S169 S290
Conclusions:
Given these results, we recommend the use of MED
calculation as a patient care tool.
Level of Evidence:
Level III
Poster 107:
The Significance of Psychosocial Factors in Acute
Back Pain Treatment and Recovery: A Cohort Study
Amitabh Goel, MD (Via Christi Clinic), Michael Campbell, MD, CAQSM,
Paul Cleland, MD, CAQSM, Wally C. Walstrom, DO, MS, CAQSM,
Michael Page, MD, William T. Peterson, MD, Danielle L. Wooldrik, DO,
Kari M. Nilsen, PhD
Disclosures:
Amitabh Goel: I Have No Relevant Financial Relationships
To Disclose
Objective:
To determine the relationship of psychosocial factors as
measured by patient beliefs and catastrophizing levels with pain and
disability measures during conservative treatment in acute back pain
subjects.
Design:
Observational Cohort Study.
Setting:
Outpatient Pain Management and Rehabilitation Clinic in a
multispecialty clinic in a suburban US setting.
Participants:
100 subjects with acute back pain, electing to partici-
pate in the study, were recruited from consecutive patient referrals.
Interventions:
Not applicable.
Main Outcome Measures:
Numeric Pain scale (NPS), Oswestry
Disability Index (ODI), Pain Beliefs Questionnaire (PBQ) and the Pain
Catastrophizing Scale (PCS).
Results:
There was a significant positive correlation between NPS and
PCS (p
¼
.03), and ODI and PCS (p
<
.001) at baseline, as well as at
completion of treatment (p
¼
.03). There was also a significant posi-
tive correlation between NPS and the PBQ Organic subscale (p
¼
.001),
and ODI and PBQ Organic subscale (p
¼
.001) at the outset of treat-
ment. However, at completion of treatment only the ODI and the PBQ
Organic subscale correlation was significant (p
<
.001). There were no
significant correlations with the PBQ Psychological subscale.
Conclusions:
In acute back pain there is a strong correlation between
psychosocial factors as measured by the PBQ and PCS and the clinical
measures of pain and disability as measured by the NPS and ODI. These
correlations are present at baseline and are maintained throughout
the course of treatment.
Level of Evidence:
Level IV
Poster 108:
The Prevalence of Spinopelvic Misalignment in
Individuals with Refractory Low Back Pain and
Association with MRI Findings
Hemra Cil, MD, Professor (University of California, San Francisco,
San Francisco, California, United States), Sibel Demir, MD,
Zachary McCormick, MD, Sigurd H. Berven, MD
Disclosures:
Hemra Cil, MD, Professor: I Have No Relevant Financial
Relationships To Disclose
Objective:
The etiology of low back pain (LBP) is multifactorial.
Morphological and postural factors can potentially affect the
occurrence of LBP. A harmonious sagittal spinopelvic alignment is
needed for a neutral posture, which is provided by balanced spi-
nopelvic curves (lumbar lordosis (LL), pelvic incidence (PI), sacral
slope (SS) and pelvic tilt (PT)). The effect of sagittal spinopelvic
alignment on LBP is poorly understood. Thus, the aim of the present
study was to determine the prevalence of sagittal spinopelvic
misalignment in a cohort of patients with LBP, refractory to
comprehensive non-operative treatment (CNT). Sagittal spinopelvic
misalignment (SPM) was also correlated with findings on lumbar
magnetic resonance imaging (MRI) in order to explore possible
relationship between degenerative changes.
Design:
Cross-sectional study.
Setting:
Spinopelvic curves were measured prospectively using
Surgimap on lateral spine standing Xrays. SPM was defined as PI-LL
10. Lumbar MRI were reviewed.
Participants:
Eighty-two consecutive patients with LBP who had
failed to respond to CNT were included.
Interventions:
Not applicable.
Main Outcome Measures:
Age, gender, body mass index(BMI), LL, PI,
SS, PT and MRI findings.
Results:
Twenty-seven of 82 participants (32%) had SPM. Patient
characteristics were as follows: mean age
¼
43.9 10.6 years, female/
male
¼
15/12, body mass index (BMI)
¼
25.4 4.8. In 24 participants
(89%), LL was higher than PI, which represented the greatest contri-
bution to sagittal spinopelvic misalignment. Ten participants (37%) had
a normal lumbar spine MRI.
Conclusions:
The present data demonstrated a 32% (95% CI 22-42%)
prevalence rate of SPM in a cohort with refractory LBP. Of these pa-
tients with SPM, 37% had a lumbar MRI without evidence of degener-
ative disc disease, facet arthropathy, disc disruption, or stenosis.
Sagittal spinopelvic misalignment may represent a primary etiology of
refractory LBP in a subgroup of patients. While larger prospective
study is needed to confirm the present findings, sagittal spinopelvic
misalignment could be considered as a modifiable factor in patients
with refractory LBP.
Level of Evidence:
Level IV
Poster 109:
Discriminating Physical Performance Phenotypes of
Patients with Chronic Low Back Pain
Patricia Z. Zheng, MD (Stanford Univ, Santa Clara, California, United
States), Amir Muaremi, PhD, Heike Leutheuser, Dipl-Phys,
Justin Norden, MPhil, Aman Sinha, MPhil, Bjoern M. Eskofier, PhD,
Matthew Smuck, MD
Disclosures:
Patricia Zheng: I Have No Relevant Financial Relation-
ships To Disclose
Objective:
Musculoskeletal disorders are associated with significant
mobility limitations. We developed new techniques to analyze free-
living accelerometry data to differentiate the physical performance
phenotypes of patients with and without chronic low back pain (cLBP).
Design:
We tracked physical activity using Actigraph in 23 patients
with cLBP. Their data was compared to those collected using the same
protocol from age and sex matched to individuals without cLBP
without known mobility limiting disorders (defined as history of painful
musculoskeletal conditions, congestive heart failure, emphysema, or
prior stroke) from the National Health and Nutrition Examination
Survey (NHANES) 2003-4 dataset. In order to characterize the accel-
erometry, we examined the data and built a predictive model using 1)
standard intervals from Freedson et al., and 2) the Physical Perfor-
mance (PP) analysis designed by our group specifically to interrogate
data from each population.
Setting:
Academic Medical Center.
Participants:
23 patients with cLBP versus 322 patients with no cLBP
or other MSK conditions.
Interventions:
Not applicable.
Main Outcome Measures:
Classification accuracy and true positive
rate of model at phenotyping cLBP versus no cLBP.
Results:
Given age and gender, we were able to create a model using
4 features of sedentary activity and 1 variable of light intensity that
achieved 91% classification accuracy with 62% true positive rate. When
we include age and gender as predictive variables, we then get true
positive rate of 81%.
Conclusions:
We show that it is possible to build models from free-
living physical activity data capable of discriminating the physical
performance phenotypes of those with and without cLBP. Similar to
our prior results, sedentary and light activity levels are most helpful in
phenotyping mobility-limiting musculoskeletal diseases.
Level of Evidence:
Level IV
S169
Abstracts / PM R 9 (2017) S131-S290