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Background: Multiple factors influence the recovery process of low back pain (LBP). The identification and increased knowledge of prognostic factors might contribute to a better understanding of the course of LBP. The purpose of this study is to investigate the association of the STarT Back Screening Tool (SBST) risk score and the type of leg pain (non-radiating LBP, referred non-radicular, and radicular radiating leg pain) with the disability trajectory (at baseline, the slope, and recovery at one year) in adults with low back pain. Methods: This is a prospective cohort study in 347 patients with low back pain who sought physiotherapy care at three primary care practices in the Netherlands. Linear mixed models were estimated to describe the association of the SBST risk score and the type of leg pain with disability at baseline, the slope in the disability trajectory, and at twelve months follow-up. Results: A medium/high risk score on the SBST is associated with higher baseline disability scores on the Oswestry Disability Index (ODI), faster initial recovery, and still a higher disability ODI score at 12 months follow-up. Non-radicular referred and radicular radiating leg pain were associated with worse baseline disability ODI scores in LBP. This association was not present for the initial recovery or at the 12 months follow-up. Conclusion: The SBST is associated with the LBP recovery trajectory. The SBST might be a useful tool to predict the disability trajectory in a heterogeneous group of people with low back pain in primary care and might, therefore, be recommended in future clinical practice guidelines. The type of leg pain was not associated with the recovery trajectory of LBP. Future research might focus on evaluating different types of leg pain. Trial registration: Clinicaltrials.gov: 109,643. [ABSTRACT FROM AUTHOR]

This study is aimed at describing the findings of high-resolution nerve ultrasound in children with Noonan syndrome (NS) and related disorders experiencing pain in their legs. This retrospective cohort study was conducted in the NS expert center of the Radboud University Medical Center in the Netherlands. Patients were eligible if they were younger than 18 years, clinically and genetically diagnosed with NS or a NS related disorder, and experienced pain in their legs. Anamneses and physical examination were performed in all children. In addition, high-resolution nerve ultrasound was used to assess nerve hypertrophy and, if needed, complemented spinal magnetic resonance imaging was performed. Over a period of 6 months, four children, three with NS and one child with NS with multiple lentigines, who experienced pain of their legs were eligible for inclusion. Muscle weakness was found in two of them. High-resolution nerve ultrasound showed (localized) hypertrophic neuropathy in all patients. One child underwent additional spinal magnetic resonance imaging, which showed profound thickening of the nerve roots and plexus. Conclusion: In the four children included with a NS and related disorders, pain was concomitant with nerve hypertrophy, which suggests an association between these two findings. The use of high-resolution nerve ultrasound and spinal magnetic resonance imaging might result in better understanding of the nature of this pain and the possible association to nerve hypertrophy in patients with NS and related disorders. What is Known: • Children with Noonan syndrome and related disorders may report pain in their legs, which is often interpreted as growing pain. • Some adults with Noonan syndrome and related disorders have hypertrophic neuropathy as a possible cause of neuropathic pain. What is New: • This is the first study using high-resolution nerve ultrasound in children with Noonan syndrome and related disorders experiencing pain in their legs. • Hypertrophic neuropathy was diagnosed as possible cause of pain in four children with Noonan syndrome and related disorders. [ABSTRACT FROM AUTHOR]

Background: Patients often report various symptoms after recovery from acute COVID-19. Previous studies on post-COVID-19 condition have not corrected for the prevalence and severity of these common symptoms before COVID-19 and in populations without SARS-CoV-2 infection. We aimed to analyse the nature, prevalence, and severity of long-term symptoms related to COVID-19, while correcting for symptoms present before SARS-CoV-2 infection and controlling for the symptom dynamics in the population without infection.Methods: This study is based on data collected within Lifelines, a multidisciplinary, prospective, population-based, observational cohort study examining the health and health-related behaviours of people living in the north of the Netherlands. All Lifelines participants aged 18 years or older received invitations to digital COVID-19 questionnaires. Longitudinal dynamics of 23 somatic symptoms surrounding COVID-19 diagnoses (due to SARS-CoV-2 alpha [B.1.1.7] variant or previous variants) were assessed using 24 repeated measurements between March 31, 2020, and Aug 2, 2021. Participants with COVID-19 (a positive SARS-CoV-2 test or a physician's diagnosis of COVID-19) were matched by age, sex, and time to COVID-19-negative controls. We recorded symptom severity before and after COVID-19 in participants with COVID-19 and compared that with matched controls.Findings: 76 422 participants (mean age 53·7 years [SD 12·9], 46 329 [60·8%] were female) completed a total of 883 973 questionnaires. Of these, 4231 (5·5%) participants had COVID-19 and were matched to 8462 controls. Persistent symptoms in COVID-19-positive participants at 90-150 days after COVID-19 compared with before COVID-19 and compared with matched controls included chest pain, difficulties with breathing, pain when breathing, painful muscles, ageusia or anosmia, tingling extremities, lump in throat, feeling hot and cold alternately, heavy arms or legs, and general tiredness. In 12·7% of patients, these symptoms could be attributed to COVID-19, as 381 (21·4%) of 1782 COVID-19-positive participants versus 361 (8·7%) of 4130 COVID-19-negative controls had at least one of these core symptoms substantially increased to at least moderate severity at 90-150 days after COVID-19 diagnosis or matched timepoint.Interpretation: To our knowledge, this is the first study to report the nature and prevalence of post-COVID-19 condition, while correcting for individual symptoms present before COVID-19 and the symptom dynamics in the population without SARS-CoV-2 infection during the pandemic. Further research that distinguishes potential mechanisms driving post-COVID-19-related symptomatology is required.Funding: ZonMw; Dutch Ministry of Health, Welfare, and Sport; Dutch Ministry of Economic Affairs; University Medical Center Groningen, University of Groningen; Provinces of Drenthe, Friesland, and Groningen. [ABSTRACT FROM AUTHOR]

