Recovery priorities in degenerative cervical myelopathy: a cross-sectional survey of an international, online community of patients

被引:47
作者
Davies, Benjamin [1 ]
Mowforth, Oliver [1 ]
Sadler, Iwan [2 ]
Aarabi, Bizhan [3 ]
Kwon, Brian [4 ]
Kurpad, Shekar [5 ]
Harrop, James S. [6 ]
Wilson, Jefferson R. [7 ]
Grossman, Robert [8 ]
Fehlings, Michael G. [7 ]
Kotter, Mark [1 ,9 ]
机构
[1] Univ Cambridge, Div Neurosurg, Dept Clin Neurosci, Cambridge, England
[2] Myelopathy Org, Cambridge, England
[3] Univ Maryland, Div Neurosurg, Baltimore, MD 21201 USA
[4] Univ British Columbia, Dept Orthopaed, Vancouver, BC, Canada
[5] Med Coll Wisconsin, Dept Neurosurg, Milwaukee, WI 53226 USA
[6] Thomas Jefferson Univ Hosp, Dept Neurosurg, Philadelphia, PA 19107 USA
[7] Toronto Western Hosp, Dept Neurosurg, Toronto, ON, Canada
[8] Houston Methodist Hosp, Dept Neurosurg, Houston, TX 77030 USA
[9] Univ Cambridge, Dept Clin Neurosci, Anne McLaren Lab Regenerat Med, Cambridge, England
基金
英国惠康基金; 美国国家卫生研究院;
关键词
SPINAL-CORD-INJURY; SPONDYLOTIC MYELOPATHY; SURGICAL DECOMPRESSION; EPIDEMIOLOGY; PREVALENCE; FEATURES; OUTCOMES; WASTE; PAIN;
D O I
10.1136/bmjopen-2019-031486
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives To establish the recovery priorities of individuals suffering with degenerative cervical myelopathy (DCM). Design A cross-sectional, observational study. Setting Patients from across the world with a diagnosis of DCM accessed the survey over an 18-month period on Myelopathy.org, an international myelopathy charity. Participants 481 individuals suffering from DCM completed the online survey fully. Main outcome measures Functional recovery domains were established through qualitative interviews and a consensus process. Individuals were asked about their disease characteristics, including limb pain (Visual Analogue Scale) and functional disability (patient-derived version of the modified Japanese Orthopaedic Association score). Individuals ranked recovery domains (arm and hand function, walking, upper body/trunk function, sexual function, elimination of pain, sensation and bladder/bowel function) in order of priority. Priorities were analysed as the modal first priority and mean ranking. The influence of demographics on selection was analysed, with significance p<0.05. Results Of 659 survey responses obtained, 481 were complete. Overall, pain was the most popular recovery priority (39.9%) of respondents, followed by walking (20.2%), sensation (11.9%) and arm and hand function (11.5%). Sexual function (5.7%), bladder and bowel (3.7%) and trunk function (3.5%) were chosen less frequently. When considering the average ranking of symptoms, while pain remained the priority (2.6 +/- 2.0), this was closely followed by walking (2.9 +/- 1.7) and arm/hand function (3.0 +/- 1.4). Sensation ranked lower (4.3 +/- 2.1). With respect to disease characteristics, overall pain remained the recovery priority, with the exception of patients with greater walking impairment (p<0.005) who prioritised walking, even among patients with lower pain scores. Conclusions This is the first study investigating patient priorities in DCM. The patient priorities reported provide an important framework for future research and will help to ensure that it is aligned with patient needs.
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页数:7
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