Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, Jan 3, 2016
Huntington's disease (HD) is an autosomal dominant neurodegenerative disease associated with ... more Huntington's disease (HD) is an autosomal dominant neurodegenerative disease associated with motor, behavioral, and cognitive deficits. The hallmark symptom of HD, chorea, is often the focus of HD clinical trials. Unfortunately, there are no self-reported measures of chorea. To address this shortcoming, we developed a new measure of chorea for use in HD, HDQLIFE Chorea. Qualitative data and literature reviews were conducted to develop an initial item pool of 141 chorea items. An iterative process, including cognitive interviews, expert review, translatability review, and literacy review, was used to refine this item pool to 64 items. These 64 items were field tested in 507 individuals with prodromal and/or manifest HD. Exploratory and confirmatory factor analyses (EFA and CFA, respectively) were conducted to identify a unidimensional set of items. Then, an item response theory graded response model (GRM) and differential item functioning analyses were conducted to select the fin...
International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity, 2004
For obese older persons, ambulation is both functionally important and a means of weight control.... more For obese older persons, ambulation is both functionally important and a means of weight control. The relationship between weight and ambulation is not known in this population. Also, the extent to which pain interferes with ambulation is not studied. To examine the relationship between obesity and ambulation, and to determine the effect of pain and body mass index (BMI) on ambulation in older persons. Retrospective study of 82 older persons, ages 55-79 y, some with no back pain recruited from the community, others with back pain or spinal stenosis recruited from a magnetic resonance imaging (MRI) scanner as part of a larger university study of spinal stenosis. Age, Visual Analog Scales for pain, BMI, patient diagnosis (no pain, mechanical back pain, and spinal stenosis), walking velocity and stride length on a 15-min laboratory ambulation test, and 1-week community ambulation measured with a pedometer (steps, distance, and energy expenditure). BMI had a significant inverse relation...
Longitudinal masked, double-controlled cohort study. To determine prognosis and predictors of fun... more Longitudinal masked, double-controlled cohort study. To determine prognosis and predictors of function and pain in persons with spinal stenosis. The clinical syndrome of spinal stenosis is common and disabling, but not clearly related to anatomic measures. Prognosis not well studied. Persons 55 to 80 years of age with and without stenosis on preliminary review of magnetic resonance imaging (MRI), and asymptomatic volunteers underwent screening, questionnaires, physical examination, ambulation testing, masked electromyogram (EMG), and masked MRI scans; these were repeated at >18 months. Twenty-three asymptomatic, 28 back pain, and 32 clinically diagnosed stenosis subjects underwent follow-up. Although initial and follow-up diagnosis tended to agree (kappa = 0.394, P < 001), there were substantial shifts between the three groups. Among persons with clinically diagnosed stenosis, every measure trended for improvement, including significant changes in pain, ambulation, and EMG. Ambulation velocity and Pain Disability Index at follow-up were predicted by initial disability measures. Pain was predicted by initial sleep difficulty but not initial pain. EMG and MRI did not predict function or pain. Clinically recognized spinal stenosis is fluctuating and largely improving, and in continuum with back pain and no symptoms. Since anatomic and neurologic deficits do not predict future function, they should not be weighed heavily in surgical risk-benefit discussions.
Prospective, masked, double controlled diagnostic trial. To determine the sensitivity and specifi... more Prospective, masked, double controlled diagnostic trial. To determine the sensitivity and specificity of electrodiagnostic consultation (EDX) for the clinical syndrome of lumbar spinal stenosis. EDX has been used for more than 50 years to diagnose spinal disorders but has not met the new standards of evidence-based medicine. A total of 150 subjects (asymptomatic volunteers and patients with MRIs suggesting back pain or spinal stenosis; 55-80 years of age) underwent physiatrist history and physical examination, MRI, and review of this data by a neurosurgeon, with each clinician masked to any outside information, leading to a unanimous consensus on diagnosis in 55. After masked EDX testing, 7 subjects with undiagnosed neuromuscular disease were discovered. EDX findings were related to "clinical gold standard" diagnoses in 48 persons. Paraspinal mapping EMG score of >4 had 100% specificity and 30% sensitivity for stenosis compared with either the back pain or asymptomatic groups (each, P < 0.04). A composite limb and paraspinal fibrillation score had a sensitivity of 47.8% and specificity of 87.5% (P = 0.008), and H-wave sensitivity was 36.4, specificity 91.3 (P = 0.026) for stenosis versus all controls. This first masked study in the 60-year history of needle electromyography also introduces anatomically validated needle placement, quantified and reproducible examination of the paraspinal muscles, and dual control populations to EDX research in spinal disorders. EDX has statistically significant, clinically meaningful specificity for spinal stenosis and detects neuromuscular diseases that may masquerade as stenosis.
