosis and physiology of ischemia varies in patients with non-ST-segment elevation myocardial infarction (NSTEMI). The prevalence, predictors, and outcomes of patients with NSTEMI who lack significant epicardial coronary artery disease (CAD) in routine clinical practice remain poorly characterized. We sought to determine the prevalence, predictors, and outcomes of patients with NSTEMI and insignificant CAD. METHODS: We analyzed 38301 patients with NSTEMI in the CRUSADE quality improvement initiative who underwent cardiac catheterization to determine the prevalence and factors associated with insignificant CAD (all coronary stenoses <50%) and inhospital outcomes for patients with and without CAD. A multivariable model was used to determine the factors associated with insignificant CAD. RESULTS: A total of 3306 (8.6%) of 38301 patients had insignificant CAD. The strongest multivariable predictors of insignificant CAD were female sex (odds ratio 2.8, 95% CI 2.6-3.1), younger age (odds ratio per 10-year decrease 1.5, 95% CI 1.5-1.6), and lack of current/recent smoking (odds ratio 1.9, 95% CI 1.7-2.0). Inhospital rates of death were 0.65% for patients with insignificant CAD compared with 2.36% for patients with CAD (P < .0001). CONCLUSION: Insignificant CAD is present in 9% of patients with NSTEMI and is associated with a low incidence of adverse outcomes. The strongest predictors of insignificant CAD are female sex and younger age. These findings underscore the need for research to understand the pathophysiology of myocardial infarction in this population.

Acute Disease↗

PubMed2005

Development and validation of a brief instrument for routine outcome monitoring in opioid maintenance pharmacotherapy services: the brief treatment outcome measure (BTOM).

AIM: To develop a brief, multi-dimensional instrument for routine, on-going treatment outcome monitoring in alcohol and other drug (AOD) services in Australia and examine the underlying psychometric properties. This study focuses on opioid maintenance pharmacotherapy (OMP) services. DESIGN: Researcher-administered test-retest interviews and clinician administered interviews. SETTING: The test-retest interviews took place in two private and two public OMP clinics in Sydney, Australia. The clinician-administered interviews took place in 37 metropolitan, rural and prison OMP services in New South Wales, Australia. PARTICIPANTS: One hundred and sixty current OMP clients for the test-retest interviews and 2004 clients commencing OMP treatment for the clinician-administered interviews. MEASURES: Thirty-two items across the domains of dependence, blood-borne virus exposure risk, drug use, health/psychological functioning and social functioning. FINDINGS: The internal reliability of the brief treatment outcome measure (BTOM) is satisfactory. Retest reliabilities for the scales and drug use scores are good to excellent indicating their consistency with multiple measurements across time and different interviewers and concurrent validation of BTOM scales with analogous scales from similar instruments yielded acceptable agreement. Average completion times of the BTOM were 14.5 min, when administered in a research context and 21 min in a clinical context. CONCLUSIONS: A brief, valid and reliable questionnaire has been developed for monitoring treatment outcome over the range of OMP services. The BTOM contains a core set of outcome measures, which can be easily adapted for integration into routine clinical practice across the range of AOD services.

Adult↗

PubMed2005

Nine-month outcome of patients treated by percutaneous coronary interventions for bifurcation lesions in the recent era: a report from the Prevention of Restenosis with Tranilast and its Outcomes (PRESTO) trial.

OBJECTIVES: The aim of this research was to determine the influence of bifurcation lesions on the outcome of patients undergoing percutaneous coronary intervention (PCI) in the recent era. BACKGROUND: The treatment of bifurcation lesions by PCI has been associated with an increased complication rate. Whether recent improvements of interventional practice have translated into improved outcomes in this patient subgroup is unknown. METHODS: The 11,482 patients enrolled in the Prevention of Restenosis with Tranilast and its Outcomes (PRESTO) were stratified according to the presence (n = 1,412) or absence (n = 10,068) of at least one bifurcation lesion treated by PCI. Baseline characteristics and outcome of patients undergoing PCI for bifurcation lesions were compared to those of patients treated for nonbifurcation lesions. RESULTS: Patients treated for bifurcation lesions were less likely to have prior myocardial infarction (MI), prior coronary artery bypass graft surgery, and had a higher proportion of current stable angina (p < 0.01 for all comparisons). Bifurcation lesions involved more frequently the left anterior descending coronary artery and were more complex (angulated, eccentric, ostial, and tortuous) than nonbifurcation lesions. Percutaneous coronary intervention of bifurcation lesions was characterized by less frequent stent implantation (71% vs. 80%); PCI of bifurcation lesions was associated with an increased rate of combined end point death/MI/target vessel revascularization (TVR) at nine months (18% vs. 15%, p = 0.002) because of increased rates of TVR (17% vs. 14%, p < 0.001), whereas death (1%) and MI (1%) were not different between groups. CONCLUSIONS: Percutaneous coronary intervention of bifurcation lesions is associated with higher TVR at follow-up. However, the risk of death, MI, death/MI was similar in patients treated for bifurcation or nonbifurcation lesions.

