|
1
|
Goode AP, Goertz C, Chakraborty H, Salsbury SA, Broderick S, Levy BT, Ryan K, Settles S, Hort S, Dolor RJ, Chrischilles EA, Kasper S, Stahl JE, Almond C, Reed SD, Shannon Z, Harris D, Daly J, Winokur P, Lurie JD. Implementation of the American- College of Physicians Guideline for Low Back Pain (IMPACt-LBP): protocol for a healthcare systems embedded multisite pragmatic cluster-randomised trial. BMJ Open 2025; 15:e097133. [PMID: 40139699 PMCID: PMC11950946 DOI: 10.1136/bmjopen-2024-097133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2024] [Accepted: 02/28/2025] [Indexed: 03/29/2025] Open
Abstract
INTRODUCTION Low back pain (LBP) is a key source of medical costs and disability, impacting over 31 million Americans at any given time and resulting in US$100-US$200 billion per year in total healthcare costs. LBP is one of the leading causes of ambulatory care visits to US physicians; problematically, these visits often result in treatments such as opioids, surgery or advanced imaging that can lead to more harm than benefit. The American College of Physicians (ACP) Guideline for Low Back Pain recommends patients receive non-pharmacological interventions as a first-line treatment. Roadmaps exist for multidisciplinary collaborative care that include well-trained primary contact clinicians with specific expertise in the treatment of musculoskeletal conditions, such as physical therapists and doctors of chiropractic, as first-line providers for LBP. These clinicians, sometimes referred to as primary spine practitioners (PSPs) routinely employ many of the non-pharmacological approaches recommended by the ACP guideline, including spinal manipulation and exercise. Important foundational work has demonstrated that such care is feasible and safe, and results in improved physical function, less pain, fewer opioid prescriptions and reduced utilisation of healthcare services. However, this treatment approach for LBP has yet to be widely implemented or tested in a multisite clinical trial in real-world practice. METHODS AND ANALYSIS The Implementation of the American College of Physicians Guideline for Low Back Pain trial is a health system-embedded pragmatic cluster-randomised trial that will examine the effect of offering initial contact with a PSP compared with usual primary care for LBP. Twenty-six primary care clinics within three healthcare systems were randomised 1:1 to PSP intervention or usual primary care. Primary outcomes are pain interference and physical function using the Patient-Reported Outcomes Measurement Information System Short Forms collected via patient self-report among a planned sample of 1800 participants at baseline, 1, 3 (primary end point), 6 and 12 months. A subset of participants enrolled early in the trial will also receive a 24-month assessment. An economic analysis and analysis of healthcare utilisation will be conducted as well as an evaluation of the patient, provider and policy-level barriers and facilitators to implementing the PSP model using a mixed-methods process evaluation approach. ETHICS AND DISSEMINATION The study received ethics approval from Advarra, Duke University, Dartmouth Health and the University of Iowa Institutional Review Boards. Study data will be made available on completion, in compliance with National Institutes of Health data sharing policies. TRIAL REGISTRATION NUMBER NCT05626049.
Collapse
Grants
- UL1 TR002537 NCATS NIH HHS
- U24 AT011189 NCCIH NIH HHS
- U24 AT009676 NCCIH NIH HHS
- UG3 AT011187 NCCIH NIH HHS
- UH3 AT011187 NCCIH NIH HHS
- National Center for Advancing Translational Sciences of the National Institutes of Health
- NIH Pragmatic Trials Collaboratory Coordinating Center through cooperative agreement from NCCIH, the National Institute of Allergy and Infectious Diseases (NIAID), the National Cancer Institute (NCI), the National Institute on Aging (NIA), the National Heart, Lung, and Blood Institute (NHLBI), the National Institute of Nursing Research (NINR), the National Institute of Minority Health and Health Disparities (NIMHD), NIAMS, the NIH Office of Behavioral and Social Sciences Research (OBSSR), and the NIH Office of Disease Prevention (ODP)
- National Institutes of Health (NIH) Pragmatic Trials Collaboratory by cooperative agreements (Clinical Coordinating Center and Data Coordinating Center) from the National Center for Complementary and Integrative Health (NCCIH), the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Collapse
Affiliation(s)
- Adam P Goode
- Duke University School of Medicine, Durham, North Carolina, USA
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Christine Goertz
- Duke University School of Medicine, Durham, North Carolina, USA
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Hrishikesh Chakraborty
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
- Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Stacie A Salsbury
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, Iowa, USA
| | - Samuel Broderick
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Barcey T Levy
- Family and Community Medicine, The University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
- College of Public Health, Department of Epidemiology, The University of Iowa, Iowa City, Iowa, USA
| | - Kelley Ryan
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Sharon Settles
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Shoshana Hort
- Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Rowena J Dolor
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Elizabeth A Chrischilles
- College of Public Health, Department of Epidemiology, The University of Iowa, Iowa City, Iowa, USA
| | - Stacie Kasper
- Family and Community Medicine, The University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
| | - James E Stahl
- Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Chandra Almond
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Shelby D Reed
- Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Zacariah Shannon
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, Iowa, USA
| | - Debra Harris
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Jeanette Daly
- Family and Community Medicine, The University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
| | - Patricia Winokur
- Internal Medicine, The University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
| | - Jon D Lurie
- Medicine, Orthopaedics, Health Policy, and Clinical Practice, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| |
Collapse
|
|
2
|
Regmi M, Liu W, Liu S, Dai Y, Xiong Y, Yang J, Yang C. The evolution and integration of technology in spinal neurosurgery: A scoping review. J Clin Neurosci 2024; 129:110853. [PMID: 39348790 DOI: 10.1016/j.jocn.2024.110853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 09/19/2024] [Accepted: 09/24/2024] [Indexed: 10/02/2024]
Abstract
Spinal disorders pose a significant global health challenge, affecting nearly 5% of the population and incurring substantial socioeconomic costs. Over time, spinal neurosurgery has evolved from basic 19th-century techniques to today's minimally invasive procedures. The recent integration of technologies such as robotic assistance and advanced imaging has not only improved precision but also reshaped treatment paradigms. This review explores key innovations in imaging, biomaterials, and emerging fields such as AI, examining how they address long-standing challenges in spinal care, including enhancing surgical accuracy and promoting tissue regeneration. Are we at the threshold of a new era in healthcare technology, or are these innovations merely enhancements that may not fundamentally advance clinical care? We aim to answer this question by offering a concise introduction to each technology and discussing in depth its status and challenges, providing readers with a clearer understanding of its actual potential to revolutionize surgical practices.
Collapse
Affiliation(s)
- Moksada Regmi
- State Key Laboratory of Vascular Homeostasis and Remodeling, Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing 100191, China; Center for Precision Neurosurgery and Oncology of Peking University Health Science Center, Peking University, Beijing 100191, China; Peking University Health Science Center, Beijing 100191, China; Henan Academy of Innovations in Medical Science (AIMS), Zhengzhou 450003, China
| | - Weihai Liu
- State Key Laboratory of Vascular Homeostasis and Remodeling, Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing 100191, China; Center for Precision Neurosurgery and Oncology of Peking University Health Science Center, Peking University, Beijing 100191, China
| | - Shikun Liu
- State Key Laboratory of Vascular Homeostasis and Remodeling, Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing 100191, China; Center for Precision Neurosurgery and Oncology of Peking University Health Science Center, Peking University, Beijing 100191, China
| | - Yuwei Dai
- State Key Laboratory of Vascular Homeostasis and Remodeling, Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing 100191, China; Center for Precision Neurosurgery and Oncology of Peking University Health Science Center, Peking University, Beijing 100191, China
| | - Ying Xiong
- State Key Laboratory of Vascular Homeostasis and Remodeling, Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing 100191, China; Center for Precision Neurosurgery and Oncology of Peking University Health Science Center, Peking University, Beijing 100191, China
| | - Jun Yang
- State Key Laboratory of Vascular Homeostasis and Remodeling, Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing 100191, China; Center for Precision Neurosurgery and Oncology of Peking University Health Science Center, Peking University, Beijing 100191, China
| | - Chenlong Yang
- State Key Laboratory of Vascular Homeostasis and Remodeling, Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing 100191, China; Center for Precision Neurosurgery and Oncology of Peking University Health Science Center, Peking University, Beijing 100191, China; Henan Academy of Innovations in Medical Science (AIMS), Zhengzhou 450003, China.
| |
Collapse
|
|
3
|
Gornet MF, Beall DP, Davis TT, Coric D, LaBagnara M, Krull A, DePalma MJ, Hsieh PC, Mallempati S, Schranck FW, Kelly C, Foley KT. Allogeneic Disc Progenitor Cells Safely Increase Disc Volume and Improve Pain, Disability, and Quality of Life in Patients With Lumbar Disc Degeneration-Results of an FDA-Approved Biologic Therapy Randomized Clinical Trial. Int J Spine Surg 2024; 18:237-248. [PMID: 38925869 PMCID: PMC11535772 DOI: 10.14444/8609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Progenitor cells derived from intervertebral disc tissue demonstrated immunomodulatory and regenerative properties in preclinical studies. We report the safety and efficacy results of a US Food and Drug Administration-approved clinical trial of these cells for the treatment of symptomatic degenerative disc disease. METHODS Sixty patients with symptomatic single-level lumbar degenerative disc disease (mean age 37.9 years, 60% men) were enrolled in a randomized, double-blinded, placebo-controlled Phase I/Phase II study at 13 clinical sites. They were randomized to receive single intradiscal injections of either low-dose cells (N = 20), high-dose cells (N = 20), vehicle alone (N = 10), or placebo (N = 10). The primary endpoint was mean visual analog scale (VAS) pain improvement >30% at 52 weeks. Disc volume was radiologically assessed. Adverse events (AEs), regardless of whether they were related to treatment, were reported. Patients were assessed at baseline and at 4, 12, 26, 52, 78, and 104 weeks posttreatment. RESULTS At week 52, the high-dose group had a mean VAS percentage decrease from baseline (-62.8%, P = 0.0005), achieving the endpoint of back pain improvement >30%; the mean change was also significantly greater than the minimal clinically important difference of a 20-point decrease (-42.8, P = 0.001). This clinical improvement was maintained at week 104. The vehicle group had a smaller significant decrease in VAS (-52.8%, P = 0.044), while the low-dose and placebo groups showed nonsignificant improvements. Only the high-dose group had a significant change in disc volume, with mean increases of 249.0 mm3 (P = 0.028) at 52 weeks and 402.1 mm3 (P = 0.028) at 104 weeks. A minority of patients (18.3%) reported AEs that were severe. Overall, 6.7% of patients experienced serious AEs, all in the vehicle (n = 1) or placebo (n = 3) groups, none treatment related. CONCLUSIONS High-dose allogeneic disc progenitor cells produced statistically significant, clinically meaningful improvements in back pain and disc volume at 1 year following a single intradiscal injection and were safe and well tolerated. These improvements were maintained at 2 years post-injection. LEVEL OF EVIDENCE: 1 CLINICAL TRIAL REGISTRATION NCT03347708-Study to Evaluate the Safety and Preliminary Efficacy of Injectable Disc Cell Therapy, a Treatment for Symptomatic Lumbar Intervertebral Disc Degeneration.
