Paper of the month July 2023

Initial Validation of a Sacroiliac Joint-Specific Disability Questionnaire
^{V.V. Patel, E. E. Sawyer, P. E. Mintken, L. A. Michener, C. L. Cofer and E. M. Lindley}
Orthopedics 2023 Pages 1-7

One of our SIMEG members, Dr. Patel, has done an excellent study. Until now, there has been no specific questionnaire for sacroiliac joint disorders (SIJD), so we have been forced to use the ODI and RDQ, which are used to assess low back pain in general, for SIJD. However, neither the medical professionals who asked the questions nor the patients who answered them felt comfortable with the assessment.

Therefore, based on their extensive clinical experience, they modified the questions of the ODI and developed the Denver SI Joint Questionnaire (DSIJQ). Among the most novel items are those related to getting up from a chair, getting up and down stairs, getting in and out of a car, and SI joint stability.

At the 2018 ICSJS in Tampa, Dr. Patel generously shared his DSIJQ slides with us. I have since translated them into Japanese and am using them in my clinical practice. My colleague PT Sasaki conducted a clinical study and wrote a paper in Japanese, the results of which he comments on below.

In this study, patients first completed a questionnaire and then again two weeks later. During this time, there was only evaluation and no treatment? participants returned after 6 months and completed the DSIJQ again. What exactly was the treatment like during this 6-month period?

Question 10 asks about SIJ stability and it is interesting to note that 20.8% did not feel unstable at all and 12.5% always felt unstable. It is possible that joint instability is not always the pathology.

The number of cases evaluated was 24, which is not sufficient. There was no separation between conservative and surgical treatment groups. As a multicenter study of our SIMEG members, we suggest that the usefulness of the DSIJQ be evaluated on the basis of a large number of surgical cases. If there is a conservative therapy that improves the DSIJQ to nearly the same level as the surgical group, that would be wonderful, and we hope that the DSIJQ will also allow us to evaluate the value of conservative therapy performed by individual physical therapists.

It would also be interesting to see, as noted by Patel et al, what changes in DSIJQ scores would occur in the preoperative and postoperative evaluation of lumbar spine disease in which there are no SIJ problems.

Again, respect to Dr. Patel for trying this.

Daisuke Kurosawa

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The comments from Takeshi Sasaki, PT.

Our hospital used to use the Roland-Morris Disability Questionnaire (RDQ) until you showed us the DSIJQ. Although the RDQ has also been used for functional assessment of patients with sacroiliac joint disorder (SIJD), it is occasionally inappropriate for use in SIJD because several items are not indicated for SIJD symptoms. The DSIJQ that you shared with me has been helpful in my clinical practice because it is a specific assessment for SIJD.

As a clinical study, we investigated the minimal clinically important difference (MCID) of the DSIJQ in the conservative [17 cases: nine men, eight women; mean age 55.1±15.9 years] and surgical [29 cases: 14 men, 15 women; mean age 43.7±12.2 years] groups of SIJD based on the RDQ criteria. The diagnosis of SIJD was confirmed in cases with a SIJ score of 4 or higher and greater than 70% pain relief with SIJ injection. The cutoff values were an 11-point decrease (22% improvement) in the conservative group and a 12-point decrease (24% improvement) in the surgical group.

I have two questions.

First, when you give the DSIJQ to patients, do you explain the location of the SIJ pain? In our hospital, when the physical therapists give the DSIJQ to the patients, the physical therapist shows the patients the affected posterior superior iliac spine and explains that the patients should write about the pain in that area on the questionnaire. The reason is that if we do not explain this to our patients, they may answer about referred pain from the SIJ.

Secondly, I have a question about the physical function test. In your country, the gait test uses the 5-minute walk test, is that the main one? In Japan, the gait test has long been dominated by the 6-minute walk test.

Thank you for sharing your useful evaluation questionnaire with us.