A New Sacroiliac Joint Questionnaire

Educational Objectives

The goal of this program is to improve the treatment of patients with pain in the sacroiliac (SI) joint. After hearing and assimilating this program, the clinician will be better able to:

1. Implement screening questionnaires for identification of SI joint pain.

Summary

Background: motivation for development of questionnaire derived from desire to determine elements of patients’ histories specific for functional limitation related to sacroiliac (SI) joint; Oswestry Disability Index (ODI) designed for lumbar spinal pain or back pain (as opposed to SI joint); goal to differentiate dysfunction related to spine vs SI joint; speaker’s group sought to design questionnaire modeled after ODI, with questions formulated specifically for SI joint; group of physicians and therapists assembled to develop questionnaire

SI joint questionnaire vs ODI: calculation and number of questions similar; some domains similar, but questions formulated more specifically for SI joint

Validation: group sought to statistically and functionally validate questionnaire; approval obtained from institutional review board; methodology involved administration of SI joint questionnaire and other questionnaires, readministration of questionnaires in ≤14 days (to test reliability), and functional testing initially and at 6 mo; physical therapists assessed patient performance on flexion, extension, single-leg stands, active straight-leg raise, timed up-and-go, progressive lifting, 5-minute walk, push/pull, sustained flexion, and sustained extension tasks

Inclusion criteria: study included wide range of patients diagnosed with pain in SI joint; criteria for inclusion included physical findings, physical examination, and positive response to injection; criteria for exclusion included confounding factors (eg, back pain, recent treatment to relieve pain in SI joint), chronic comorbid conditions (eg, bad hips or knees), and pregnancy

Tools for assessment: included Denver SI Joint Questionnaire (DSIJQ), Visual Analog Scale, ODI, Short Form 36 survey, and self-reported overall satisfaction; some patients underwent surgery; functional testing performed during evaluation

Correlation with functional testing: no clear correlation found between DSIJQ and composite of all functional tests; strongest correlations found with timed up-and-go test and 5-minute walk test

Reliability and estimation of error: results similar with DSIJQ and ODI (both of which showed good reliability); estimates of error relatively low; DSIJQ considerably more responsive, compared with ODI, in terms of changes in SI joint-related pain and disability, suggesting questionnaire more responsive than ODI to changes in pathology of SI joint

Audience questions: can questionnaire identify pain in SI joint in setting of multifactorial pain (eg, SI joint, myofascial, facet, hip) — speaker hopes so; questions in questionnaire focus on pain in SI joint; somewhat dependent on ability of patient to differentiate pain in spine from pain related to other sources and thorough clinical assessment of patient; patients often have difficulty localizing pain, do patients self-report or is coaching to define location of pain involved — all questionnaires have similar issues; diagnostic injection resulting in relief of pain can help patients identify component of pain related to SI joint

Readings

Copay AG et al: Is the Oswestry Disability Index a valid measure of response to sacroiliac joint treatment? Qual Life Res 2016 Feb;25(2):283-92.

Disclosures

For this program, members of the faculty and planning committee reported nothing to disclose.

Acknowledgements

Dr. Patel was recorded at the 3rd International Conference on Sacroiliac Joint Surgery, held February 21-24, 2018, in Tampa, FL, and presented by the University of South Florida Department of Continuing Education. For information about upcoming CME opportunities from the University of South Florida, please visit www.usf.edu/continuing-education/. The Audio Digest Foundation thanks the speakers and the University of South Florida for their cooperation in the production of this program.

CME/CE INFO

Accreditation:

The Audio- Digest Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Audio- Digest Foundation designates this enduring material for a maximum of 0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Audio Digest Foundation is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's (ANCC's) Commission on Accreditation. Audio Digest Foundation designates this activity for 0 CE contact hours.

Lecture ID:

OR411303

Expiration:

This CME course qualifies for AMA PRA Category 1 Credits™ for 3 years from the date of publication.

Instructions:

To earn CME/CE credit for this course, you must complete all the following components in the order recommended: (1) Review introductory course content, including Educational Objectives and Faculty/Planner Disclosures; (2) Listen to the audio program and review accompanying learning materials; (3) Complete posttest (only after completing Step 2) and earn a passing score of at least 80%. Taking the course Pretest and completing the Evaluation Survey are strongly recommended (but not mandatory) components of completing this CME/CE course.

Estimated time to complete this CME/CE course:

Approximately 2x the length of the recorded lecture to account for time spent studying accompanying learning materials and completing tests.