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Martin Nikolaus Stienen,Nicolai Maldaner,Marketa Sosnova,Holger Joswig,Marco Vincenzo Corniola,Luca Regli,Gerhard Hildebrandt,Karl Schaller,Oliver Pascal Gautschi 대한척추신경외과학회 2020 Neurospine Vol.17 No.1
Objective: The patient-reported outcome measure (PROM)-based evaluation in lumbar degenerative disc disease (DDD) is today’s gold standard but has limitations. We studied the impact of lower extremity motor deficits (LEMDs) on PROMs and a new objective outcome measure. Methods: We evaluated patients with lumbar DDD from a prospective 2-center database. LEMDs were graded according to the British Medical Research Council (BMRC; 5 [normal] –0 [no movement]). The PROM-based evaluation included pain (visual analogue scale), disability (Oswestry Disability Index [ODI] & Roland-Morris Disability Index [RMDI]), and health-related quality of life (HRQoL; Short-Form 12 physical component summary/mental component summary & EuroQol-5D index). Objective functional impairment (OFI) was determined as age- and sex-adjusted Timed-Up and Go (TUG) test value. Results: One hundred five of 375 patients (28.0%) had a LEMD. Patients with LEMD had slightly higher disability (ODI: 52.8 vs. 48.2, p=0.025; RMDI: 12.6 vs. 11.3, p=0.034) but similar pain and HRQoL scores. OFI T-scores were significantly higher in patients with LEMD (144.2 vs. 124.3, p=0.006). When comparing patients with high- (BMRC 0–2) vs. low-grade LEMD (BMRC 3–4), no difference was evident for the PROM-based evaluation (all p>0.05) but patients with high-grade LEMD had markedly higher OFI T-scores (280.9 vs. 136.0, p=0.001). Patients with LEMD had longer TUG test times and OFI T-scores than matched controls without LEMDs. Conclusion: Our data suggest that PROMs fail to sufficiently account for LEMD-associated disability, which is common and oftentimes bothersome to patients. The objective functional evaluation with the TUG test appears to be more sensitive to LEMD-associated disability. An objective functional evaluation of patients with LEMD appears reasonable.
Anna Maria Zeitlberger,Marketa Sosnova,Michal Ziga,Valentin Steinsiepe,Oliver P. Gautschi,Martin N. Stienen,Nicolai Maldaner 대한척추신경외과학회 2020 Neurospine Vol.17 No.1
Epidural steroid injection (ESI) represents a popular treatment option in patients with lumbar degenerative disc disease (DDD). The main objective of the article was to determine whether the 6-minute walking test (6WT) could assist in the discrimination between ESI responders and nonresponders. We used a validated 6WT smartphone application to assess self-measured objective functional impairment (OFI) in 3 patients with DDD undergoing ESI. Patient-reported outcome measures (PROMs), including the Core Outcome Measures Index and the Oswestry Disability Index, were obtained at baseline and at the 3-, 7-, and 28-day follow-up. Descriptive analyses were used to compare PROMs with OFI over time. Two patients responded well to the ESI, illustrated by clinically meaningful improvements in PROMs. This improvement was accompanied by a substantial increase in the 6WT distance (case I: 358 m vs. 517 m and case II: 296 m vs. 625 m). One patient reported only moderate improvement in leg pain and conflicting results in the other PROMs. The 6WT demonstrated a persistent OFI (487 m vs. 488 m). This patient was considered a nonresponder and underwent surgical treatment. This case series illustrates the feasibility of the smartphone-based 6WT as a tool to assess OFI in patients undergoing ESI for lumbar DDD.
Siegmund Philipp Lang,Ezra Tilahun Yoseph,Aneysis D. Gonzalez-Suarez,Robert Kim,Parastou Fatemi,Katherine Wagner,Nicolai Maldaner,Martin N. Stienen,Corinna Clio Zygourakis 대한척추신경외과학회 2024 Neurospine Vol.21 No.2
Objective: In the digital age, patients turn to online sources for lumbar spine fusion information, necessitating a careful study of large language models (LLMs) like chat generative pre-trained transformer (ChatGPT) for patient education. Methods: Our study aims to assess the response quality of Open AI (artificial intelligence)’s ChatGPT 3.5 and Google’s Bard to patient questions on lumbar spine fusion surgery. We identified 10 critical questions from 158 frequently asked ones via Google search, which were then presented to both chatbots. Five blinded spine surgeons rated the responses on a 4-point scale from ‘unsatisfactory’ to ‘excellent.’ The clarity and professionalism of the answers were also evaluated using a 5-point Likert scale. Results: In our evaluation of 10 questions across ChatGPT 3.5 and Bard, 97% of responses were rated as excellent or satisfactory. Specifically, ChatGPT had 62% excellent and 32% minimally clarifying responses, with only 6% needing moderate or substantial clarification. Bard’s responses were 66% excellent and 24% minimally clarifying, with 10% requiring more clarification. No significant difference was found in the overall rating distribution between the 2 models. Both struggled with 3 specific questions regarding surgical risks, success rates, and selection of surgical approaches (Q3, Q4, and Q5). Interrater reliability was low for both models (ChatGPT: k = 0.041, p = 0.622; Bard: k = -0.040, p = 0.601). While both scored well on understanding and empathy, Bard received marginally lower ratings in empathy and professionalism. Conclusion: ChatGPT3.5 and Bard effectively answered lumbar spine fusion FAQs, but further training and research are needed to solidify LLMs’ role in medical education and healthcare communication.