Collapse
Affiliation(s)
| | | | | | - Domagoj Coric
- Carolinas Medical Center/Carolina Neurosurgery & Spine Associates, Charlotte, NC, USA
| | - Michael LaBagnara
- Semmes-Murphey Clinic and Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | | | - Michael J DePalma
- Virginia iSpine Physicians/Virginia Spine Research Institute, Richmond, VA, USA
| | | | | | | | | | - Kevin T Foley
- Semmes-Murphey Clinic and Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA
| |
Collapse
|
|
4
|
Tretiakov PS, Onafowokan OO, Lorentz N, Galetta M, Mir JM, Das A, Dave P, Yee T, Buell TJ, Jankowski PP, Eastlack R, Hockley A, Schoenfeld AJ, Passias PG. Assessing the Economic Benefits of Enhanced Recovery After Surgery (ERAS) Protocols in Adult Cervical Deformity Patients: Is the Initial Additive Cost of Protocols Offset by Clinical Gains? Clin Spine Surg 2024; 37:164-169. [PMID: 38637936 DOI: 10.1097/bsd.0000000000001625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 03/10/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE To assess the financial impact of Enhanced Recovery After Surgery (ERAS) protocols and cost-effectiveness in cervical deformity corrective surgery. STUDY DESIGN Retrospective review of prospective CD database. BACKGROUND Enhanced Recovery After Surgery (ERAS) can help accelerate patient recovery and assist hospitals in maximizing the incentives of bundled payment models while maintaining high-quality patient care. However, the economic benefit of ERAS protocols, nor the heterogeneous components that make up such protocols, has not been established. METHODS Operative CD patients ≥18 y with complete pre-(BL) and up to 2-year(2Y) postop radiographic/HRQL data were stratified by enrollment in Standard-of-Care ERAS beginning in 2020. Differences in demographics, clinical outcomes, radiographic alignment targets, perioperative factors, and complication rates were assessed through means comparison analysis. Costs were calculated using PearlDiver database estimates from Medicare pay scales. QALY was calculated using NDI mapped to SF6D using validated methodology with a 3% discount rate to account for a residual decline in life expectancy. RESULTS In all, 127 patients were included (59.07±11.16 y, 54% female, 29.08±6.43 kg/m 2 ) in the analysis. Of these patients, 54 (20.0%) received the ERAS protocol. Per cost analysis, ERAS+ patients reported a lower mean total 2Y cost of 35049 USD compared with ERAS- patients at 37553 ( P <0.001). Furthermore, ERAS+ patients demonstrated lower cost of reoperation by 2Y ( P <0.001). Controlling for age, surgical invasiveness, and deformity per BL TS-CL, ERAS+ patients below 70 years old were significantly more likely to achieve a cost-effective outcome by 2Y compared with their ERAS- counterparts (OR: 1.011 [1.001-1.999, P =0.048]. CONCLUSIONS Patients undergoing ERAS protocols experience improved cost-effectiveness and reduced total cost by 2Y post-operatively. Due to the potential economic benefit of ERAS for patients incorporation of ERAS into practice for eligible patients should be considered.
Collapse
Affiliation(s)
- Peter S Tretiakov
- Departments of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, NY
| | - Oluwatobi O Onafowokan
- Departments of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, NY
| | - Nathan Lorentz
- Departments of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, NY
| | - Matthew Galetta
- Departments of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, NY
| | - Jamshaid M Mir
- Departments of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, NY
| | - Ankita Das
- Departments of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, NY
| | - Pooja Dave
- Departments of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, NY
| | - Timothy Yee
- Department of Neurosurgery, University of California San Francisco, CA
| | - Thomas J Buell
- Department of Neurological Surgery, University of Pittsburg, PA
| | - Pawel P Jankowski
- Department of Neurosurgery, Hoag Neurosciences Institute, Irvine, CA
| | - Robert Eastlack
- Department of Orthopaedic Surgery, Scripps Health, San Diego, CA
| | - Aaron Hockley
- Department of Neurological Surgery, University of Alberta, Edmonton, AB, Canada
| | - Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Peter G Passias
- Departments of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, NY
| |
Collapse
|
|
5
|
Anderson BR, Herman PM, Hays RD. Predictors of Pain Management Strategies in Adults with Low-Back Pain: A Secondary Analysis of Amazon Mechanical Turk Survey Data. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024; 30:297-305. [PMID: 37646759 PMCID: PMC10954603 DOI: 10.1089/jicm.2023.0233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Objective: To evaluate the associations between baseline demographics, health conditions, pain management strategies, and health-related quality-of-life (HRQoL) measures with pain management strategies at 3-month follow-up in respondents reporting current low-back pain (LBP). Study design: Cohort study of survey data collected from adults with LBP sampled from Amazon Mechanical Turk crowdsourcing panel. Methods: Demographics, health conditions, and the Patient-Reported Outcomes Measurement Information System (PROMIS)-10 were included in the baseline survey. Respondents reporting LBP completed a more comprehensive survey inquiring about pain management strategies and several HRQoL measures. Bivariate then multivariate logistic regression estimated odds ratios (ORs) with 95% confidence intervals (CIs) for the association between baseline characteristics and pain management utilization at 3-month follow-up. Model fit statistics were evaluated to assess the predictive value. Results: The final cohort included 717 respondents with completed surveys. The most prevalent pain management strategy at follow-up was other care (n = 474), followed by no care (n = 94), conservative care only (n = 76), medical care only (n = 51), and medical and conservative care combined (n = 22). The conservative care only group had higher (better) mental and physical health PROMIS-10 scores as opposed to the medical care only and combination care groups, which had lower (worse) physical health scores. In multivariate models, estimated ORs (95% CIs) for the association between baseline and follow-up pain management ranged from 4.6 (2.7-7.8) for conservative care only to 16.8 (6.9-40.7) for medical care only. Additional significant baseline predictors included age, income, education, workman's compensation claim, Oswestry Disability Index score, and Global Chronic Pain Scale grade. Conclusions: This study provides important information regarding the association between patient characteristics, HRQoL measures, and LBP-related pain management utilization.
Collapse
Affiliation(s)
- Brian R. Anderson
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA, USA
| | - Patricia M. Herman
- RAND Center for Collaborative Research in Complementary and Integrative Health, RAND Corporation, Santa Monica, CA, USA
| | - Ron D. Hays
- Department of Medicine, UCLA Division of General Internal Medicine & Health Services Research, Los Angeles, CA, USA
| |
Collapse
|
|
6
|
Antonioli E, Tavares Malheiro D, Damazio Teich V, Dias Paião I, Cendoroglo Neto M, Lenza M. Cost-effectiveness of a second opinion program on spine surgeries: an economic analysis. BMC Health Serv Res 2023; 23:1441. [PMID: 38115007 PMCID: PMC10731842 DOI: 10.1186/s12913-023-10405-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 11/29/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND In this study we proposed a new strategy to measure cost-effectiveness of second opinion program on spine surgery, using as measure of effectiveness the minimal important change (MIC) in the quality of life reported by patients, including the satisfaction questionnaire regarding the treatment and direct medical costs. METHODS Retrospective analysis of patients with prior indication for spine surgery included in a second opinion program during May 2011 to May 2019. Treatment costs and outcomes were compared considering each patients' recommended treatment before and after the second opinion. Costs were measured under the perspective of the hospital, including hospital stay, surgical room, physician and staff fees and other costs related to hospitalization when surgery was performed and physiotherapy or injection costs when a conservative treatment was recommended. Reoperation costs were also included. For comparison analysis, we used data based on our clinical practice, using data from patients who underwent the same type of surgical procedure as recommended by the first referral. The measure of effectiveness was the percentage of patients who achieved the MIC in quality of life measured by the EQ-5D-3 L 2 years after starting treatment. An incremental cost-effectiveness ratio (ICER) was calculated. RESULTS Based upon the assessment of 1,088 patients that completed the entire second opinion process, conservative management was recommended for 662 (60.8%) patients; 49 (4.5%) were recommended to injection and 377 (34.7%) to surgery. Complex spine surgery, as arthrodesis, was recommended by second opinion in only 3.7% of cases. The program resulted in financial savings of -$6,705 per patient associated with appropriate treatment indication, with an incremental effectiveness of 0.077 patients achieving MIC when compared to the first referral, resulting in an ICER of $-87,066 per additional patient achieving the MIC, ranging between $-273,016 and $-41,832. CONCLUSION After 2 years of treatment, the second opinion program demonstrated the potential for cost-offsets associated with improved quality of life.
Collapse
Affiliation(s)
- Eliane Antonioli
- Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627/701 - Jardim Leonor - CEP, São Paulo, SP, 05652-900, Brazil.
| | - Daniel Tavares Malheiro
- Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627/701 - Jardim Leonor - CEP, São Paulo, SP, 05652-900, Brazil
| | - Vanessa Damazio Teich
- Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627/701 - Jardim Leonor - CEP, São Paulo, SP, 05652-900, Brazil
| | - Isabela Dias Paião
- Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627/701 - Jardim Leonor - CEP, São Paulo, SP, 05652-900, Brazil
| | - Miguel Cendoroglo Neto
- Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627/701 - Jardim Leonor - CEP, São Paulo, SP, 05652-900, Brazil
| | - Mario Lenza
- Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627/701 - Jardim Leonor - CEP, São Paulo, SP, 05652-900, Brazil
| |
Collapse
|
|
7
|
Nouni-García R, Carbonell-Soliva Á, Orozco-Beltrán D, López-Pineda A, Tomás-Rodríguez MI, Gil-Guillén VF, Quesada JA, Carratalá-Munuera C. Association of Visiting the Physiotherapist with Mortality in the Spanish General Population: A Population-Based Cohort Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2187. [PMID: 38138290 PMCID: PMC10744916 DOI: 10.3390/medicina59122187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: The purpose of this retrospective population-based cohort study was to analyse the association between attendance of physiotherapy with mortality in the Spanish general population and describe the profile of people who do not visit a physiotherapist in Spain. Material and Methods: The data sources were the 2011/2012 National Health Survey (ENSE11) and the national database of death in Spain, and the participants were all adult respondents in the ENSE11. Results: Of 20,397 people, 1101 (5.4%) visited the physiotherapist the previous year, and the cumulative incidence of total mortality was 5.4% (n = 1107) at a mean follow-up of 6.2 years. Visiting the physiotherapist was associated with lower all-cause mortality in the population residing in Spain, quantified at 30.1% [RR = 0.699; 95% CI (0.528-0.927); p = 0.013]. The factors associated with not visiting a physiotherapist were the following: rating one's health as good (9.8%; n = 1017; p < 0.001), not having any hospital admission in the previous year (9.6%; n = 1788; p < 0.001), not having visited the general practitioner in the previous month (9.6%; n = 1408; p < 0.001), and not having attended a day hospital in the previous year (9.7%; n = 1836; p < 0.001). Conclusions: Visiting a physiotherapist was associated with a lower mortality from all causes in the population living in Spain.
