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Activities and functional assessment 1 year after spinal fusion for 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.
Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
1999 (English)In: European spine journal, ISSN 0940-6719, Vol. 8, no 2, 100-109 p.Article in journal (Refereed) Published
Abstract [en]

The results of spinal fusion in patients with paralytic deformities are usually presented as the correction of the deformity. When evaluating the surgical results in such patients, it is advantageous to classify the patients into subgroups because of the varying dysfunction and disabilities. The aim of this study was to evaluate the effect of spinal fusion in patients with paralytic scoliosis in relation to function in terms of Impairments, activities in terms of Disabilities, and dependence in terms of Handicaps 1 year postoperatively, with emphasis on subgroups. A total of 94 patients with paralytic scoliosis and 18 different diagnoses were evaluated 1 year after surgery. The patients were classified according to whether or not they could understand verbal instructions. The patients were also grouped according to the Scoliosis Research Society classification of diagnoses. A set of instruments was used with the variables classified according to WHO’s International Classification of Impairments, Disabilities, and Handicaps (ICIDH). This consists of the patient’s/relative’s motives for surgery, persistent skin discoloration, ambulating or use of wheelchair, use of a brace, sitting balance, weight distribution on a sitting surface, angle of scoliosis, reaching, pain estimation, activities of daily living (ADL) Klein and Bell, care given, time spent resting, and seating supports. The set of instrument also included a follow-up questionnaire comprising 12 different areas, where the patients/relatives assessed the results of surgery. The study showed that spinal fusion in paralytic scoliosis led to showed improvements in the whole group of patients at the Impairment level in the angle of scoliosis, sitting balance, weight distribution, and reduced number of patients with persistent skin discoloration, and at the Handicap level in reduced time for resting during the day, reduced number of seating supports in the wheelchair, and in the use of a brace. Most of the parameters were unchanged. The results in the subgroups were almost the same as in the whole group, although pain and reaching at the Impairment level, and ADL at the Disability level, could not be measured in the patients who were unable to understand verbal instructions. The subjectively assessed results showed that seating posture was ranked positively irrespective of the motive for surgery. The study showed that the patients with paralytic scoliosis maintained or improved their function and level of independence in terms of Impairment and Handicap 1 year postoperatively. The subjective results assessed by the patients/relatives also showed a positive outcome of surgery. Weight distribution on a seating surface was improved, but still uneven, and with respect to better sitting balance and increasing time sitting in a wheelchair, this can involve a risk for pressure sores and needs further investigation. When introducing outcomes including the Disability level, one must take the importance of homogeneity in the groups into consideration.

Place, publisher, year, edition, pages
1999. Vol. 8, no 2, 100-109 p.
Keyword [en]
Paralytic scoliosis, Spinal fusion, Activity, Function, The International Classification of Impairments Disabilities and Handicaps (ICIDH)
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-13733DOI: 10.1007/s005860050137OAI: oai:DiVA.org:liu-13733DiVA: diva2:21222
Available from: 2002-12-14 Created: 2002-12-14
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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