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Preoperative evaluation of activitiy and function in patients with paralytic scoliosis
Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences. (Landstinget i Östergötland; Centre for Public Health Sciences; Centre for Public Health Sciences; Folkhälsovetenskapligt centrum; Folkhälsovetenskapligt centrum)
1998 (English)In: European spine journal, ISSN 0940-6719, Vol. 7, no 4, 294-301 p.Article in journal (Refereed) Published
Abstract [en]

Preoperative evaluation of patients with paralytic scoliosis should take into account the consequences of surgery on the every day life of the patient. However, the parameters that are customarily used in these operations relate only to very narrow measures such as the angle of scoliosis or kyphosis. The aim of this study was to introduce a set of instruments appropriate for measuring both function and activities in paralytic scoliosis patients. The study took as its starting point the WHO International Classification of Impairments, Disabilities and Handicaps (ICIDH), in which an activity is described at the level of the individual and function at the level of the organ. A consecutive series of 100 paralytic scoliosis patients with 18 different diagnoses were evaluated preoperatively with a set of instruments that had been specially developed at Linköping hospital, in which the variables are classified according to the system used in the ICIDH. The set of instruments included general information and evaluation of activities and function – sitting, balance, weight distribution to sitting surface, angle of scoliosis, reaching, pain estimation, activities of daily living (ADL) Barthel and ADL Klein and Bell, care given, time spent resting, and seating supports). The results showed that patients with paralytic scoliosis constitute a heterogeneous group in activities and function. Even when the patients were grouped into four subgroups according to the Scoliosis Research Society Classification, they remained very heterogeneous. However, reaching, Klein and Bell Activities of Daily Living and pain could only evaluate patients who could understand verbal instructions. In those who could not, assessment relied more heavily on measures of function and level of dependence. It was concluded that the choice of assessment must be guided by the patient’s ability to understand verbal instructions irrespective of his/her disorder. It is important to use the three levels – impairments, disabilities and handicaps – in order to focus on the different outcomes in the two groups with respect to the patient’s total situation.

Place, publisher, year, edition, pages
1998. Vol. 7, no 4, 294-301 p.
Keyword [en]
Paralytic scoliosis, Neuromuscular disorders, Activity, Function, International Classification of Impairments Disabilities and Handicaps (ICIDH)
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-13732DOI: 10.1007/s005860050078OAI: oai:DiVA.org:liu-13732DiVA: diva2:21221
Available from: 2002-12-14 Created: 2002-12-14 Last updated: 2009-08-19
In thesis
1. Pre- and postoperative evaluation of function and activity in patients with paralytic scoliosis
Open this publication in new window or tab >>Pre- and postoperative evaluation of function and activity in patients with paralytic scoliosis
2002 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis evaluates surgical correction in patients with paralytic scoliosis with emphasis on function and activity. The thesis includes four studies of 100 consecutive patients preoperatively evaluated and surgically corrected between 1992 and 1996 at Linköping University Hospital. Eighteen different diagnoses were represented. The postoperative follow-ups were at one year and in average seven years. Six patients dropped out during the first year and twelve during the long-term follow-up period. The assessments included general information, lung function, and measurements of radiographs, function and activity - seating posture, ADL, pain, care and need for rest. The patients or relatives view on the effects of surgery were evaluated in follow-up questionnaires.

The preoperative results of the 100 patients described a heterogeneous group in terms of function and activity. Even when the patients were grouped into subgroups according to the Scoliosis Research Society classification, they remained heterogeneous. In patients who could understand verbal instructions assessments that needed co-operation could be used and in those who could not understand verbal instructions, assessments relied more heavily on measures of function and level of dependence. Preoperative results of weight distribution on the seating surface were explained by thoracolumbar/lumbar spinal imbalance and pelvic obliquity R2=0.45 (n=45).

The one-year follow-up of 94 patients showed improvements in angle of scoliosis, sitting balance, weight distribution to the seating surface, seating supports in the wheelchair, time needed for rest. The results in subgroups were almost the same as in the whole group. The subjective results for patients or relatives in the follow-up questionnaire showed a positive outcome of surgery. In the comparison between the one-year follow-up and the long-term follow-up there were further improvements in sitting balance, ADL, and care given, but the angle of scoliosis was increased. These results were in line with patients’ and relatives’ assessments in the follow-up questionnaire and in the open-ended questions.

Due to the heterogeneity of patients with paralytic scoliosis, irrespective of disorder, it is important to focus on different subgroups with regards to the patients’ total situation. The surgically corrected and stabilised spine resulted in the strength to keep the body upright with improvements in function, activity and possibilities to belong in social activities. Further improvements were shown between the one-year follow-up and the long-term follow-up. It is recommended that patients who have been surgically corrected for paralytic scoliosis are followed for more than one year.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2002. 59 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 748
Keyword
Activities of daily living, disability evaluation, paralysis, complications, physiopathology, scoliosis complications, etiology, physiopathology, surgery, posture, treatment outcome, wheelchairs
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-5236 (URN)91-7373-191-9 (ISBN)
Public defence
2002-11-01, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 09:00 (English)
Opponent
Available from: 2002-12-14 Created: 2002-12-14 Last updated: 2012-01-25Bibliographically approved

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Larsson, Eva-LenaAaro, StigÖberg, Birgitta

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