Michele C Battié

University of Alberta, Edmonton, Alberta, Canada

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Publications (169)464.4 Total impact

  • Yue Wang · Tapio Videman · Steven K. Boyd · Michele C. Battié
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    ABSTRACT: The ideal target of bone mineral density (BMD) measurements of the spine is the trabecula-rich vertebral body. Yet, spine BMD measurements routinely obtained with dual energy X-ray absorptiometry (DXA) also include the posterior elements of the vertebra, which are mainly cortical bone and insensitive to bone loss. We compared the bone mass of the vertebral body and posterior elements to determine the contributions of vertebral components to vertebral BMD measurements. A micro-CT study of lumbar vertebral bone. From a spine archive, 144 cadaveric lumbar vertebrae (L1-L5) from 48 male human spines (mean age 50 years) were scanned in air using micro-CT (μCT) to measure bone volume, bone mineral content (BMC) and BMD of the vertebral body, posterior elements, and entire vertebra. The contributions of the vertebral components to the total vertebral BMC and volume were compared, and the correlations between the BMC and BMD of the vertebrae and their components were examined. Overall, the vertebral body contributed about 1/3 of the total vertebral BMC, and 2/3 of the total vertebral volume, and the posterior elements contributed the remainder. The vertebral body BMC and BMD were poorly correlated to those of the posterior elements (r=0.39 for BMC and r=0.34 for BMD, p<0.0001), and moderately correlated to the whole vertebra (r=0.77 and 0.75, respectively, p<0.0001). The BMC and BMD of the posterior elements and whole vertebra were more strongly correlated (r=0.89 and 0.84, respectively, p<0.0001). The posterior elements are the primary contributor to vertebral BMC and BMD measurements. DXA spine BMD measurements are likely to be more representative of the posterior elements than the targeted vertebral body. The findings elucidate the extent of the limitation of DXA spine BMD measurements. Copyright © 2015 Elsevier Inc. All rights reserved.
    No preview · Article · Jun 2015 · The spine journal: official journal of the North American Spine Society
  • F S Algarni · D P Gross · A Senthilselvan · M C Battié
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    ABSTRACT: Older workers often take longer to recover and experience more missed workdays after work-related injuries, but it is unclear why or how best to intervene. Knowing the characteristics of older injured workers may help in developing interventions to reduce the likelihood of work disability. To describe and compare several characteristics between younger and middle-aged working adults (25-54 years), adults nearing retirement (55-64 years) and adults past typical retirement (≥65 years), who sustained work-related musculoskeletal injuries. In this cross-sectional study, Alberta workers' compensation claimants with subacute and chronic work-related musculoskeletal injuries were studied. A wide range of demographic, employment, injury and clinical characteristics were investigated. Descriptive statistics were computed and compared between the age groups. Among 8003 claimants, adults 65 years or older, compared to those 25-54 and 55-64 years, had lower education (16 versus 10 and 12%, P < 0.001) and were more likely to work in trades, transport and related occupations (50 versus 46 and 44%, P < 0.001), to have less offers of modified work (57 versus 39 and 42%, P < 0.001), more fractures (18 versus 14 and 11%, P < 0.001) and no further rehabilitation recommended after assessment (28 versus 18 and 20%, P < 0.01). Injured workers past typical retirement age appeared to be a disadvantaged group with significant challenges from a vocational rehabilitation perspective. They were less likely to have modified work options available or be offered rehabilitation, despite having more severe injuries. © The Author 2015. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
    No preview · Article · Mar 2015 · Occupational Medicine
  • M Fortin · L E Gibbons · T Videman · M C Battié
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    ABSTRACT: This longitudinal study aimed to clarify the longstanding controversy over whether variations in paraspinal muscle morphology (e.g., size, composition and asymmetry) are predictors of low back pain (LBP). A sample of 99 Finnish men were included in this population-based longitudinal study. Data were collected through a structured interview, physical examination and magnetic resonance imaging (MRI). Baseline measurements of the lumbar multifidus and erector spinae muscles were obtained from T2-weighted axial images at L3-L4 and L5-S1, and interview data were obtained at baseline, 1- and 15-year follow-ups. Few of the paraspinal muscle parameters investigated were predictors of change in LBP frequency, intensity or sciatica at 1- and 15-year follow-ups in the population-based sample, and findings were not consistent across muscles and spinal levels. However, greater multifidus and erector spinae fatty infiltration at L5-S1 was associated with a higher risk of having continued, frequent, persistent LBP at 1-year follow-up. None of the relationships observed was confounded by body mass index or the amount of physical activity at work or leisure. This longitudinal study provided evidence that variations in paraspinal muscle morphology on MRI have a limited, if not uncertain, role in the short- and long-term predictions of LBP in men.
