The development of a screening instrument to select patients at risk of residual complaints after lumbar disc surgery.
OBJECTIVE
A considerable number of patients who undergo surgery for a lumbosacral radicular syndrome (LRS) continue to experience disability, pain, and loss of work capacity. The goal of the study is to develop a brief screening instrument to identify these patients at risk of residual complaints.


METHODS
In a prospective study of 277 patients, the predictors for the outcomes disability, pain, and loss of work capacity were investigated. The best predictive model was constructed using a stepwise selection procedure (forward selection), which calculates the discriminative power of the model. Based on the relationship between regression coefficients, a clinical prediction rule was derived that predicted the probability of residual complaints after surgery for LRS.


RESULTS
At 6 month follow-up 141 patients (51%) had residual complaints. The discriminative power of the instrument was .78 (AUC). The "Nijmegen Outcome of Lumbar Disc surgery Screening-instrument" (NOLDS) was based on the variables "lower education level", "younger age", "pain 3 days postoperatively", "passive pain coping", and "fear of movement/(re)injury".


CONCLUSIONS
The results of the study are promising, showing that a brief clinical screening instrument can be used to identify patients at risk of residual complaints at 6 months after surgery for LRS. The early identification of patients at risk having residual complaints may make it possible to start tailored treatment early in the rehabilitation process.
den Boer
J J
JJ
Department of Rehabilitation, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands. J.denboer@reval.umcn.nl
Oostendorp
R A B
RA
Evers
A W M
AW
Beems
T
T
Borm
G F
GF
Munneke
M
M
D000203:Activities of Daily Living; D000328:Adult; D019540:Area Under Curve; D004185:Disability Evaluation; D005239:Fear; D005260:Female; D006801:Humans; D016015:Logistic Models; D017116:Low Back Pain / Q000523:psychology / Q000601:surgery*; D008161:Lumbosacral Region / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome