ID

31518

Description

LOW BACK PAIN DATA COLLECTION Version 2.0.3 Revised August 24th, 2017 www.ichom.org Conditions: Lumbar Disc Herniation | Lumbar Stenosis | Lumbar Spondylolisthesis | Degenerative Scoliosis | Adult Idiopathic Scoliosis | Degenerative Disc Disorder | Other Degenerative Lumbar Disorders | Mechanical, Acute, and Chronic Lumbar Back Pain and Back-Related Leg Pain Conditions Not Covered: Individuals < 18 Years of Age | Spinal Infection | Spinal Tumor | Spinal Fractures | Traumatic Dislocation | Congenital Scoliosis Documented as >20 Degrees, Moderate, Large, or Severe Treatment Approaches: Conservative Therapy (e.g. physical therapy, chiropractic, drug therapy, injections, etc.) | Surgical Therapy (e.g. spinal fusion, decompression, or discectomy) This ODM-file contains a clinical follow-up form to document disease recurrence, to be reported when occurs. Use of the following Scores: ODI - Oswestry Disability Index Version 2.1a: The ODI is free for all health care organizations, but a license is needed for use (therefore not included in this version of the standard set). Please visit eprovide: https://eprovide.mapi-trust.org/ NPRS - Numerical Pain Rating Scale: The NPRS is free for all health care organizations, and a license is not needed. EQ-5D-3L - EuroQol‐5D descriptive system (EQ-­5D‐3L) and visual analogue scale (EQ-­VAS): The EQ-5D-3L is free for non-profits and academic research, but a license is needed for use (therefore not included in this version of the standard set). https://euroqol.org/support/how-to-obtain-eq-5d/ Publication: R Carter Clement, Adina Welander, Caleb Stowell, Thomas D Cha, John L Chen, Michelle Davies, Jeremy C Fairbank, Kevin T Foley, Martin Gehrchen, Olle Hagg, Wilco C Jacobs, Richard Kahler, Safdar N Khan, Isador H Lieberman, Beth Morisson, Donna D Ohnmeiss, Wilco C Peul, Neal H Shonnard, Matthew W Smuck, Tore K Solberg, Bjorn H Stromqvist, Miranda L Van Hooff, Ajay D Wasan, Paul C Willems, William Yeo & Peter FRitzell (2015) A proposed set of metrics for standardized outcome reporting in the management of low back pain, Acta Orthopaedica, 86:5, 523-533 ICHOM received an endorsement of Arthritis Research UK for the development of this standard set.

Link

www.ichom.org

Keywords

Versions (3)
  1. 8/23/18 8/23/18 - Sarah Riepenhausen
  2. 8/31/18 8/31/18 - Sarah Riepenhausen
  3. 4/30/20 4/30/20 - Sarah Riepenhausen
Copyright Holder

ICHOM

Uploaded on

August 31, 2018

DOI

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License

Creative Commons BY-NC 3.0
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ICHOM Low Back Pain

English

Clinical Follow-up Form (Disease recurrence)

1 forms  
Patient ID
Description

Patient ID

Alias
UMLS CUI-1
C1269815
Indicate the patient's medical record number.
Description

This number will not be shared with ICHOM. In the case patient-level data is submitted to ICHOM for benchmarking or research purposes, a separate ICHOM Patient Identifier will be created and cross-linking between the ICHOM Patient Identifier and the medical record number will only be known at the treating institution. INCLUSION CRITERIA: All patients TIMING: On all forms REPORTING SOURCE: Administrative or clinical RESPONSE OPTIONS: According to institution

Data type

integer

Alias
UMLS CUI [1]
C1269815
Acute Complications of Treatment
Description

Acute Complications of Treatment

Alias
UMLS CUI-1
C0087111
UMLS CUI-2
C0009566
Indicate if the current surgery is a reoperation at the same level because the prior surgery at the same level did not reach its technical or clinical goals
Description

