bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reduced Lower Extremity Functioning Is Associated With an Increased Rate of Being a Nondriver: The National Health and Aging Trends Study
Authors: Cisewski Jodi A , Durbin Laura L , Bond Elizabeth G , Qian Min , Guralnik Jack M , Kasper Judith , Mielenz Thelma J 
Published: March 2019

Abstract

Background
Driving a motor vehicle is an important aspect of mobility for older adults. Limited lower extremity functioning performance, as measured by the Short Physical Performance Battery (SPPB), has been associated with various negative health outcomes, but little is known about the association of SPPB scores with driving status.

Objective
The purpose of this study was to evaluate whether lower (poorer) SPPB scores are associated with an increased rate for being a current nondriver among a nationally representative sample of community-dwelling older adults.

Design
The National Health and Aging Trends Study is a longitudinal cohort study.

Methods
A population of 5935 participants, surveyed annually from 2011 to 2014 for the National Health and Aging Trends Study, was used to examine the relationship between SPPB and driving status. Using weighted data, multivariable Poisson regression with generalized estimating equations was used to calculate the rate ratios, adjusting for covariates and clustering due to the complex survey design.

Results
Participants with a low (poor) SPPB score (0–5) had a rate for being a current nondriver 2.01 times the rate (or 101% increase) of those with a high (good) SPPB score (10–12) (adjusted 95% confidence interval = 1.78–2.26).

Limitations
Current nondrivers were not asked whether they planned to resume driving if they had not driven in the previous year.

Conclusions
Unlike other factors, such as cognitive decline, lower SPPB scores (poorer lower extremity functioning) are significantly associated with an increased rate of being a current nondriver and are a modifiable risk factor. Further research is needed to examine whether optimum exercises and other physical therapist interventions focused on improving lower extremity strength and balance ultimately improve driving outcomes.
Physicians’ intention to provide exercise counseling to patients in Taiwan: an examination based on the Theory of Planned Behavior
Authors: Lynn An-Min , Huang Jiun-Hau 
Published: March 2019

Abstract
Increasingly more clinical guidelines have recommended that physicians provide exercise counseling (EC) to patients to help improve their lifestyle and enhance treatment effects. However, little is known about physicians’ EC intention and associated factors. This study aimed to systematically examine physicians’ EC intention using the Theory of Planned Behavior (TPB). Using the TPB as a theoretical and structural framework, 27 TPB items were developed and factor-analyzed to form five factors (i.e., attitudes toward positive and negative EC outcomes, subjective norms, and perceived control over EC under facilitating and constraining conditions) with satisfactory psychometric properties. Responses from 1,006 physicians (response rate 90.5%) were analyzed using multivariate logistic regression to examine the TPB-based factors associated with greater EC intention. Physicians’ favorable attitudes toward positive EC outcomes (adjusted odds ratio [AOR] 4.03) were most strongly linked to high EC intention, followed by supportive subjective norms (AOR 3.74) and high perceived control under facilitating conditions (AOR 1.64). Specifically, physicians’ EC intention was related to their attitudes toward better treatment effects and gaining respect from patients because of EC, perceived support for EC from patients and senior physicians, and perceived control over EC concerning their behavioral change skills. These findings could inform EC promotion efforts in clinical settings and medical education. EC-related training should be incorporated into medical school curriculum, residency training, and continuing medical education to enhance physicians’ EC-related knowledge and competence, including lifestyle management and behavioral change skills. Attention should also be paid to the role of patients and senior physicians in promoting EC.
Exposure to Cold Unmasks Potential Biomarkers of Fibromyalgia Syndrome Reflecting Insufficient Sympathetic Responses to Stress
Authors: Pardo José V. , Larson Robert C. , Spencer Rachel J. , Lee Joel T. , Pasley Jeffrey D. , Torkelson Carolyn J. , Larson Alice A. 
Published: March 2019

Objectives:
Fibromyalgia syndrome (FMS) is a chronically painful condition whose symptoms are widely reported to be exacerbated by stress. We hypothesized that female patients with FMS differ from pain-free female controls in their sympathetic responses, a fact that may unmask important biomarkers and factors that contribute to the etiology of FMS.