Angioplasty, Balloon, Coronary↗

PubMed2005

The National Hospice Outcomes Project: development and implementation of a multi-site hospice outcomes study.

Hospice has become a major component of end-of-life care, but little scientific information is available to guide clinicians in knowing when the use of hospice is appropriate, in knowing how to measure the impact of its care, and in knowing which hospice interventions lead to the best outcomes. The National Hospice Outcomes Project (NHOP) arose from the need to identify patient factors and hospice interventions that are associated with better end-of-life outcomes. Clinical Practice Improvement (CPI) methodology allowed us to generate a large comprehensive database that could identify scientifically hospice interventions associated with better outcomes for specific patient populations. The complex interplay of patients, medical and complementary treatments, and families can be evaluated. This paper describes an overview of the research methods used for the NHOP, describes the project's 13 clinical sites and study population of 1,306 patients, and presents some basic findings from the study.

Adult↗

PubMed1999

Determinants of the outcome of intrauterine insemination: analysis of outcomes of 9963 consecutive cycles.

OBJECTIVE: Our aim was to determine which factors influence the effectiveness of intrauterine insemination. STUDY DESIGN: This article is a retrospective statistical analysis of outcomes of 9963 consecutive intrauterine insemination cycles. RESULTS: Patient age was the main determinant of pregnancy outcome (analysis of variance F ratio = 29, P <.0001), followed by the number of follicles at the time of intrauterine insemination (analysis of variance F ratio = 9, P <.0001) and sperm motility in the inseminate (analysis of variance F ratio = 4, P =.002). A total of 18.9% of all patients <26 years old conceived, compared with 13.9% of those 26-30 years old, 12.4% of those 31-35 years old, 11.1% of those 36-40 years old, 4.7% of those 41-45 years old, and 0.5% of patients >45 years old (P <.001). When analyzed by single years, ongoing pregnancy rates after intrauterine insemination remained high through age 32 years. Across all ages and causes of infertility, 7.6% of patients with 1 follicle at the time of intrauterine insemination conceived, compared with 10. 1% with 2, 14.0% with 4, and 16.9% with 6 follicles (P <.01). When ovulation occurred before intrauterine insemination (ie, no visible follicular structures), 4.6% of patients conceived. The likelihood of pregnancy was maximized when motile sperm numbers were >/=4 million and sperm motility was >/=60%. Differences in pregnancy outcomes between sperm processing options were related to differences in sperm motility after processing; use of methods incorporating motility enhancement with pentoxifylline and motile sperm concentration through silica gradients yielded the highest overall pregnancy rates. CONCLUSION: When the results of ongoing retrospective analysis of intrauterine insemination outcomes are applied, overall intrauterine insemination pregnancy rates have increased from 5.8% per cycle in 1991 to 13.4% per cycle in 1996, during which time the average age of patients undergoing intrauterine insemination has increased from 36.1 (+/-0.2) to 39.2 (+/-0.1) years.

Adult↗

PubMed1997

Refractive outcome of radial keratotomy: does the result of the first eye predict outcome in the second eye?

