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Article: Appropriateness criteria for surgery improve clinical outcomes in patients with low back pain and/or sciatica

TitleAppropriateness criteria for surgery improve clinical outcomes in patients with low back pain and/or sciatica
Authors
KeywordsAppropriateness Criteria
Health-Related
Low Back Surgery
Lumbar
Outcome
Quality Of Care
Quality Of Life
Rand Method
Sciatica
Spine
Treatment
Issue Date2010
PublisherLippincott, Williams & Wilkins. The Journal's web site is located at http://www.spinejournal.com
Citation
Spine, 2010, v. 35 n. 6, p. 672-683 How to Cite?
AbstractStudy Design. Prospective, controlled, observational outcome study using clinical, radiographic, and patient/physician-based questionnaire data, with patient outcomes at 12 months follow-up. Objective. To validate appropriateness criteria for low back surgery. Summary of Background Data. Most surgical treatment failures are attributed to poor patient selection, but no widely accepted consensus exists on detailed indications for appropriate surgery. Methods. Appropriateness criteria for low back surgery have been developed by a multispecialty panel using the RAND appropriateness method. Based on panel criteria, a prospective study compared outcomes of patients appropriately and inappropriately treated at a single institution with 12 months follow-up assessment. Included were patients with low back pain and/or sciatica referred to the neurosurgical department. Information about symptoms, neurologic signs, the health-related quality of life (SF-36), disability status (Roland-Morris), and pain intensity (VAS) was assessed at baseline, at 6 months, and at 12 months follow-up. The appropriateness criteria were administered prospectively to each clinical situation and outside of the clinical setting, with the surgeon and patients blinded to the results of the panel decision. The patients were further stratified into 2 groups: appropriate treatment group (ATG) and inappropriate treatment group (ITG). Results. Overall, 398 patients completed all forms at 12 months. Treatment was considered appropriate for 365 participants and inappropriate for 33 participants. The mean improvement in the SF-36 physical component score at 12 months was significantly higher in the ATG (mean: 12.3 points) than in the ITG (mean: 6.8 points) (P =0.01), as well as the mean improvement in the SF-36 mental component score (ATG mean: 5.0 points; ITG mean: - 0.5 points) (P = 0.02). Improvement was also significantly higher in the ATG for the mean VAS back pain (ATG mean: 2.3 points; ITG mean: 0.8 points; P = 0.02) and Roland-Morris disability score (ATG mean: 7.7 points; ITG mean: 4.2 points; P = 0.004). The ATG also had a higher improvement in mean VAS for sciatica (4.0 points) than the ITG (2.8 points), but the difference was not significant (P = 0.08). The SF-36 General Health score declined in both groups after 12 months, however, the decline was worse in the ITG (mean decline: 8.2 points) than in the ATG (mean decline: 1.2 points) (P = 0.04). Overall, in comparison to ITG patients, ATG patients had significantly higher improvement at 12 months, both statistically and clinically. Conclusion. In comparison to previously reported literature, our study is the first to assess the utility of appropriateness criteria for low back surgery at 1-year follow-up with multiple outcome dimensions. Our results confirm the hypothesis that application of appropriateness criteria can significantly improve patient outcomes. © 2010, Lippincott Williams & Wilkins.