Materials and Methods:
In a pilot study, blood pressure (BP), skin temperature, thermogenic activity, circulating glucose, and pain sensitivity of 13 individuals with FMS and 11 controls at room temperature (24°C) were compared with that after exposure to cold (19°C).

Results:
When measured at 24°C, BP, skin temperature, blood glucose, and brown adipose tissue (BAT) activity, measured using 18F-fluorodeoxyglucose positron-emission tomography/computed tomography, did not differ between controls and individuals with FMS. However, after cold exposure (19°C), BP and BAT activity increased in controls but not in individuals with FMS; skin temperature on the calf and arm decreased in controls more than in individiuals with FMS; and circulating glucose was lower in individiuals with FMS than in controls. Pain sensitivity did not change during the testing interval in response to cold.

Discussion:
The convergence of the effect of cold on 4 relatively simple measures of thermogenic, cardiovascular, and metabolic activity, each regulated by sympathetic activity, strongly indicate that individuals with FMS have impaired sympathetic responses to stress that are observable and highly significant even when measured in extraordinarily small sample populations. If insufficient sympathetic responses to stress are linked to FMS, stress may unmask and maximize these potential clinical biomarkers of FMS and be related to its etiology.
Multimodal Nutritional Management in Primary Lumbar Spine Surgery
Authors: Xu Bin , Xu Wei-xing , Lao Yang-jun , Ding Wei-guo , Lu Di , Sheng Hong-feng 
Published: March 2019

Study Design.
A prospective randomized controlled trial.

Objective.
The purpose of this study was to evaluate the clinical effect and safety of a new multimodal nutritional management (MNM) protocol for patients receiving primary lumbar spine surgery.

Summary of Background Data.
Poor nutritional status is common in the perioperative period in primary lumbar spine surgery, and may impede recovery after surgery.

Methods.
A total of 187 patients were included in this prospective randomized controlled trial. They were randomly assigned to the MNM group or the control group. Albumin (ALB) infusion, postoperative ALB level, electrolyte disorders, postoperative electrolyte levels, transfusion rate, postoperative hemoglobin level, length of stay (LOS), and complications were compared between the groups.

Results.
Compared with the control group, the rate and the total amount of ALB infusion were lower in the MNM group, and the postoperative level of ALB in the MNM group was higher on the first postoperative day, and the third postoperative day. The incidence of hypokalemia, hyponatremia, and hypocalcemia were lower in the MNM group. In the MNM group, the postoperative levels of sodium, potassium, and calcium were higher than the control group. The transfusion rate was similar between the two groups. The hemoglobin level was similar between the two groups on first postoperative day, but was higher in the MNM group on third postoperative day. LOS in the MNM group was shorter than in the control group. The incidence of wound drainage was lower in the MNM group. No statistical differences were observed regarding surgical complications between the two groups.

Conclusion.
The MNM protocol effectively reduced ALB infusion, the incidence of electrolyte disorders, and wound drainage, increased the postoperative levels of ALB, sodium, potassium, and calcium, and reduced the LOS without increasing the rate of postoperative complications.

Level of Evidence: 2
Minimally Effective Dose of Bone Morphogenetic Protein in Minimally Invasive Lumbar Interbody Fusions
Authors: Lytle Evan J. , Slavnic Dejan , Tong Doris , Bahoura Matthew , Govila Lisa , Gonda Roger , Houseman Clifford , Soo Teck-Mun 
Published: March 2019

Study Design.
Retrospective longitudinal cohort.

Objective.
We sought to demonstrate the minimally effective bone morphogenetic protein (BMP) dose to achieve fusion in minimally invasive transforaminal lumbar interbody fusions.

Summary of Background Data.
Multiple studies have been conducted, which used a wide range of BMP doses for lumbar fusions highlighting associated risks and benefits. There is, however, a paucity in the literature in determining the minimally effective dose.

Methods.
Consecutive patients who underwent transforaminal lumbar interbody fusion from 2009 to 2014 were reviewed. Fusion was determined by a combination of computed tomography and dynamic x-ray by independent radiologists. We used backward stepwise multiple logistic regression with fusion as the dependent variable to determine whether BMP dose/level was a significant predictor for fusion. To determine the minimally effective dose of BMP/level, separate logistic regressions for different BMP dose ranges and sensitivity analyses were used. A P value ≤0.025 was considered significant.

