Back Pain: del Real MT

van Tulder M, Becker A, Bekkering T, Breen A, del Real MT, Hutchinson A, Koes B, Laerum E, Malmivaara A, Anonymous00002. · No affiliation provided · Eur Spine J. · Pubmed #16550447 No free full text.

This publication has no abstract.

Kovacs FM, Royuela A, Jensen TS, Estremera A, Amengual G, Muriel A, Galarraga I, Martínez C, Arana E, Sarasíbar H, Salgado RM, Abraira V, López O, Campillo C, del Real MT, Zamora J. · Departamento Científico, Fundación Kovacs, Palma de Majorca, Spain. · Acta Radiol. · Pubmed #19431057 No free full text.

Abstract: BACKGROUND: Correlation between clinical features and magnetic resonance imaging (MRI) findings is essential in low-back-pain patients. Most previous studies have analyzed concordance in the interpretation of lumbar MRI among a few radiologists who worked together. This may have overestimated concordance. PURPOSE: To evaluate intra- and interobserver agreement in the interpretation of lumbar MRI performed in an open 0.2 T system. MATERIAL AND METHODS: Seven radiologists from two different geographic settings in Spain interpreted the lumbar MRIs of 50 subjects representative of the general Danish population aged 40 years. The radiologists interpreted the images in routine clinical practice, having no knowledge of the clinical and demographic characteristics of the subjects and blinded to their colleagues' assessments. Six of the radiologists evaluated the same MRIs 14 days later, having no knowledge of the previous results. Data on the existence of disc degeneration, high-intensity zones, disc contour, Schmorl nodes, Modic changes, osteophytes, spondylolisthesis, and spinal stenosis were collected in the Nordic Modic Consensus Group Classification form. Intra- and interobserver agreement was analyzed for variables with a prevalence >or=10% and <or=90% by means of the kappa statistic. RESULTS: Intra- and interobserver agreement was excellent for variables related to Modic changes, and fair to good for disc contour, high-intensity zones, and Schmorl nodes. The evaluations for disc degeneration and osteophytes were found to have fair to good intraobserver agreement and poor interobserver agreement. The agreement for the evaluations of spondylolisthesis and spinal stenosis was not analyzed because they were observed in <10% of reports. CONCLUSION: Images from 0.2 T MRIs appear to lead to good agreement in the reporting of disc contour, high-intensity zones, Schmorl nodes, and, in particular, Modic changes, suggesting that they can possibly be reliably used for clinical research purposes. In contrast, assessment of osteophytes and disc degeneration is not reliable.

Kovacs FM, Abraira V, Royuela A, Corcoll J, Alegre L, Cano A, Muriel A, Zamora J, del Real MT, Gestoso M, Mufraggi N. · Departamento Científico, Fundación Kovacs, Palma de Mallorca, Spain. · Spine (Phila Pa 1976). · Pubmed #18246018 No free full text.

Abstract: STUDY DESIGN: Cohort study. OBJECTIVE: To estimate the minimal clinically important change (MCIC) on the pain intensity numerical rating scale (PI-NRS) and the Roland Morris Disability Questionnaire (RMQ) in subacute and chronic patients with low back pain (LBP), with and without referred pain to the leg (LP), seen in the routine clinical practice of the Spanish National Health Service. SUMMARY OF BACKGROUND DATA: MCIC have been explored in Anglo-Saxon and Northern European LBP patients. No data on the influence of LP on MCIC are available. In Southern European patients, determinants of disability have shown to be different, and MCIC for pain and disability are unknown. METHODS: Data from the postmarketing surveillance of 1349 LBP subacute and chronic patients treated in routine clinical practice were used for this study. Three different methods were used to estimate the MCIC over a 12-week period: the mean change score (MCS), the minimal detectable change (MDC), and the optimal cutoff point in receiver operant curves (OCP). Patients' own "global perceived effect" was used as the external criterion. The effect on MCIC of initial scores, duration of pain, and existence of LP were assessed. RESULTS: Different methods led to different MCIC values, with those deriving from OCP being the smallest. Depending on the methods which were used, the MCIC for LBP ranged from 1.5 to 3.2 PI-NRS points in patients with a baseline score below 7 points, and from 2.5 to 4.3 in patients with a baseline score >or=9 points. The MCIC for disability ranged from 2.5 to 6.8 RMQ points in those with baseline scores below 10 points, and from 5.5 to 13.8 in those baseline scores >or=15 points. These values were similar for patients with LP, and were not influenced by the duration of pain. CONCLUSION: In subacute and chronic patients, improvements in LBP of <or=1.5 PI-NRS points, or in disability of <or=2.5 RMQ points should be seen as irrelevant. In those patients, MCIC range values are similar in patients with LP, are consistent across different cultural settings and remain stable no matter what the duration of pain is.