[Development and validation of the Visual Analogue Scale (VAS) Spine Score].

The aim of the study was the development and validation of a new subjective rating scale for assessment of outcome in patients with thoracolumbar fractures and fracture dislocations. The VAS spine score consists of 19 score items, using 100-mm visual analogue scales. The items are answered by the patients independently of rater assessment. To measure the analogue scales and calculate the score, a computer-aided system was evolved consisting of self-developed software and digitizer board. The overall score is the mean of all items answered with values between 0 and 100. The individual score loss is calculated as the difference between the preinjury score and at follow-up with values between 0 and 100. The VAS spine score was tested for reliability with a group of 136 healthy volunteers. We performed a test-retest study with an interval of 24 h. For statistical analysis of the validity, we prospectively followed a group of 53 patients with the new outcome score. We chose patients with injuries of the thoracolumbar spine, all having been operatively treated by combined posterior-anterior stabilization and fusion between 1994 and 1996. In the reference group, the average test score was 91.95 (58-100) and 92.10 (58-100) at retest. The mean individual difference between test and retest scored 1.037 (0-8). A high reliability was proved by a strong correlation with a coefficient of 0.976 (p < 0.001). A high internal consistency of the VAS spine score was shown by a Cronbach-alpha of 0.9117. The mean score for the preinjury status of the patients was comparable to the reference group, amounting to 89.60 (21-100). The mean score at the time of implant removal was significantly (p < 0.001) decreased to 58.25 (13-97). Until the time of follow-up a significant (p < 0.001) increase was noted, and the group scored 66.08 (15-100) at follow-up. This was a significant (p < 0.001) difference compared with the preinjury status. The individual score loss averaged 24.1 (0-80). In the patient group we also noted a Cronbach-alpha > 0.95, indicating a high internal consistency. With the VAS spine score the authors have inaugurated a new tool for outcome measurement in the treatment of patients with thoracolumbar injuries. The study has proved the score to be both reliable and valid. The application of the score is helpful in analyzing the subjective outcome, and the results can be correlated with objective measures. The score is a useful tool for comparative clinical studies, addressing the outcome after different methods of treatment.

[1]  W. Pförringer,et al.  [Analysis of the cost of illness in backache]. , 1998, Medizinische Klinik.

[2]  A. Apley.  An assessment of assessment. , 1990, The Journal of bone and joint surgery. British volume.

[3]  L. Lasagna,et al.  The quantification of pain: An analysis of words used to describe pain and analgesia in clinical trials , 1982, Clinical pharmacology and therapeutics.

[4]  Greenough Cg,et al.  Assessment of outcome in patients with low-back pain. , 1992 .

[5]  E C Huskisson,et al.  Vertical or horizontal visual analogue scales. , 1979, Annals of the rheumatic diseases.

[6]  K. H. Nilsen,et al.  Assessment of the Progress of the Back-Pain Patient , 1982, Spine.

[7]  E. Taşdemiroğlu,et al.  Long‐Term Follow‐Up Results of Thoracolumbar Fractures After Posterior Instrumentation , 1995, Spine.

[8]  G. Waddell,et al.  Assessment of Severity in Low‐Back Disorders , 1984, Spine.

[9]  G. Waddell,et al.  Clinical assessment of lumbar impairment. , 1987, Clinical orthopaedics and related research.

[10]  M Rosen,et al.  The reliability of a linear analogue for evaluating pain , 1976, Anaesthesia.

[11]  G H Guyatt,et al.  Measuring health status: what are the necessary measurement properties? , 1992, Journal of clinical epidemiology.

[12]  J. Kostuik,et al.  Evaluation of Surgical Treatment for Burst Fractures , 1990, Spine.

[13]  G. Lawlis,et al.  The Development of the Dallas Pain Questionnaire: An Assessment of the Impact of Spinal Pain on Behavior , 1989, Spine.

[14]  G. Schuh,et al.  [Late results after lumbar vertebrae fracture with Lorenz Böhler conservative treatment]. , 1992, Der Unfallchirurg.

[15]  M. Roland,et al.  A study of the natural history of back pain. Part I: development of a reliable and sensitive measure of disability in low-back pain. , 1983, Spine.