PURPOSE: To present a method of quantifying variability in the outcome of a refractive surgical procedure using the SD of the difference between achieved and expected refractive changes. We used this method to determine whether the refractive outcome of radial keratotomy in a first eye is predictive of outcome in the second eye. METHODS: We retrospectively identified patients who underwent eight-incision radial keratotomy in the first eye from February 1993 through April 1994, with follow-up refraction 2.5 to 5 months postoperatively. This group consisted of 129 eyes of 81 patients. Thirty-nine patients had bilateral surgery with appropriate follow-up. Achieved refractive change was analyzed by multivariate linear and nonlinear regression to yield an expected refractive change for each eye based on patient age and optical zone size. RESULTS: Residuals, defined as the difference between the achieved and expected refractive change, were normally distributed. The SD of the residuals was 0.68 diopter and was independent of the expected correction. The prediction of second-eye refractive change was not significantly improved by incorporating the residual from the first eye into the regression prediction. CONCLUSIONS: The SD of the difference between the achieved and expected refractive change is an appropriate measure of the variability in refractive outcome following a refractive surgical procedure. Surgeons who perform bilateral simultaneous radial keratotomy do not sacrifice refractive accuracy in the second eye.

Adult↗

PubMed2004

Cognitive therapy outcome: the effects of hopelessness in a naturalistic outcome study.

This study prospectively examined the effect of hopelessness on outcome in cognitive therapy. Hopelessness has a central role in cognitive theories of depression, and consistently predicts suicide attempts and suicide completion. Furthermore, there is indirect evidence that hopelessness predicts cognitive therapy outcome, in terms of early termination of therapy, perhaps in part because theories of therapy change suggest that "remoralization" is a critical first phase of change. It was hypothesized that hopelessness non-responsiveness early in therapy would be predictive of eventual outcome, over and above hopelessness severity at intake. In a naturalistic study of 122 patients diagnosed with unipolar depression, it was found that non-responsive hopelessness predicted outcome in cognitive therapy, and this effect is over and above any effect of initial severity of hopelessness or depression. These findings suggest that patients whose level of hope is responsive to early interventions make more rapid and pronounced improvements during "real world" cognitive therapy.

Adolescent↗

PubMed2001

The outcome of retinopathy of prematurity: screening for retinopathy of prematurity using an outcome predictive program.

PURPOSE: The purpose of this study was to compare the calculated risk of progression to threshold retinopathy of prematurity (ROP) and risk of an unfavorable structural outcome using the computer program, RM-ROP, with the observed incidence for infants born at Jackson Memorial Hospital (JMH) and to determine how many children would have been treated unnecessarily if the threshold criteria for treatment were lowered on the basis of the clinical findings and RM-ROP risk calculations. DESIGN: Noncomparative interventional case series. PARTICIPANTS: All 292 surviving premature infants weighing 1250 g or less at birth and born at JMH between January 1, 1997, and December 31, 1998, were included in the study. METHODS: Baseline demographic factors and data from sequential ophthalmic examinations were entered into the RM-ROP program for risk calculation. Infants reaching threshold disease received diode laser indirect photocoagulation of the avascular retina. Three-month follow-up was obtained for infants receiving laser treatment. MAIN OUTCOME MEASURES: The development of threshold ROP and an unfavorable structural outcome, defined as a posterior retinal fold or posterior retinal detachment occurring within 3 months of threshold disease. RESULTS: Thirty-eight eyes were diagnosed with threshold ROP, with 18 of 20 subjects having bilateral disease. Three-month posttreatment follow-up was obtained on all 20 children, with 19 having good structural outcomes. Thirty-two percent of eyes (12 of 38) reaching threshold never had a risk estimate greater than 0.10. However, only 6% of eyes (35 of 546) that did not reach threshold ever had a model predicted risk greater than 0.15. All right eyes with zone 1 prethreshold disease, 60% of those with zone 2 stage 2+ disease, and 23% with zone 2 stage 3 disease progressed to threshold ROP. CONCLUSIONS: The similarity between the risk distributions for the Miami and the Multicenter Trial of Cryotherapy for Retinopathy of Prematurity study indicates the similarity in the populations with respect to risk factors identified as important by the model. The Miami data validated the model, with eyes reaching threshold having higher risks than eyes that did not. Actual risk estimates for eyes reaching threshold can be small. Changing the threshold criteria for treatment on the basis of various clinical and computer-generated prethreshold risk levels in our population would have resulted in the unnecessary treatment of many infants who never progressed to threshold disease. In the Miami population, if the model were used to manage an individual subject, close attention would have to be paid to small differences in risk. Although the RM-ROP software program may be a useful tool for following premature infants with ROP, the clinical examination remains the "gold standard."

Disease Progression↗

PubMedDate not supplied

Change and stability of change after treatment of drug misuse: 2-year outcomes from the National Treatment Outcome Research Study (UK).

