Table 3 Individual Study Characteristics
From: Prognostic factors in non-surgically treated sciatica: A systematic review
ID | Author | Population studied | Subjects | Sciatica definition | Treatment | Follow-up (months) | Study Quality | Predictors studied | Outcomes measured |
|---|---|---|---|---|---|---|---|---|---|
1 | Balague et al (1999) [12] | Consecutive hospital admissions with severe acute sciatica | 82 66% male mean age 43 yrs 73 at follow-up | Unilateral leg pain +/- LBP and positive neurological signs and/or radiological evidence of spinal nerve root compression | Conservative "intensive pain management" | 12 | High | Age, gender, duration of symptoms, smoking, previous sciatica, EMG, BMI, QOL, disability, pain, imaging results (MRI, CT), neurological signs, antibody test | "Recovery" (composite score including pain, disability & muscle strength) Recovery defined as: ODI Score ≤ 20 VAS pain ≤ 15 Normal muscle strength test (score 5) |
2 | Beauvais et al (2003) [13] | Consecutive patients attending rheumatology departments with symptoms of sciatica or femoral neuralgia of < 1 month duration and disc herniation on CT | 75 58% male mean age 41 yrs 60 at follow-up | Symptoms & examination consistent with sciatic or femoral neuralgia and CT evidence of intervertebral disk herniation | Conservative Bed rest, analgesics, lumbar brace +/- epidural steroid injection | 3 | Adequate | Age, gender, distribution of pain, duration of pain, previous sciatica, presence of severe pain requiring inpatient treatment, CT findings | "Recovery" Complete = return to usual work/activities, little or no analgesia Partial = residual pain, frequent analgesic use, complete or partial return to work, limited athletic activities Failure = persistent pain, continuous analgesic use, unable to return to work |
3 | Carragee & Kim (1997) [14] | Consecutive patients referred to hospital for MRI scan with symptoms suggestive of sciatica and available for 2 year follow-up | 188 58% male mean age 42.5 yrs 135 at follow-up | Lower extremity radicular pain (greater than back pain) and Positive SLR test or motor weakness and abnormal MRI scan | Usual care Conservative 64% and surgical 36% | 24 | Adequate | Disc morphology on MRI, age, gender, height, weight, duration, affected side, previous spinal surgery, occupation (heaviness of work), SLR, motor weakness, co-morbidity, smoking, alcohol, workers compensation, litigation, mode of treatment. | Composite measure of overall outcome comprising sum of scores on 0-10 scale for self-reported pain, medication use, activity restriction and satisfaction, total divided by 4 to give outcome score > 6 = good ≤6 = poor |
4 | Hasenbring et al (1994) [15] | Consecutive patients admitted to hospital with acute radicular pain and radiologically diagnosed disc prolapse | 111 60% male mean age 41.7 yrs 90 at follow-up | Acute radicular pain and radiologically diagnosed lumbar disc prolapse or protrusion | Usual care Surgical 66% Conservative 34% | 6 | Adequate | Depression (BDI), "daily hassles in fifteen areas of daily living including work, home, relationships and financial" (KISS) "emotional, cognitive & coping reactions to pain" (KSI), health locus of control", duration of symptoms, nature of onset, previous surgery, disc displacement on imaging, paresis, scoliosis, treatment (surgical/conservative), obesity, age, social status, occupation (posture, heaviness of work), duration of inability to work | Pain Intensity Self report 8 point scale |
5 | Jensen et al 2007 [16] | Consecutive patients referred to a specialist outpatient back pain centre with symptoms suggestive of sciatica and enrolled in an RCT of active conservative treatment | 187 55.5% male mean age 45 yrs 154 at follow-up | Radicular symptoms with a dermatomal distribution | Conservative Education, reassurance, analgesia, +/- exercise programme +/- manual physiotherapy If surgery required patients excluded from follow-up analysis | 14 | High | MRI findings (disc contour, height, signal & herniation); nerve root compromise; spinal stenosis (central, lateral, foraminal). Age Gender Treatment | "Recovery" (composite score including pain on 11 point VRS & disability on RMDQ) Recovery defined as: Pain score < 1 & RMDQ ≤ 3 |
6 | Komori et al 2002 [17] | Consecutive patients presenting to hospital with unilateral leg pain and with radiologically confirmed herniated disc | 131 no demographic data presented 90 at follow-up | Unilateral leg pain and MRI evidence of herniated nucleus pulposus | Usual care Conservative - rest, medication, traction. If surgery required patients excluded from follow-up analysis | 12 | Poor | Age, gender, occupation (heaviness of work), previous LBP or sciatica, Duration of symptoms Leg symptoms ( pain, SLR, FST, motor paresis & sensory disturbance) Level & type of herniation/disc degeneration on MRI scan | Outcome defined according to residual self-reported symptoms and disability on 3 point scale (poor, fair, good) |
7 | Miranda et al (2002) [19] | Employees of Finnish forestry industry receiving annual questionnaire about musculoskeletal pain | 3312 74% male mean age 45.3 yrs 2984 at follow-up | Self-reported low back pain with leg pain radiating below the knee | None | 12 | High | Age, gender, weight, height, smoking, driving, mental stress Occupational activities (twisting, bending, kneeling or squatting, working with arms raised, lifting), heaviness of work, 'overload' at work, risk of accident at work, Physical exercise and sporting activity in general & specific sports | Outcome defined as persistence of pain based on self report of sciatic pain Persistence = sciatica pain on >30 days/year in 2 consecutive years (1994 & 1995) on modified NMQ) |
8 | Vroomen et al (2002) [18] | Consecutive patients presenting to GP with 1st episode of sciatica and pain sufficient to justify further therapy. Study performed concurrently with RCT of bed rest | 183 56% male mean age 46 yrs 169 at follow-up | Leg pain in dermatomal distribution and ≥ 2 of the following: • Increased pain on coughing & sneezing • Sensory loss • Muscle weakness • Reflex loss • Positive nerve root irritation signs | Usual care Surgery if indicated (15%) A second analysis excluding patients who had surgical treatment (n = 156) was performed | 3 | Adequate | Age, gender, education, living alone, employment, previous sciatica, previous LBP, family history, co-morbidity, smoking, sporting activity, BMI, Duration of symptoms, revised Oswestry score, Roland disability score, MPQ score Leg pain > back pain Pain-related symptoms and examination findings (SLR, FST, paresis, sensory loss, finger to floor distance) | Poor outcome defined as absence of any improvement at 3 months based on self-reported change in symptoms |