INCLUSION CRITERIA: Surgically treated patients TIMING: when occurs REPORTING SOURCE: Clinical TYPE: Single Answer

Data type

integer

Alias
UMLS CUI [1,1]
C0558347
UMLS CUI [1,2]
C0741419
UMLS CUI [1,3]
C0037949
UMLS CUI [1,4]
C2946261
UMLS CUI [1,5]
C0445247
Indicate the type of reoperation
Description

Hardware removal: removal of implants (For example, screws, rods) Non-union: failure of bony consolidation of bridge/union at minimum 12 months after surgery Neuro-compression: compression of neural structures with or without neurological deficits (select recurrent disc herniation or other neuro- compression) Post-op infection: superficial or deep (subfascial) wound/tissue infection after surgery Implant malposition: incorrect position of the implant Implant failure: problem due to an implant (For example, loosening, breakage) Wrong level: procedure mistakenly performed at wrong vertebral level Sagittal imbalance: sagittal malalignment of the spine (select lumbar flatback deformity or junctional kyphosis) Cerebrospinal fluid leakage: includes CSF fistula, seudomeningocele, etc. Epidural hematoma: collection of blood adjacent to dura, potentially creating compression INCLUSION CRITERIA: Surgically treated patients, If answered 'yes' to having a reoperation (REOP) TIMING: when occurs REPORTING SOURCE: clinical TYPE: Single Answer

Data type

integer

Alias
UMLS CUI [1,1]
C0558347
UMLS CUI [1,2]
C0741419
UMLS CUI [1,3]
C0332307
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Similar models

Clinical Follow-up Form (Disease recurrence)

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Patient ID
C1269815 (UMLS CUI-1)
Patient ID
Item
Indicate the patient's medical record number.
integer
C1269815 (UMLS CUI [1])
Item Group
Acute Complications of Treatment
C0087111 (UMLS CUI-1)
C0009566 (UMLS CUI-2)
Item
Indicate if the current surgery is a reoperation at the same level because the prior surgery at the same level did not reach its technical or clinical goals
integer
C0558347 (UMLS CUI [1,1])
C0741419 (UMLS CUI [1,2])
C0037949 (UMLS CUI [1,3])
C2946261 (UMLS CUI [1,4])
C0445247 (UMLS CUI [1,5])
Current procedure a reoperation at same level?
Code List
Indicate if the current surgery is a reoperation at the same level because the prior surgery at the same level did not reach its technical or clinical goals
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
Item
Indicate the type of reoperation
integer
C0558347 (UMLS CUI [1,1])
C0741419 (UMLS CUI [1,2])
C0332307 (UMLS CUI [1,3])
Type of reoperation (if applicable)
Code List
Indicate the type of reoperation
CL Item
Hardware removal (1)
C1096445 (UMLS CUI-1)
(Comment:en)
CL Item
Non-union (2)
C0037935 (UMLS CUI-1)
C1272705 (UMLS CUI-2)
(Comment:en)
CL Item
Neuro-compression (3)
C0576717 (UMLS CUI-1)
(Comment:en)
CL Item
Post-op infection (4)
C0038941 (UMLS CUI-1)
(Comment:en)
CL Item
Implant malposition (5)
C0333042 (UMLS CUI-1)
C0021102 (UMLS CUI-2)
(Comment:en)
CL Item
Implant failure (6)
C0854676 (UMLS CUI-1)
(Comment:en)
CL Item
Wrong level (7)
C2224801 (UMLS CUI-1)
C3845811 (UMLS CUI-2)
(Comment:en)
CL Item
Sagittal imbalance (8)
C1397014 (UMLS CUI-1)
C0205129 (UMLS CUI-2)
(Comment:en)
CL Item
Cerebrospinal fluid leakage (9)
C0023182 (UMLS CUI-1)
(Comment:en)
CL Item
Epidural hematoma (10)
C0877172 (UMLS CUI-1)
(Comment:en)
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