Collapse
Affiliation(s)
- Rauf Nouni-García
- Institute of Health and Biomedical Research of Alicante, General University Hospital of Alicante, Diagnostic Center, Fifth Floor, Pintor Baeza Street, 12, 03110 Alicante, Spain; (R.N.-G.); (V.F.G.-G.)
- Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), 03550 San Juan de Alicante, Spain; (D.O.-B.); (J.A.Q.); (C.C.-M.)
- Clinical Medicine Department, School of Medicine, University of Miguel Hernández de Elche, Ctra, Nacional N-332 s/n, 03550 San Juan de Alicante, Spain;
| | - Álvaro Carbonell-Soliva
- Clinical Medicine Department, School of Medicine, University of Miguel Hernández de Elche, Ctra, Nacional N-332 s/n, 03550 San Juan de Alicante, Spain;
- The Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), University Hospital of San Juan de Alicante, Ctra, Nacional N-332 s/n, 03550 San Juan de Alicante, Spain
| | - Domingo Orozco-Beltrán
- Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), 03550 San Juan de Alicante, Spain; (D.O.-B.); (J.A.Q.); (C.C.-M.)
- Clinical Medicine Department, School of Medicine, University of Miguel Hernández de Elche, Ctra, Nacional N-332 s/n, 03550 San Juan de Alicante, Spain;
- The Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), University Hospital of San Juan de Alicante, Ctra, Nacional N-332 s/n, 03550 San Juan de Alicante, Spain
| | - Adriana López-Pineda
- Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), 03550 San Juan de Alicante, Spain; (D.O.-B.); (J.A.Q.); (C.C.-M.)
- Clinical Medicine Department, School of Medicine, University of Miguel Hernández de Elche, Ctra, Nacional N-332 s/n, 03550 San Juan de Alicante, Spain;
- The Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), University Hospital of San Juan de Alicante, Ctra, Nacional N-332 s/n, 03550 San Juan de Alicante, Spain
| | - María Isabel Tomás-Rodríguez
- Pathology and Surgery Department, School of Medicine, University of Miguel Hernández de Elche, Ctra, Nacional N-332 s/n, 03550 Alicante, Spain;
| | - Vicente F. Gil-Guillén
- Institute of Health and Biomedical Research of Alicante, General University Hospital of Alicante, Diagnostic Center, Fifth Floor, Pintor Baeza Street, 12, 03110 Alicante, Spain; (R.N.-G.); (V.F.G.-G.)
- Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), 03550 San Juan de Alicante, Spain; (D.O.-B.); (J.A.Q.); (C.C.-M.)
- Clinical Medicine Department, School of Medicine, University of Miguel Hernández de Elche, Ctra, Nacional N-332 s/n, 03550 San Juan de Alicante, Spain;
| | - José A. Quesada
- Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), 03550 San Juan de Alicante, Spain; (D.O.-B.); (J.A.Q.); (C.C.-M.)
- Clinical Medicine Department, School of Medicine, University of Miguel Hernández de Elche, Ctra, Nacional N-332 s/n, 03550 San Juan de Alicante, Spain;
| | - Concepción Carratalá-Munuera
- Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), 03550 San Juan de Alicante, Spain; (D.O.-B.); (J.A.Q.); (C.C.-M.)
- Clinical Medicine Department, School of Medicine, University of Miguel Hernández de Elche, Ctra, Nacional N-332 s/n, 03550 San Juan de Alicante, Spain;
| |
Collapse
|
|
8
|
Kassay A, Soliman MAR, Jhawar BS. Recommendations for inversion table therapy. Disabil Rehabil 2023; 45:3779-3782. [PMID: 36444821 DOI: 10.1080/09638288.2022.2133174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 09/28/2022] [Accepted: 10/02/2022] [Indexed: 11/30/2022]
Abstract
In the USA, low back pain related illness accounts for approximately 149 million workdays lost each year. Initial management of back pain typically involves allied healthcare professionals who implement various treatments, such as chiropractic manipulation, physiotherapy, and acupuncture which have varying outcomes and levels of supporting evidence. Another passive treatment for back pain is inversion table therapy (ITT). It is a form of spinal traction which is thought to have a role in relieving low back pain due to the gravity-facilitated traction of the spine which distracts the lumbar vertebrae. However, ITT is not without risk. According to the Food and Drug Administration (FDA) Medical Device Reporting Events Database, ITT has resulted in serious injuries including spinal cord injury, fractures, lacerations, and death. The FDA has regulated ITT for only manufacturers that indicated medical use; however, most manufacturers have not made such medical claims and were exempt from FDA regulation. This article discusses the risks of ITT, the current regulatory process for ITT, and the need for a better understanding of the role of ITT in the treatment of spinal pain while optimizing consumer safety.Implications for rehabilitationInversion table therapy (ITT) is a form of spinal traction which is thought to have a role in relieving low back pain due to the gravity-facilitated traction of the spine which distracts the lumbar vertebrae.According to the Food and Drug Administration (FDA) statistics, injuries due to non-powered traction from various medical devices have been rising since 2011.The FDA has regulated ITT for only manufacturers that indicated medical use; however, most manufacturers have not made such medical claims and were exempt from FDA regulation.This article discusses the risks of ITT, the current regulatory process for ITT, and the need for a better understanding of the role of ITT in the treatment of spinal pain while optimizing consumer safety.
Collapse
Affiliation(s)
- Andrea Kassay
- Department of Neurosurgery, Western University, Windsor, Canada
| | - Mohamed A R Soliman
- Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, NY, USA
| | - Balraj S Jhawar
- Department of Neurosurgery, Western University, Windsor, Canada
| |
Collapse
|
|
9
|
Barbosa JC, Comachio J, Marques AP, Saragiotto BT, Magalhaes MO. Effect of a telerehabilitation exercise program versus a digital booklet with self-care for patients with chronic non-specific neck pain: a protocol of a randomized controlled trial assessor-blinded, 3 months follow-up. Trials 2023; 24:616. [PMID: 37770963 PMCID: PMC10537532 DOI: 10.1186/s13063-023-07651-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 09/13/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Neck pain is the fourth worldwide leading cause of disability and represents 22% of musculoskeletal disorders. Conservative intervention has been strongly recommended to treat chronic neck pain and Telerehabilitation is the alternative for the treatment of musculoskeletal conditions. There is a lack of high-quality research on the effects of telerehabilitation in patients with neck pain and functional disability. Therefore, this study aims to evaluate the effect of a telerehabilitation exercise program versus a digital booklet only with self-care information in individuals with non-specific chronic neck pain. METHODS This is a prospectively registered, assessor-blinded, two-arm randomized controlled trial comparing a telerehabilitation exercise program versus a digital booklet with self-care information. Seventy patients will be recruited with non-specific chronic neck pain. Follow-ups will be conducted post-treatment, 6 weeks, and 3 months after randomization. The primary outcome will be disability at post-treatment (6 weeks) measured using neck pain disability. Secondary outcomes will be pain intensity levels, global perceived effect, self-efficacy, quality of life, kinesiophobia, and adherence to treatment. In our hypothesis, patients allocated to the intervention group experience outcomes that are similar to those of those assigned to the self-care digital booklet. Our hypothesis can then be approved or disapproved based on the results of the study. DISCUSSION This randomized clinical trial will provide reliable information on the use of telerehabilitation to treat patients with chronic non-specific neck pain. TRIAL REGISTRATION The study was prospectively registered at the Brazilian Registry of Clinical Trials (number: RBR-10h7khvk). Registered on 16 September 2022.
Collapse
Affiliation(s)
- Juliene Corrêa Barbosa
- Master's Program in Human Movement Sciences, Federal University of Pará, Belém-Pará, 66050-160, Brazil
| | - Josielli Comachio
- School of Health Sciences, Faculty of Medicine and Health, Sydney Musculoskeletal HealthCharles Perkins CentreUniversity of Sydney, Sydney, NSW, 2009, Australia
| | - Amelia Pasqual Marques
- Department of Physiotherapy, Speech-Language Pathology and Audiology and Occupational Therapy, Faculty of Medicine, University of São Paulo, Rehabilitation Sciences Program, São Paulo, 05360-160, Brazil
| | - Bruno Tirotti Saragiotto
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São, Paulo, São Paulo, 03071-000, Brazil
- Discipline of Physiotherapy, Graduate School of Health, University of Technology, Sydney, Sydney, Australia
| | | |
Collapse
|
|
10
|
Remotti E, Nduaguba C, Woolley PA, Ricciardelli R, Phung A, Kim R, Urits I, Kaye AD, Hasoon J, Simopoulos T, Yazdi C, Robinson CL. Review: Discogenic Back Pain: Update on Treatment. Orthop Rev (Pavia) 2023; 15:84649. [PMID: 37641793 PMCID: PMC10460631 DOI: 10.52965/001c.84649] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
Purpose of Review Lower back pain (LBP) has a lifetime prevalence of 80% in the United States population. Discogenic back pain (DBP), a subcategory of LBP, occurs as a result of the interverbal disc degeneration without disc herniation. Diagnosis relies on history, physical exam, and imaging such as MRI, provocative discography, or CT discography. Recent Findings Treatment of DBP involves a multifaceted approach with an emphasis on conservative measures including behavioral modification, pharmacologic management, and other non-pharmacologic interventions with invasive therapy reserved for select patients. Due to the paucity of data on the treatment of DBP, treatment also relies on data derived from treatment of chronic LBP (CLBP). Summary Despite the scarcity of data for the treatment of DBP, treatments do exist with varying efficacy for DBP. Novel techniques such as the use of biologics may provide another avenue for treatment though further studies are needed to better evaluate the most efficacious regimen for both novel and existing treatments.