[16]  M. Blauth,et al.  TRANSPEDIKULARE SPONGIOSAPLASTIK AM THORAKOLUMBALEN UBERGANG : KLINISCHE, RONTGENOLOGISCHE UND COMPUTERTOMOGRAPHISCHE ERGEBNISSE , 1999 .

[17]  H. Tscherne,et al.  Klinische und computertomographische Spätergebnisse nach transpedikulärer Spongiosaplastik , 1997 .

[18]  L. Gotzen,et al.  [Indications, technique and results of monosegmental dorsal spondylodesis in wedge compression fractures (grade II) of the thoracolumbar spine]. , 1992, Der Unfallchirurg.

[19]  J N Weinstein,et al.  Thoracolumbar burst frac-tures: the clinical efficacy and outcome of nonoperative management , 1993 .

[20]  R. K. Snider,et al.  Thoracolumbar Spinal Injuries: A Comparative Study of Recumbent and Operative Treatment in 100 Patients , 1980, Spine.

[21]  E. Ohnhaus,et al.  Methodological problems in the measurement of pain: A comparison between the verbal rating scale and the visual analogue scale , 1975, PAIN.

[22]  A R Feinstein,et al.  Benefits and obstacles for development of health status assessment measures in clinical settings. , 1992, Medical care.

[23]  J. Morris,et al.  An analysis of conservative (non-surgical) management of thoracolumbar fractures and fracture-dislocations with neural damage. , 1980, The Journal of bone and joint surgery. American volume.

[24]  P. Hax,et al.  Operative Behandlung von Verletzungen des thorakolumbalen Übergangs , 1999, Der Unfallchirurg.

[25]  G. Waddell,et al.  Chronic Low‐Back Pain, Psychologic Distress, and Illness Behavior , 1984, Spine.

[26]  E. Beck.  Konservative Behandlung von Frakturen und Luxationen von Thorax- und Lendenwirbelsäule , 1980 .

[27]  J. Weinstein,et al.  Thoracolumbar “Burst” Fractures Treated Conservatively: A Long-Term Follow-up , 1988, Spine.

[28]  N. Haas,et al.  [Results of different surgical procedures in the treatment of fresh injuries of the thoracic and lumbar spine]. , 1987, Der Unfallchirurg.

[29]  C. Chapman,et al.  Toward validation of pain measurement tools for children: a pilot study , 1993, Pain.

[30]  N. Lebwohl,et al.  Nonoperative management of stable thoracolumbar burst fractures with early ambulation and bracing. , 1993, Spine.

[31]  D. Reid,et al.  The nonoperative treatment of burst fractures of the thoracolumbar junction. , 1988, The Journal of trauma.

[32]  J. Atkinson,et al.  Measurement of pain: Patient preference does not confound pain measurement , 1981, Pain.

[33]  E. C. Huskisson,et al.  Graphic representation of pain , 1976, Pain.

[34]  P. Mcgrath,et al.  An assessment of children's pain: a review of behavioral, physiological and direct scaling techniques , 1987, Pain.

[35]  K. Searls,et al.  Acute thoracolumbar burst fractures in the absence of neurologic deficit. A comparison between operative and nonoperative treatment. , 1984, Clinical orthopaedics and related research.

[36]  K. Okuyama,et al.  Outcome of Anterior Decompression and Stabilization for Thoracolumbar Unstable Burst Fractures in the Absence of Neurologic Deficits , 1996, Spine.

[37]  J. Fleiss.  The design and analysis of clinical experiments , 1987 .

[38]  E. Huskisson.  Measurement of pain. , 1974, Lancet.

[39]  D. Benson.  Unstable Thoracolumbar Fractures, with Emphasis on the Burst Fracture , 1988, Clinical orthopaedics and related research.

[40]  A. Feinstein,et al.  Improving the reliability of orthopaedic measurements. , 1992, The Journal of bone and joint surgery. British volume.

[41]  H. Beecher,et al.  The measurement of pain; prototype for the quantitative study of subjective responses. , 1957, Pharmacological reviews.

[42]  S. Tromanhauser,et al.  Pedicle Screw Instrumentation for Thoracolumbar Burst Fractures and Fracture‐Dislocations , 1992, Spine.