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Patient satisfaction is crucial in pay-for-performance initiatives. To achieve further improvement in satisfaction, modifiable factors should be identified according to the surgery type. Using a prospective cohort, we compared the overall treatment satisfaction after microendoscopic lumbar decompression between patients treated postoperatively with a conventional physical therapy (PT) program (control; n = 100) and those treated with a PT program focused on low back pain (LBP) improvement (test; n = 100). Both programs included 40 min outpatient sessions, once per week for 3 months postoperatively. Adequate compliance was achieved in 92 and 84 patients in the control and test cohorts, respectively. There were no significant differences in background factors; however, the patient-reported pain score at 3 months postoperatively was significantly better, and treatment satisfaction was significantly higher in the test than in the control cohort (−0.02 ± 0.02 vs. −0.03 ± 0.03, p = 0.029; 70.2% vs. 55.4%, p = 0.045, respectively). In the multivariate logistic regression analysis, patients treated with the LBP program tended to be more satisfied than those treated with the conventional program, independent of age, sex, and diagnosis (adjusted odds ratio = 2.34, p = 0.012). Postoperative management with the LBP program could reduce pain more effectively and aid spine surgeons in achieving higher overall satisfaction after minimally invasive lumbar decompression, without additional pharmacological therapy.

BackgroundOf the shoulder external rotators, the infraspinatus and teres minor are the key muscles that contribute to the dynamic stability of the shoulder. It is crucial to properly measure the strength values to evaluate muscle function and training load for shoulder external rotators. A suspension scale (SPS) can measure the mass of the suspended object, and it may be possible to apply it to measure strength. However, the utility of strength measurements using an SPS has not been clarified in previous studies. In this study, we aimed to investigate the intra-rater reliability of measuring the strength of shoulder external rotators using an SPS and the relationship between strength measurement using an SPS and a handheld dynamometer (HHD).MethodologyThe participants were 10 healthy males with 20 shoulders (24.5 ± 2.5 years old; height = 172.8 ± 5.4 cm; weight = 69.6 ± 8.1 kg). Upper extremity strength was measured at 90° shoulder abduction, 90° external rotation, 0° horizontal adduction/abduction, 90° elbow flexion, and 0° forearm pronation/supination in the prone position. The isometric strength of shoulder external rotation was measured with the SPS and HHD, and one examiner measured the maximum strength value. The intra-rater reliability of the two methods using SPS and HHD was evaluated using the intraclass correlation coefficient (ICC1,2), standard error of measurement (SEM), minimum detectable change (MDC), and Bland-Altman analysis. The relationship between the SPS and HHD was calculated as the correlation coefficient between the strength values of SPS and HHD.ResultsThe intra-rater reliability of the strength measurement of shoulder external rotators using SPS was ICC1,2 0.98 (95% confidence interval = 0.95-0.99), and SEM and MDC were 0.3 and 0.9, respectively. The measurements using SPS had no fixed and proportional biases. A significant positive correlation was observed between SPS and HHD (r = 0.94, p < 0.01).ConclusionsThe SPS is an alternative to the HHD for measuring the strength of shoulder external rotators. Thus, measuring the strength of shoulder external rotators using an SPS may be applied as a cost-effective and portable assessment method for shoulder function.