The National Treatment Outcome Research Study (NTORS) is a longitudinal, multisite, prospective cohort study that assesses changes in illicit drug use and other problems after treatment in national (UK) drug misuse treatment programmes. Clients were recruited from 54 residential and community-based drug treatment programmes throughout England. Four modalities were studied: inpatient drug dependence units, residential/rehabilitation programmes, methadone maintenance, and methadone reduction programmes. Data on substance use behaviours and physical and psychological health were collected by structured face-to-face interviews at intake, 1- and 2-year follow-up. Data are presented for 549 clients. A majority of clients achieved widespread improvements across a range of outcome measures after treatment in existing treatment services. For most outcomes, reductions in problem behaviours at the group level occurred within the first year and were maintained at 2 years. Considerable stability of outcomes at the individual level was also found. Abstinence from illicit drugs was substantially increased among clients from both residential and community programmes, and there were also substantial reductions in frequency of use of heroin, nonprescribed methadone, benzodiazepines, and crack cocaine. Injecting and shared use of injecting equipment was also reduced. Heavy drinking was common at intake and was not reduced at follow-up. Psychological and physical health problems were reduced on both groups at follow-up. These changes represent important clinical benefits to the individual clients, to their families, and to society.

Cohort Studies↗

PubMed2001

1998 European Cataract Outcome Study: report from the European Cataract Outcome Study Group.

PURPOSE: To collect clinical data on cataract surgery to allow participating surgeons to compare their performance with that of their colleagues in an anonymous manner. SETTING: Surgeons from 31 surgical units providing cataract surgery in 13 European countries. METHODS: Every patient at each participating unit having surgery during 1 study month was evaluated. Data were reported to the coordinating center at the time of surgery and at the final examination. When the study was closed 6 months after surgery, all participants were provided with the outcomes from their own patients so they could compare them with outcomes from other centers. RESULTS: The study included preoperative and intraoperative data on 2950 patients. Complete follow-up data were available for 2731 patients. The surgical audit included surgically induced astigmatism, proximity of target refraction, and the frequency of major complications. For each variable, a large variation in outcome between participating centers was found. Most centers had results both above and below average for different variables. CONCLUSION: Cataract surgery data collected from 31 units in 13 European countries allowed participants to compare their performance with that of their colleagues in an anonymous manner. Significant variation was found in the outcomes among the units, with many units reporting results above and below the averages.

Aged↗

PubMed2005

Estimating variability in outcomes attributable to therapists: a naturalistic study of outcomes in managed care.

To estimate the variability in outcomes attributable to therapists in clinical practice, the authors analyzed the outcomes of 6,146 patients seen by approximately 581 therapists in the context of managed care. For this analysis, the authors used multilevel statistical procedures, in which therapists were treated as a random factor. When the initial level of severity was taken into account, about 5% of the variation in outcomes was due to therapists. Patient age, gender, and diagnosis as well as therapist age, gender, experience, and professional degree accounted for little of the variability in outcomes among therapists. Whether or not patients were receiving psychotropic medication concurrently with psychotherapy did affect therapist variability. However, the patients of the more effective therapists received more benefit from medication than did the patients of less effective therapists.

Adult↗

PubMed2002

National audit of the outcome of primary surgery for rhegmatogenous retinal detachment. II. Clinical outcomes.

PURPOSE: This national study was designed to audit anatomical outcome and complications relating to primary surgery for rhegmatogenous retinal detachments. This paper presents success and complication rates, and examines variations in outcome. METHODS: Sampling and recruitment details of this nationwide cross-sectional survey of 768 patients of 167 consultant ophthalmologists having their first operation for rhegmatogenous retinal detachment have been described. The main clinical outcomes detailed here are anatomical reattachment at 3 months after surgery and complications related to surgery. Consultants with a declared special interest in retinal surgery and able to perform pars plana vitrectomy were designated specialists for the analyses. RESULTS: Overall reattachment rate with a single procedure was 77% (95% CI 73.9-80.2). There were significant differences in reattachment rates between specialists and non-specialists. Without allowing for case-mix, specialists had a reattachment rate of 82% (95% CI 77.9-85.7) with a single procedure and non-specialists 71% (95% CI 65.9-76.0). Allowing for case-mix, there was a significant difference between specialists and non-specialists for grade 2 detachments of 87% and 70% respectively (P < 0.0001). Analysing detachments by break type, the largest difference between specialists and non-specialists was observed for retinal detachments secondary to horseshoe tears, 80% and 68% respectively (P < 0.003). Specialists met the standards set for primary reattachment rates, while non-specialists did not. Over a third of patients had at least one complication reported at some point during the audit period. CONCLUSIONS: Significant differences were seen in reattachment rates between specialists and non-specialists, overall and for specific subgroups of patients. This study provides relevant, robust and valid standards to enable all surgeons to audit their own surgical outcomes for primary retinal detachment repair in rhegmatogenous retinal detachments, identify common categories of failure and aim to improve results.