Collapse
Affiliation(s)
- Edgar Remotti
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Chinoso Nduaguba
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Parker A Woolley
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Ryan Ricciardelli
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Anh Phung
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Rosa Kim
- Georgetown University Hospital, Department of General Surgery, Medstar, Washington, DC
| | | | - Alan David Kaye
- Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA
| | - Jamal Hasoon
- UTHealth McGovern Medical School, Department of Anesthesiology, Critical Care and Pain Medicine, Houston, TX
| | - Thomas Simopoulos
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Cyrus Yazdi
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Christopher L Robinson
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| |
Collapse
|
|
11
|
Joujon-Roche R, Dave P, Tretiakov P, Mcfarland K, Mir J, Williamson TK, Imbo B, Krol O, Lebovic J, Schoenfeld AJ, Vira S, Passias PG. Surgical costs in adult cervical Deformity: Do higher cost surgeries lead to better Outcomes? J Clin Neurosci 2023; 113:126-129. [PMID: 37267875 DOI: 10.1016/j.jocn.2023.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 04/06/2023] [Accepted: 04/22/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND As our focus on delivering cost effective healthcare increases, interventions like cervical deformity surgery, which are associated with high resource utilization, have received greater scrutiny. The purpose of this study was to assess relationship between surgical costs, deformity correction, and patient reported outcomes in ACD surgery. METHODS ACD Patients ≥ 18 years with baseline (BL) and 2-year (2Y) data were included. Cost of surgery was calculated by applying average Medicare reimbursement rates by CPT code to surgical details of each patient in the cohort. CPT codes for corpectomy, ACDF, osteotomy, decompression, levels fused, and instrumentation were considered in the analysis. Costs of complications and reoperations were intentionally excluded from the cost analysis. Patients were ranked into two groups by surgical cost: lowest cost (LC) and highest cost (HC). ANCOVA assessed differences in outcomes while accounting for covariates as appropriate. RESULTS 113 met inclusion criteria. While mean age, frailty, BMI and gender composition were similar between cost groups, mean CCI was significantly higher in the HC group compared to that of the LC group (p=.014). At baseline, LC and HC groups had similar HRQLs and radiographic deformity (all p >.05). Logistic regression accounting for baseline age, deformity and CCI found that HC patients had significantly lower odds of undergoing reoperation within 2-years (OR: 0.309, 95 % CI: 0.193 - 0.493, p <.001). Furthermore, logistic regression accounting for baseline age, deformity and CCI found odds of DJF were significantly lower for those in the HC group (OR: 0.163, 95 % CI: 0.083 - 0.323, p <.001). At 2-years, logistic regression accounting for age and baseline TS-CL found HC patients still had significantly higher odds of reaching a "0″ TS-CL modifier at 2-years (OR: 3.353, 95 % CI: 1.081 - 10.402, p=.036). Logistic regression accounting for age and baseline NDI score found HC patients had significantly higher odds of reaching MCID in NDI at 2-years (OR: 4.477, 95 % CI: 1.507 - 13.297, p=.007). A similar logistic regression accounting for age and baseline mJOA score found odds of reaching MCID in mJOA significantly higher for high-cost patients (OR: 2.942, 95 % CI: 1.101 - 7.864, p=.031). CONCLUSIONS While patient presentation influences surgical planning and costs, this study attempted to control for such variations to assess impact of surgical costs on outcomes. Despite continued scrutiny over healthcare costs, we found that more costly surgical interventions can produce superior radiographic alignment as well as patient reported outcomes for patients with cervical deformity.
Collapse
Affiliation(s)
- Rachel Joujon-Roche
- Department of Orthopaedics. NYU Langone Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Pooja Dave
- Department of Orthopaedics. NYU Langone Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Peter Tretiakov
- Department of Orthopaedics. NYU Langone Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Kimberly Mcfarland
- Department of Orthopaedics. NYU Langone Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Jamshaid Mir
- Department of Orthopaedics. NYU Langone Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Tyler K Williamson
- Department of Orthopaedics. NYU Langone Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Bailey Imbo
- Department of Orthopaedics. NYU Langone Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Oscar Krol
- Department of Orthopaedics. NYU Langone Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Jordan Lebovic
- Department of Orthopaedics. NYU Langone Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Shaleen Vira
- Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Peter G Passias
- Department of Orthopaedics. NYU Langone Medical Center-Orthopaedic Hospital, New York, NY, USA.
| |
Collapse
|
|
12
|
Lambrechts MJ, Pitchford C, Hogan D, Li J, Fogarty C, Rawat S, Leary EV, Cook JL, Choma TJ. Lumbar spine intervertebral disc desiccation is associated with medical comorbidities linked to systemic inflammation. Arch Orthop Trauma Surg 2023; 143:1143-1153. [PMID: 34623492 DOI: 10.1007/s00402-021-04194-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 09/24/2021] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Symptomatic disc degeneration is a common cause of low back pain. Recently, the prevalence of low back pain has swiftly risen leading to increased patient disability and loss of work. The increase in back pain also coincides with a rapid rise in patient medical comorbidities. However, a comprehensive study evaluating a link between patient's medical comorbidities and their influence on lumbar intervertebral disc morphology is lacking in the literature. METHODS Electronic medical records (EMR) were retrospectively reviewed to determine patient-specific medical characteristics. Magnetic resonance imaging (MRI) was evaluated for lumbar spine intervertebral disc desiccation and height loss according to the Griffith-modified Pfirrmann grading system. Bivariate and multivariable linear regression analyses assessed strength of associations between patient characteristics and lumbar spine Pfirrmann grade severity (Pfirrmann grade of the most affected lumbar spine intervertebral disc) and cumulative grades (summed Pfirrmann grades for all lumbar spine intervertebral discs). RESULTS In total, 605 patients (304 diabetics and 301 non-diabetics) met inclusion criteria. Bivariate analysis identified older age, diabetes, American Society of Anesthesiologists (ASA) class, hypertension, chronic obstructive pulmonary disease (COPD), peripheral vascular disease, and hypothyroidism as being strongly associated with an increasing cumulative Pfirrmann grades. Multivariable models similarly found an association linking increased cumulative Pfirrmann grades with diabetes, hypothyroidism, and hypertension, while additionally identifying non-white race, heart disease, and previous lumbar surgery. Chronic pain, depression, and obstructive sleep apnea (OSA) were associated with increased Pfirrmann grades at the most affected level without an increase in cumulative Pfirrmann scores. Glucose control was not associated with increasing severity or cumulative Pfirrmann scores. CONCLUSION These findings provide specific targets for future studies to elucidate key mechanisms by which patient-specific medical characteristics contribute to the development and progression of lumbar spine disc desiccation and height loss. LEVEL OF EVIDENCE III (retrospective cohort).
Collapse
Affiliation(s)
- Mark J Lambrechts
- Department of Orthopaedic Surgery, Orthopaedic Resident, University Physicians, University of Missouri, Columbia, MO, 65212, USA.
| | - Chase Pitchford
- School of Medicine, University of Missouri, Columbia, MO, USA
| | - Daniel Hogan
- School of Medicine, University of Missouri, Columbia, MO, USA
| | - Jinpu Li
- Department of Orthopaedic Surgery, Orthopaedic Resident, University Physicians, University of Missouri, Columbia, MO, 65212, USA.,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, USA
| | - Casey Fogarty
- Department of Orthopaedic Surgery, Orthopaedic Resident, University Physicians, University of Missouri, Columbia, MO, 65212, USA.,School of Medicine, University of Missouri, Columbia, MO, USA
| | - Sury Rawat
- Department of Orthopaedic Surgery, Orthopaedic Resident, University Physicians, University of Missouri, Columbia, MO, 65212, USA.,School of Medicine, University of Missouri, Columbia, MO, USA
| | - Emily V Leary
- Department of Orthopaedic Surgery, Orthopaedic Resident, University Physicians, University of Missouri, Columbia, MO, 65212, USA.,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, USA
| | - James L Cook
- Department of Orthopaedic Surgery, Orthopaedic Resident, University Physicians, University of Missouri, Columbia, MO, 65212, USA.,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, USA
| | - Theodore J Choma
- Department of Orthopaedic Surgery, Orthopaedic Resident, University Physicians, University of Missouri, Columbia, MO, 65212, USA
| |
Collapse
|
|
13
|
Yedulla NR, Olszewski A, Elhage KG, Makhni MC. Online access to spine care: do institutions advertise themselves as multidisciplinary? JOURNAL OF SPINE SURGERY (HONG KONG) 2022; 8:436-442. [PMID: 36606000 PMCID: PMC9808106 DOI: 10.21037/jss-22-38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 09/07/2022] [Indexed: 11/25/2022]
Abstract
Background The primary aim of our study is to assess the extent to which healthcare systems advertise their spine care programs as multidisciplinary and furthermore clarify whether these institutions accurately reflect this description in their online access to spine care. The secondary aim of our study is to determine what proportion of institutions enable patients to self-schedule appointments online and select providers. Methods Newsweek's 2021 list entitled "Best Hospitals 2021-United States" was utilized to obtain an extensive list of top-rated hospitals in the country. Institutions were considered to be advertising themselves as multidisciplinary if they used this term or similar wording (such as "care encompassing broad range of specialties", "interdisciplinary", "multidisciplinary"). Each institution's website was additionally assessed for the existence of: (I) a standard overview website or multiple individual sites for respective spine-focused divisions (i.e., orthopaedic surgery, neurosurgery, physical medicine and rehabilitation, anesthesiology); (II) online self-scheduling; (III) triage questions prior to requesting appointments; and (IV) selection choice for specific providers. Results In total, 334 institutions were included in analysis, with 66% utilizing multidisciplinary terminology in describing their institution on their website. However, most institutions only had a standard overview website with no separate websites for respective divisions (54%). Institutions described as multidisciplinary were more likely to have a link on a central page to each division (31% vs. 4%, P<0.001). No significant differences were found between institutions described as multidisciplinary and those not described as such when considering triage questions, online self-scheduling, and choice of provider. Conclusions Though the majority of spine care centers are described as multidisciplinary, the patient experience when navigating websites online does not always meet this standard. Further progress in website design, automated triaging, and online scheduling are needed to truly achieve multidisciplinary care.
