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Ростовский Государственный Медицинский Университет

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Appendix M: Bone Age—Ossication ofHand, Olecranon, andIliac Apophysis

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Content: The ossication of the iliac apophysis is divided into ve stages (1–5): Risser 0: no ossication of the iliac apophysis; greatest remaining growth (greater

risk of progression for scoliosis).

Risser 1: less than 25% of the iliac apophysis is ossied; menarche occurs in girls;

it is the end of the pubertal growth spurt (ascending side). Risser 2: between 25% and 50% of the iliac apophysis is ossied. Risser 3: between 50% and 75% of the iliac apophysis is ossied. Risser 4: more than 75% of the iliac apophysis is ossied. Risser 5: the apophysis has fused with the iliac crest (skeletal maturation is com-

pleted) and the risk of progression for curve <40° is minimal. Clinical relevance: The Risser sign is a marker of skeletal maturation, and it helps to estimate the risk of progression of several orthopedic disorders, including idiopathic scoliosis.

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Further Readings

1. Sanders J, Khoury JC, Kishan S, et al. Predicting scoliosis progression from

skeletal maturity: a simplied classication during adolescence. J Bone Joint Surg Am. 2008;90(3):540–53.

2. Canavese F, Charles YP, Dimeglio A, etal. A comparison of the simplied olec-

ranon and digital methods of assessment of skeletal maturity during the pubertal growth spurt. Bone Joint J. 2014;96(11):1556–60.

3. Risser JC.The Iliac apophysis: an invaluable sign in the management of scolio-

sis. Clin Orthop. 1958;11:111–19.

Appendix N: Oswestry Disability

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Questionnaire (ODI)

Abstract The Oswestry Disability Index (ODI) is among the most widely used

patient-reported outcome measures for the assessment of spinal conditions. Traditionally, the ODI has been administered in outpatient clinics on a face-to-face basis, which can be expensive and time consuming.

Keywords Oswestry Disability Questionnaire (ODI); assessment of disability;

outcome measurement

Definition

Oswestry Disability Index (ODI), also known as the Oswestry Low Back Pain Disability Questionnaire, is a patient questionnaire which assesses the amount of

restriction imposed by pain on ten domains: pain intensity, personal care, lifting, walking, sitting, standing, sleeping, sex life, social life, and traveling. Each question offers six answers, which allows the assessment of subtle differences of disability [1, 3].

Content: ODI was developed by Fairbank etal. [2]. It is one of the most commonly used questionnaires in the eld of low back pain. It is available in several languages and has proven good internal consistency and test-retest reliability. The test is considered the “gold standard” of low back functional outcome tools.

Clinical Application: Assessment of the degree of disability caused by low back pain and leg pain.

Scoring Instructions

For each section there are six possible answers—between 0 and 5. The patient is asked to identify which of the six statements in each domain applies to them at the time of evaluation. The sentences are arranged from no impairment (0) to maximum impairment (5).

https://doi.org/10.1007/978-3-030-80356-8

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Appendix N: Oswestry Disability Questionnaire (ODI)

If all ten sections are completed the score is calculated as follows: Example: 18 (total scored) of 50 (total possible score)×100=36% (18:50×100=36) The alternative option is to calculate the total score and multiply by two Example 2: 12 (total scored)×2=24 If one section is missed or not applicable the score is calculated: 16 (total scored) 45 (total possible score)×100=35.5%

Minimum detectable change (90% condence): 10% points (change of less than this may be attributable to error in the measurement)

Interpretation ofScores

0–20% Minimal

disability

21–40% Moderate

disability

41–60% Severe

disability

61–80% Crippled Back pain affects all aspects of the lives of these patients in their

81–100% Bed-bound or

exaggerating symptoms

The patient can cope with most living activities. Usually no treatment is indicated apart from advice on lifting, sitting, and exercise.

The patient experiences more pain and difculty with sitting, lifting, and standing. Travel and social life are more difcult and this has an impact on their travel and social life, which can result in being signed off work. Personal care, sexual activity, and sleeping are not grossly affected. The patient can usually be managed by conservative means.

