Abstract
Purpose
To investigate the prognostic value of electrodiagnostic testing in patients with sciatica receiving physical therapy.
Methods
Electrodiagnostic testing was performed on 38 patients with sciatica participating in a randomized trial comparing different physical therapy interventions. Patients were grouped and analyzed according to the presence or absence of radiculopathy based on electrodiagnostic testing. Longitudinal data analysis was conducted using multilevel growth modeling with ten waves of data collected from baseline through the treatment and post-treatment periods up to 6 months. The primary outcome measure was changes in low back pain-related disability assessed using the Roland and Morris disability questionnaire (RMDQ).
Results
Patients with radiculopathy (n = 19) had statistically significant and clinically meaningful improvements in RMDQ scores at every post-treatment follow-up occasion regardless of treatment received. The final multilevel growth model revealed improvements in RMDQ scores in patients with radiculopathy at the 6-week (−8.1, 95 % CI −12.6 to −2.6; P = 0.006) and 6-month (−4.1, 95 % CI −7.4 to −0.7; P = 0.020) follow-up occasions compared to patients without radiculopathy. Treatment group was not a significant predictive factor at any follow-up occasion. An interaction between electrodiagnostic status and time revealed faster weekly improvements in RMDQ scores in patients with radiculopathy at the 6-week (−0.72, 95 % CI −1.4 to −0.04; P = 0.040) through the 16-week (−0.30, 95 % CI, −0.57 to −0.04; P = 0.028) follow-up occasions compared to patients without radiculopathy.
Conclusions
The presence of lumbosacral radiculopathy identified with electrodiagnostic testing is a favorable prognostic factor for recovery in low back pain-related disability regardless of physical therapy treatment received.
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References
Daube JR, Rubin DI (2009) Needle electromyography. Muscle Nerve 39:244–270. doi:10.1002/mus.21180
Katirji B (2007) Electromyography in clinical practice: a case study approach. Mosby, Philadelphia, PA
Preston DC, Shapiro B (2005) Electromyography and neuromuscular disorders: clinical-electrophysiologic correlations. Butterworth-Heinemann, Newton, MA
Kimura J (2001) Electrodiagnosis in diseases of nerve and muscle: principles and practice. Oxford University Press, USA
Dumitru D (2001) Electrodiagnostic Medicine. Hanley & Belfus, Philadelphia, PA
Martin BI, Deyo RA, Mirza SK, Turner JA, Comstock BA, Hollingworth W, Sullivan SD (2008) Expenditures and health status among adults with back and neck problems. JAMA 299:656–664. doi:10.1001/jama.299.6.656
Abenhaim L, Rossignol M, Gobeille D, Bonvalot Y, Fines P, Scott S (1995) The prognostic consequences in the making of the initial medical diagnosis of work-related back injuries. Spine 20:791–795
Andersen JC (2011) Is immediate imaging important in managing low back pain? J Athl Train 46:99–102. doi:10.4085/1062-6050-46.1.99
Tubach F, Beaute J, Leclerc A (2004) Natural history and prognostic indicators of sciatica. J Clin Epidemiol 57:174–179. doi:10.1016/s0895-4356(03)00257-9
Bajpai J, Saini S, Singh R (2013) Clinical correlation of magnetic resonance imaging with symptom complex in prolapsed intervertebral disc disease: a cross-sectional double blind analysis. J Craniovertebr Junction Spine 4:16–20. doi:10.4103/0974-8237.121619
Koes BW, van Tulder MW, Peul WC (2007) Diagnosis and treatment of sciatica. BMJ 334:1313–1317. doi:10.1136/bmj.39223.428495.BE
Van Boxem K, Cheng J, Patijn J, van Kleef M, Lataster A, Mekhail N, Van Zundert J (2010) 11. Lumbosacral radicular pain. Pain Pract 10:339–358. doi:10.1111/j.1533-2500.2010.00370.x
Engel CC, von Korff M, Katon WJ (1996) Back pain in primary care: predictors of high health-care costs. Pain 65:197–204
