The purpose of the present study was to translate the Roland-Morris (RM) questionnaire into Brazilian-Portuguese and adapt and validate it. First 3 English teachers independently translated the original questionnaire into Brazilian-Portuguese and a consensus version was generated. Later, 3 other translators, blind to the original questionnaire, performed a back translation. This version was then compared with the original English questionnaire. Discrepancies were discussed and solved by a panel of 3 rheumatologists and the final Brazilian version was established (Brazil-RM). This version was then pretested on 30 chronic low back pain patients consecutively selected from the spine disorders outpatient clinic. In addition to the traditional clinical outcome measures, the Brazil-RM, a 6-point pain scale (from no pain to unbearable pain), and its numerical pain rating scale (PS) (0 to 5) and a visual analog scale (VAS) (0 to 10) were administered twice by one interviewer (1 week apart) and once by one independent interviewer. Spearman's correlation coefficient (SCC) and intraclass correlation coefficient (ICC) were computed to assess test-retest and interobserver reliability. Cross-sectional construct validity was evaluated using the SCC. In the pretesting session, all questions were well understood by the patients. The mean time of questionnaire administration was 4 min and 53 s. The SCC and ICC were 0.88 (P<0.01) and 0.94, respectively, for the test-retest reliability and 0.86 (P<0.01) and 0.95, respectively, for interobserver reliability. The correlation coefficient was 0.80 (P<0.01) between the PS and Brazil-RM score and 0.79 (P<0.01) between the VAS and Brazil-RM score. We conclude that the Brazil-RM was successfully translated and adapted for application to Brazilian patients, with satisfactory reliability and cross-sectional construct validity.

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Translation, adaptation and validation of the Roland-Morris questionnaire - Brazil Roland-Morris

Treatment of patients with chronic low back pain and its evolving disability primarily tries to improve the patients’ levels of activities and participation. Mostly, self-reported questionnaires have been used for clinical as well as research purposes to assess daily functioning (1,2), of which the most commonly used will be discussed below. However, this information may not necessarily reflect the real capacity of a patient’s performance. A recent review showed that the correlation of self-reported disability and physical activity level was at best moderate for patients with chronic low back pain (3). In order to improve objectivity, measures of body function, e.g., spinal mobility and lumbar extensor muscle strength, have been used, although the correlation with the level of disability is very weak (4,5). Furthermore, there are major concerns about reliability and validity (6–8). Besides the self-reported disability measures, many have urged to use more objective and direct measures of low back pain–specific functional capacity (5,9,10). Capacity is defined as the highest probable level of functioning that a person may reach in an activity domain at any given moment in a standardized environment. Although there is still no consensus for the definition of functional capacity evaluation (FCE), in the past decades, several FCE measures have been developed, of which the Isernhagen Work Systems Functional Capacity Evaluation (IWS-FCE) is among the most frequently used (11,12). However, recently published psychometric data have shown that some of the tasks included in the IWS-FCE are not reliable (13,14). Unfortunately, the entire sequence of tasks in, for example, the IWS-FCE, is time consuming and expensive, as is the training of the test observer. Therefore, we have decided not to include these measures in this review. Nevertheless, in order to keep up with, for example, the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials recommendations to evaluate several core outcome domains, including physical functioning (9), we wanted to include easy to use performance tasks. Several tasks have been described (8,15–17), but most of them are not low back pain specific, and some, such as the Back Performance Scale, show insufficient factor structure, as in this measure the quality of the performance is also scored (1,18). Therefore, we decided only to include a performance task that assesses lifting, an activity that specifically might be hampered by low back pain. For the selection of the self-reported disability questionnaires and lifting performance tasks, we only selected questionnaires/tests that are low back pain specific and of which all psychometric, including responsiveness, properties have been studied in relevant low back pain populations and published in peer-reviewed journals. Other criteria for selection were: being available in at least English and for performance task measures, easy to administer, inexpensive, and not time consuming when used in clinical practice.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/acr.20542

Measures of function in low back pain/disorders: Low Back Pain Rating Scale (LBPRS), Oswestry Disability Index (ODI), Progressive Isoinertial Lifting Evaluation (PILE), Quebec Back Pain Disability Scale (QBPDS), and Roland‐Morris Disability Questionnaire (RDQ)

Objective: To determine the efficacy of epidural corticosteroid injections for sciatica. 

Methods: Three epidural injections (two day intervals) of 2 ml prednisolone acetate (50 mg) or 2 ml isotonic saline were administered to patients with sciatica presumably due to a disk herniation lasting 15–180 days. Self evaluation was the main judgment criterion at day 20. Patients who recovered or showed marked improvement were considered as success. Pain measured by VAS, the SLR test, Schober's test, Dallas pain questionnaire, and the Roland-Morris index were evaluated at days 0, 5, 20, and 35. Only analgesics were authorised, patients requiring non-steroidal anti-inflammatory drugs (NSAIDs) before day 20 were considered as failure. 