Collapse
Affiliation(s)
- Nikhil R. Yedulla
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Adam Olszewski
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Kareem G. Elhage
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Melvin C. Makhni
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
|
14
|
Pritchard KT, Baillargeon J, Lee WC, Raji MA, Kuo YF. Trends in the Use of Opioids vs Nonpharmacologic Treatments in Adults With Pain, 2011-2019. JAMA Netw Open 2022; 5:e2240612. [PMID: 36342717 PMCID: PMC9641539 DOI: 10.1001/jamanetworkopen.2022.40612] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
IMPORTANCE Chronic pain prevalence among US adults increased between 2010 and 2019. Yet little is known about trends in the use of prescription opioids and nonpharmacologic alternatives in treating pain. OBJECTIVES To compare annual trends in the use of prescription opioids, nonpharmacologic alternatives, both treatments, and neither treatment; compare estimates for the annual use of acupuncture, chiropractic care, massage therapy, occupational therapy, and physical therapy; and estimate the association between calendar year and pain treatment based on the severity of pain interference. DESIGN, SETTING, AND PARTICIPANTS A serial cross-sectional analysis was conducted using the nationally representative Medical Expenditure Panel Survey to estimate the use of outpatient services by cancer-free adults with chronic or surgical pain between calendar years 2011 and 2019. Data analysis was performed from December 29, 2021, to August 5, 2022. EXPOSURES Calendar year (2011-2019) was the primary exposure. MAIN OUTCOMES AND MEASURES The association between calendar year and mutually exclusive pain treatments (opioid vs nonpharmacologic vs both vs neither treatment) was examined. A secondary outcome was the prevalence of nonpharmacologic treatments (acupuncture, chiropractic care, massage therapy, occupational therapy, and physical therapy). All analyses were stratified by pain type. RESULTS Among the unweighted 46 420 respondents, 9643 (20.4% weighted) received surgery and 36 777 (79.6% weighted) did not. Weighted percentages indicated that 41.7% of the respondents were aged 45 to 64 years and 55.0% were women. There were significant trends in the use of pain treatments after adjusting for demographic factors, socioeconomic status, health conditions, and pain severity. For example, exclusive use of nonpharmacologic treatments increased in 2019 for both cohorts (chronic pain: adjusted odds ratio [aOR], 2.72; 95% CI, 2.30-3.21; surgical pain: aOR, 1.53; 95% CI, 1.13-2.08) compared with 2011. The use of neither treatment decreased in 2019 for both cohorts (chronic pain: aOR, 0.43; 95% CI, 0.37-0.49; surgical pain: aOR, 0.59; 95% CI, 0.46-0.75) compared with 2011. Among nonpharmacologic treatments, chiropractors and physical therapists were the most common licensed healthcare professionals. CONCLUSIONS AND RELEVANCE Among cancer-free adults with pain, the annual prevalence of nonpharmacologic pain treatments increased and the prevalent use of neither opioids nor nonpharmacologic therapy decreased for both chronic and surgical pain cohorts. These findings suggest that, although access to outpatient nonpharmacologic treatments is increasing, more severe pain interference may inhibit this access.
Collapse
Affiliation(s)
- Kevin T. Pritchard
- Department of Nutrition, Metabolism, and Rehabilitation Sciences, School of Public and Population Health, University of Texas Medical Branch, Galveston
| | - Jacques Baillargeon
- Department of Epidemiology, School of Public and Population Health, University of Texas Medical Branch, Galveston
| | - Wei-Chen Lee
- Department of Internal Medicine, University of Texas Medical Branch, Galveston
| | - Mukaila A. Raji
- Department of Internal Medicine, University of Texas Medical Branch, Galveston
| | - Yong-Fang Kuo
- Department of Biostatistics and Data Science, School of Public and Population Health, University of Texas Medical Branch, Galveston
| |
Collapse
|
|
15
|
Jin MC, Jensen M, Zhou Z, Rodrigues A, Ren A, Barros Guinle MI, Veeravagu A, Zygourakis CC, Desai AM, Ratliff JK. Health Care Resource Utilization in Management of Opioid-Naive Patients With Newly Diagnosed Neck Pain. JAMA Netw Open 2022; 5:e2222062. [PMID: 35816312 PMCID: PMC9280399 DOI: 10.1001/jamanetworkopen.2022.22062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Research has uncovered heterogeneity and inefficiencies in the management of idiopathic low back pain, but few studies have examined longitudinal care patterns following newly diagnosed neck pain. OBJECTIVE To understand health care utilization in patients with new-onset idiopathic neck pain. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used nationally sourced longitudinal data from the IBM Watson Health MarketScan claims database (2007-2016). Participants included adult patients with newly diagnosed neck pain, no recent opioid use, and at least 1 year of continuous postdiagnosis follow-up. Exclusion criteria included prior or concomitant diagnosis of traumatic cervical disc dislocation, vertebral fractures, myelopathy, and/or cancer. Only patients with at least 1 year of prediagnosis lookback were included. Data analysis was performed from January 2021 to January 2022. MAIN OUTCOMES AND MEASURES The primary outcome of interest was 1-year postdiagnosis health care expenditures, including costs, opioid use, and health care service utilization. Early services were those received within 30 days of diagnosis. Multivariable regression models and regression-adjusted statistics were used. RESULTS In total, 679 030 patients (310 665 men [45.6%]) met the inclusion criteria, of whom 7858 (1.2%) underwent surgery within 1 year of diagnosis. The mean (SD) age was 44.62 (14.87) years among nonsurgical patients and 49.69 (9.53) years among surgical patients. Adjusting for demographics and comorbidities, 1-year regression-adjusted health care costs were $24 267.55 per surgical patient and $515.69 per nonsurgical patient. Across all health care services, $95 379 949 was accounted for by nonsurgical patients undergoing early imaging who did not receive any additional conservative therapy or epidural steroid injections, for a mean (SD) of $477.53 ($1375.60) per patient and median (IQR) of $120.60 ($20.70-$452.37) per patient. On average, patients not undergoing surgery, physical therapy, chiropractic manipulative therapy, or epidural steroid injection, who underwent either early advanced imaging (magnetic resonance imaging or computed tomography) or both early advanced and radiographic imaging, accumulated significantly elevated health care costs ($850.69 and $1181.67, respectively). Early conservative therapy was independently associated with 24.8% (95% CI, 23.5%-26.2%) lower health care costs. CONCLUSIONS AND RELEVANCE In this cross-sectional study, early imaging without subsequent intervention was associated with significantly increased health care spending among patients with newly diagnosed idiopathic neck pain. Early conservative therapy was associated with lower costs, even with increased frequency of therapeutic services, and may have reduced long-term care inefficiency.
Collapse
Affiliation(s)
- Michael C Jin
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Michael Jensen
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Zeyi Zhou
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Adrian Rodrigues
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Alexander Ren
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | | | - Anand Veeravagu
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Corinna C Zygourakis
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Atman M Desai
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - John K Ratliff
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
|
16
|
Olufawo MO, Evans SS, Stecher PT, Youkilis SL, Dibble CF, Greenberg JK, Ray WZ, Hamilton BH, Leuthardt EC. Making Meaningful Use of Price Transparency Data: Describing Price Variation of Spine Surgery and Imaging in a Single System. Neurosurgery 2022; 91:e88-e94. [DOI: 10.1227/neu.0000000000002062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 04/26/2022] [Indexed: 11/19/2022] Open
|
|
17
|
Ikwuezunma I, Wang K, Margalit A, Sponseller P, Jain A. Cost-utility Analysis Comparing Bracing Versus Observation for Skeletally Immature Patients with Thoracic Scoliosis. Spine (Phila Pa 1976) 2021; 46:1653-1659. [PMID: 34366411 DOI: 10.1097/brs.0000000000004189] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cost-utility analysis. OBJECTIVE This study aimed to investigate the cost-utility of bracing versus observation in patients with thoracic scoliosis who would be indicated for bracing. SUMMARY OF BACKGROUND DATA There is high-quality evidence that bracing can prevent radiographic progression of spinal curvature in adolescent idiopathic scoliosis (AIS) patients with curves between 25° and 40° and Risser 0 to 2 skeletal maturity index. However, to our knowledge, the cost-utility of bracing in AIS has not been established. METHODS A decision-analysis model comparing bracing versus observation was developed for a hypothetical 10-year old girl (Risser 0, Sanders 3) with a 35° main thoracic curve. We estimated the probability, cost, and quality-adjusted life years (QALY) for each node based on comprehensive review of the literature. Costs were adjusted for inflation based on Consumer Price Index and reported in terms of 2020 real dollars. Incremental net monetary benefit (INMB) was calculated based on a probabilistic sensitivity analysis using Monte Carlo simulations of 1000 hypothetical patients. One-way sensitivity analyses were performed by varying cost, probability, and QALY estimates. RESULTS Our decision-analysis model revealed that bracing was the dominant treatment choice over observation at $50,000/QALY willingness to pay threshold. In simulation analysis of a hypothetical patient cohort, bracing was associated with lower net lifetime costs ($60,377 ± $5,340 with bracing vs. $85,279 ± $4543 with observation) and higher net lifetime QALYs (24.1 ± 2.0 with bracing vs. 23.9 ± 1.8 with observation). Bracing was associated with an INMB of $36,093 (95% confidence interval $18,894-$55,963) over observation over the patient's lifetime. The model was most sensitive to the impact of bracing versus observation on altering the probability of requiring surgery, either as an adolescent or an adult. CONCLUSION Cost-utility analysis supports scoliosis bracing as the preferred choice in management of appropriately indicated AIS patients with thoracic scoliosis.Level of Evidence: 5.
Collapse
Affiliation(s)
- Ijezie Ikwuezunma
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | | | | |
Collapse
|
|
18
|
Williams C, Jerome M, Fausel C, Dodson E, Stemper I, Centeno C. Regenerative Injection Treatments Utilizing Platelet Products and Prolotherapy for Cervical Spine Pain: A Functional Spinal Unit Approach. Cureus 2021; 13:e18608. [PMID: 34659923 PMCID: PMC8500543 DOI: 10.7759/cureus.18608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2021] [Indexed: 11/19/2022] Open
Abstract
Background The increasing burden of musculoskeletal disorders combined with the high utilization of opiates and the relatively limited ability of traditional approaches to satisfactorily address many of these conditions has spurred an increased interest in alternative treatments such as regenerative medicine therapies. Evidence is growing to support the use of regenerative injection treatments, including prolotherapy, platelet-rich plasma (PRP), platelet lysate (PL), and mesenchymal stromal cells. This study aims to offer a proof of concept via a case series of patients with neck pain treated using a functional spinal unit (FSU) model with combination prolotherapy, PRP, and PL injections. Methodology A chart review identified patients with neck pain treated with a combination of cervical injections using concentrated platelets and prolotherapy. Results A total of 14 patients met the inclusion criteria. The average decrease in the Numeric Pain Score was 2.8 (p = 0.002). The mean decrease in the Functional Rating Index was 27.3 (p = 0.004) at 24 months. Two patients had mild adverse reactions. Conclusions This case series demonstrates basic safety and clinically significant improvements in patients treated for neck pain with autologous concentrated platelet products and prolotherapy utilizing an FSU treatment protocol. Additional clinical studies are warranted with a larger patient sample size and longer follow-up periods.