Cross-sectional study. To determine if the amount of lumbar paraspinal denervation increases with... more Cross-sectional study. To determine if the amount of lumbar paraspinal denervation increases with age and present normative data on the amount of denervation present in asymptomatic subjects. To our knowledge, there are no data on the relationship of paraspinal denervation with age or normative data on the amount of denervation expected in asymptomatic older adults. We combined the data from our current study of asymptomatic adults, age 55-79 years, and a previous study of asymptomatic adults, age 18-58 years, who underwent lumbar paraspinal muscle needle electromyography using a validated needle electromyography (MiniPM) technique. We then compared the results of the age group 55-79 to that of the age group 18-54. The older group scored significantly higher than the younger group by 1.7 (P = 0.008, 95% confidence interval 0.5-3.0). Linear regression showed that age was a significant predictor of the MiniPM score (beta = 0.04, and P = 0.04). For subjects 55 years and older, mean MiniPM score on one side was 2.3 (standard deviation 3.6). The upper range of the 95th percentile was 10. The amount of lumbar paraspinal muscle denervation does increase with age. Understanding the range of findings in asymptomatic subjects will help us interpret lumbar paraspinal needle electromyography findings in patients with spinal disorders.
Clinical symptoms associated with lumbar spinal stenosis (LSS) are believed to be due to neurogen... more Clinical symptoms associated with lumbar spinal stenosis (LSS) are believed to be due to neurogenic claudication caused by narrowing of the central and lateral spinal canals. However, there is a paucity of published data on these relationships. The purpose of the present study was to examine the relationship between clinical symptoms associated with LSS and osseous anterior-posterior (AP) spinal canal diameter as measured on axial magnetic resonance imaging. Cross-sectional study conducted at a University Spine Program. Fifty persons with a clinical diagnosis of LSS were administered measures of clinical pain and perceived function. Walking distance in the laboratory and community was also assessed. Participants also underwent magnetic resonance imaging of the spine. Using recommended upper limits from the literature, patients with smaller canals reported greater perceived disability, but no other group differences emerged. In the entire sample, AP spinal canal diameter was not significantly associated with any of the clinical symptom measures examined. Body mass index was found to be significantly related to walking distance, but not perceived function or pain. AP spinal canal diameter is not predictive of clinical symptoms associated with LSS. The findings also suggest that body mass may play a significant role in functional limitations observed in this population.
Archives of Physical Medicine and Rehabilitation, 2006
To assess the relations between clinically recognized lumbar spinal stenosis and the conclusions ... more To assess the relations between clinically recognized lumbar spinal stenosis and the conclusions of masked radiologists and electrodiagnosticians. Prospective, masked, double-controlled trial. University spine center. One hundred fifty persons age 55 to 80 years with or without back pain and with or without magnetic resonance imaging (MRI)-demonstrated stenosis, screened for neuropathy risk, previous surgery, or cancer. Questionnaires on pain and function; ambulation testing and physical examination; and masked electrodiagnotics and MRI. Diagnostic impressions of the examining clinician, radiologist, and electrodiagnostician. Following application of post hoc exclusion criteria and elimination of patients due to incomplete or inadequate test data, the clinical diagnosis was lumbar stenosis in 50 subjects, back pain in 44 subjects, and no pain in 32 subjects. Radiologic and clinical impression had no relation (P = .80 vs asymptomatic, P = .99 vs back pain controls). Electrodiagnostic impression trended to relate to clinical impression (P = .14 vs asymptomatic, P = .09 vs back pain). Retrospective application of age-related electrodiagnostic norms for paraspinal electromyographic and limb motor unit changes, established in this study, reclassified 13 of the 17 asymptomatic persons whom the electrodiagnostician thought had stenosis. The clinical impression did correspond to history and physical examination findings typically associated with spinal stenosis and to the independent impression of a neurosurgeon who examined MRI and clinical, but not to the electrodiagnostic data. The impression obtained from an MRI scan does not determine whether lumbar stenosis is a cause of pain. Electrodiagnostic consultation may be useful, especially if age-related norms obtained in this study are applied.
