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Pre- and postoperative evaluation of function and activity in patients with paralytic scoliosis
Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
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 [en]
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: urn:nbn:se:liu:diva-5236ISBN: 91-7373-191-9 (print)OAI: oai:DiVA.org:liu-5236DiVA: diva2:21225
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
List of papers
1. Preoperative evaluation of activitiy and function in patients with paralytic scoliosis
Open this publication in new window or tab >>Preoperative evaluation of activitiy and function in patients with paralytic scoliosis
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.

Keyword
Paralytic scoliosis, Neuromuscular disorders, Activity, Function, International Classification of Impairments Disabilities and Handicaps (ICIDH)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13732 (URN)10.1007/s005860050078 (DOI)
Available from: 2002-12-14 Created: 2002-12-14 Last updated: 2009-08-19
2. Activities and functional assessment 1 year after spinal fusion for paralytic scoliosis
Open this publication in new window or tab >>Activities and functional assessment 1 year after spinal fusion for paralytic scoliosis
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.

Keyword
Paralytic scoliosis, Spinal fusion, Activity, Function, The International Classification of Impairments Disabilities and Handicaps (ICIDH)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13733 (URN)10.1007/s005860050137 (DOI)
Available from: 2002-12-14 Created: 2002-12-14
3. Weight distribution in the sitting position in patients with paralytic scoliosis: pre- and postoperative evaluation
Open this publication in new window or tab >>Weight distribution in the sitting position in patients with paralytic scoliosis: pre- and postoperative evaluation
2002 (English)In: European spine journal, ISSN 0940-6719, Vol. 11, no 2, 94-99 p.Article in journal (Refereed) Published
Abstract [en]

Patients with paralytic scoliosis spend most of their time in the sitting position. The spinal deformity, pelvic obliquity and uneven weight distribution on the seating surface necessitates frequent seating adaptations in the wheelchair. In this prospective study, 45 wheelchair-bound patients were evaluated preoperatively and 43 postoperatively. The pre- and postoperative evaluation was done by an independent observer. Surgical correction was performed between 1993 and 1996. Assessments included sitting balance on a box; number of seating supports in the wheelchair; weight distribution on the seating surface, measured with a computerized EMED system; Cobb angle; hip dislocation; mediolateral translation of T1 and of the apex vertebra with reference to a perpendicular line drawn upwards from the spinal process of S1; and pelvic obliquity from a line drawn between the most proximal points in the iliac crests. X-rays for the measurement of Cobb angle and pelvic obliquity were performed in sitting position. Reference values for normal weight distribution on the seating surface were obtained for 27 normal subjects and revealed a mean value of 59% of weight supported on one side. A stepwise regression analysis on the preoperative results showed that pelvic obliquity and thoracolumbar/lumbar spinal imbalance explained weight distribution on the seating surface (R2=0.45). There were significant improvements in all variables except in sitting balance and imbalance of T1, 1 year postoperatively. When dividing the material into two subgroups, the results showed no significant difference in any of the assessed parameters of the scoliosis, pelvic obliquity, or sitting position between individuals with even (50-59% on one side) and those with uneven (60-100% on one side) weight distribution postoperatively. The results of the assessment showed a significant improvement after surgical correction, but the majority still had pelvic obliquity and uneven weight distribution in a sitting position. The weight distribution on the seating surface preoperatively was explained by thoracolumbar/lumbar spinal imbalance and pelvic obliquity, with R2 = 0.45. There were no significant differences in any variables in comparisons between individuals with even weight distribution and those with uneven weight distribution. For the group with even weight distribution, however, the mean pelvic obliquity was 6° and in the group with uneven weight distribution the mean pelvic obliquity was 12°. Attention to seating surface and adjustment of seating position is needed for patients with paralytic scoliosis.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13734 (URN)10.1007/s00586-001-0373-7 (DOI)
Available from: 2002-12-14 Created: 2002-12-14 Last updated: 2009-08-19
4. Long-term follow-up of functioning after spinal surgery in patients with neuromuscular scoliosis
Open this publication in new window or tab >>Long-term follow-up of functioning after spinal surgery in patients with neuromuscular scoliosis
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.

Keyword
neuromuscular scoliosis, long-term follow-up, functioning, function, activity
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13735 (URN)10.1097/01.brs.0000180403.11757.6a (DOI)
Available from: 2002-12-14 Created: 2002-12-14 Last updated: 2010-05-24

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