    No preview · Article · Aug 2014 · Scandinavian Journal of Medicine and Science in Sports
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    ABSTRACT: Lumbar spinal stenosis is one of the most commonly diagnosed spinal disorders in older adults. Although the pathophysiology of the clinical syndrome is not well understood, a narrow central canal or intervertebral foramen is an essential or defining feature. The aim of the present study was to estimate the magnitude of genetic versus environmental influences on central lumbar spinal stenosis and to investigate disc degeneration and stature or bone development as possible genetic pathways. A classic twin study with multivariate analyses considering lumbar level and other covariates was conducted. The study sample comprised 598 male twins (147 monozygotic and 152 dizygotic pairs), 35–70 years of age, from the population-based Finnish Twin Cohort. The primary phenotypes were central lumbar stenosis as assessed qualitatively on magnetic resonance imaging (MRI) and quantitatively measured dural sac cross-sectional area. Additional phenotypes (to examine possible genetic pathways) included disc bulging and standing height, as an indicator of overall skeletal size or development. The heritability estimate (h2) for qualitatively assessed central lumbar spinal stenosis on MRI was 66.9% (95% confidence interval [95% CI] 56.8, 74.5). The broad-sense heritability estimate for dural sac cross-sectional area was 81.2% (95% CI 74.5, 86.1), with a similar magnitude of genetic influences across lumbar levels (h2 = 72.4–75.6). The additive genetic correlation of quantitatively assessed stenosis and disc bulging was extremely high. There was no indication of shared genetic influences between stenosis and stature. Central lumbar spinal stenosis and associated dural sac dimensions are highly genetic, and disc degeneration (bulging) appears to be one pathway through which genes influence spinal stenosis.
    No preview · Article · Aug 2014 · Arthritis and Rheumatology
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    ABSTRACT: Objective To examine whether use of FCE leads to better outcomes for injured workers. Functional capacity evaluations (FCE) are commonly used to identify work abilities and to inform return-to-work (RTW) decisions. FCE results therefore have important consequences. Design A cluster randomised controlled trial was conducted with analysis at level of claimant (registration ISRCTN61284905). Setting The study was conducted at a workers’ compensation rehabilitation facility in Edmonton, Canada. Participants Data were collected on all claimants undergoing RTW assessment at the facility for musculoskeletal conditions. Participants were predominantly employed (59%) males (73%) with chronic musculoskeletal conditions (median duration 496 days). Interventions Clinicians who were trained and experienced in performing FCE were randomised into two groups. One group included 14 clinicians who were trained to conduct a semi-structured functional interview, while the control group continued to use standard FCE procedures. Main Outcome Measures Outcomes included RTW recommendations following assessment, functional work level at time of assessment and 1, 3, and 6 months after assessment, as well as compensation outcomes. Analysis included Mann-Whitney U, Chi square and t tests. Results Participants included 203 claimants of whom 103 were tested with FCE. All outcomes were similar between groups and no statistically or clinically significant differences were observed. Mean differences between groups on functional work levels at assessment and follow-up ranged from 0.1 to 0.3 out of 4 (3% to 8% difference, p>0.05). Conclusions Performance-based FCE does not appear to enhance RTW outcomes beyond information gained from semi-structured functional interviewing. Use of functional interviewing has the potential to improve efficiency of RTW assessment without compromising clinical, RTW, or compensation outcomes.