Collapse
Affiliation(s)
- Christopher Williams
- Physical Medicine and Rehabilitation, Interventional Orthopedics and Regenerative Medicine, Interventional Orthopedics of Atlanta, Atlanta, USA
| | - Mairin Jerome
- Physical Medicine and Rehabilitation, Regenerative SportsCare Institute, New York, USA
| | - Chaz Fausel
- Physical Medicine and Rehabilitation, Advanced Regenerative Health, Denver, USA
| | - Ehren Dodson
- Research and Development, Regenexx, LLC, Des Moines, USA
| | - Ian Stemper
- Research and Development, Regenexx, LLC, Des Moines, USA
| | | |
Collapse
|
|
19
|
Gliedt JA, Walker RJ, Lu K, Dawson AZ, Egede LE. The Relationship Between Patient Satisfaction and Healthcare Expenditures in Adults with Spine Related Disorders: An Analysis of the 2008 to 2015 Medical Expenditures Panel Survey (MEPS). Spine (Phila Pa 1976) 2021; 46:1409-1417. [PMID: 33826590 PMCID: PMC8463412 DOI: 10.1097/brs.0000000000004047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVE The aim of this study was to investigate the relationship between patient satisfaction (PS) and healthcare expenditures (HCE) in adults with spine related disorders (SRDs). SUMMARY OF BACKGROUND DATA SRDs are widespread and pose a high cost to society. PS and HCE have yet to be studied in this population. METHODS Fifteen thousand eight hundred fifty adults with SRDs from the Medical Expenditures Panel Survey (MEPS) (2008-2015) were analyzed. The MEPS medical conditions files were used to identify SRDs based on International Classification of Diseases-9 codes. Frequencies and percentages of sample demographics were calculated. HCE was measured as total direct payments for care provided during the survey year. A composite PS score was constructed using a 0 to 10 rating of their healthcare providers combined with the frequency in which patients felt they were listened to, were given understandable explanations, were respected, and were given enough time. Mean unadjusted HCE were calculated for each year and by quartile of PS. A two-part model consisting of a probit model and subsequent generalized linear model with gamma distribution was performed, adjusting for relevant covariates. Margins command was used to calculate incremental estimates of HCE. RESULTS Mean unadjusted HCE increased annually from $7057 (95% confidence interval [CI], $6516, $7597) in 2008 to $9820 (95% CI, $8811, $10,830) in 2015 for adults with SRDs. Adjusting for predisposing factors, individuals in second, third, and fourth quartiles of PS were significantly different from the first quartile. Adjusting for predisposing and enabling factors, only fourth quartile was significantly different from first quartile. After adjusting for predisposing, enabling and need factors, second, third, and fourth quartiles were no longer significantly different from the first quartile. CONCLUSION Expenditures have increased over time in adults with SRDs. PS is significantly associated with expenditures after controlling for predisposing and enabling factors, but not significant after controlling for need factors. Need factors appear to explain the relationship between lower levels of PS and higher HCE in adults with SRDs.Level of Evidence: 2.
Collapse
Affiliation(s)
- Jordan A. Gliedt
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rebekah J. Walker
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kaiwei Lu
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Aprill Z. Dawson
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Leonard E. Egede
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| |
Collapse
|
|
20
|
Santra D, Goswami S, Mandal JK, Basu SK. Low back pain expert systems: Clinical resolution through probabilistic considerations and poset. Artif Intell Med 2021; 120:102163. [PMID: 34629151 DOI: 10.1016/j.artmed.2021.102163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 07/22/2021] [Accepted: 08/31/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Proper diagnosis of Low Back Pain (LBP) is quite challenging in especially the developing countries like India. Though some developed countries prepared guidelines for evaluation of LBP with tests to detect psychological overlay, implementation of the recommendations becomes quite difficult in regular clinical practice, and different specialties of medicine offer different modes of management. Aiming at offering an expert-level diagnosis for the patients having LBP, this paper uses Artificial Intelligence (AI) to derive a clinically justified and highly sensitive LBP resolution technique. MATERIALS AND METHODS The paper considers exhaustive knowledge for different LBP disorders (classified based on different pain generators), which have been represented using lattice structures to ensure completeness, non-redundancy, and optimality in the design of knowledge base. Further the representational enhancement of the knowledge has been done through construction of a hierarchical network, called RuleNet, using the concept of partially-ordered set (poset) with respect to the subset equality (⊆) relation. With implicit incorporation of probability within the knowledge, the RuleNet is used to derive reliable resolution logic along with effective resolution of uncertainties during clinical decision making. RESULTS The proposed methodology has been validated with clinical records of seventy seven LBP patients accessed from the database of ESI Hospital Sealdah, India over a period of one year from 2018 to 2019. Achieving 83% sensitivity of the proposed technique, the pain experts at the hospital find the design clinically satisfactory. The inferred outcomes have also been found to be homogeneous with the actual or original diagnosis. DISCUSSIONS The proposed approach achieves the clinical and computational efficiency by limiting the shortcomings of the existing methodologies for AI-based LBP diagnosis. While computational efficiency (with respect to both time and space complexity) is ensured by inferring clinical decisions through optimal processing of the knowledge items using poset, the clinical acceptability has been ascertained reaching to the most-likely diagnostic outcomes through probabilistic resolution of clinical uncertainties. CONCLUSION The derived resolution technique, when embedded in LBP medical expert systems, would provide a fast, reliable, and affordable healthcare solution for this ailment to a wider range of general population suffering from LBP. The proposed scheme would significantly reduce the controversies and confusion in LBP treatment, and cut down the cost of unnecessary or inappropriate treatment and referral.
Collapse
Affiliation(s)
- Debarpita Santra
- Department of Computer Science and Engineering, Faculty of Engineering, Technology and Management, University of Kalyani, Block C, Nadia, Kalyani, West Bengal PIN - 741245, India.
| | - Subrata Goswami
- ESI Institute of Pain Management, ESI Hospital Sealdah premises, 301/3 Acharya Prafulla Chandra Road, Kolkata, 700009, West Bengal, India
| | - Jyotsna Kumar Mandal
- Department of Computer Science and Engineering, Faculty of Engineering, Technology and Management, University of Kalyani, Block C, Nadia, Kalyani, West Bengal PIN - 741245, India
| | - Swapan Kumar Basu
- Department of Computer Science, Institute of Science, Banaras Hindu University, Varanasi, 221005, Uttar Pradesh, India
| |
Collapse
|
|
21
|
Measuring the Appropriateness of Spinal Manipulation for Chronic Low Back and Chronic Neck Pain in Chiropractic Patients. Spine (Phila Pa 1976) 2021; 46:1344-1353. [PMID: 34517404 PMCID: PMC8438222 DOI: 10.1097/brs.0000000000004009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN RAND/UCLA Appropriateness Method (RUAM) applied to chiropractic manipulation for patients with chronic low-back pain (CLBP) and chronic neck pain (CNP). OBJECTIVE Determine the rate of appropriate care provided by US chiropractors. SUMMARY OF BACKGROUND DATA Spinal manipulation has been shown effective for CLBP and CNP but may not be appropriate for all patients with these conditions. METHODS Ratings of the appropriateness of spinal and cervical manipulation previously developed by two RUAM expert panels were applied to data abstracted from random samples of patient charts from chiropractors in six US regions to determine the appropriateness of manipulation for each patient. RESULTS Of 125 chiropractors sampled, 89 provided charts that could be abstracted. Of the 2128 charts received, 1054 were abstracted. Charts received but not abstracted included 460 that were unusable (e.g., illegible), and 555 did not have CLBP or CNP. Across the abstracted charts 72% had CLBP, 57% had CNP, and 29% had both; 84% of patients with CLBP and 86% with CNP received manipulation. Patients with CLBP who had minor neurologic findings, sciatic nerve irritation, or no joint dysfunction were significantly less likely to receive manipulation. Patients with CNP who had substantial trauma etiology, no joint dysfunction, or no radiographs were significantly less likely to receive manipulation. Most manipulation for CLBP (64%) was appropriate and most manipulation for CNP (93%) was for patients where appropriateness was uncertain or equivocal. The proportions of patients receiving inappropriate manipulation for either condition were low (1%-3%) as were the numbers of patients presenting to these chiropractors for which manipulation was inappropriate. CONCLUSION Chiropractors in this US sample tend to provide manipulation to very few patients with CLBP or CNP for which it is inappropriate. However, more research is needed to determine which patients with CNP benefit from manipulation.Level of Evidence: 4.
Collapse
|
|
22
|
Patient Goal-directed Care in an Orthopaedic Spine Specialty Clinic. J Am Acad Orthop Surg 2021; 29:e880-e887. [PMID: 34106092 DOI: 10.5435/jaaos-d-20-01105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 05/03/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Using health-related goals to direct care could improve quality and reduce cost of medical care; however, the effect of these goals for patients with spinal pathologies is not well understood. The purpose of this study was to describe patient-reported goals by provider type and to evaluate the effect of patient-provider goal awareness on patient satisfaction and treatment pathway. METHODS A pilot program was instituted in which all new or existing patients scheduled with either a single spine surgeon or a nonsurgical spine nurse practitioner were asked to complete a paper survey instrument regarding their goals of care before their visit. The patient goals were then discussed between the provider and the patient. Univariate and multivariate analyses were performed to evaluate relationships between patient goals, provider seen, diagnosis, and treatment recommendations. RESULTS There were 703 respondents to the survey, of whom 416 were included for subgroup analysis. Patient-reported goals varied by provider type. When examining rates of recommended interventions by patient goals, notable differences were observed for 7 of the 13 goal categories. Significant differences in intervention recommendations by provider type existed for physical therapy, medications, MRI, and surgery (all P < 0.001). After controlling for other variables, seeing a surgeon, thoracolumbar pathology, and goals of "return to activity or social events I enjoy," and "learn about spine surgery" were significant independent predictors of recommendation for surgery (all odds ratio > 3 and P < 0.05). This model generated an area under the curve of 0.923 (95% confidence interval, 0.861 to 0.986), indicating outstanding discrimination in predicting recommendation for surgery. Patient satisfaction scores rose from 91.5% to 92.2%, but this difference was not statistically significant (P = 0.782). CONCLUSION Specific patient-reported goals vary by provider type and are associated with specific diagnosis and treatment recommendations. Goal-directed care may improve the design of treatment pathways and the overall patient experience.
