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A correlative study of the spine impairment rating, the pain disability status, and the physical performance status of individuals with poly-trauma history over two years and with a spine impairment

      The study measured the pain disability status (PS) of poly-trauma subjects with chronic non-malignant pain (CNMP) and spine impairment and investigated the correlation between PS, whole person impairment rating due to the spine (WPIS) and scores from Physical Performance Tests (PPT). A retrospective study was undertaken in an outpatient rehabilitation clinic. 30 subjects (13 men) with CNMP due to spine impairment from poly-trauma >two years completed the PDQ. Outcome measures were: the Pain Disability Questionnaire (PDQ) and the Diagnosis-Based Impairment method (DBI), both from the AMA Guides Sixth Edition. The PDQ measured the PS. The DBI quantified the WPIS, established by exact criteria and then adjusted by grade modifiers. The Physical Performance Tests (PPT) were: 6-Minute Walk Test (6MWT), Berg Balance Scale (BBS), & Dynamic Gait Index (DGI). Pearson correlation coefficients (r) examined total PDQ, WPIS, and PPT associations. Owing to the study’s exploratory nature, a conservative alpha of .01 was used for statistical analysis. Total PDQ, resulted in: 17% mild; 30% moderate; 47% severe; and, 6% extreme PS. The DBI showed: 14% WPIS at cervical neck; 7% WPIS at thoracic; and, 15% WPIS at lumbar. Total WPIS from all subjects had a mean of 25% (SD=10.6%). A statistically significant negative correlation was found between PDQ and: 6MWT-distance (r=-.559, p= .002); 6MWT-metabolic equivalents (r=-.562, p=.002); 6MWT-speed (r=-.550, p=.002); DGI (r=-.561, p=.002); and, BBS (r=-.570, p=.002). Though not significant based on our criteria, there was a positive association between PDQ and WPIS (r=.341, p=.070). We found that poly-trauma subjects with spine impairment(s) had: severe PS, high WPIS, walked less distance slowly, low energy expenditure capacity, poor dynamic gait, and high balance deficits. These findings suggest that the PDQ is a potential indicator of physical performance status in individuals with spine impairments. Further research into its application amongst other patient populations, such as in Radiculopathies, would be beneficial.