    No preview · Article · May 2014 · Archives of physical medicine and rehabilitation
  • Yue Wang · Michele C. Battié
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    ABSTRACT: The World Health Organization defines epidemiology as the study of the distribution and determinants of health-related states or events (WHO 2012). This chapter on the epidemiology of disc degeneration begins with a brief overview of the early observations of disc degeneration and growing interest in the phenomenon, including the introduction and evolution of the currently ambiguous term “degenerative disc disease.” Attention is given to case definition, as it is a core concept in epidemiology and the study of occurrence rates. While definitions used for disc degeneration vary and depend greatly on the methods used to study or image the disc, the occurrence rates of degenerative findings reported in this chapter focus on population-based studies using MRI, which may provide a reference for clinical observations. Finally, we briefly discuss environmental, behavioral, and constitutional factors associated with accelerated disc degeneration, where there has been a recent dramatic shift in views.
    No preview · Chapter · Jan 2014
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    ABSTRACT: Purpose: Functional capacity evaluations (FCE) are used to identify work abilities and are commonly integrated into rehabilitation programs. We studied whether integrating FCE into rehabilitation leads to better outcomes for injured workers. Methods: A cluster randomised controlled trial was conducted at a workers' compensation rehabilitation facility (registration ISRCTN61284905). Clinicians were randomised into 2 groups: 1 group used FCE while another conducted semi-structured functional interviews. Outcomes included recommendations following assessment, rehabilitation program outcomes including functional work levels and pain intensity, as well as compensation outcomes at 1, 3, and 6 months after assessment. Analysis included Mann-Whitney U, Chi square and t tests. Results: Subjects included 225 claimants of whom 105 were tested with FCE. Subjects were predominantly employed (84 %) males (63 %) with sub-acute musculoskeletal conditions (median duration 67 days). Claimants undergoing FCE had ~15 % higher average functional work levels recommended at time of assessment (Mann-Whitney U = 4,391.0, p < 0.001) but differences at other follow-up times were smaller (0-8 %), in favour of functional interviewing, and not statistically significant. Clinically important improvement during rehabilitation in functional work level (0.9/4, SRM = 0.94), pain intensity (2.0/10, SRM = 0.88) and self-reported disability (21.8/100, SRM = 1.45) were only observed in those undergoing the functional interview. Conclusions: Performance-based FCE integrated into occupational rehabilitation appears to lead to higher baseline functional work levels compared to a semi-structured functional interview, but not improved RTW rates or functional work levels at follow-up. Functional interviewing has potential for efficiency gains and higher likelihood of clinically important improvement following rehabilitation, however further research is needed.
    No preview · Article · Dec 2013 · Journal of Occupational Rehabilitation
  • Christy C Tomkins-Lane · Michele C Battié · Richard Hu · Luciana Macedo
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    ABSTRACT: There is no clear picture of pathoanatomy in clinically diagnosed LSS. Findings in the literature regarding imaging in LSS are heterogeneous. Characterize the pathoanatomy of LSS, as reported in the radiology reports, for a large community-based sample of patients with the clinical diagnosis of LSS. Retrospective review of clinical radiology reports. The sample comprised patients 40 years of age or older, with clinically diagnosed LSS. Radiology reports for lumbar MRI were obtained and data were extracted pertaining to the type and location of LSS. 173 subjects with a mean age of 66.2 ± 11.7 years were included (61% women). 68.2% had mixed stenosis, 19.1% had central stenosis only, and 12.7% had lateral stenosis only. By level, the most prevalent findings were at L4/5 (93%), L3/4 (66%) and L5/S1 (48%). This pattern was different in those with lateral stenosis only, where the proportion of findings at L5/S1 was higher than at L3/4. 156 subjects (90.2%) had findings of at least moderate severity. Considering moderate-severe findings only, 31% had mixed stenosis and 40.0% had multi-level findings (90.5% at adjacent segments). When mild findings were included for subjects with at least one moderate-severe finding the rate of mixed stenosis increased to 59%, and multi-level stenosis to 68.6%. The most common multi-level combinations were L3/4 and L4/5 for two-level stenosis and L2/3 through L4/5 for three-level. Results of this study confirm a number of pathoanatomical patterns in people diagnosed with LSS, including a high proportion of stenosis at L4/5, followed by L3/4 and L5/S1. Results also suggest a high prevalence of multi-levels stenosis at adjacent segments. The prevalence of mixed stenosis varied from 31% to 68.2%; inclusion of mild findings resulted in a higher rate of both mixed and multi-level stenosis, compared to analysis of moderate-severe findings only. These results may guide future studies on LSS pathophysiology, by focusing attention toward the most prevalent radiological findings.