Archives of Physical Medicine and Rehabilitation, 2012
Objective-Examine predictors of community walking performance and walking capacity in lumbar spin... more Objective-Examine predictors of community walking performance and walking capacity in lumbar spinal stenosis (LSS), compared to individuals with low back pain and asymptomatic controls.
American Journal of Physical Medicine & Rehabilitation, 2007
To examine the impact of clinician factors on technical data within an electrodiagnostic consulta... more To examine the impact of clinician factors on technical data within an electrodiagnostic consultation for low-back pain and spinal stenosis. Examiner differences on single-segment paraspinal mapping scores and other findings were examined in a prospective, masked, double-controlled trial involving 150 people aged 55-80 yrs who were selected for no symptoms, back pain, or possible spinal stenosis. Unmasked clinicians were more variable than masked physicians (F2,219 = 4.808, P =or<0.01) and gave lower scores to people they felt had mechanical back pain. The percentage of inadequate segmental scores differed among clinicians (0-16.6%, F8,226 = 4.170, P < 0.001), with fellows having more difficulty than faculty (11.76 +/- 32.38% vs. 0.75 +/- 8.67%) (t233 = 3.753, P < 0.001). Correction of clinician bias improved the relationship between paraspinal score and subjects' ability to walk (weighted regression R = 0.129, B = -0.047, P < 0.001; unweighted regression R = 0.090, B = -0.045, P < 0.001). Objective testing is adversely affected by clinician factors including prejudgment, experience, and individual idiosyncrasies. Less variation is found in more codified procedures. For electrodiagnostic consultation, correction of variability improves the relationship of test results to disability.
American Journal of Physical Medicine & Rehabilitation, 2006
Performed by thousands of specialists and researched for >60 yrs, electrod... more 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. 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. 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). The electrodiagnostic examination can be successfully masked. This information will help future research in electrodiagnostics meet the criteria of evidence-based medicine.
American Journal of Physical Medicine & Rehabilitation, 2011
The aim of this study was to determine the specificity of needle electromyography for lumbar radi... more The aim of this study was to determine the specificity of needle electromyography for lumbar radiculopathy in subjects with low back pain and sciatica without stenosis. Subjects 55 yrs or older with diagnoses of low back pain and sciatica underwent a standardized monopolar needle evaluation by blinded electromyographers as part of a spinal stenosis study. The presence or absence of radiculopathy was determined using different electrodiagnostic criteria. Seventy-two subjects with a mean age of 64.6 years (SD, 7.0 yrs) were studied. When only positive sharp waves or fibrillations were considered abnormal, most of the diagnostic criteria--two limb muscles + associated lumbar paraspinal muscle abnormal, two limb muscles abnormal, or one limb muscle + associated lumbar paraspinal muscle abnormal--had 97%, 96%, and 92% specificity, respectively. When 30% or greater polyphasia in the limb muscles was also considered abnormal, the respective specificities were 90%, 81%, and 85%. When 20% or greater polyphasia in the limb muscles was also considered abnormal, the respective specificities were 90%, 74%, and 71% [corrected]. There is good specificity for lumbosacral radiculopathy when appropriate diagnostic criteria are used.
asymptomatic group. Analysis of variance showed that the pain VAS (p ! 0.001), 15-minute walk tes... more asymptomatic group. Analysis of variance showed that the pain VAS (p ! 0.001), 15-minute walk test (p = 0.01), 7-day walk (p = 0.02), QBPDS (p ! 0.001), and PDI (p ! 0.001) were different between at least two groups. All the variables in the stenosis group were worse than in the asymptomatic group, but only the pain VAS, QBPDS, and PDI in the LBP group were worse than in the asymptomatic group. In both the stenosis and LBP group the QBPDS and PDI were only related to pain VAS. Conclusion: Seniors with spinal stenosis and LBP have more disability than asymptomatic seniors. The 15-minute walking test with the stenosis group was slower than with the asymptomatic seniors. However, they compensate so that their 7-day walking distance is not as significantly decreased.
Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, Jan 3, 2016
Huntington's disease (HD) is an autosomal dominant neurodegenerative disease associated with ... more Huntington's disease (HD) is an autosomal dominant neurodegenerative disease associated with motor, behavioral, and cognitive deficits. The hallmark symptom of HD, chorea, is often the focus of HD clinical trials. Unfortunately, there are no self-reported measures of chorea. To address this shortcoming, we developed a new measure of chorea for use in HD, HDQLIFE Chorea. Qualitative data and literature reviews were conducted to develop an initial item pool of 141 chorea items. An iterative process, including cognitive interviews, expert review, translatability review, and literacy review, was used to refine this item pool to 64 items. These 64 items were field tested in 507 individuals with prodromal and/or manifest HD. Exploratory and confirmatory factor analyses (EFA and CFA, respectively) were conducted to identify a unidimensional set of items. Then, an item response theory graded response model (GRM) and differential item functioning analyses were conducted to select the fin...
International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity, 2004
For obese older persons, ambulation is both functionally important and a means of weight control.... more For obese older persons, ambulation is both functionally important and a means of weight control. The relationship between weight and ambulation is not known in this population. Also, the extent to which pain interferes with ambulation is not studied. To examine the relationship between obesity and ambulation, and to determine the effect of pain and body mass index (BMI) on ambulation in older persons. Retrospective study of 82 older persons, ages 55-79 y, some with no back pain recruited from the community, others with back pain or spinal stenosis recruited from a magnetic resonance imaging (MRI) scanner as part of a larger university study of spinal stenosis. Age, Visual Analog Scales for pain, BMI, patient diagnosis (no pain, mechanical back pain, and spinal stenosis), walking velocity and stride length on a 15-min laboratory ambulation test, and 1-week community ambulation measured with a pedometer (steps, distance, and energy expenditure). BMI had a significant inverse relation...
Longitudinal masked, double-controlled cohort study. To determine prognosis and predictors of fun... more Longitudinal masked, double-controlled cohort study. To determine prognosis and predictors of function and pain in persons with spinal stenosis. The clinical syndrome of spinal stenosis is common and disabling, but not clearly related to anatomic measures. Prognosis not well studied. Persons 55 to 80 years of age with and without stenosis on preliminary review of magnetic resonance imaging (MRI), and asymptomatic volunteers underwent screening, questionnaires, physical examination, ambulation testing, masked electromyogram (EMG), and masked MRI scans; these were repeated at >18 months. Twenty-three asymptomatic, 28 back pain, and 32 clinically diagnosed stenosis subjects underwent follow-up. Although initial and follow-up diagnosis tended to agree (kappa = 0.394, P < 001), there were substantial shifts between the three groups. Among persons with clinically diagnosed stenosis, every measure trended for improvement, including significant changes in pain, ambulation, and EMG. Ambulation velocity and Pain Disability Index at follow-up were predicted by initial disability measures. Pain was predicted by initial sleep difficulty but not initial pain. EMG and MRI did not predict function or pain. Clinically recognized spinal stenosis is fluctuating and largely improving, and in continuum with back pain and no symptoms. Since anatomic and neurologic deficits do not predict future function, they should not be weighed heavily in surgical risk-benefit discussions.
Prospective, masked, double controlled diagnostic trial. To determine the sensitivity and specifi... more Prospective, masked, double controlled diagnostic trial. To determine the sensitivity and specificity of electrodiagnostic consultation (EDX) for the clinical syndrome of lumbar spinal stenosis. EDX has been used for more than 50 years to diagnose spinal disorders but has not met the new standards of evidence-based medicine. A total of 150 subjects (asymptomatic volunteers and patients with MRIs suggesting back pain or spinal stenosis; 55-80 years of age) underwent physiatrist history and physical examination, MRI, and review of this data by a neurosurgeon, with each clinician masked to any outside information, leading to a unanimous consensus on diagnosis in 55. After masked EDX testing, 7 subjects with undiagnosed neuromuscular disease were discovered. EDX findings were related to "clinical gold standard" diagnoses in 48 persons. Paraspinal mapping EMG score of >4 had 100% specificity and 30% sensitivity for stenosis compared with either the back pain or asymptomatic groups (each, P < 0.04). A composite limb and paraspinal fibrillation score had a sensitivity of 47.8% and specificity of 87.5% (P = 0.008), and H-wave sensitivity was 36.4, specificity 91.3 (P = 0.026) for stenosis versus all controls. This first masked study in the 60-year history of needle electromyography also introduces anatomically validated needle placement, quantified and reproducible examination of the paraspinal muscles, and dual control populations to EDX research in spinal disorders. EDX has statistically significant, clinically meaningful specificity for spinal stenosis and detects neuromuscular diseases that may masquerade as stenosis.