Results.
There were 1102 interspaces among 690 patients. Average BMP dose was 1.28 mg/level. Overall fusion was 95.2% with a mean follow-up of 19 months. BMP dose/level was a significant predictor for fusion. Odds of fusion increased by 2.02 when BMP dose range was increased from (0.16–1 mg/level) to (1.0–2 mg/level), but fusion odds did not increase when BMP dose increased to more than 2 mg/level.

Conclusion.
BMP dose/level was a significant predictor for fusion. There was a significant increase in odds of fusion when BMP dose increased from 0.16 to 1 mg/level to 1.0 to 2 mg/level. No benefit from increasing the dose more than 2 mg/level was found, suggesting 1.0 mg/level to be the minimally effective BMP dose.

Level of Evidence: 3
PROMIS Correlates With Legacy Outcome Measures in Patients With Neck Pain and Improves Upon NDI When Assessing Disability in Cervical Deformity
Authors: Johnson Bradley , Stekas Nicholas , Ayres Ethan , Moses Michael J. , Jevotovsky David , Fischer Charla , Buckland Aaron J. , Errico Thomas , Protopsaltis Themistocles 
Published: March 2019

Study Design.
Retrospective cohort study.

Objective.
To evaluate the ability of patient reported outcome measurement information system (PROMIS) assessments to capture disability related to cervical sagittal alignment and secondarily to compare these findings to legacy outcome measures.

Summary of Background Data.
PROMIS is a validated patient-reported outcome metric that is increasing in popularity due to its speed of administration relative to legacy metrics. The ability of PROMIS to capture disability from sagittal alignment and baseline health status in patients with neck pain has not been investigated.

Methods.
Patients presenting with a chief complaint of neck pain from December 2016 to July 2017 were included. Demographics and comorbidities were retrospectively collected. All patients prospectively completed the neck disability index (NDI), EQ-5D, visual analog scale (VAS) neck, VAS arm, PROMIS physical function, PROMIS pain intensity, and PROMIS pain interference metrics. Cervical sagittal alignment parameters were measured on standing X-rays. The correlations between outcome measures, health status indexes, psychiatric diagnoses, and sagittal alignment were analyzed.

Results.
Two hundred twenty-six patients were included. The sample was 58.4% female with a mean age of 55.1 years. In patients with neck pain, PROMIS physical function correlated strongly with the NDI (r = −0.763, P < 0.01), EQ-5D (r = 0.616, P < 0.01), VAS neck pain (−0.466, P < 0.01), and VAS arm pain (r = −0.388, P < 0.01). One hundred seventy-seven patients (69.96%) were included in the radiographic analysis. 20.3% of the radiographic cohort had cervical deformity and in this group, less cervical lordosis correlated with PROMIS pain intensity and EQ-5D but not NDI. In patients without cervical deformity, no outcome metric was found to correlate significantly with cervical alignment parameters.

Conclusion.
PROMIS domains correlated strongly with legacy outcome metrics. For the whole cohort, sagittal alignment was not correlated with outcomes. In patients with sagittal cervical deformity, worsening alignment correlated with PROMIS pain intensity and EQ-5D but not NDI.

Level of Evidence: 3
90-day Readmission in Elective Primary Lumbar Spine Surgery in the Inpatient Setting
Authors: Rubel Nicolas C. , Chung Andrew S. , Wong Michael , Lara Nina J. , Makovicka Justin L. , Arvind Varun , Chang Michael S. , Cho Samuel K. 
Published: March 2019

Study Design.
Secondary analysis of a large administrative database.

Objective.
The objectives of this study are to: 1) identify the incidence and cause of 90-day readmissions following primary elective lumbar spine surgery, 2) offer insight into potential risk factors that contribute to these readmissions, and 3) quantify the cost associated with these readmissions.