    No preview · Article · Nov 2013 · Journal of Back and Musculoskeletal Rehabilitation
  • Christy C Tomkins-Lane · Michele C Battié · Luciana G. Macedo
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    ABSTRACT: Walking capacity is a primary outcome indicator for individuals with lumbar spinal stenosis (LSS). Therefore, there is a demand for psychometrically sound measures of walking that are responsive to change. The primary objective of this study was to examine longitudinal construct validity of the Physical Function Scale of the Swiss Spinal Stenosis Questionnaire, the Oswestry Disability Index (ODI), and the walking capacity items from these scales specifically for the assessment of walking capacity in LSS using the objective Self-Paced Walking Test as the external standard. A secondary objective was to examine responsiveness of measures of walking using a self-reported walking capacity change scale as the external criterion standard. Prospective cohort PATIENT SAMPLE: Twenty six patients were included in this study (17 women and 9 men), with an average age of 68.5 (9.2) years. All participants had LSS diagnosed by a spine specialist surgeon based on both clinical examination and imaging, as well as self-reported walking limitations (neurogenic claudication). Self-report Measures: Physical Function Scale of the Swiss Spinal Stenosis Questionnaire (PF Scale), Oswestry Disability Index (ODI), self-reported walking capacity change score. Self-Paced Walking Test (SPWT). Longitudinal construct validity was assessed using the correlational method. Internal responsiveness was examined using Guyatt's responsiveness index (GRI) and external responsiveness using Receiver Operating Characteristics analysis (ROC). Change in the SPWT and the self-reported walking capacity change score were both used as external criteria for analysis. This study was funded by the Health Research Fund administered by Alberta Innovates Health Solutions, as well as the EFF Small Faculties Grant from the University of Alberta. There are no conflicts of interest. The highest correlations with change in the SPWT were 0.78 for the ODI walking item, and 0.78 for the walking capacity change score. Change in the PF Scale and ODI score were correlated with change in the criterion SPWT at r=0.56 and r=0.70 respectively. There were no differences observed between the PF Scale and ODI for any of the responsiveness indices. The PF Scale, ODI, and walking capacity change score are able to detect changes in walking capacity in people with LSS. The individual walking capacity item from the ODI appears to be the most valid and responsive to changes in measured walking and may be a reasonable alternative for measuring walking when an objective test such as the SPWT is not feasible.
    No preview · Article · Nov 2013 · The spine journal: official journal of the North American Spine Society
  • Tapio Videman · Michele C Battié · Laura E Gibbons · Kevin Gill
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    ABSTRACT: Many studies have focused on either the intervertebral disc, as a culprit in back pain problems, or the vertebral body, but very few studies have examined both structures and their relation. The goals were to measure the concordant changes in morphology of the discs and vertebrae during 5, 10 and 15-year follow-ups. Longitudinal study. Among a general population sample of 232 men that had been scanned in 1992-1993, 105 men were re-examined in 1997-1998 and 2007-2008. Mean age at 15-year follow-up was 63 years. A confirmatory sample with 10-year follow-up was also included. 1.5 Tesla scanners with surface coils were used at baseline and follow-up. Image analysing software was used to measure distances and areas of interest of mid-sagittal and mid-axial spine images. The disc heights decreased at 5 years by 3.4% (0.4 mm) and 3.3 % (0.4 mm) and at 15 years 8.7 % (1.0 mm) and 11.3 % (1.3 mm) in the upper and the lower discs respectively (p<0.001). While not clear after 5years, vertebra heights increased in mean by 3.1 % (0.8 mm) in the upper lumbar levels and by 4.7 % (1.1 mm) in the lower vertebrae after 15 years (p<0.001). Vertebra height increases were associated with disc narrowing (P=0.001). The mean annual shortening of the lumbar spine L1-S1 block was 0.13 mm/year, which was in line with the mean standing height, which decreased little (174.7 cm at baseline and 174.4 cm at follow-up). Discs and vertebrae degenerate or remodel in concert: decreases in disc height appear to be compensated, in part, by accompanying increases in adjacent vertebra heights. The mechanism behind this novel finding and its implications require further study.
