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Long-term follow-up of functioning after spinal surgery in patients with neuromuscular scoliosis
Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping. Linköping University, Department of Neuroscience and Locomotion, Orthopaedics and Sports Medicine. Linköping University, Faculty of Health Sciences.
Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping. Linköping University, Department of Neuroscience and Locomotion, 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.
2005 (English)In: Spine, ISSN 0362-2436, Vol. 30, no 19, 2145-2152 p.Article in journal (Refereed) Published
Abstract [en]

Study Design. A prospective study of 100 consecutive preoperative patients with neuromuscular scoliosis whose activities and function were evaluated in a long-term follow-up.

Objectives. To evaluate long-term follow-up of functioning in patients with neuromuscular scoliosis.

Summary of Background Data. Few studies of patients operated for neuromuscular scoliosis are prospective, with long-term follow-up based on assessments of activities and function.

Methods. The follow-up included 82 patients with neuromuscular scoliosis who were evaluated before surgery from 1992 to 1996. The follow-up time was 84.5 months on average. The assessments comprised sitting, angle of scoliosis, lung function, reaching, pain estimation, activities of daily living (ADL), care given, and time used for resting. A follow-up questionnaire as well two open-ended questions about the positive and negative effects of the surgery were sent to the patients/parents.

Results. Improvements after surgery were shown in the Cobb angle, lung function, seating position, ADL, and time used for resting. In a comparison between the 1-year follow-up and the long-term follow-up, there were further improvements in sitting, ADL, and care given but an increased Cobb angle. These results were in line with the assessments reported by patients and relatives. Only minor differences were shown in long-term outcome in subgroups according to understand/not understand verbal instructions. Patient age 21 years or less seemed more improved than those age 22 years and older at the time of surgery.

Conclusions. The comparison of the preoperative and long-term follow-ups showed that patients were mostly improved. Further improvements were shown beyond the 1-year follow-up. The subjective assessments also confirmed the results. The heterogeneity of patients with neuromuscular scoliosis makes it important to evaluate the patients in subgroups and in relation to age.

Place, publisher, year, edition, pages
2005. Vol. 30, no 19, 2145-2152 p.
Keyword [en]
neuromuscular scoliosis, long-term follow-up, functioning, function, activity
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-13735DOI: 10.1097/01.brs.0000180403.11757.6aOAI: oai:DiVA.org:liu-13735DiVA: diva2:21224
Available from: 2002-12-14 Created: 2002-12-14 Last updated: 2010-05-24
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, StigNormelli, HelenaÖberg, Birgitta

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