Abstract | OBJECTIVES: To validate an operational definition of piriformis syndrome based on prolongation of the H-reflex with hip flexion, adduction, and internal rotation (FAIR) and to assess efficacy of conservative therapy and surgery to relieve symptoms and reduce disability. DESIGN: Before-after trial of cohorts identified by operational definition. SETTING: Outpatient departments of 2 hospitals and 4 physicians' offices. Surgery performed at 3 hospitals. PATIENTS: Consecutive sample of 918 patients (1014 legs) with follow-up on 733. INTERVENTION: Patients with significant (3 standard deviations [SDs]) FAIR tests received injection, physical therapy, and serially reported pain and disability assessments. Forty-three patients (6.47%) had surgery. MAIN OUTCOME MEASURES: RESULTS: At 3 SDs, the FAIR test had sensitivity and specificity of.881 and.832, respectively. Seventy-nine percent (514/655) of FAIR test positive (FTP) patients improved 50% or more from injection and physical therapy at a mean follow-up of 10.2 months. Average improvement was 71.1%. Of 385 FTP patients with disability data, mean disability fell from 35.37% prestudy (SD =.2275) to 12.96% poststudy (SD =.1752), a 62.8% improvement. Twenty-eight surgical FTP patients (68.8%) showed 50% or greater improvement; mean improvement was 68% at a mean follow-up of 16 months. Surgery reduced the mean FAIR test to 1.35 +/- 2.17 months postoperatively. FTP patients generally improved 10% to 15% more than others after conservative treatment. CONCLUSIONS:
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Authors | Loren M Fishman, George W Dombi, Christopher Michaelsen, Stephen Ringel, Jacob Rozbruch, Bernard Rosner, Cheryl Weber |
Journal | Archives of physical medicine and rehabilitation
(Arch Phys Med Rehabil)
Vol. 83
Issue 3
Pg. 295-301
(Mar 2002)
ISSN: 0003-9993 [Print] United States |
PMID | 11887107
(Publication Type: Journal Article, Review)
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Copyright | Copyright 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation |
Chemical References |
- Anesthetics, Local
- Lidocaine
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Topics |
- Activities of Daily Living
- Anesthetics, Local
(therapeutic use)
- Electric Stimulation
- Electrodiagnosis
(methods)
- Female
- H-Reflex
(physiology)
- Humans
- Lidocaine
(therapeutic use)
- Male
- Middle Aged
- Neural Conduction
(physiology)
- Physical Therapy Specialty
- Sciatica
(diagnosis, surgery, therapy)
- Sensitivity and Specificity
- Syndrome
- Treatment Outcome
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