Pain is reported as the main problem for this particular group of patients. However, travel, personal care, social life, sexual activity, and sleep are also affected. These patients require detailed investigation to rule out possible red ags.

home and working environment. They require active intervention. Patients require careful observation during their physical

examination to discriminate between patients who are experiencing severe pain or exaggerating their symptoms.

1.1.1 Oswestry Low Back Pain Disability Questionnaire

Instructions

This questionnaire has been designed to give us information as to how your

back or leg pain is affecting your ability to manage in everyday life. Please

answer by checking ONE box in each section for the statement which best

applies to you. We realize that you may consider that two or more statements

in any one section apply but please just shade out the spot that indicates the

statement which most clearly describes your problem.

Section 1: Pain intensity

▫ I have no pain at the moment.

▫ The pain is very mild at the moment

Appendix N: Oswestry Disability Questionnaire (ODI)

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▫ The pain is moderate at the moment

▫ The pain is fairly severe at the moment

▫ The pain is very severe at the moment

▫ The pain is the worst imaginable at the moment

Section 2: Personal care (washing, dressing, etc.)

▫ I can look after myself normally without causing extra pain

▫ I can look after myself normally but it causes extra pain

▫ It is painful to look after myself and I am slow and careful

▫ I need some help but manage most of my personal care

▫ I need help every day in most aspects of self-care

▫ I do not get dressed, I wash with difculty and stay in bed

Section 3: Lifting

▫ I can lift heavy weights without extra pain

▫ I can lift heavy weights but it gives extra pain

▫ Pain prevents me from lifting heavy weights off the oor, but I can manage

if they are conveniently placed, e.g., on a table

▫ Pain prevents me from lifting heavy weights, but I can manage light to

medium weights if they are conveniently positioned

▫ I can lift very light weights

▫ I cannot lift or carry anything at all

Section 4: Walking

▫ Pain does not prevent me from walking any distance

▫ Pain prevents me from walking more than one mile

▫ Pain prevents me from walking more than 1/2 mile

▫ Pain prevents me from walking more than 1/4 mile

▫ I can only walk using a stick or crutches

▫ I am in bed most of the time and have to crawl to the toilet

Section 5: Sitting

▫ I can sit in any chair as long as I like

▫ I can only sit in my favorite chair as long as I like

▫ Pain prevents me from sitting more than one hour

▫ Pain prevents me from sitting more than 30minutes

▫ Pain prevents me from sitting more than 10minutes

▫ Pain prevents me from sitting at all

Section 6: Standing

▫ I can stand as long as I want without extra pain

▫ I can stand as long as I want but it gives me extra pain

▫ Pain prevents me from standing for more than one hour

▫ Pain prevents me from standing for more than 30minutes

▫ Pain prevents me from standing for more than 10minutes

▫ Pain prevents me from standing at all

Section 7: Sleeping

▫ Pain does not prevent me from sleeping well

▫ I can sleep well only by using medication

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▫ Even when I take medication, I have less than 6hours’ sleep

▫ Even when I take medication, I have less than 4hours’ sleep

▫ Even when I take medication, I have less than 2hours’ sleep

▫ Pain prevents me from sleeping at all

Section 8: Social life

▫ My social life is normal and gives me no extra pain

▫ My social life is normal but increases the degree of pain

▫ Pain has no signicant effect on my social life apart from limiting my more

energetic interests, e.g., dancing

▫ Pain has restricted my social life and I do not go out as often

▫ Pain has restricted my social life to my home

▫ I have no social life because of pain

Section 9: Travelling

▫ I can travel anywhere without extra pain

▫ I can travel anywhere but it gives me extra pain

▫ Pain is bad, but I manage journeys over 2hours

▫ Pain restricts me to journeys of less than 1hour

▫ Pain restricts me to short necessary journeys under 30minutes

▫ Pain prevents me from traveling except to the doctor or hospital

Section 10: Employment/homemaking

▫ My normal homemaking/job activities do not cause pain

▫ My normal homemaking/job activities increase my pain, but I can still per-

form all that is required of me

▫ I can perform most of my homemaking/job duties, but pain prevents me

from performing more physically stressful activities (e.g., lifting, vacuuming)

▫ Pain prevents me from doing anything but light duties

▫ Pain prevents me from doing even light duties

▫ Pain prevents me from performing any job or homemaking chores

Appendix N: Oswestry Disability Questionnaire (ODI)