Evaluating ambulatory function as an outcome following treatment for spinal metastases: A systematic review.
Surgery; Systematic review; Decision-making; Spinal metastases; Ambulatory function; Non-operative treatment
BACKGROUND CONTEXT: Studies regarding treatment of spinal metastases are critical to evidence-based decision-making. However, variation exists in how a key outcome, ambulatory function, is assessed. PURPOSE: To characterize the sources and tools investigators have used to evaluate ambulatory function as an outcome following treatment of spinal metastases. We also sought to understand the ways ambulatory function has been conceptualized in prior studies. STUDY DESIGN: Systematic review of the literature. PATIENT SAMPLE: We identified 44 published studies for inclusion. Samples within these investigations ranged from 20 to 2,096 subjects. OUTCOME MEASURES: We describe the methods investigators have used to evaluate ambulatory function following treatment for spinal metastases. METHODS: We conducted a systematic review through PubMed, Scopus and Web of Science following PRISMA guidelines. We included studies that consisted of adult patients receiving operative or non-operative treatment for spinal metastases. We also required that study investigators specified post-treatment ambulatory function as an outcome. We recorded year of publication, study design, types of spinal metastases included in the study, treatments employed, and sample size. We also described the source (medical record, study-specific observer and/or provider, patient and/or participant), tool (standardized measure, quantitative, qualitative) and concept (eg, ambulatory vs. non-ambulatory; independent ambulation vs. ambulatory with assistance vs. non-ambulatory) used to assess ambulatory function. RESULTS: We found the plurality of studies relied on medical record documentation as their source. Amongst prospective studies, only a minority used a quantitative measure (eg, prespecified degree of walking ability) to assess ambulatory function. Most studies conceptualized ambulatory function as a dichotomized outcome, typically ambulatory versus non-ambulatory or a similar equivalent. CONCLUSIONS: Wide variation exists in how ambulatory function is defined in studies involving patients with spinal metastases. We suggest several improvements that will allow a more robust assessment of the quality and quantity of ambulatory function among patients treated for spinal metastases.
Nguyen L; Agaronnik N; Ferrone ML; Katz JN; Schoenfeld AJ
The Spine Journal : Official Journal Of The North American Spine Society
2021
2021-05-13
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1016/j.spinee.2021.05.001" target="_blank" rel="noreferrer noopener">10.1016/j.spinee.2021.05.001</a>
The Relationship Between Eyebrow and Eyelid Position in Patients With Ptosis, Dermatochalasis and Controls.
PURPOSE: The purpose of this study is to explore mechanical and co-innervational factors involved in both voluntary and involuntary brow elevation among people affected by ptosis and dermatochalasis. METHODS: In this prospective cohort study of normal controls and eyelids with ptosis or dermatochalasis, marginal reflex distance (MRD1) and brow height were measured under the following conditions: neutral position, involuntary mechanical brow elevation, voluntary brow elevation, and maximal eyelid opening. The primary outcome measure was change in MRD1. Secondary outcome measures included brow height and coupling (mm brow height change per mm MRD1 change). Analysis of variance and t tests were performed for intra- and intercondition comparisons, respectively. RESULTS: Mechanical (involuntary) brow elevation significantly raised MRD1 in control eyelids and eyelids with dermatochalasis, but not in eyelids with ptosis. Voluntary brow elevation produced significantly greater brow height than maximal eyelid opening in controls and eyelids with dermatochalasis, but not in eyelids with ptosis. Maximal eyelid opening increased MRD1 greater than voluntary brow elevation significantly in control eyelids, but not in eyelids with dermatochalasis or ptosis. Coupling of the brow and eyelid margin during maximal eyelid opening was significantly greater in eyelids with ptosis relative to controls. CONCLUSIONS: In eyelids with ptosis, mechanical brow elevation does not change eyelid position; however, voluntary brow elevation raises eyelid position to a similar position as maximal eyelid opening. These results argue against the contention that the brow is elevated to mechanically lift the eyelid in ptosis and instead suggest that the brow elevation is driven by efforts to raise the eyelid, possibly via co-innervation.
Sinha Kunal R; Al Shaker Sara; Yeganeh Amir; Moreno Tyler; Rootman Daniel B
Ophthalmic plastic and reconstructive surgery
2019
2019-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/IOP.0000000000001178" target="_blank" rel="noreferrer noopener">10.1097/IOP.0000000000001178</a>