Adolescent↗

PubMed2001

Routine outcome measurement in a child and adolescent mental health service: an evaluation of HoNOSCA. The Health of the Nation Outcome Scales for Children and Adolescents.

OBJECTIVE: This paper evaluates a range of properties for a clinician-based instrument designed for routine use in a child and adolescent mental health service (CAMHS). METHOD: The Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) is a new outcome measure with great promise. Case vignettes were used to examine interrater reliability. HoNOSCA was implemented for routine outpatient use by multidisciplinary staff with a return rate of 84%. The 305 ratings obtained at assessment were analysed by age, gender and diagnosis. A sample of 145 paired ratings with a 3-month interval were examined for the measurement of change over time. RESULTS: Interrater reliability of the total score indicates moderate reliability if absolute scores are used and good reliability if the total score is used for relative comparisons. Most scales have good to very good reliability. The scales discriminated between age and gender in the expected way. HoNOSCA correlated with clinicians' views of change and was sensitive to change over a 3-month period. The total score seemed a proxy for severity. CONCLUSION: Routine outcome instruments must be explored in settings where they will be used and with realistic training. HoNOSCA appears to be of value in routine outcome measurement and although questions remain about reliability and validity, the results strongly support further investigation.

Adolescent↗

PubMed2002

Hemodialysis vascular access preferences and outcomes in the Dialysis Outcomes and Practice Patterns Study (DOPPS).

BACKGROUND: Synthetic grafts have generally been found to exhibit lower survival rates and higher complication rates than native arteriovenous fistulae. We investigated whether survival of grafts relative to fistulae was better in facilities with a preference for grafts, hypothesizing that such facilities may place more grafts because grafts produced superior outcomes. METHODS: The study was based on a national U.S. sample of 133 hemodialysis facilities participating in the Dialysis Outcomes and Practice Patterns Study (DOPPS), a prospective, observational study of dialysis treatment practices and outcomes. Vascular access preferences were ascertained from medical directors, nurse managers, and actual practice within each facility (% graft use among prevalent patients). Logistic regression was used to model the odds ratio (OR) of graft placement (vs. fistula) and Cox regression was used to model time from access creation to initial failure. RESULTS: Grafts were preferred by 21% of medical directors and 40% of nurse managers. Patients in facilities in which the medical director or nurse manager expressed a preference for grafts were more than twice as likely to have a graft than a fistula (AOR = 2.3, P < 0.01; reference group = facilities that did not prefer grafts), suggesting that facility preferences influence the type of access created. Overall, grafts were more prevalent than fistulae in dialysis facilities, but displayed a higher relative risk of failure (RR 1.33, P < 0.0001). However, the risk of graft versus fistula failure did not vary by expressed preference of the medical director: the relative risk of graft versus fistula failure was 1.39 in facilities in which the medical director preferred grafts and 1.39 in facilities in which the medical director preferred fistulae. Moreover, the relative risk of graft versus fistula failure was 1.57 in facilities that used more than the median percentage of grafts and 1.19 in facilities that used less than the median percentage of grafts. CONCLUSIONS: No evidence was found that graft outcomes are superior in facilities that prefer grafts to fistulae. The observed variation in vascular access practice patterns suggests opportunities for quality improvement if optimal practices can be defined.

Adult↗

PubMed2002

Emergency Medical Services Outcomes Project (EMSOP) IV: pain measurement in out-of-hospital outcomes research.

The purpose of the Emergency Medical Services Outcomes Project (EMSOP) is to develop a foundation and framework for out-of-hospital outcomes research. In prior work (EMSOP I), discomfort had the highest weighted score among outcome categories for the top 3 adult conditions (ie, minor trauma, respiratory distress, chest pain) and the first and third highest rankings for children's conditions (ie, minor trauma, respiratory distress). In this fourth article in the EMSOP series, we discuss issues relevant to the measurement of pain in the out-of-hospital setting, recommended pain measures that require evaluation, and implications for outcomes research focusing on pain. For adults, adolescents, and older children, 2 verbal pain-rating scales are recommended for out-of-hospital evaluation: (1) the Adjective Response Scale, which includes the responses "none," "slight," "moderate," "severe," and "agonizing," and (2) the Numeric Response Scale, which includes responses from 0 (no pain) to 100 (worst pain imaginable). The Oucher Scale, combining a visual analog scale with pictures, seems most promising for out-of-hospital use among younger children. Future research in out-of-hospital care should be conducted to determine the utility and feasibility of these measures, as well as the effectiveness of interventions for pain relief.

Adult↗

PubMed2001

The association of abnormal alpha-fetoprotein and adverse pregnancy outcome: does increased fetal surveillance affect pregnancy outcome?

OBJECTIVE: Our purpose was to investigate whether adverse outcomes associated with elevated maternal serum alpha-fetoprotein levels may be prevented by intensive antenatal monitoring. STUDY DESIGN: Records of patients with elevated maternal serum alpha-fetoprotein values of > or =2.0 multiples of the median between 1995 and 1999 were reviewed. Pregnancy histories were analyzed to determine whether intensive antenatal monitoring (twice-weekly nonstress tests and determinations of the amniotic fluid index) would have detected the adverse outcomes when routine obstetric care would have missed them. Women with elevations explained by multiple gestations, structural abnormalities, or a fetal death were excluded. RESULTS: The study enrolled 136 patients. Twenty-three patients were excluded because of multiple gestations, structural or chromosomal abnormalities, or fetal death or for lack of available follow-up. Seventy-eight patients had no perinatal complications, but 12 of these patients underwent heightened surveillance. One of these patients was subjected to an induction of labor. Thirty-five pregnancies had complications (21 with preterm labor, 7 with pregnancy-induced hypertension, 6 with growth restriction or oligohydramnios, 1 with abruptio placentae, and 1 with vasa previa). Of these 35 pregnancies, 22 were followed up with routine obstetric care and 13 with heightened surveillance. Heightened surveillance did not achieve earlier or improved detection in this group. These results suggest that routine pregnancy management is an adequate strategy for providing care to pregnant patients with unexplained elevated maternal serum alpha-fetoprotein levels. Adverse outcomes were detected with routine pregnancy management or were undetectable even with intensive management. CONCLUSION: Increased risks of pregnancy-induced hypertension, preterm delivery, intrauterine growth restriction, intrauterine fetal death, oligohydramnios, and abruptio placentae are associated with elevated maternal serum alpha-fetoprotein levels. However, in our study, routine pregnancy management was an acceptable method of detecting these adverse outcomes when they were detectable.

Abruptio Placentae↗

PubMed2003

Does the outcome 2 months after lumbar disc surgery predict the outcome 12 months later?

PURPOSE: To assess the prognostic value of some preoperative and early post-operative indicators in the prediction of disability 14 months after lumbar disc surgery. METHODS: Of 173 patients, who had participated in baseline measurements, 145 (84%) attended the 14-month follow-up. Before surgery the duration and intensity of pain was assessed. Follow-up questionnaires were completed during check-ups and included items on pain (VAS), Oswestry and Million disability indices, depression (BDS) and work status. RESULTS: Two months after surgery average back pain was 67% lower and leg pain 70% lower than pre-operatively. The median Oswestry and Million disability indices were 14 and 15 at 2-months and remained low also at 14-months check-up. Further, the post-operative Oswestry and Million disability indices and BDS were highly associated with 14-month back and leg pain. Although the outcome of the patients was mostly good, 5% and 8% of them, respectively, reported severe pain at 2- and 14-month check-ups. CONCLUSIONS: As recovery following lumbar disc surgery occurred to a great extent during the first 2 months, the early post-operative outcome appears to be quite a reliable indicator of the postoperative outcome in 1-year follow-up. The strong association between pain and the disability indices allows us to conclude that both the Million and Oswestry indices are clinically useful instruments in the evaluation of outcome in these cases.

Adult↗