Introduction: Multicenter, randomized, double-blinded crossover study. The Netherlands (ClinicalTrials.gov NCT02112474). We hypothesized that the pain suppressive effects of 1000 Hz and 30 Hz spinal cord stimulation (SCS) strategies are equally effective in patients with chronic, neuropathic, unilateral leg pain after back surgery. Methods: Thirty-two patients (18–70 years, minimum leg pain 50 mm on 100 mm visual analog scale (VAS), minimal back pain) were randomized (1:1) to start 1000 Hz or 30 Hz neurostimulation for 9 days. After a 5-day washout, they crossed over, for another 9 days. Primary outcome was pain suppression (mean of VAS scores 4×/day) during the crossover period. The main investigators were blinded to strategy allocation, patients were blinded to the outcome, a blinded assessor analyzed the primary outcome. Results: The primary outcome was analyzed in 26 patients. There was no period effect (delta 4 mm, p = 0.42, 95% CI [− 5, 13]), allowing direct intrapatient comparison of the treatment effect (delta 1 mm, p = 0.92, 95% CI [− 13, 14]). Ninety-two percent of patients in both periods experienced greater than 34% pain suppression (minimal clinically important difference, MCID). Secondary outcomes (22 patients): pain suppression and improved quality of life were sustained at 12 months; both were statistically significant and clinically relevant. Fifty percent of patients had greater than 80% pain suppression (p < 0.001). At study termination, all events were resolved; no unanticipated events were reported. Medtronic provided a grant for additional study costs. Conclusion: We conclude that our hypothesis regarding the effect of 1000 Hz and 30 Hz stimulation strategies on pain suppression was confirmed. Both stimulation strategies led to a large, sustainable, clinically relevant pain suppression and improvement in quality of life. [ABSTRACT FROM AUTHOR]

Open microdiscectomy is a frequently performed surgical procedure for sciatica caused by lumbar disc herniation. Percutaneous transforaminal endoscopic discectomy (PTED) has been introduced as a less invasive alternative and 1-year results show non-inferiority in leg pain reduction and dominancy in cost-effectiveness. To compare the long-term cost-effectiveness of PTED with open microdiscectomy among patients with sciatica caused by lumbar disc herniation as measured at two years. Randomized controlled trial at four clinics in the Netherlands which ran from February 2016 to April 2019. Patients were aged from 18 to 70 years and had at least 6 weeks of radiating leg pain caused by lumbar disc herniation. The trial included a predetermined set of 125 PTED patients who were the early cases performed by three surgeons who had not performed PTED before the trial. Eventually 304 patients were allocated to PTED and 309 to open microdiscectomy. Primary effect measures included leg pain as measured on the VAS for leg pain and health-related quality of life (QALYs). Costs were measured from a societal perspective. An economic evaluation was conducted alongside the PTED trial. A cost-effectiveness analysis and a cost-utility analysis were conducted. The primary analysis was conducted according to the intention-to-treat approach. All missing data were imputed using multiple imputation by chained equations (MICE), stratified by treatment group. Predictive mean matching was used to create 10 complete datasets. Disaggregate cost differences were analyzed using linear regression models, both adjusted and unadjusted for confounders. Differences in total costs and effects between treatment groups were obtained from a system of seemingly unrelated regressions (SUR) that accounted for the potential correlation between costs and effects. These total cost and effect differences were adjusted for baseline and confounders. Incremental cost-effectiveness ratios were calculated by dividing incremental costs by incremental effects. Uncertainty was estimated by bootstrapping and presented using Cost-effectiveness Planes and Cost-Effectiveness Acceptability Curves. At 24 months, 92% of the follow-up data were available. Statistically significant differences in leg pain and QALYs were found in favor of PTED at 24-month follow-up (leg pain: 7.3; QALYs: 0.043). Surgery costs were higher for PTED than for open microdiscectomy (ie, €4,500/patient vs €4,095/patient). All other disaggregate costs as well as total societal costs were lower for PTED than for open microdiscectomy, namely primary care, secondary care, medication, informal care, absenteeism, presenteeism and productivity loss. Per performed PTED procedure, €138 in health care costs and €2787 in societal costs are saved. Cost-effectiveness acceptability curves indicated that the probability of PTED being cost-effective compared with open microdiscectomy (meaning on average less costly and more effective) was 99.4% for leg pain and 99.2% for QALYs, regardless of the willingness-to-pay. Results suggest that PTED is less costly and more effective, and therefore cost-effective compared with microdiscectomy for patients with sciatica from the societal perspective. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

