Clinical Neuroscience

[Measuring of functional impairment of lumbal spine]

VALASEK Tamás1, VARGA Péter Pál2, KLEMENCSICS István2, SZÖVÉRFI Zsolt2, BOZSÓDI Árpád, ÉLTES Péter Endre2, LAZÁRY Áron2

MARCH 25, 2015

Clinical Neuroscience - 2015;68(03-04)

[Background and purpose - The purpose of our study was to outline the Hungarian validation process of the Oswestry Disability Index, the Quebec Back Pain Disability Scale, the Roland-Morris Disability Questionnaire and the Core Outcome Measurement Index, as well as to draw up recommendations regarding their future applications. Methods - The Hungarian versions were brought to life after a cultural and linguistic adaptation. Next to the above-mentioned questionnaires, the questionnaire booklet used for validation also contained the WHOQoL-BREF general quality of life questionnaire and a pain measuring Visual Analog Scale. The data of low-back pain patients were registered twice in two weeks. We determined the internal homogeneity (Cronbach alpha), reproducibility, standard error of measurement and the minimal detectable change of the questionnaires. Patients were assigned into different two subgroups (surgical / non-surgical, with / without affection of nerve roots) and differences between the subgroups were examined with the help of the questionnaires. We determined the physical subscale of the WHOQoL-BREF and the correlation between the pain and the studied questionnaires. Results - The value of Cronbach alpha was between 0.85 and 0.95. All four questionnaires showed significant differences (p<0.001) between the subgroups. The correlation studies brought strong and significant results (p<0.001, r>0.5) in every case. The values of reproducibility were between 0.93-0.92. The results of standard measurement error: 4.8 (Oswestry), 5.2 (Quebec), 1.6 (Roland-Morris), 0.59 (Core Index). The minimal detectable change was 13; 14; 4, and 2 points, respectively. Conclusion - The Hungarian versions of all four questionnaires are valid. They can be applied with scientific certainty to measure low back pain patients. From the studied questionnaires, we especially recommend the wide-raging application of the Oswestry Disability Index and the Core Outcome Measurement Index based on their psychometric and application features. ]


  1. Semmelweis Egyetem, Egészségtudományi Kar, Alapozó Egészségtudományi Intézet, Budapest
  2. Országos Gerincgyógyászati Központ, Budapest



Further articles in this publication

Clinical Neuroscience

[Effects of maternal epilepsy and antiepileptic therapy in women during pregnancy]

VANYA Melinda, ÁRVA-NAGY Nóra, SZILI Károly, SZOK Délia, BÁRTFAI György

[Objective - The aim of this study was to analyse the effects of epilepsy and antiepileptic drug (AED) treatment on pregnancy and the perinatal outcome, retrospectively. Methods - We examined the obstetric and fetal outcomes among women with epilepsy (WWE), who were followed-up at the Department of Neurology, and who delivered at the Department of Obstetrics and Gynaecology (n=91) between 31th December 2000 and 31th March 2014. Statistical comparisons of different obstetric and fetal parameters on a sample of 91 WWE and 182 non-WWE were assessed by the chi-square-test, the independent sample t-test. Results - The rate of major congenital malformations (MCMS) among the newborns of all AEDs exposed mothers was 7.69%. There were three peaks of seizures: during the third trimester, during delivery and in the puerperium. The prevalence of miscarriages, post-term birth and the rate of caesarean section were significantly higher among the WWE than among the non-WWE (p=0.001; p<0.001; p=0.02). Parameters of neonates (birth weight, birth length, head-, and chest circumference) were significantly different between the WWE group and the non-WWE group (p=0.003, p<0.001, p<0.001, p<0.001) Conclusions - In contrast with recent publications, there were significant differences in the parameters of neonates between the two groups. Our results are in accordance with those of previous studies from the aspect of AED-related MCM, the elevated risk of miscarriages and pre-existing hypertension. ]

Clinical Neuroscience

[Shifting function of working memory in psychotic disorders]


[Background and aims - Mental disorders with psychotic features are overlapping in many ways and there are a growing number of comparative studies in the last decades regarding this. Cognitive deficit is well underpinned in schizophrenia, but fewer studies are conducted in this area including patients with bipolar affective disorder. Therefore the aim of the present study was to investigate the cognitive performance of these two patient groups and healthy controls. The Wisconsin Card Sorting Task is a very sensitive measure of the shifting function. Schizophrenic patients perform consistently poorer on this task than healthy controls, while there are not much data about individuals with bipolar affective disorder. Methods - The Wisconsin Card Sorting Task and clinical symptom rating scales were administered to 26 patients with schizophrenia, 24 with bipolar affective disorder and 21 healthy controls. Results - Significant differences were found among the performance of the three groups using four different dimensions of the Wisconsin Card Sorting Task. The schizophrenic group made more perseverative errors and achieved less conceptual level responses and completed fewer categories compared to healthy controls. Patients with schizophrenia were able to complete fewer categories and had fewer conceptual level responses than the bipolar group. No significant differences were observed between patients with bipolar disorder and healthy controls. Conclusions - According to these results, patients with schizophrenia and bipolar affective disorder showed no similarities on the Wisconsin Card Sorting Task. Bipolar patients performed the task on the same level as healthy individuals did. The two mental disorders influence cognitive performance differently.]

Clinical Neuroscience

[Help! Accumulation of manuscripts!]