Results: 42 patients were included in the control group (CG), 43 in the steroid group (SG). On an intention to treat analysis 15/42 (36%) in the CG and 22/43 (51%) in the SG (p=0.15) were considered as success (difference 15.5%, 95% CI (-5.4 to 36.3)). Among the 48 failures, 14 patients (6 CG, 8 SG) required NSAIDs, 3 (2 CG, 1 SG) required surgery, and 7 (3 CG, 4 SG) other treatments. On analysis according to protocol, in 74 remaining patients 12/35 (34%) in the CG and 22/39 (56%) in the SG (p=0.057) were considered as success (difference 22.1%, 95% CI (0.0 to 44.2)). For all secondary end points intragroup improvement with time was significant, but intergroup differences were not. 

Conclusion: The efficacy of isotonic saline administered epidurally for sciatica cannot be excluded, but epidural steroid injections provide no additional improvement.

https://ard.bmj.com/content/annrheumdis/62/7/639.full.pdf

Epidural corticosteroid injections for sciatica: a randomised, double blind, controlled clinical trial

Background: Camptocormia is defined as an abnormal flexion of the trunk that appears when standing or walking and disappears in the supine position. The origin of the disorder is unknown, but it is usually attributed either to a primary or a secondary paravertebral muscle myopathy or a motor neurone disorder. Camptocormia is also observed in a minority of patients with parkinsonism. Objective: To characterise the clinical and electrophysiological features of camptocormia and parkinsonian symptoms in patients with Parkinson’s disease and camptocormia compared with patients with Parkinson’s disease without camptocormia. Methods: Patients with parkinsonism and camptocormia (excluding patients with multiple system atrophy) prospectively underwent a multidisciplinary clinical (neurological, neuropsychological, psychological, rheumatological) and neurophysiological (electromyogram, ocular movement recording) examination and were compared with age-matched patients with Parkinson’s disease without camptocormia. Results: The camptocormia developed after 8.5 (SD 5.3) years of parkinsonism, responded poorly to levodopa treatment (20%) and displayed features consistent with axial dystonia. Patients with camptocormia were characterised by prominent levodopa-unresponsive axial symptoms (ie, axial rigidity, gait disorder and postural instability), along with a tendency for greater error in the antisaccade paradigm. Conclusion: We suggest that (1) the salient features of parkinsonism observed in patients with camptocormia are likely to represent a specific form of Parkinson’s disease and camptocormia is an axial dystonia and (2) both camptocormia and parkinsonism in these patients might result from additional, non-dopaminergic neuronal dysfunction in the basal ganglia.

/pdf/parkinson-s-disease-with-camptocormia-1uinov4out.pdf

Parkinson’s disease with camptocormia

Objective To evaluate the effectiveness of acupressure in terms of disability, pain scores, and functional status.

Design Randomised controlled trial.

Setting Orthopaedic clinic in Kaohsiung, Taiwan.

Participants 129 patients with chronic low back pain.

Intervention Acupressure or physical therapy for one month.

Main outcome measures Self administered Chinese versions of standard outcome measures for low back pain (primary outcome: Roland and Morris disability questionnaire) at baseline, after treatment, and at six month follow-up.

Results The mean total Roland and Morris disability questionnaire score after treatment was significantly lower in the acupressure group than in the physical therapy group regardless of the difference in absolute score (- 3.8, 95% confidence interval - 5.7 to - 1.9) or mean change from the baseline (- 4.64, - 6.39 to - 2.89). Acupressure conferred an 89% (95% confidence interval 61% to 97%) reduction in significant disability compared with physical therapy. The improvement in disability score in the acupressure group compared with the physical group remained at six month follow-up. Statistically significant differences also occurred between the two groups for all six domains of the core outcome, pain visual scale, and modified Oswestry disability questionnaire after treatment and at six month follow-up.

Conclusions Acupressure was effective in reducing low back pain in terms of disability, pain scores, and functional status. The benefit was sustained for six months.

https://www.bmj.com/content/bmj/332/7543/696.full.pdf

Treatment of low back pain by acupressure and physical therapy: randomised controlled trial

Functional disability is one of the main components of low back pain (LBP)-associated morbidity and should be taken into account in the evaluation and care of patients. This article describes the French-language adaptation and validation of the Roland and Morris Disability Questionnaire. This self-administered questionnaire proved rapid, simple to use, reliable, valid, and sensitive to changes in clinical status, suggesting that its widespread use may be possible in settings ranging from epidemiological or clinical research to individual LBP patient evaluation in daily clinical practice.