Summary of Background Data.
As bundled-payment models for the reimbursement of surgical services become more popular in spine, the focus is shifting toward long-term patient outcomes in the context of 90-day episodes of care. With limited data available on national 90-day readmission statistics available, we hope to provide evidence that will aid in the development of more cost-effective perioperative care models.

Methods.
Using ICD-9 coding, we identified all patients 18 years of age and older in the 2014 Nationwide Readmissions Database (NRD) who underwent an elective, inpatient, primary lumbar spine surgery. Using multivariate logistic regression, we identified independent predictors of 90-day readmission while controlling for a multitude of confounding variables and completed a comparative cost analysis.

Results.
We identified 169,788 patients who underwent a primary lumbar spine procedure. In total 4268 (2.5%) were readmitted within 90 days. There was no difference in comorbidity burden between cohorts (readmitted vs. not readmitted) as quantified by the Elixhauser Comorbidity index. Independent predictors of increased odds of 90-day readmission were: anemia, uncomplicated diabetes and diabetes with chronic complications, surgical wound disruption and acute myocardial infarction at the time of the index admission, self-pay status, and an anterior surgical approach. Implant complications were identified as the primary related cause of readmission. These readmissions were associated with a significant cost increase.

Conclusion.
There are clearly identifiable risk factors that increase the odds of hospital readmission within 90 days of primary lumbar spine surgery. An overall 90-day readmission rate of 2.5%, while relatively low, carries significantly increased cost to both the patient and hospital.

Level of Evidence: 3
Health-related Quality of Life and Postural Changes of Spinal Alignment in Female Adolescents Associated With Back Pain in Adolescent Idiopathic Scoliosis
Authors: Makino Takahiro , Kaito Takashi , Sakai Yusuke , Takenaka Shota , Yoshikawa Hideki 
Published: March 2019

Study Design.
A prospective cross-sectional study.

Objective.
To identify risk factors for chronic back pain and back pain at rest in adolescent idiopathic scoliosis (AIS) patients, particularly focusing on the psychological backgrounds of the patients and on postural changes of radiographical parameters for spinal alignment.

Summary of Background Data.
Back pain has been recognized as a relatively common condition in AIS. However, the effect of patients’ psychological backgrounds and dynamic changes of spinal alignment on back pain are unclear.

Methods.
One hundred two consecutive female AIS patients (mean age, 14.1 yrs [range, 10–18]) who first visited our outpatient clinic between July 2013 and December 2017 were included. Using SRS-22r questionnaire, the presence of chronic back pain and back pain at rest and the scores of self-image and mental health were evaluated. Using full-length standing and supine posteroanterior radiographs, parameters related to curve profiles and coronal global balance were measured, and postural changes of these parameters were calculated. From full-length standing lateral radiographs, sagittal spinal and spino-pelvic alignment parameters were also measured. Multivariate logistic regression analysis was performed to identify risk factors for back pain.

Results.
The prevalence of chronic back pain was 22.5% and that of back pain at rest was 25.5%. Poor self-image and mental health scores in SRS-22r were identified as risk factors for chronic back pain. Higher Risser grade, poor self-image score, large postural changes of apical vertebral translation at the main thoracic curve, and hyperlordosis in the lumbar spine were identified as risk factors for back pain at rest.

Conclusion.
Psychological distress and large postural changes of spinal alignment played an important role in the occurrence of back pain. Physicians should pay more attention to mental healthcare of AIS patients as well as to radiographical assessments of curve severity for better health-related quality of life.

Level of Evidence: 4
The Use of Halo Gravity Traction in the Treatment of Severe Early Onset Spinal Deformity
Authors: Iyer Sravisht , Duah Henry Ofori , Wulff Irene , Osei Tutu Henry , Mahmud Rufai , Yankey Kwadwo Poku , Akoto Harry , Boachie-Adjei Oheneba 
Published: March 2019

Study Design.
Retrospective Review of Prospective cohort.

Objective.
To describe the feasibility of preoperative halo gravity traction (HGT) with subsequent growing rod/guided growth (GR/GG) placement in early onset spinal deformity (EOSD).

Summary of Background Data.
In children with severe EOSD, primary implantation of GR/GG constructs is not always possible. We describe a staged protocol with preoperative HGT followed by GR/GG implantation.