Collapse
|
|
23
|
Artificial Intelligence and the Future of Spine Surgery: A Practical Supplement to Modern Spine Care? Clin Spine Surg 2021; 34:216-219. [PMID: 33290325 DOI: 10.1097/bsd.0000000000001119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 11/07/2020] [Indexed: 10/22/2022]
|
|
24
|
The Effects of a Passive Exoskeleton on Human Thermal Responses in Temperate and Cold Environments. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18083889. [PMID: 33917655 PMCID: PMC8067969 DOI: 10.3390/ijerph18083889] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 11/17/2022]
Abstract
The exoskeleton as functional wearable equipment has been increasingly used in working environments. However, the effects of wearing an exoskeleton on human thermal responses are still unknown. In this study, 10 male package handlers were exposed to 10 °C (COLD) and 25 °C (TEMP) ambient temperatures while performing a 10 kg lifting task (LIFTING) and sedentary (REST) both with (EXO) and without the exoskeleton (WEXO). Thermal responses, including the metabolic rate and mean skin temperature (MST), were continuously measured. Thermal comfort, thermal sensation and sweat feeling were also recorded. For LIFTING, metabolic heat production is significant decrease with the exoskeleton support. The MST and thermal sensation significantly increase when wearing the exoskeleton, but thermal discomfort and sweating are only aggravated in TEMP. For REST, MST and thermal sensation are also increased by the exoskeleton, and there is no significant difference in the metabolic rate between EXO and WEXO. The thermal comfort is significantly improved by wearing the exoskeleton only in COLD. The results suggest that the passive exoskeleton increases the local clothing insulation, and the way of wearing reduces the “pumping effect”, which makes a difference in the thermal response between COLD and TEMP. Designers need to develop appropriate usage strategies according to the operative temperature.
Collapse
|
|
25
|
Abstract
STUDY DESIGN Review article. OBJECTIVE A review of the literature evaluating the cost-effectiveness of undergoing adult spinal deformity surgery and potential avenues for reducing costs. METHODS A review of the current literature and synthesis of data to provide an update on the cost effectiveness of undergoing adult spinal deformity surgery. RESULTS Compared with nonoperative management, operative management for adult spinal deformity is associated with improved patient-reported outcomes and quality of life; however, it is associated with significant financial and resource use. CONCLUSION Operative management for adult spinal deformity has been shown to be effective but is associated with significant cost and resource utilization. The optimal operative treatment is highly dependent on the patients' symptomatology and is surgeon dependent. Maximizing preoperative surgical health and minimizing postoperative complications are key measures in reducing the cost and resource utilization of adult spinal deformity surgery. Future studies are needed to evaluate how to optimize the cost-effectiveness.
Collapse
Affiliation(s)
- Anthony M. Alvarado
- University of Kansas Medical Center, Kansas City, KS, USA,Anthony M. Alvarado, Department of Neurosurgery, University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 2021, Kansas City, KS 66160, USA.
| | | | | |
Collapse
|
|
26
|
Sciubba DM, Pennington Z, Ehresman J. Guest Editorial: Predictive Analytics, Calculators and Cost Modeling in Spine Surgery. Global Spine J 2021; 11:4S-6S. [PMID: 33890809 PMCID: PMC8076808 DOI: 10.1177/2192568220977185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Daniel M. Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Zach Pennington
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Jeff Ehresman
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD USA
| |
Collapse
|
|
27
|
Yeung CM, Lightsey HM, Isaac S, Isaac Z, Gilligan CJ, Zaidi H, Ludwig SC, Kang JD, Makhni MC. Improving Spine Models of Care. JBJS Rev 2021; 9:e20.00183. [PMID: 33982981 DOI: 10.2106/jbjs.rvw.20.00183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Caleb M Yeung
- Departments of Orthopaedic Surgery (C.M.Y., H.M.L., J.D.K., and M.C.M.), Physical Medicine and Rehabilitation (S.I. and Z.I.), Anesthesiology (C.J.G.), and Neurosurgery (H.Z.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Harry M Lightsey
- Departments of Orthopaedic Surgery (C.M.Y., H.M.L., J.D.K., and M.C.M.), Physical Medicine and Rehabilitation (S.I. and Z.I.), Anesthesiology (C.J.G.), and Neurosurgery (H.Z.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sean Isaac
- Departments of Orthopaedic Surgery (C.M.Y., H.M.L., J.D.K., and M.C.M.), Physical Medicine and Rehabilitation (S.I. and Z.I.), Anesthesiology (C.J.G.), and Neurosurgery (H.Z.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Zacharia Isaac
- Departments of Orthopaedic Surgery (C.M.Y., H.M.L., J.D.K., and M.C.M.), Physical Medicine and Rehabilitation (S.I. and Z.I.), Anesthesiology (C.J.G.), and Neurosurgery (H.Z.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christopher J Gilligan
- Departments of Orthopaedic Surgery (C.M.Y., H.M.L., J.D.K., and M.C.M.), Physical Medicine and Rehabilitation (S.I. and Z.I.), Anesthesiology (C.J.G.), and Neurosurgery (H.Z.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hasan Zaidi
- Departments of Orthopaedic Surgery (C.M.Y., H.M.L., J.D.K., and M.C.M.), Physical Medicine and Rehabilitation (S.I. and Z.I.), Anesthesiology (C.J.G.), and Neurosurgery (H.Z.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Steven C Ludwig
- Department of Orthopaedic Surgery, University of Maryland Medical System, Baltimore, Maryland
| | - James D Kang
- Departments of Orthopaedic Surgery (C.M.Y., H.M.L., J.D.K., and M.C.M.), Physical Medicine and Rehabilitation (S.I. and Z.I.), Anesthesiology (C.J.G.), and Neurosurgery (H.Z.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Melvin C Makhni
- Departments of Orthopaedic Surgery (C.M.Y., H.M.L., J.D.K., and M.C.M.), Physical Medicine and Rehabilitation (S.I. and Z.I.), Anesthesiology (C.J.G.), and Neurosurgery (H.Z.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
|
28
|
Cher BAY, Yakusheva O, Liu H, Bynum JPW, Davis MA. The Effect of Healthcare Provider Availability on Spine Spending. J Gen Intern Med 2021; 36:654-661. [PMID: 32935308 PMCID: PMC7947080 DOI: 10.1007/s11606-020-06191-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/27/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Spine conditions are costly and a major cause of disability. A growing body of evidence suggests that healthcare utilization and spending are driven by provider availability, which varies geographically and is a topic of healthcare policy debate. OBJECTIVE To estimate the effect of provider availability on spine spending. DESIGN Retrospective cohort study using relocation as a natural experiment. PARTICIPANTS Fee-for-service Medicare beneficiaries over age 65 who relocated to a new hospital referral region between 2010 and 2014. MAIN MEASURES We used generalized linear models to evaluate how changes in per-beneficiary availability of three types of healthcare providers (primary care physicians, spine surgeons, and chiropractors) affected annual per-beneficiary spine spending. We evaluated increases and decreases in provider availability separately. To account for the relative sizes of the provider workforces, we also calculated estimates of the effects of changes in national workforce size on changes in national spine spending. KEY RESULTS The association between provider availability and spending was generally stronger among beneficiaries who experienced a decrease (versus an increase) in availability. Of the three provider groups, spine surgeon availability was most strongly associated with spending. Among beneficiaries who experienced a decrease in availability, a decrease in one spine surgeon per 10,000 beneficiaries was associated with a decrease of $36.97 (95% CI: $12.51, $61.42) in annual spending per beneficiary, versus a decrease of $1.41 (95% CI: $0.73, $2.09) for a decrease in primary care physician availability. However, changes in the national workforce size of primary care physicians were associated with the largest changes in national spine spending. CONCLUSIONS Provider availability affects individual spine spending, with substantial changes observed at the national level. The effect depends on provider type and whether availability increases or decreases. Policymakers should consider how changes in the size of the physician workforce affect healthcare spending.
Collapse
Affiliation(s)
| | - Olga Yakusheva
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA.,Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Haiyin Liu
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Julie P W Bynum
- Department of Internal Medicine, Geriatric and Palliative Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Matthew A Davis
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, USA.,Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
| |
Collapse
|
|
29
|
Coeckelberghs E, Verbeke H, Desomer A, Jonckheer P, Fourney D, Willems P, Coppes M, Rampersaud R, van Hooff M, van den Eede E, Kulik G, de Goumoëns P, Vanhaecht K, Depreitere B. International comparative study of low back pain care pathways and analysis of key interventions. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:1043-1052. [PMID: 33427958 DOI: 10.1007/s00586-020-06675-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 11/20/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Low back pain (LBP) is a major public health problem worldwide. Significant practice variation exists despite guidelines, including strong interventionist focus by some practitioners. Translation of guidelines into pathways as integrated treatment plans is a next step to improve implementation. The goal of the present study was to analyze international examples of LBP pathways in order to identify key interventions as building elements for care pathway for LBP and radicular pain. METHODS International examples of LBP pathways were searched in literature and grey literature. Authors of pathways were invited to fill a questionnaire and to participate in an in-depth telephone interview. Pathways were quantitatively and qualitatively analyzed, to enable the identification of key interventions to serve as pathway building elements. RESULTS Eleven international LBP care pathways were identified. Regional pathways were strongly organized and included significant training efforts for primary care providers and an intermediate level of caregivers in between general practitioners and hospital specialists. Hospital pathways had a focus on multidisciplinary collaboration and stepwise approach trajectories. Key elements common to all pathways included the consecutive screening for red flags, radicular pain and psychosocial risk factors, the emphasis on patient empowerment and self-management, the development of evidence-based consultable protocols, the focus on a multidisciplinary work mode and the monitoring of patient-reported outcome measures. CONCLUSION Essential building elements for the construction of LBP care pathways were identified from a transversal analysis of key interventions in a study of 11 international examples of LBP pathways.
Collapse
Affiliation(s)
| | - Hilde Verbeke
- Leuven Center for Algology and Pain Management, University Hospitals Leuven, Leuven, Belgium
| | - Anja Desomer
- Belgian Health Care Knowledge Centre, Brussels, Belgium
| | | | - Daryl Fourney
- Division of Neurosurgery, Department of Surgery, University of Saskatchewan, Saskatoon, Canada
| | - Paul Willems
- Department of Orthopedic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Maarten Coppes
- Groningen Spine Center, University Medical Center Groningen, Groningen, The Netherlands
| | - Raja Rampersaud
- Department of Surgery, Division of Orthopaedics, University Health Network Toronto, Toronto, Canada
| | | | | | - Gerit Kulik
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Pierre de Goumoëns
- Department of Rheumatology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, KULeuven, Leuven, Belgium
| | - Bart Depreitere
- Neurosurgery, University Hospital Leuven, Herestraat 49, 3000, Leuven, Belgium.
| |
Collapse
|
|
30
|
Atchison JW, Tolchin RB, Ross BS, Eubanks JE. Manipulation, Traction, and Massage. BRADDOM'S PHYSICAL MEDICINE AND REHABILITATION 2021:316-337.e7. [DOI: 10.1016/b978-0-323-62539-5.00016-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
|
|
31
|
Silverman LI, Heaton W, Farhang N, Saxon LH, Dulatova G, Rodriguez-Granrose D, Flanagan F, Foley KT. Perspectives on the Treatment of Lumbar Disc Degeneration: The Value Proposition for a Cell-Based Therapy, Immunomodulatory Properties of Discogenic Cells and the Associated Clinical Evaluation Strategy. Front Surg 2020; 7:554382. [PMID: 33392242 PMCID: PMC7772215 DOI: 10.3389/fsurg.2020.554382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 11/25/2020] [Indexed: 12/12/2022] Open
Abstract
Low back pain (LBP) is a serious medical condition that affects a large percentage of the population worldwide. One cause of LBP is disc degeneration (DD), which is characterized by progressive breakdown of the disc and an inflamed disc environment. Current treatment options for patients with symptomatic DD are limited and are often unsuccessful, so many patients turn to prescription opioids for pain management in a time when opioid usage, addiction, and drug-related deaths are at an all-time high. In this paper, we discuss the etiology of lumbar DD and currently available treatments, as well as the potential for cell therapy to offer a biologic, non-opioid alternative to patients suffering from the condition. Finally, we present an overview of an investigational cell therapy called IDCT (Injectable Discogenic Cell Therapy), which is currently under evaluation in multiple double-blind clinical trials overseen by major regulatory agencies. The active ingredient in IDCT is a novel allogeneic cell population known as Discogenic Cells. These cells, which are derived from intervertebral disc tissue, have been shown to possess both regenerative and immunomodulatory properties. Cell therapies have unique properties that may ultimately lead to decreased pain and improved function, as well as curb the numbers of patients pursuing opioids. Their efficacy is best assessed in rigorous double-blinded and placebo-controlled clinical studies.