Cross-sectional study. To determine if the amount of lumbar paraspinal denervation increases with... more Cross-sectional study. To determine if the amount of lumbar paraspinal denervation increases with age and present normative data on the amount of denervation present in asymptomatic subjects. To our knowledge, there are no data on the relationship of paraspinal denervation with age or normative data on the amount of denervation expected in asymptomatic older adults. We combined the data from our current study of asymptomatic adults, age 55-79 years, and a previous study of asymptomatic adults, age 18-58 years, who underwent lumbar paraspinal muscle needle electromyography using a validated needle electromyography (MiniPM) technique. We then compared the results of the age group 55-79 to that of the age group 18-54. The older group scored significantly higher than the younger group by 1.7 (P = 0.008, 95% confidence interval 0.5-3.0). Linear regression showed that age was a significant predictor of the MiniPM score (beta = 0.04, and P = 0.04). For subjects 55 years and older, mean MiniPM score on one side was 2.3 (standard deviation 3.6). The upper range of the 95th percentile was 10. The amount of lumbar paraspinal muscle denervation does increase with age. Understanding the range of findings in asymptomatic subjects will help us interpret lumbar paraspinal needle electromyography findings in patients with spinal disorders.
Clinical symptoms associated with lumbar spinal stenosis (LSS) are believed to be due to neurogen... more Clinical symptoms associated with lumbar spinal stenosis (LSS) are believed to be due to neurogenic claudication caused by narrowing of the central and lateral spinal canals. However, there is a paucity of published data on these relationships. The purpose of the present study was to examine the relationship between clinical symptoms associated with LSS and osseous anterior-posterior (AP) spinal canal diameter as measured on axial magnetic resonance imaging. Cross-sectional study conducted at a University Spine Program. Fifty persons with a clinical diagnosis of LSS were administered measures of clinical pain and perceived function. Walking distance in the laboratory and community was also assessed. Participants also underwent magnetic resonance imaging of the spine. Using recommended upper limits from the literature, patients with smaller canals reported greater perceived disability, but no other group differences emerged. In the entire sample, AP spinal canal diameter was not significantly associated with any of the clinical symptom measures examined. Body mass index was found to be significantly related to walking distance, but not perceived function or pain. AP spinal canal diameter is not predictive of clinical symptoms associated with LSS. The findings also suggest that body mass may play a significant role in functional limitations observed in this population.
Archives of Physical Medicine and Rehabilitation, 2006
To assess the relations between clinically recognized lumbar spinal stenosis and the conclusions ... more To assess the relations between clinically recognized lumbar spinal stenosis and the conclusions of masked radiologists and electrodiagnosticians. Prospective, masked, double-controlled trial. University spine center. One hundred fifty persons age 55 to 80 years with or without back pain and with or without magnetic resonance imaging (MRI)-demonstrated stenosis, screened for neuropathy risk, previous surgery, or cancer. Questionnaires on pain and function; ambulation testing and physical examination; and masked electrodiagnotics and MRI. Diagnostic impressions of the examining clinician, radiologist, and electrodiagnostician. Following application of post hoc exclusion criteria and elimination of patients due to incomplete or inadequate test data, the clinical diagnosis was lumbar stenosis in 50 subjects, back pain in 44 subjects, and no pain in 32 subjects. Radiologic and clinical impression had no relation (P = .80 vs asymptomatic, P = .99 vs back pain controls). Electrodiagnostic impression trended to relate to clinical impression (P = .14 vs asymptomatic, P = .09 vs back pain). Retrospective application of age-related electrodiagnostic norms for paraspinal electromyographic and limb motor unit changes, established in this study, reclassified 13 of the 17 asymptomatic persons whom the electrodiagnostician thought had stenosis. The clinical impression did correspond to history and physical examination findings typically associated with spinal stenosis and to the independent impression of a neurosurgeon who examined MRI and clinical, but not to the electrodiagnostic data. The impression obtained from an MRI scan does not determine whether lumbar stenosis is a cause of pain. Electrodiagnostic consultation may be useful, especially if age-related norms obtained in this study are applied.