TAJTI János, RAJNA Péter

Clinical Neuroscience

[Statement of Hungarian Epilepsy League]


Clinical Neuroscience

[Proconvulsive effect of antiepileptic drugs]


[Antiepileptic drugs can provoke and worsen seizures, what is called paradoxical effect. Paradoxical seizure worsening can occur as a nonspecific manifestation of drug intoxication in number of antiepileptic drugs. The other type is a specific type, when antiepileptic drugs with pure GABAergic and sodium channel blocker mechanism of action provoke myoclonic, absence and atonic seizures in specific epilepsy syndromes, mainly in idiopathic generalized epilepsies. Antiepileptic drug-induced exacerbation of seizures is a common, often unrecognized clinical problem, which can be avoided by a careful syndromic diagnosis and by using broad spectrum antiepileptic drugs.]

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[Measuring quality of life (QoL) has a growing importance in the field of health technology assessment. It is especially true for chronic diseases, such as psoriatic arthritis, which has significant impact on patients’ quality of life through the intensity of symptoms and the duration of the disease. The quality of life measurement can only be reliable and valid if an appropriate instrument is used. One of the most critical elements of the validity of quality of life intruments is the method used for adapting the questionnaire to foreign languages. Authors present their results and experience in the Hungarian adaptation of the Psoriatic Arthritis Quality of Life (PSAQoL) questionnaire.]

Clinical Neuroscience

Independent validation of the Quality of Life in Essential Tremor Questionnaire (QUEST)

KOVÁCS Márton, MAKKOS Attila, JANSZKY József, KOVÁCS Norbert

Quality of Life in Essential Tremor Questionnaire (QUEST) was specially developed for essential tremor population to measure the health-related quality of life. Besides the development of the Hungarian version, we performed an independent testing of the scale adding further information on its clinimetric properties. In this study 133 ET patients treated at University of Pécs, Hungary, were enrolled. Besides QUEST, we assessed Patient’s Global Impression-Severity (PGI-S) and Fahn-Tolosa-Marin Tremor Rating Scales. After the independent validation in accordance to the Classic Theory of Tests, we evaluated cut-off values for detecting clinically meaningful ET-related disabilities based on receiver operating characteristics analysis. Cronbach’s a was 0.897. QUEST demonstrated high convergent validity with PGI and divergent validity with disease-duration, positive family history, need for deep brain stimulation surgery, and the presence of depression and anxiety. Presence of moderate ET-related disabilities was identified by scores > 11.25 points on QUEST-SI (sensitivity: 77.4%, specificity: 83.3%); whereas scores > 20.35 points indicated severe ET-related disabilities (sensitivity: 83.3%, specificity: 59.1%). We demonstrated that the fundamental clinimetric properties of the QUEST are satisfactory.

LAM Extra for General Practicioners



[The new NICE guidelines on lower back pain emphasise the importance of clinical assessment. Radiological imaging methods are used primarily to exclude severe diseases, such as tumour, infection, trauma or inflammation. It’s crucial to inform patients and encourage them to use self-management and stay active. Pain management is guided by the analgesic ladder. A complex physical and psychological treatment is used, which involves a structured exercise programme, manual therapy and acupuncture, taking into account the preferences of the patient. Depending on the aetiology, surgical intervention should be considered in therapy-resistant cases. Finally, the authors compare the above guidelines with the Hungarian practice in this field.]

Lege Artis Medicinae


TÓTH Edit Ágnes

[It is estimated that 80% of the adult population consult their general practitioner for lower back pain at some point in their life. Apart from family doctors all medical specialists may encounter this complaint, which makes the wide-spread knowledge of this topic desirable. Pain associated with spinal diseases has two distinct types, non-inflammatory and inflammatory pain. Non-inflammatory diseases may cause moderate pain that increases with movement or functional limitation lasting for a few days, other times cause a pain pattern of varying intensity that radiates to the lower extremities and is accompanied by neurological symptoms, more rarely, present as cauda equina syndrome. In most cases, the underlying cause of the symptoms is a degenerative disorder of the spine. Spinal pain of inflammatory origin, on the other hand, is characterized by pain that worsens at night, characteristically narrowed mobility, changes in the skin, mucous membranes and joints, and sometimes fever or bad general condition. This type of pain is primarily caused by seronegative spondyloarthritis or, rarely, various pyogenic or non-pyogenic bacterial infections. Management of lower back pain aims to cease pain and restore function. These are achieved by unloading, medical pain relief, antiinflammatory drugs, muscle relaxants and antidepressants, as well as physiotherapy. In special cases the administration of other drugs (e.g., antibiotics) may be necessary along with pain relief. In seronegative spondyloarthritis traditional approaches will hopefully be supplemented by biological therapy in the future. This review of recently published results on spinal diseases accompanied by lower back pain will possibly help doctors in state-of-the art care of their patients.]

Clinical Oncology

[Biomarkers - today and tomorrow]


[Biomarkers (tumor markers in oncology) are able to make exact, objective and reproducible distinction between two groups. Biomarkers can serve different purposes, as to estimate the patient’s survival without treatment (prognostic marker), to select those patients who would respond optimally to treatment (predictive marker), to follow the patient in order to detect of a relapse (monitoring marker), helping identifi cation the tumor-type (diagnostic marker). The main task for a biomarker is to find the best treatment with less toxicity. The main enemy of biomarkers is the heterogeneity of the tumor, the continuous change in its geno- and phenotype, which can explain the low sensitivity and specifi city. More attention should be given to standardization and validity. It is highly possible, that biomarker-panel as well as marker-based clinical trials will be used in the near future.]