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Orthopedic Tip of the Week

Orthopedic Tip of the Month

Traditional medical care has emphasized "objective" measures such as imaging and lab modalities. However, multifactorial conditions, such as LBP are best explained by a biopsychosocial model of illness rather than a biomedical one of disease. This necessitates that "subjective" measures of pain, distress, and perception of functional abilities (i.e. disability) also be utilized.

Measuring outcomes that matter to the patients themselves is of paramount importance. Patient-centered outcomes include pain severity, distress, and ability to perform common ADL's (disability). Interestingly, the "objective" tests, such as imaging, lab tests, and physical impairments (muscle strength and range of motion) correlate poorly with self-reported symptoms and functional status (i.e. disability). Therefore, patient-centered outcomes derived from self-administered questionnaires have achieved a suprisingly high level of significance.

Using outcome assessment questionnaires is paramount to support the medical need of onging care for both the patient and carrier. Therefore, how much change do we need ? If the initial Visual Analog Scale (VAS) was 5 or more, a change of at least 2 points was needed to influence disability scores significantly. If the initail VAS socre was less than 5, then a VAS change of at least 1 point would have a clinically relevant effect on functioning.

Rehabilitation of the Spine, 2nd Edition, Craig Liebenson


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