Balague F, Nordin M, Sheikhzadeh A, Echegoyen AC, Brisby H, Hoogewoud HM, Fredman P, Skovron ML (1999) Recovery of severe sciatica. Spine 24:2516–2524
Selim AJ, Ren XS, Fincke G, Deyo RA, Rogers W, Miller D, Linzer M, Kazis L (1998) The importance of radiating leg pain in assessing health outcomes among patients with low back pain. Results from the Veterans Health Study. Spine 23:470–474
Fritz JM, Thackeray A, Childs JD, Brennan GP (2010) A randomized clinical trial of the effectiveness of mechanical traction for sub-groups of patients with low back pain: study methods and rationale. BMC Musculoskelet Disord 11:81. doi:10.1186/1471-2474-11-81
Fritz JM, Lindsay W, Matheson JW, Brennan GP, Hunter SJ, Moffit SD, Swalberg A, Rodriquez B (2007) Is there a subgroup of patients with low back pain likely to benefit from mechanical traction? Results of a randomized clinical trial and subgrouping analysis. Spine 32:E793–E800. doi:10.1097/BRS.0b013e31815d001a
Frost H, Lamb SE, Stewart-Brown S (2008) Responsiveness of a patient specific outcome measure compared with the Oswestry Disability Index v2.1 and Roland and Morris Disability Questionnaire for patients with subacute and chronic low back pain. Spine 33:2450–2457. doi:10.1097/BRS.0b013e31818916fd (discussion 2458)
Ostelo RW, de Vet HC (2005) Clinically important outcomes in low back pain. Best Pract Res Clin Rheumatol 19:593–607. doi:10.1016/j.berh.2005.03.003
Ostelo RWJG, Deyo RA, Stratford P, Waddell G, Croft P, Von Korff M, Bouter LM, De Vet HC, de Vet HC (2008) Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change. Spine 33:90
Lauridsen HH, Hartvigsen J, Manniche C, Korsholm L, Grunnet-nilsson N, Grunnet-Nilsson N (2006) Responsiveness and minimal clinically important difference for pain and disability instruments in low back pain patients. BMC Musculoskelet Disord 7:16
Fairbank JC, Couper J, Davies JB, O’Brien JP (1980) The Oswestry low back pain disability questionnaire. Physiotherapy 66:271–273
Childs JD, Piva SR, Fritz JM (2005) Responsiveness of the numeric pain rating scale in patients with low back pain. Spine 30:1331–1334
Jaeschke R, Singer J, Guyatt GH (1989) Measurement of health status. Ascertaining the minimal clinically important difference. Control Clin Trials 10:407–415
Waddell G, Newton M, Henderson I, Somerville D, Main CJ (1993) A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain 52:157–168
Dillingham TR, Lauder TD, Andary M, Kumar S, Pezzin LE, Stephens RT, Shannon S (2000) Identifying lumbosacral radiculopathies: an optimal electromyographic screen. Am J Phys Med Rehabil 79:496–503
Chouteau WL, Annaswamy TM, Bierner SM, Elliott AC, Figueroa I (2010) Interrater reliability of needle electromyographic findings in lumbar radiculopathy. Am J Phys Med Rehabil 89(7):561–569
Kwok OM, Underhill AT, Berry JW, Luo W, Elliott TR, Yoon M (2008) Analyzing longitudinal data with multilevel models: an example with individuals living with lower extremity intra-articular fractures. Rehabil Psychol 53:370–386. doi:10.1037/a0012765
Kristjansson SD, Kircher JC, Webb AK (2007) Multilevel models for repeated measures research designs in psychophysiology: an introduction to growth curve modeling. Psychophysiology 44:728–736. doi:10.1111/j.1469-8986.2007.00544.x
Hedeker D, Gibbons RD (2006) Longitudinal data analysis. Wiley, Hoboken, New Jersey
Tabachnick BG, Fidell LS (2006) Using Multivariate Statistics, 5th edn. Allyn & Bacon, New York
Bickel R (2007) Multilevel analysis for applied research: it’s just regression! Methodology in the social sciences. The Guilford Press, New York, NY
Singer JD, Willett JB (2003) Applied longitudinal data analysis: modeling change and event occurrence. Oxford University Press, Oxford, New York
Ostelo RW, Deyo RA, Stratford P, Waddell G, Croft P, Von Korff M, Bouter LM, de Vet HC (2008) Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change. Spine (Phila Pa 1976) 33(1):90–94