Persistent Identifierhttp://hdl.handle.net/10722/170166
ISSN
2015 Impact Factor: 2.439
2015 SCImago Journal Rankings: 1.459
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorDanonHersch, Nen_US
dc.contributor.authorSamartzis, Den_US
dc.contributor.authorWietlisbach, Ven_US
dc.contributor.authorPorchet, Fen_US
dc.contributor.authorVader, JPen_US
dc.date.accessioned2012-10-30T06:05:44Z-
dc.date.available2012-10-30T06:05:44Z-
dc.date.issued2010en_US
dc.identifier.citationSpine, 2010, v. 35 n. 6, p. 672-683en_US
dc.identifier.issn0362-2436en_US
dc.identifier.urihttp://hdl.handle.net/10722/170166-
dc.description.abstractStudy Design. Prospective, controlled, observational outcome study using clinical, radiographic, and patient/physician-based questionnaire data, with patient outcomes at 12 months follow-up. Objective. To validate appropriateness criteria for low back surgery. Summary of Background Data. Most surgical treatment failures are attributed to poor patient selection, but no widely accepted consensus exists on detailed indications for appropriate surgery. Methods. Appropriateness criteria for low back surgery have been developed by a multispecialty panel using the RAND appropriateness method. Based on panel criteria, a prospective study compared outcomes of patients appropriately and inappropriately treated at a single institution with 12 months follow-up assessment. Included were patients with low back pain and/or sciatica referred to the neurosurgical department. Information about symptoms, neurologic signs, the health-related quality of life (SF-36), disability status (Roland-Morris), and pain intensity (VAS) was assessed at baseline, at 6 months, and at 12 months follow-up. The appropriateness criteria were administered prospectively to each clinical situation and outside of the clinical setting, with the surgeon and patients blinded to the results of the panel decision. The patients were further stratified into 2 groups: appropriate treatment group (ATG) and inappropriate treatment group (ITG). Results. Overall, 398 patients completed all forms at 12 months. Treatment was considered appropriate for 365 participants and inappropriate for 33 participants. The mean improvement in the SF-36 physical component score at 12 months was significantly higher in the ATG (mean: 12.3 points) than in the ITG (mean: 6.8 points) (P =0.01), as well as the mean improvement in the SF-36 mental component score (ATG mean: 5.0 points; ITG mean: - 0.5 points) (P = 0.02). Improvement was also significantly higher in the ATG for the mean VAS back pain (ATG mean: 2.3 points; ITG mean: 0.8 points; P = 0.02) and Roland-Morris disability score (ATG mean: 7.7 points; ITG mean: 4.2 points; P = 0.004). The ATG also had a higher improvement in mean VAS for sciatica (4.0 points) than the ITG (2.8 points), but the difference was not significant (P = 0.08). The SF-36 General Health score declined in both groups after 12 months, however, the decline was worse in the ITG (mean decline: 8.2 points) than in the ATG (mean decline: 1.2 points) (P = 0.04). Overall, in comparison to ITG patients, ATG patients had significantly higher improvement at 12 months, both statistically and clinically. Conclusion. In comparison to previously reported literature, our study is the first to assess the utility of appropriateness criteria for low back surgery at 1-year follow-up with multiple outcome dimensions. Our results confirm the hypothesis that application of appropriateness criteria can significantly improve patient outcomes. © 2010, Lippincott Williams & Wilkins.en_US
dc.languageengen_US
dc.publisherLippincott, Williams & Wilkins. The Journal's web site is located at http://www.spinejournal.comen_US
dc.relation.ispartofSpineen_US
dc.subjectAppropriateness Criteriaen_US
dc.subjectHealth-Relateden_US
dc.subjectLow Back Surgeryen_US
dc.subjectLumbaren_US
dc.subjectOutcomeen_US
dc.subjectQuality Of Careen_US
dc.subjectQuality Of Lifeen_US
dc.subjectRand Methoden_US
dc.subjectSciaticaen_US
dc.subjectSpineen_US
dc.subjectTreatmenten_US
dc.titleAppropriateness criteria for surgery improve clinical outcomes in patients with low back pain and/or sciaticaen_US
dc.typeArticleen_US
dc.identifier.emailSamartzis, D:dspine@hku.hken_US
dc.identifier.authoritySamartzis, D=rp01430en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1097/BRS.0b013e3181b71a79en_US
dc.identifier.pmid20139809-
dc.identifier.scopuseid_2-s2.0-78650098212en_US
dc.identifier.hkuros173071-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-78650098212&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume35en_US
dc.identifier.issue6en_US
dc.identifier.spage672en_US
dc.identifier.epage683en_US
dc.identifier.isiWOS:000276566800014-
dc.publisher.placeUnited Statesen_US
dc.identifier.scopusauthoridDanonHersch, N=16642078200en_US
dc.identifier.scopusauthoridSamartzis, D=34572771100en_US
dc.identifier.scopusauthoridWietlisbach, V=7004656205en_US
dc.identifier.scopusauthoridPorchet, F=7003908347en_US
dc.identifier.scopusauthoridVader, JP=7005750880en_US

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