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OBJECTIVE: To determine risk factors for negative global treatment outcomes as self-assessed by patients undergoing surgical treatment for lumbar spinal stenosis (LSS). METHODS: Patients from the Spine Tango registry undergoing first-time surgery for LSS were analyzed. The primary outcome was global treatment outcomes measured at the last available follow-up ≥3 months postoperatively using a single question rating how much the operation had helped the patient's back problem (negative = no change/operation made things worse). A 2-level logistic mixed effects model with the treating department as the random effect was used to assess factors associated with a negative outcome. RESULTS: A total of 4504 patients from 39 departments in 10 countries were included. Overall, 14.4% of patients reported a negative global treatment outcome after an average follow-up of 1.3 years. In patients with dominant leg pain, negative outcome was associated with higher baseline back pain; in those with dominant back pain, it was associated with higher baseline back pain, ASA (American Society of Anesthesiologists) ≥3, lower age, not having rigid stabilization, not having disc herniation, and the vertebral level of the most severely affected segment (L5/S1 vs. L3/4). Four departments had significantly higher odds of a negative outcome, whereas 1 department had significantly lower odds. Three out of the 4 negative effects were related to 2 departments from 1 country. CONCLUSIONS: LSS surgery fails to help at least 1 in 10 patients. High baseline back pain is the most important factor associated with a negative treatment outcome. Department-level and potentially country-level factors of unknown origin explained a nonnegligible variation in the treatment results.

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INTRODUCTION: A small proportion of individuals with non-specific low back pain (NSLBP) develop persistent problems. Up to 80% of the total costs for NSLBP are owing to chronic NSLBP. Psychosocial factors have been described to be important in the transition from acute to chronic NSLBP. Guidelines recommend the use of the Acute Low Back Pain Screening Questionnaire (ALBPSQ) and the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) to identify individuals at risk of developing persistent problems, such as long-term absence of work, persistent restriction in function or persistent pain. These instruments can be used with a cutoff value, where patients with values above the threshold are further assessed with a more comprehensive examination. METHODS: We systematically reviewed studies evaluating the accuracy of the ALBPSQ and ÖMPSQ to predict persistent problems. RESULTS: The 13 included studies used different cutoff values for the screening questionnaires ranging from 68 to 147. The pooled sensitivity was 0.59 (0.43-0.74), while the pooled specificity was 0.77 (0.66-0.86). Heterogeneity (I (2)) was 90.02% for sensitivity and 95.41% for specificity. CONCLUSION: Thus, we do not recommend the use of one cutoff value, but the use of a prediction model with all the individual items.

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BACKGROUND AND PURPOSE: The comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for low back pain (LBP) can be used to describe functioning and the influence of the environment of patients with LBP with a selection of 78 categories, from the ICF components 'body functions', 'body structures', 'activities and participation' and 'environmental factors'. The reliability of the qualifiers' scale of the ICF Core Set for LBP has not yet been studied. METHODS: Reliability study was conducted in three study centres in the German-speaking part of Switzerland. In the first step, two physiotherapists independently assessed 31 patients with LBP with the original qualifier scale of the 78 ICF categories from the comprehensive ICF Core Set for LBP. After the first 31 patients, inter-rater reliability was assessed and the response options were reduced based on a Rasch analysis. The second sample (n = 30) was assessed by the physiotherapists with the modified qualifier scale and inter-rater reliability was calculated again. RESULTS: The percentage agreement for the ICF categories ranged from 19% to 87%, mean 44% (nominal kappa from -0.73 to 0.54, median 0.22; weighted kappa -0.2 to 0.69, median 0.38) in the first round with the original qualifier scale. In the second round with the reduced response options, the percentage agreement ranged from 23% to 90%, mean 49% (nominal kappa from -0.15 to 0.71, median 0.24; weighted kappa -0.16 to 0.81, median 0.25). The overall percentage agreement was 44% in the first round and 49% with the reduced response categories. The overall kappa value in the first round was 0.29 and in the second round 0.32. There was a small but statistically significant improvement in the agreement. CONCLUSION: The low-to-moderate reliability found in this study requires an improved operationalization (e.g. the definition and description of each response category) and improved instructions for the ICF Core Set for LBP.

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Low back pain (LBP) can restrict function with all the personal, interpersonal, and social consequences, such as a loss of independence and the inability to fulfil diverse roles in social life. Therefore, the prevention of the consequences of LBP would reduce costs, individual burdens and social burdens. Being able to fulfil the requirements of daily living is a cornerstone of quality of life. Early identification of patients who are likely to develop chronic pain with persistent restricted function is important, as effective prevention needs informed allocation of health care and social work. The aim of this study was to report and discuss the predictive value of instruments used to identify patients at risk of chronic LBP. Medline, Embase, CINAHL, Central, PEDro, Psyndex, PsychInfo/PsycLit, and Sociofile were systematically searched up to July 2004. Reference lists of systematic reviews on risk factors, and reference lists of the studies included were also searched. The selected studies evaluated predictive values of tools or predictive models applied 2-12 weeks after an initial medical consultation for a first or a new episode of non-specific LBP with restriction in function. Instruments had to predict function-related outcomes. Because of the heterogeneity of the instruments used we did not pool the data. Sixteen publications on function-related outcomes were included. The predictive instruments in these studies showed only moderate ability to predict or explain function-related outcome (maximal 51% of the variability). There was great variability in the predictors included and not all known risk factors were included in the models. The reviewed tools showed a limited ability to predict function-related outcome in patients with risk of chronic low back pain. Future instruments should be based on models with a comprehensive set of known risk factors. These models should be constructed and validated by international, coordinated research teams.

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The purpose of this study was to evaluate the immediate influence of eccentric muscle action on vertical jump performance in athletes performing sports with a high demand of explosive force development. In this randomized, controlled crossover trial, 13 Swiss elite athletes (national team members in ski jump, ski alpine, snowboard freestyle and alpine, ski freestyle, and gymnastics) with a mean age of 22 years (range 20-28) were randomized into 2 groups. After a semistandardized warm-up, group 1 did 5 jumps from a height of 60 cm, landing with active stabilization in 90 degrees knee flexion. One minute after these modified drop jumps, they performed 3 single squat jumps (SJ) and 3 single countermovement jumps (CMJ) on a force platform. The athletes repeated the procedure after 1 hour without the modified drop jumps. In a crossover manner, group 2 did the first warm-up without and the second warm-up with the modified drop jumps. Differences of the performance (jump height and maximal power) between the different warm-ups were the main outcomes. The mean absolute power and absolute height (without drop jumps) were CMJ 54.9 W.kg(-1) (SD = 4.1), SJ 55.0 W.kg(-1) (SD = 5.1), CMJ 44.1 cm (SD = 4.1), and SJ 40.8 cm (SD = 4.1). A consistent tendency for improvement with added drop jumps to the warm-up routine was observed compared with warm-up without drop jumps: maximal power CMJ +1.02 W.kg(-1) (95% confidence interval [CI] = +0.03 to +2.38), p = 0.045; maximal power SJ +0.8 W.kg(-1) (95% CI = -0.34 to +2.02), p = 0.148; jump height CMJ +0.48 cm (95% CI = -0.26 to +1.2), p = 0.182; SJ +0.73 cm (95% CI = -0.36 to +1.18), p = 0.169. Athletes could add modified drop jumps to the warm-up before competitions to improve explosive force development.

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