Hicks GE, Fritz JM, Delitto A, McGill SM (2005) Preliminary development of a clinical prediction rule for determining which patients with low back pain will respond to a stabilization exercise program. Arch Phys Med Rehabil 86:1753–1762. doi:10.1016/j.apmr.2005.03.033
Campbell M, Grimshaw J, Steen N (2000) Sample size calculations for cluster randomised trials. Changing Professional Practice in Europe Group (EU BIOMED II Concerted Action). J Health Serv Res Policy 5:12–16
Rigler I, Podnar S (2007) Impact of electromyographic findings on choice of treatment and outcome. Eur J Neurol 14:783–787. doi:10.1111/j.1468-1331.2007.01855.x
Annaswamy TM, Bierner SM, Chouteau W, Elliott AC (2012) Needle electromyography predicts outcome after lumbar epidural steroid injection. Muscle Nerve 45:346–355. doi:10.1002/mus.22320
Falck B, Nykvist F, Hurme M, Alaranta H (1993) Prognostic value of EMG in patients with lumbar disc herniation—a five year follow up. Electromyogr Clin Neurophysiol 33:19–26
Fish DE, Shirazi EP, Pham Q (2008) The use of electromyography to predict functional outcome following transforaminal epidural spinal injections for lumbar radiculopathy. J Pain 9:64–70. doi:10.1016/j.jpain.2007.08.011
Peul WC, van den Hout WB, Brand R, Thomeer RT, Koes BW (2008) Prolonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation: two year results of a randomised controlled trial. BMJ 336:1355–1358. doi:10.1136/bmj.a143
Luijsterburg PA, Verhagen AP, Ostelo RW, van Os TA, Peul WC, Koes BW (2007) Effectiveness of conservative treatments for the lumbosacral radicular syndrome: a systematic review. Eur Spine J 16:881–899. doi:10.1007/s00586-007-0367-1
Vroomen PC, de Krom MC, Slofstra PD, Knottnerus JA (2000) Conservative treatment of sciatica: a systematic review. J Spinal Disord 13:463–469
Andersson GB, Brown MD, Dvorak J, Herzog RJ, Kambin P, Malter A, McCulloch JA, Saal JA, Spratt KF, Weinstein JN (1996) Consensus summary of the diagnosis and treatment of lumbar disc herniation. Spine 21:75S–78S
Klenerman L, Slade PD, Stanley IM, Pennie B, Reilly JP, Atchison LE, Troup JD, Rose MJ (1995) The prediction of chronicity in patients with an acute attack of low back pain in a general practice setting. Spine 20:7
Grotle M, Vøllestad NK, Brox JI (2006) Clinical course and impact of fear-avoidance beliefs in low back pain: prospective cohort study of acute and chronic low back pain: iI. Spine 31:1038
Waddell G, Somerville D, Henderson I, Newton M (1992) Objective clinical evaluation of physical impairment in chronic low back pain. Spine 17:617–628
Modic MT, Obuchowski NA, Ross JS, Brant-zawadzki MN, Grooff PN, Mazanec DJ, Benzel EC, Brant-Zawadzki MN (2005) Acute low back pain and radiculopathy: MR imaging findings and their prognostic role and effect on outcome. Radiology:597–604
Koes BW, Van Tulder MW, Peul WC, van Tulder MW (2007) Diagnosis and treatment of sciatica. BMJ: Br Med J 334:5
Dillingham TR (2002) Electrodiagnostic approach to patients with suspected radiculopathy. Phys Med Rehabil Clin N Am 13:567–588
Lauder TD, Dillingham TR, Andary M, Kumar S, Pezzin LE, Stephens RT, Shannon S (2000) Effect of history and exam in predicting electrodiagnostic outcome among patients with suspected lumbosacral radiculopathy. Am J Phys Med Rehabil 79:60–68 quiz 75-66
Conflict of interest
Funding from EMPI, Inc. was received to support this study. EMPI, Inc. played no role in the design of the study, analysis and interpretation of the data, and submission of the manuscript.
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Savage, N.J., Fritz, J.M., Kircher, J.C. et al. The prognostic value of electrodiagnostic testing in patients with sciatica receiving physical therapy. Eur Spine J 24, 434–443 (2015). https://doi.org/10.1007/s00586-014-3469-6
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DOI: https://doi.org/10.1007/s00586-014-3469-6