    No preview · Article · Nov 2013 · The spine journal: official journal of the North American Spine Society
  • Ashley B McKillop · Linda J Carroll · Michele C Battié
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    ABSTRACT: The clinical syndrome of lumbar spinal stenosis (LSS) is a commonly diagnosed lumbar condition associated with pain and disability. Psychological factors, including depression, also affect these and other health-related outcomes. Yet, the prognostic value of depression specifically in the context of LSS is unclear. The aim of this systematic review was to examine the literature on depression as a prognostic factor of outcomes in patients with LSS. Best-evidence synthesis. Patients receiving the diagnosis of LSS and surgery. A best-evidence synthesis was conducted, including articles published between 1980 and May 2012. Each article meeting inclusion criteria, including a longitudinal design, was critically appraised on its methodological quality by two authors independently, who then met to reach consensus. Only studies deemed scientifically admissible were included in the review. Among the 20 articles that met the inclusion criteria, 13 were judged scientifically admissible. The evidence supports an association between preoperative depression and postoperative LSS-related symptom severity (a combination of pain, numbness, weakness and balance issues) and disability. The effect size for these associations was variable, ranging from no effect to a moderate effect. For example, an increase of 5 points on a 63-point depression scale doubled the odds of being below the median in LSS-related symptom severity at follow-up. Findings on the association between preoperative depression and postoperative pain alone and walking capacity were more variable. Findings support that preoperative depression is likely a prognostic factor for postoperative LSS-related symptom severity and disability at various follow-up points. The prognostic value of depression on the outcomes of pain and walking capacity is less clear. Nonetheless, depression should be considered in the clinical care of this population.
    No preview · Article · Oct 2013 · The spine journal: official journal of the North American Spine Society
  • Maryse Fortin · Tapio Videman · Laura E Gibbons · Michele C Battié
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    ABSTRACT: The purpose of this study was to define the natural progression of age-related changes of the lumbar paraspinal muscles during adulthood, and investigate the influence of lifestyle and individual factors (e.g. physical activity levels at work and leisure, body mass index (BMI), and low back pain (LBP)). This population-based longitudinal study included a sample of 99 adult male twins. Data were collected through a structured interview, physical examination, and magnetic resonance imaging (MRI). Measurements of the lumbar multifidus and erector spinae muscles were obtained from T2-weighted axial images at L3-L4 and L5-S1 at baseline and 15-year follow-up. Muscle cross-sectional area (CSA), functional CSA (FCSA) (fat-free mass) and FCSA/CSA (composition), as well as CSA and FCSA asymmetry, and FCSA/CSA side-to-side differences, were measured. Subjects' mean age was 47.3±7.4 at baseline and 62.3±8.0 at follow-up. Over the 15-year period, both muscles exhibited a decrease in CSA and FCSA and an increase in fatty infiltration and side-to-side differences in size and composition at both spinal levels. Both muscles displayed greater changes at L5-S1 than L3-L4. Age and BMI were found to be significantly associated with the degree of paraspinal muscle changes over time. However, there was no association between the change in paraspinal muscle size, composition or asymmetry with the level of physical demands at work or leisure, or LBP history. The present longitudinal study suggests that over adulthood the multifidus and erector spinae undergo similar morphological changes. Moreover, our findings suggest that the long-term progression of lumbar paraspinal muscle changes evaluated through MRI are not associated with the range of physical demand levels as were typical of Finnish men, or LBP history.