French validation of a disability rating scale for the evaluation of low back pain (EIFEL questionnaire)

L'incapacite fonctionnelle represente un des aspects majeurs de la morbidite des lombalgies qu'il est necessaire de prendre en compte dans l'evaluation et la prise en charge des patients. Cet article decrit les principales etapes de l'adaptation en francais puis de la validation du Disability Questionnaire de Roland et Morris. Ce questionnaire auto-administre s'est revele court, simple, reproductible, valide et sensible au changement. Une large utilisation, dans des contextes aussi differents que la recherche epidemiologique ou clinique, l'expertise mais aussi la pratique clinique, pour l'evaluation individuelle des patients parait donc possible

Validation française d'une échelle d'incapacité fonctionnelle pour l'évaluation des lombalgies (EIFEL).

Associations between ocular and extra-ocular assessment in primary Sjögren's syndrome.

Primary Sjögren’s syndrome (pSS) is a systemic autoimmune disease, with heterogenous manifestations. Main symptoms included dryness features due to the exocrinopathy, fatigue, and joint pain. In addition, systemic manifestations occur in approximately 30 to 40% of the patients with pSS. Previous attempts made to determine distinct pSS phenotypes used only symptom-based classifications, neglecting the B-cell biological activity and the systemic manifestations, which are clearly linked with disease prognosis.We aimed to identify distinct phenotypes among pSS patients, based on all disease features, including symptoms, systemic manifestations, and biological features, using a non-supervised hierarchical cluster analysis.We included pSS patients enrolled in the prospective French Paris-Saclay cohort, if satisfying the ACR/EULAR criteria. We performed an unsupervised multiple correspondence analysis using 26 selected variables to widely cover pSS manifestations: VAS for pain, fatigue, ocular and oral dryness; systemic manifestations as defined by ESSDAI domains; biological parameters such as rheumatoid factor (RF), anti-SSA, -SSB, -RNP, -centromere, -DNA antibodies, high IgG levels, monoclonal component, cryoglobulinemia, low C4 levels; and abnormal Schirmer’s test and presence of focal sialadenitis. The first axes were then considered to perform hierarchical clustering based on the Ward method. The number of clusters was determined visually on the plotted dendrogram and with the gain in inertia.We included 458 pSS patients in the analyses (95% women, median age 49 yrs). Cluster hierarchical classification yield in three homogenous groups of patients.1. Cluster 1 (n=121) included patients with high symptom burden (median [IQR] ESSPRI 6.6 [5.6–7.7]), but low systemic activity (ESSDAI 1; [0-2])2. Cluster 2 (n=110) included a higher proportion of men (15%) and of patients from African ancestry (19%), with high level of dryness (overall dryness VAS 66 [46–81]) and fatigue (VAS 70 [45–84] but low level of pain (pain VAS 53 [20–77]; high systemic activity (ESSDAI 5 [2–8]): lymphadenopathy (11%), cutaneous (7%), pulmonary (12%), PNS (11%), and articular (40%) involvements; frequent other auto-antibodies: anti-RNP (9.2%), anti-centromere (12%), anti-DNA (16%) and cryoglobulinemia (3.5%).3. Cluster 3 (n=195) included younger patients (median age 44 yrs), with low symptom burden (ESSPRI 4.9 [3.3–6.2]), low systemic activity (ESSDAI 2 [1–4]), but with frequent B-cell activation signs: biological ESSDAI domain (58%), high IgG levels (52%), rheumatoid factors (58%), low C4 levels (22%); and higher rates of anti-SSA (86%) and -SSB (46%) antibodies.Patients with history of lymphoma were identified in cluster 2 (n=8, 5.6%) and 3 (n=7, 3.6%).Using an unsupervised clustering method, and including parameter that encompass all disease features, we identified three distinct subgroups of pSS patients that were 1/ high symptom burden without systemic features; 2/ Systemic features 3/ B-cell biologically active with low-symptom burden. Our study highlights the underlying idea of heterogeneous pathophysiological mechanisms and could help further stratifications among pSS patients. Further studies are needed to assess whether disease evolution is different across these subgroups.NIL.NIL.None Declared.

/pdf/pos0165-determination-of-distinct-phenotypes-of-primary-3t7kzjo4.pdf

Pos0165 determination of distinct phenotypes of primary sjögren’s disease using cluster analysis based on clinical and biological manifestations: data from 458 patients from the paris saclay sjögren’s syndrome cohort

E. Berge

Papers

French validation of a disability rating scale for the evaluation of low back pain (EIFEL questionnaire)

Validation française d'une échelle d'incapacité fonctionnelle pour l'évaluation des lombalgies (EIFEL).

Associations between ocular and extra-ocular assessment in primary Sjögren's syndrome.

Pos0165 determination of distinct phenotypes of primary sjögren’s disease using cluster analysis based on clinical and biological manifestations: data from 458 patients from the paris saclay sjögren’s syndrome cohort