Activities and functional assessment 1 year after spinal fusion for paralytic scoliosis

Abstract

The results of spinal fusion in patients with paralytic deformities are usually presented as the correction of the deformity. When evaluating the surgical results in such patients, it is advantageous to classify the patients into subgroups because of the varying dysfunction and disabilities. The aim of this study was to evaluate the effect of spinal fusion in patients with paralytic scoliosis in relation to function in terms of Impairments, activities in terms of Disabilities, and dependence in terms of Handicaps 1 year postoperatively, with emphasis on subgroups. A total of 94 patients with paralytic scoliosis and 18 different diagnoses were evaluated 1 year after surgery. The patients were classified according to whether or not they could understand verbal instructions. The patients were also grouped according to the Scoliosis Research Society classification of diagnoses. A set of instruments was used with the variables classified according to WHO's International Classification of Impairments, Disabilities, and Handicaps (ICIDH). This consists of the patient's/relative's motives for surgery, persistent skin discoloration, ambulating or use of wheelchair, use of a brace, sitting balance, weight distribution on a sitting surface, angle of scoliosis, reaching, pain estimation, activities of daily living (ADL) Klein and Bell, care given, time spent resting, and seating supports. The set of instrument also included a follow-up questionnaire comprising 12 different areas, where the patients/relatives assessed the results of surgery. The study showed that spinal fusion in paralytic scoliosis led to showed improvements in the whole group of patients at the Impairment level in the angle of scoliosis, sitting balance, weight distribution, and reduced number of patients with persistent skin discoloration, and at the Handicap level in reduced time for resting during the day, reduced number of seating supports in the wheelchair, and in the use of a brace. Most of the parameters were unchanged. The results in the subgroups were almost the same as in the whole group, although pain and reaching at the Impairment level, and ADL at the Disability level, could not be measured in the patients who were unable to understand verbal instructions. The subjectively assessed results showed that seating posture was ranked positively irrespective of the motive for surgery. The study showed that the patients with paralytic scoliosis maintained or improved their function and level of independence in terms of Impairment and Handicap 1 year postoperatively. The subjective results assessed by the patients/relatives also showed a positive outcome of surgery. Weight distribution on a seating surface was improved, but still uneven, and with respect to better sitting balance and increasing time sitting in a wheelchair, this can involve a risk for pressure sores and needs further investigation. When introducing outcomes including the Disability level, one must take the importance of homogeneity in the groups into consideration.

Long-term follow-up of functioning after spinal surgery in patients with Rett syndrome

“…We could not use the whole set of instruments because of the girls' difficulties in understanding verbal instructions during the assessments [5][6][7]. Accordingly, we could not measure activities of daily living from an objective perspective.…”

“…We could not use the ADL, pain estimation, and reaching variables, or the lung function test because the patients with Rett syndrome could not understand or follow verbal instructions [5][6][7]. Along with the invitation to take part in the long-term follow-up, two-open-ended questions were mailed to the parents: ''What do you think has improved since the surgery?''…”

“…In a previous study by Larsson et al [6] for children who do not understand verbal instructions, the parents' motives for surgery most often wanted to obtain improvements in seating posture and respiration.…”

Early individualized postoperative occupational therapy training in 100 patients improves ADL after hip fractureA randomized trial

“…ADL and IADL ability was assessed by using the Klein-Bell (1982) ADL scale, which has been translated into Swedish and validated (Hagsten and Söderback 1994, Larsson et al 1999. In this study, 75 observation points within 4 areas: dressing, toilet visits, mobility and bathing/hygiene, were considered to be relevant.…”

Activity performance and upper extremity function in cervical spinal cord injury patients according to the Klein–Bell ADL Scale

“…20,21 The K-B scale has been translated into Swedish 29 and was validated in three studies. [30][31][32] In the present study, the assessment of patient's level of independence in basic ADL was made via a semistructured interview conducted by the first author. The K-B Scale was presented verbally to the patient before the interview.…”