    No preview · Article · Oct 2013 · Medicine and science in sports and exercise
  • Yue Wang · Jan S Owoc · Steven K Boyd · Tapio Videman · Michele C Battié

    No preview · Article · Sep 2013 · Bone
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    ABSTRACT: The phenotype, or observable trait of interest, is at the core of studies identifying associated genetic variants and their functional pathways, as well as diagnostics. Yet, despite remarkable technological developments in genotyping and progress in genetic research, relatively little attention has been paid to the equally important issue of phenotype. This is especially true for disc degeneration-related disorders, and the concept of degenerative disc disease, in particular, where there is little consensus or uniformity of definition. Greater attention and rigour are clearly needed in the development of disc degeneration-related clinical phenotypes if we are to see more rapid advancements in knowledge of this area. When selecting phenotypes, a basic decision is whether to focus directly on the complex clinical phenotype (e.g. the clinical syndrome of spinal stenosis), which is ultimately of interest, or an intermediate phenotype (e.g. dural sac cross-sectional area). While both have advantages, it cannot be assumed that associated gene variants will be similarly relevant to both. Among other considerations are factors influencing phenotype identification, comorbidities that are often present, and measurement issues. Genodisc, the European research consortium project on disc-related clinical pathologies has adopted a strategy that will allow for the careful characterisation and examination of both the complex clinical phenotypes of interest and their components.
    Full-text · Article · Jul 2013 · European Spine Journal
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    ABSTRACT: Physical therapy (PT) is commonly prescribed for patients with lumbar spinal stenosis (LSS); however, little is known about its effectiveness. To systematically review randomized controlled trials (RCT), controlled trials and cohort studies evaluating the effectiveness of PT for LSS. Studies were searched on electronic databases to January 2012. Inclusion criteria were: clinical diagnosis of LSS with confirmatory imaging, evaluation of PT treatment, presence of a comparison group and outcomes of pain, disability, function or quality of life. Outcomes were extracted and when possible pooled using RevMan 5. Ten studies were included: 5 RCTs, 2 controlled trials, 2 mixed design and 1 longitudinal cohort study. Pooled effects of 2 studies revealed that the addition of a PT modality to exercise had no statistically significant effect on outcome. Pooled effects results of RCTs evaluating surgery versus PT demonstrated that surgery was better than physical therapy for pain and disability at long term (2 years) only. Other results suggested that exercise is significantly better than no exercise, that cycling and body weight supported treadmill walking have similar effects, and that corsets are better than no corsets. The limitations of this review include the low quality and small number of studies, as well as the heterogeneity in outcomes and treatments. We were unable to draw conclusions on which PT treatment is superior for LSS. There was low quality evidence suggesting that modalities have no additional effect to exercise and that surgery leads to better long term (2 years) outcomes for pain and disability, but not walking distance, than PT in patients with LSS.
    Full-text · Article · Jul 2013 · Physical Therapy
  • Annu Näkki · Michele C Battié · Jaakko Kaprio
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    ABSTRACT: Disc-related disorders are highly genetic conditions with heritability estimates of up to 75 % and yet, few genomic locations have been moderately associated with the disorders. Candidate gene studies have shown possible disease associations on loci and genes of 1p21.1 (COL11A1), 6q27 (THBS2), 9q22.31 (ASPN), 10p12.31 (SKT), 20q11.2 (GDF5) and 20q13.12 (MMP9). More recently, in 2012, the first genome-wide association study revealed variants on loci and genes of 3p26.2, 6p21.32 (HLA region) and 6q26 (PARK2) that associate with disc-related disorders. In many other complex diseases, large meta-analyses of hundreds of thousands of study subjects and loci have revealed remarkable pathways. As methodology is evolving rapidly, we have already stepped into the era of routinely sequencing all bases in all human exons and we are approaching the era of sequencing the entire genome of study subjects with common diseases. The past decade has taught us that the common variants seen throughout populations seem to have low effects in many common diseases, explain relatively little of the overall heritability of the diseases and demand thousands of study subjects to identify associations. It seems that familial rare variants play an important role in many common diseases leading us back to valuing studies with large families and isolated populations. Moreover, careful characterization of environmental conditions are needed to explore and determine gene-environment interactions as genes that increase disease risk in one context may not do so under another context.