Archives of Physical Medicine and Rehabilitation, 2012
Objective-Examine predictors of community walking performance and walking capacity in lumbar spin... more Objective-Examine predictors of community walking performance and walking capacity in lumbar spinal stenosis (LSS), compared to individuals with low back pain and asymptomatic controls.
American Journal of Physical Medicine & Rehabilitation, 2007
To examine the impact of clinician factors on technical data within an electrodiagnostic consulta... more To examine the impact of clinician factors on technical data within an electrodiagnostic consultation for low-back pain and spinal stenosis. Examiner differences on single-segment paraspinal mapping scores and other findings were examined in a prospective, masked, double-controlled trial involving 150 people aged 55-80 yrs who were selected for no symptoms, back pain, or possible spinal stenosis. Unmasked clinicians were more variable than masked physicians (F2,219 = 4.808, P =or<0.01) and gave lower scores to people they felt had mechanical back pain. The percentage of inadequate segmental scores differed among clinicians (0-16.6%, F8,226 = 4.170, P < 0.001), with fellows having more difficulty than faculty (11.76 +/- 32.38% vs. 0.75 +/- 8.67%) (t233 = 3.753, P < 0.001). Correction of clinician bias improved the relationship between paraspinal score and subjects' ability to walk (weighted regression R = 0.129, B = -0.047, P < 0.001; unweighted regression R = 0.090, B = -0.045, P < 0.001). Objective testing is adversely affected by clinician factors including prejudgment, experience, and individual idiosyncrasies. Less variation is found in more codified procedures. For electrodiagnostic consultation, correction of variability improves the relationship of test results to disability.
American Journal of Physical Medicine & Rehabilitation, 2006
Performed by thousands of specialists and researched for >60 yrs, electrod... more 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. 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. 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). The electrodiagnostic examination can be successfully masked. This information will help future research in electrodiagnostics meet the criteria of evidence-based medicine.
American Journal of Physical Medicine & Rehabilitation, 2011
The aim of this study was to determine the specificity of needle electromyography for lumbar radi... more The aim of this study was to determine the specificity of needle electromyography for lumbar radiculopathy in subjects with low back pain and sciatica without stenosis. Subjects 55 yrs or older with diagnoses of low back pain and sciatica underwent a standardized monopolar needle evaluation by blinded electromyographers as part of a spinal stenosis study. The presence or absence of radiculopathy was determined using different electrodiagnostic criteria. Seventy-two subjects with a mean age of 64.6 years (SD, 7.0 yrs) were studied. When only positive sharp waves or fibrillations were considered abnormal, most of the diagnostic criteria--two limb muscles + associated lumbar paraspinal muscle abnormal, two limb muscles abnormal, or one limb muscle + associated lumbar paraspinal muscle abnormal--had 97%, 96%, and 92% specificity, respectively. When 30% or greater polyphasia in the limb muscles was also considered abnormal, the respective specificities were 90%, 81%, and 85%. When 20% or greater polyphasia in the limb muscles was also considered abnormal, the respective specificities were 90%, 74%, and 71% [corrected]. There is good specificity for lumbosacral radiculopathy when appropriate diagnostic criteria are used.
asymptomatic group. Analysis of variance showed that the pain VAS (p ! 0.001), 15-minute walk tes... more asymptomatic group. Analysis of variance showed that the pain VAS (p ! 0.001), 15-minute walk test (p = 0.01), 7-day walk (p = 0.02), QBPDS (p ! 0.001), and PDI (p ! 0.001) were different between at least two groups. All the variables in the stenosis group were worse than in the asymptomatic group, but only the pain VAS, QBPDS, and PDI in the LBP group were worse than in the asymptomatic group. In both the stenosis and LBP group the QBPDS and PDI were only related to pain VAS. Conclusion: Seniors with spinal stenosis and LBP have more disability than asymptomatic seniors. The 15-minute walking test with the stenosis group was slower than with the asymptomatic seniors. However, they compensate so that their 7-day walking distance is not as significantly decreased.
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Papers by Jennifer Miner