Methods.
EOSD patients treated with HGT prior to GR/GG implantation were included. HGT used traction up to 50% body weight for 4 to 29 weeks. Pulmonary function tests (PFTs) were performed before and after HGT. Coronal Cobb (CC) and Sagittal Cobb (SC) angles were measured on the Pre-HGT, Post-HGT and 6 week postop x-rays.

Results.
Thirty patients were included. Average age at GR/GG implantation was 9 years. Most cases (n = 24, 80%) were idiopathic. Most pts had kyphoscoliosis (n = 16, 53.3%). Pre-HGT CC averaged 112 ± 22° and SC averaged 106 ± 26°. CC and SC improved 29% after HGT. There was a significant improvement in body mass index following HGT. CC improved further to 70 ± 14° (36% vs. pre-HGT) and SC to 63 ± 21° (41%) with GR/GG placement. HGT-related complications occurred in nine patients (30%); eight pin site infections, one cranial abscess. Most HGT complications were managed with local pin care and oral antibiotics. Halo revision was required in two pts (6.7%). There was no change in PFTs with HGT (P > 0.05). Averagely, 14 levels were spanned during GR/GG implantation; two patients required vertebral column resection. Surgical complications occurred in nine (30%) patients. At average 16 month follow-up, seven patients (23.3%) required reoperation.

Conclusion.
Preoperative HGT can make severe EOSD curves amenable to GR/GG implantation. HGT results in ∼30% correction with improvement to ∼35–40% following GR/GG. HGT has a 30% complication rate but most are pin-site infections managed with pin-site care and oral antibiotics; 6.7% of patients require revision.

Level of Evidence: 4
Spinal Fusion in Parkinson's Disease Patients
Authors: Shah Neil V. , Beyer George A. , Solow Maximillian , Liu Shian , Tarabichi Saad , Stroud Sarah G. , Hollern Douglas A. , Bloom Lee R. , Liabaud Barthélemy , Agarwal Sanjeev , Passias Peter G. , Paulino Carl B. , Diebo Bassel G. 
Published: March 2019

Study Design.
Retrospective analysis.

Objective.
To compare outcomes and complication rates between patients with and without Parkinson's disease (PD) patients undergoing surgery for adult spinal deformity (ASD).

Summary of Background Data.
There is limited literature evaluating the impact of PD on long-term outcomes after thoracolumbar fusion surgery for ASD.

Methods.
Patients admitted from 2009 to 2011 with diagnoses of ASD who underwent any thoracolumbar fusion procedure with a minimum 2-year follow-up surveillance were retrospectively reviewed using New York State's Statewide Planning and Research Cooperative System. A 1:1 propensity score-match by age, Deyo score, and number of fused vertebral levels was conducted before comparing surgical outcomes of patients with ASD with and without PD. Univariate analysis compared demographics, complications, and subsequent revision. Multivariate binary stepwise logistic regression models identified independent predictors of these outcomes (covariates: age, sex, Deyo Index score, and PD diagnosis).

Results.
A total of 576 propensity score-matched patients were identified (PD: n = 288; no-PD: n = 288), with a mean age of 69.7 years (PD) and 70.2 years (no-PD). Each cohort had comparable distributions of age, sex, race, insurance provider, Deyo score, and number of levels fused (all P > 0.05). Patients with PD incurred higher total charges across ASD surgery–related visits ($187,807 vs. $126,610, P < 0.001), yet rates of medical complications (35.8% PD vs. 34.0% no-PD, P = 0.662) and revision surgery (12.2% vs. 10.8%, P > 0.05) were comparable. Postoperative mortality rates were comparable between PD and no-PD cohorts (2.8% vs. 1.4%, P = 0.243). Logistic regression identified nine-level or higher spinal fusion as a significant predictor for an increase in total complications (odds ratio = 5.64); PD was not associated with increased odds of any adverse outcomes.

Conclusion.
Aside from higher hospital charges incurred, patients with PD experienced comparable overall complication and revision rates to a propensity score-matched patient cohort without PD from the general population undergoing thoracolumbar fusion surgery. These results can support management of concerns and postoperative expectations in this patient cohort.

Level of Evidence: 3