    No preview · Article · Jul 2013 · European Spine Journal
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    Maryse Fortin · Yan Yuan · Michele C Battié
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    ABSTRACT: Paraspinal muscle asymmetry in cross-sectional area (CSA) and composition have been associated with low back pain (LBP) and pathology. Yet, substantial multifidus asymmetry has also been reported in asymptomatic men and little is known about other factors influencing asymmetry. The goal of this study was to identify a range of behavioral, environmental and constitutional factors associated with paraspinal muscle asymmetry. A cross-sectional study of a general population sample of 202 adult male twins was conducted. Data were collected through a structured interview, physical examination and magnetic resonance imaging. Measurements of multifidus and erector spinae CSA and the ratio of fat-free CSA to total CSA were obtained from T2-weighted axial images at the L3-L4 and L5-S1 spinal levels. In multivariable analyses, greater asymmetry in multifidus CSA at L3-L4 was associated with less occupational physical demands and disc narrowing. Handedness was the only factor associated with multifidus CSA asymmetry at L5-S1. For erector spinae, greater age, handedness and disc narrowing were associated with CSA asymmetry at L3-L4 and sports activity, handedness, disc narrowing and familial aggregation at L5-S1. In multivariable analyses of asymmetry in muscle composition, familial aggregation explained 7-20% of the variance in side-to-side differences for the multifidus and erector spinae at both levels measured. Handedness and pain severity also entered the model for erector spinae asymmetry at L5-S1, and disability, handedness and disc narrowing for multifidus at L5-S1. We relied on subjects' recall for LBP history, occupation and physical activity participation. Few of the factors investigated were associated with paraspinal muscle asymmetry, and associations were inconsistent and modest, explaining little of the variance in paraspinal muscle asymmetry.
    Full-text · Article · Jun 2013 · Physical Therapy
  • Yue Wang · Jan S Owoc · Steven K Boyd · Tapio Videman · Michele C Battié
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    ABSTRACT: Previous studies suggest that age and disc degeneration are associated with variations in vertebral trabecular architecture. In particular, disc space narrowing, a severe form of disc degeneration, may predispose the anterior portion of a vertebra to fracture. We studied 150 lumbar vertebrae and 209 intervertebral discs from 48 cadaveric lumbar spines of middle-aged men to investigate regional trabecular differences in relation to age, disc degeneration and disc narrowing. The degrees of disc degeneration and narrowing were evaluated using radiography and discography. The vertebrae were dried and scanned on a μCT system. The μCT images of each vertebral body were processed to include only vertebral trabeculae, which were first divided into superior and inferior regions, and further into central and peripheral regions, and then anterior and posterior regions. Structural analyses were performed to obtain trabecular microarchitecture measurements for each vertebral region. On average, the peripheral region had 12-15% greater trabecular bone volume fraction and trabecular thickness than the central region (P<0.01). Greater age was associated with better trabecular structure in the peripheral relative to the central region. Moderate and severe disc degeneration were associated with higher trabecular thickness in the peripheral region of the vertebral trabeculae (P<0.05). The anterior region was of lower bone quality than the posterior region, which was not associated with age. Slight to moderate narrowing was associated with greater trabecular bone volume fraction in the anterior region of the inferior vertebra (P<0.05). Similarly, greater disc narrowing was associated with higher trabecular thickness in the anterior region (P<0.05). Better architecture of peripheral trabeculae relative to central trabeculae was associated with both age and disc degeneration. In contrast to the previous view that disc narrowing stress-shields the anterior vertebra, disc narrowing tended to associate with better trabecular architecture in the anterior region, as opposed to posterior region.
    No preview · Article · Jun 2013 · Bone
  • Article: Letters.