Introduction: Lower leg pain (LLP), including medial tibial stress syndrome (MTSS) and chronic exertional compartment syndrome (CECS), remains a major problem for the military.Objective: Evaluation of patient characteristics and short-term results of the rehabilitation program for service members used in the Military Rehabilitation Centre Aardenburg.Methods: This retrospective study includes 161 service members of the Netherlands Armed Forces. Service members were grouped into the following diagnostic categories: MTSS (n = 47), conservative treatment of CECS (n = 34), and rehabilitation after operative intervention of the CECS (CECSo; n = 80).Results: The results showed a significant improvement in all groups regarding the Patient-Specific Functional Scale (PSFS). Only the CECSo group showed significant improvement on the Numeric Pain Rating Score (NPRS). None of the patient characteristics like gender, age, military service, duration of symptoms, and treatment setting were identified to correlate with outcome results.Conclusions: Short-term results of the rehabilitation program for service members with LLP are successful as obtained with the PSFS. Evaluation by the NPRS seems insufficient and researchers should consider using other outcome measurements. The CECSo group seems to benefit the most from the rehabilitation program. No patient characteristics could be identified to correlate with outcome results. [ABSTRACT FROM AUTHOR]

Accompanying leg pain is commonly observed in patients with chronic low back pain (CLBP) and is assumed to be an indicator for the disorder severity. However, it is still unknown whether it is possible to estimate a patient's functional status by the extent of leg pain present. In a post rehabilitation cohort of 132 patients with CLBP (mean age 44.3 years) the relationship between pain extent and functional status was determined using pain drawings scored for pain extent by a simplified scoring system (Lower Extremity Region: LER) and several function related questionnaires. Primary outcomes were pain extent, pain intensity ratings (Visual Analog Scale: VAS), disability status (Oswestry Disability Index: ODI) and physical and mental health (Short Format 12: SF-12). Statistically significant differences between patients with low (1-2) and high (&ges; 3) LER scores were found in VAS, ODI and SF-12 physical health scores, however, the LER score has a poor diagnostic accuracy in predicting desirable versus undesirable VAS, ODI and SF-12 scores. Pain intensity (VAS), back disability (ODI) and physical health are worse in CLBP patients with high LER scores. However LER scores cannot be used to predict elevated VAS, ODI and SF-12 scores in an individual patient. [ABSTRACT FROM AUTHOR]

Open microdiscectomy (OM) is the standard procedure for the treatment of sciatica caused by a lumbar disc herniation. Percutaneous transforaminal endoscopic discectomy (PTED) is an alternative procedure which is performed under conscious sedation. To determine if PTED is noninferior to OM in leg pain reduction, among patients with sciatica caused by lumbar disc herniation. Furthermore, an economic evaluation was conducted. Randomized controlled trial. PTED (n=304) or OM (n=309). The primary outcome was self-reported leg pain measured by a 0-100 visual analog scale (VAS), assuming a noninferiority margin of 5. Secondary outcomes included self-reported functional status, back pain, health-related quality of life and self-perceived recovery. Costs were measured from a societal perspective. Outcomes were measured until one year following surgery and were longitudinally analyzed. A 12-month, pragmatic, randomized, controlled, noninferiority trial in which 613 patients were randomized at four clinics in the Netherlands, from February 2016 to April 2019. Patients were aged from 18 to 70 years and had at least 6 weeks of radiating leg pain caused by lumbar disc herniation. The trial included a predetermined set of 125 PTED patients who were the early cases performed by surgeons who did not perform PTED before the trial. At 12 months, the mean (SD) VAS score for leg pain was statically significantly lower among patients who underwent 67.3 (21.7) PTED than for 69.9 (20.6) OM (adjusted between-group difference of 7.4, 95% confidence interval 3.5 to 12.0). The blood loss was smaller, mean length of hospitalization was shorter, and timing mobilization was shorter in the PTED-group. Within one year, 5.3% in the PTED group compared to 5.6% in the OM group, underwent repeated surgery. Secondary patient-reported outcomes were similarly in favor of PTED. Cost-effectiveness acceptability curves indicated that the probability of PTED being cost-effective compared with OM was almost 1.0 for both outcomes, regardless of the willingness-to-pay. Results of the current study show that PTED is noninferior to OM in leg pain reduction. PTED resulted in more favorable results for patient self-reported leg pain, back pain, functional status, quality of life and recovery. Furthermore, results suggest that PTED is cost-effective compared with OM for patients with lumbar disc herniation from the societal perspective. Even though these differences are small and may not reach clinical relevance, PTED should be considered as an effective alternative to OM in treating sciatica. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]