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Kati Kristiina Kyrölä,Järvenpää Salme,Järviluoma Tuija,Irmola Tero,Kauppinen Eero,Häkkinen Arja 대한척추신경외과학회 2018 Neurospine Vol.15 No.2
Objective: To evaluate the intra- and interrater reliability (I-IR) of sagittal spinopelvic parameters from digital full-spine plain radiographs with basic software tools in an unselected adult population with degenerative spinal complaints who were evaluated for surgery. Methods: Forty-nine adult full-spine digital radiographs were measured twice by 3 independent observers, including an experienced spine surgeon, an experienced radiologist, and a resident orthopedic surgeon. Clinical picture archiving and communication system workstations and software tools were used and landmarks were set manually. The I-IR of the sagittal vertical axis (SVA), pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), and thoracic kyphosis in T4–T12 (TK) were assessed. Results: The intrarater intraclass correlation coefficient (ICC) scores varied from 0.82 to 0.99. The interrater ICC scores ranged from 0.78 to 0.99. The intrarater standard error of measurement (SEM) values for SS, PT, PI, and TK varied from 0.8° to 5.0°, and the interrater SEM values ranged from 2.5° to 6.2°, depending on the parameter and the reading round. The I-IR SEM values for SVA varied from 2.2 to 5.7 mm and from 4.6 to 5.0 mm, respectively. Kappa values were >0.88 for all readers. The intrarater variability was the smallest for the most experienced rater. Conclusion: The I-IR of measuring sagittal spinopelvic parameters on digital full-spine images with basic software tools was high. Parameters consisting of several anatomic landmarks were more liable to error. Rater experience had a positive influence on reliability and repeatability. Reader experience should be assessed before accepting measurements for surgical planning and the interpretation of surgical correction during postoperative follow-up.
Kati Kyrölä,Susanna Hiltunen,Mikko M. Uimonen,Jari Ylinen,Arja Häkkinen,Jussi P. Repo 대한척추신경외과학회 2022 Neurospine Vol.19 No.2
Objective: Adult spinal deformity (ASD) have lower health-related quality of life (HRQoL) compared to the general population. Applying Rasch measurement theory (RMT), this study tested the revised Scoliosis Research Society-22 (SRS-22r) HRQoL instrument among symptomatic adult patients with degenerative spinal disorders and varying degrees of ASD. Methods: SRS-22r data from 637 outpatient spine clinic patients with degenerative spine conditions were investigated for unidimensionality, item/scale fit, differential item functioning (DIF), scale coverage/targeting, and person separation index (PSI) using RMT. Results: Unidimensionality of the SRS-22r was not supported for either the total score or for 3 of its 5 domains. Item fit was acceptable for 11/22 items. The individual domains showed good coverage despite the degree of structural disorders. Ordered thresholds were achieved by merging response categories in some of the items. DIF towards age or sex was found in 11/22 items and in some domain items. The PSI exceeded 0.7 for the SRS-22r total score. Conclusion: The individual domain scores of the SRS-22r perform better than the total score providing good coverage and targeting among patients with ASD. Refinements of items and domains may improve the structural validity of the instrument to meet the criteria for measuring ASD patients, even when multidimensionality persists.
Trunk Muscle Strength After Lumbar Spine Fusion: A 12-Month Follow-up
Outi Elina Ilves,Marko Henrik Neva,Keijo Häkkinen,Joost Dekker,William J. Kraemer,Sami Tarnanen,Kati Kyrölä,Jari Ylinen,Kirsi Piitulainen,Salme Järvenpää,Tiina Kaistila,Arja Häkkinen 대한척추신경외과학회 2019 Neurospine Vol.16 No.2
Objective: The aim of this study was to investigate changes in trunk muscle strength 12 months after lumbar spine fusion (LSF) compared to preoperative strength. Methods: A total of 194 patients (mean±standard deviation [SD] age, 61±21 years) who underwent LSF participated in this prospective longitudinal study. Physical measurements of the participants were made before surgery and 12 months postoperatively. Isometric trunk extension and flexion strength was measured using a strain-gauge dynamometer in the standing position. Strength changes were calculated. Regression analysis was performed to explore which factors predicted strength levels at 12 months postoperatively. Results: The preoperative mean±SD extension strength was 205±144 N, which increased to 258±142 N (p<0.001) at the 12-month follow-up. Flexion strength increased from 295±172 N to 364±164 N (p<0.001). The preoperative extension/flexion strength ratio was 0.75±0.38 and remained similar (0.73±0.26) at 12 months postoperatively (p=0.39). Conclusion: Although trunk muscle strength increased by 26% for extension and 23% for flexion at the 12-month postoperative follow-up, both values remained objectively low. In addition, flexion strength remained higher than extension strength, which indicates an imbalance between those muscle groups. Age, severe back pain, and low trunk muscle strength before surgery predicted low trunk muscle strength at 1 year after spinal fusion.