    Luciana G Macedo · Yue Wang · Michele C Battié
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    ABSTRACT: Study Design. A total of 200 patients with low back pain (LBP) completed an English and Marathi Oswestry Disability Index (ODI) questionnaires (100 each), visual analogue scale, and Roland-Morris Disability Questionnaire. Objective. To validate the English and Marathi versions of ODI (version 2.1a). Summary of Background Data. Patient-orientated assessment methods are important in the evaluation of treatment outcome. The ODI is one of the condition-specific questionnaires recommended for the use of patients with LBP. Methods. An adaptation of the ODI (version 2.1a) for Marathi language was carried out according to established guidelines. Results. Average age of patients who answered the English ODI was 42 ± 15, whereas that of Marathi-speaking patients was 52 ± 15 years. About 40% were males. The Cronbach α reliability score was 0.877 for English and 0.943 for Marathi. Forty-seven and 53 of these patients were retested with English and Marathi ODI within 2 weeks (to assess test-retest reliability). The intraclass correlation coefficient (ICC) for the test-retest reliability of the questionnaire was 0.877 and 0.943 for English and Marathi respectively. The ODI scores correlated with visual analogue scale pain intensity (r = 0.67, P < 0.0001) and Roland-Morris Disability Questionnaire score (r = 0.71, P < 0.0001) for English and visual analogue scale (r = 0.325, P < 0.001) and Roland-Morris Disability Questionnaire scores (r = 0.503, P < 0.0001) for Marathi. The receiver operating characteristic curve analysis showed comparable performance in discriminating the existence of sign and symptoms (area under curve = 0.947, P < 0.0001, 95% confidence interval: 0.893–0.999 for English and Marathi (area under curve: 0.834, P < 0.0001, 95% confidence interval: 0.735–0.933) for severe compared with nonsevere LBP proving discriminative validity. Results showed that English ODI is valid and reliable. Conclusion. The Marathi version of Oswestry questionnaire is reliable and valid, and shows psychometric characteristics as good as the English version. It should represent a valuable tool for use in future patient-orientated outcome studies for population with LBP in India.
    No preview · Article · May 2013 · Spine
  • Christy C Tomkins-Lane · Michele C Battié
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    ABSTRACT: Identifying factors associated with walking capacity in people with lumbar spinal stenosis (LSS) may provide a better understanding of neurogenic claudication and inform future rehabilitation research. To examine factors associated with objectively measured walking capacity in a sample of people with LSS and self-reported walking limitations. Participants included 49 individuals (65.8 years ± 10) who were at least 45 years of age with clinically diagnosed lumbar spinal stenosis (LSS) confirmed on MRI or CT imaging. All participants completed a Self-Paced Walking Test with visual analog pain scales and body diagrams before and immediately after walking. Questionnaires included the Physical Function and Symptom Severity Scales of the Swiss Spinal Stenosis Questionnaire, the Oswestry Disability Index (ODI) and the Health Utilities Index. Univariate linear relationships were examined, followed by development of a multivariate linear regression model with walking distance (m) as the dependent variable. A post-hoc analysis was also conducted including post-test symptom variables. Variables retained from univariate analyses included years of leg pain, pre-test leg pain severity, the ODI, balance problems, and quality of life. When these variables were considered for a final model, only the ODI and balance problems were retained (R ^{2} =0.33). Other than balance, none of the pre-test symptom variables entered into the final model. Post-hoc analysis including post-test symptom variables found the presence and severity of post-test leg pain to be most highly associated with walking distance. In an explanatory model considering the ODI, balance and these two post-walking factors, only presence of post-test leg pain added to the model (R ^{2} =0.42). Factors found to be most highly associated with walking capacity in LSS were self-reported, pain-related function (ODI), balance problems, and presence of leg pain immediately following walking.
    No preview · Article · Mar 2013 · Journal of Back and Musculoskeletal Rehabilitation

Publication Stats

6k Citations
464.40 Total Impact Points


  • 1995-2015
    • University of Alberta
      • • School of Public Health
      • • Department of Physical Therapy
      • • Faculty of Rehabilitation Medicine
      Edmonton, Alberta, Canada
  • 2010
    • ORTON Foundation, Helsinki, Finland
      Helsinki, Uusimaa, Finland
  • 1997-2009
    • University of Helsinki
      • Department of Dental Public Health
      Helsinki, Uusimaa, Finland
  • 1994-2001
    • University of Jyväskylä
      • Department of Health Sciences
      Jyväskylä, Province of Western Finland, Finland
  • 1995-1997
    • University of Kuopio
      Kuopio, Northern Savo, Finland
  • 1986-1997
    • University of Washington Seattle
      • Department of Medicine
      Seattle, Washington, United States