Collapse
Affiliation(s)
- Lara Ionescu Silverman
- DiscGenics Inc., Salt Lake City, UT, United States.,Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Will Heaton
- DiscGenics Inc., Salt Lake City, UT, United States
| | | | | | | | | | | | - Kevin T Foley
- DiscGenics Inc., Salt Lake City, UT, United States.,Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, United States.,Semmes-Murphey Clinic, Memphis, TN, United States
| |
Collapse
|
|
32
|
Whedon JM, Bezdjian S, Dennis P, Fischer VA, Russell R. Cost comparison of two approaches to chiropractic care for patients with acute and sub-acute low Back pain care episodes: a cohort study. Chiropr Man Therap 2020; 28:68. [PMID: 33308275 PMCID: PMC7734754 DOI: 10.1186/s12998-020-00356-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 11/23/2020] [Indexed: 12/29/2022] Open
Abstract
Background Low back pain (LBP) imposes a costly burden upon patients, healthcare insurers, and society overall. Spinal manipulation as practiced by chiropractors has been found be cost-effective for treatment of LBP, but there is wide variation among chiropractors in their approach to clinical care, and the most cost-effective approach to chiropractic care is uncertain. To date, little has been published regarding the cost effectiveness of different approaches to chiropractic care. Thus, the current study presents a cost comparison between chiropractic approaches for patients with acute or subacute care episodes for low back pain. Methods We employed a retrospective cohort design to examine costs of chiropractic care among patients diagnosed with acute or subacute low back pain. The study time period ranged between 07/01/2016 and 12/22/2017. We compared cost outcomes for patients of two cohorts of chiropractors within health care system: Cohort 1) a general network of providers, and Cohort 2) a network providing conservative evidence-based care for rapid resolution of pain. We used generalized linear regression modeling to estimate the comparative influence of demographic and clinical factors on expenditures. Results A total of 25,621 unique patients were included in the analyses. The average cost per patient for Cohort 2 (mean allowed amount $252) was lower compared to Cohort 1 (mean allowed amount $326; 0.77, 95% CI 0.75–0.79, p < .001). Patient and clinician related factors such as health plan, provider region, and sex also significantly influenced costs. Conclusions This study comprehensively analyzed cost data associated with the chiropractic care of adults with acute or sub-acute low back pain cared by two cohorts of chiropractic physicians. In general, providers in Cohort 2 were found to be significantly associated with lower costs for patient care as compared to Cohort 1. Utilization of a clinical model characterized by a patient-centered clinic approach and standardized, best-practice clinical protocols may offer lower cost when compared to non-standardized clinical approaches to chiropractic care. Supplementary Information The online version contains supplementary material available at 10.1186/s12998-020-00356-z.
Collapse
Affiliation(s)
- James M Whedon
- Southern California University of Health Sciences, 16200 Amber Valley Drive, Whittier, CA, 90604, USA.
| | - Serena Bezdjian
- Southern California University of Health Sciences, 16200 Amber Valley Drive, Whittier, CA, 90604, USA
| | | | | | - Robb Russell
- Southern California University of Health Sciences, 16200 Amber Valley Drive, Whittier, CA, 90604, USA
| |
Collapse
|
|
33
|
Nicol AL, Adams MCB, Gordon DB, Mirza S, Dickerson D, Mackey S, Edwards D, Hurley RW. AAAPT Diagnostic Criteria for Acute Low Back Pain with and Without Lower Extremity Pain. PAIN MEDICINE (MALDEN, MASS.) 2020; 21:2661-2675. [PMID: 32914195 PMCID: PMC8453619 DOI: 10.1093/pm/pnaa239] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Low back pain is one of the most common reasons for which people visit their doctor. Between 12% and 15% of the US population seek care for spine pain each year, with associated costs exceeding $200 billion. Up to 80% of adults will experience acute low back pain at some point in their lives. This staggering prevalence supports the need for increased research to support tailored clinical care of low back pain. This work proposes a multidimensional conceptual taxonomy. METHODS A multidisciplinary task force of the ACTTION-APS-AAPM Pain Taxonomy (AAAPT) with clinical and research expertise performed a focused review and analysis, applying the AAAPT five-dimensional framework to acute low back pain. RESULTS Application of the AAAPT framework yielded the following: 1) Core Criteria: location, timing, and severity of acute low back pain were defined; 2) Common Features: character and expected trajectories were established in relevant subgroups, and common pain assessment tools were identified; 3) Modulating Factors: biological, psychological, and social factors that modulate interindividual variability were delineated; 4) Impact/Functional Consequences: domains of impact were outlined and defined; 5) Neurobiological Mechanisms: putative mechanisms were specified including nerve injury, inflammation, peripheral and central sensitization, and affective and social processing of acute low back pain. CONCLUSIONS The goal of applying the AAAPT taxonomy to acute low back pain is to improve its assessment through a defined evidence and consensus-driven structure. The criteria proposed will enable more rigorous meta-analyses and promote more generalizable studies of interindividual variation in acute low back pain and its potential underlying mechanisms.
Collapse
Affiliation(s)
- Andrea L Nicol
- Department of Anesthesiology, University of Kansas School of Medicine, Kansas City, Kansas
| | - Meredith C B Adams
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Debra B Gordon
- Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, Washington
| | - Sohail Mirza
- Department of Orthopedic Surgery, Geisel School of Medicine at Dartmouth University, Hanover, New Hampshire
| | - David Dickerson
- Department of Anesthesiology, NorthShore University Health System, Evanston, Illinois
| | - Sean Mackey
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California
| | - David Edwards
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert W Hurley
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston Salem, North Carolina
- Department of Neurobiology and Anatomy, Wake Forest University School of Medicine, Winston Salm, North Carolina, USA
| |
Collapse
|
|
34
|
Mao JZ, Laird PS, Imperato NS, Knepley KD, Khan A, Agyei JO, O'Connor TE, Pollina J, Mullin JP. Utilization, Utility, and Variability in Usage of Adjunctive Hyperbaric Oxygen Therapy in Spinal Management: A Review of the Literature. World Neurosurg 2020; 145:492-499.e2. [PMID: 32889196 DOI: 10.1016/j.wneu.2020.08.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 08/09/2020] [Accepted: 08/10/2020] [Indexed: 11/16/2022]
Abstract
The objective of this review was to understand the clinical utilization, utility, and variability in the usage of adjunctive hyperbaric oxygen therapy (HBOT). Surgical site infection is associated with high morbidity and mortality, increased health care expenditure, and decreased quality of life. With the increasing prevalence of adult spinal deformity and spinal fusion surgery, it is imperative to understand the potential benefits of adjunctive treatments. HBOT is a safe and common procedure indicated to treat various medical conditions. We conducted a literature search across 3 databases for English articles published between December 1, 2019 and December 1, 2000. Thirteen studies were included. HBOT may lessen the duration of antimicrobial therapy and mitigate instrument removal and revision surgery. The current usage indications for HBOT are supported by level III evidence for chronic osteomyelitis and level IV evidence for osteoradionecrosis. However, the same level of evidence exists to support the beneficial use of adjunctive HBOT for noncomplicated spinal infections within 2 months after surgery. When cultured, the most common organisms were Staphylococcus aureus and other low-virulence organisms. The most common treatment protocol consists of 90-minute sessions of 100% Fio2 at 2-3 atmosphere absolute with a mean of 35.3 ± 11.6 sessions for 5.2 ± 1.4 weeks. Adjunctive HBOT should be considered in select high-risk patients. Further improvements in diagnosis and categorization of spinal infections are necessary and will indelibly aid the decision making for the initiation of HBOT.
Collapse
Affiliation(s)
- Jennifer Z Mao
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA; Department of Biomedical Sciences, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Patrick S Laird
- Department of Biomedical Sciences, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Nicholas S Imperato
- Department of Biomedical Sciences, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Kurt D Knepley
- Department of Biomedical Sciences, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Asham Khan
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Justice O Agyei
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Tim E O'Connor
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - John Pollina
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Jeffrey P Mullin
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA.
| |
Collapse
|
|
35
|
A cost utility analysis of treating different adult spinal deformity frailty states. J Clin Neurosci 2020; 80:223-228. [PMID: 33099349 DOI: 10.1016/j.jocn.2020.07.047] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 07/06/2020] [Accepted: 07/19/2020] [Indexed: 11/22/2022]
Abstract
The aim of this study was to investigate the cost utility of treating non-frail versus frail or severely frail adult spinal deformity (ASD) patients. 79 surgical ASD patients >18 years with available frailty and ODI data at baseline and 2-years post-surgery (2Y) were included. Utility data was calculated using the ODI converted to the SF-6D. QALYs utilized a 3% discount rate to account for decline to life expectancy (LE). Costs were calculated using the PearlDiver database. ICER was compared between non-operative (non-op.) and operative (op.) NF and F/SF patients at 2Y and LE. When compared to non-operative ASD, the ICER was $447,943.96 vs. $313,211.01 for NF and F/SF at 2Y, and $68,311.35 vs. $47,764.61 for NF and F/SF at LE. Frail and severely frail patients had lower cost per QALY compared to not frail patients at 2Y and life expectancy, and had lower ICER values when compared to a non-operative cohort of ASD patients. While these results support operative correction of frail and severely frail patients, it is important to note that these patients are often at worse baseline disability, which is closely related to frailty scores, and have more opportunity to improve postoperatively. Furthermore, there may be a threshold of frailty that is not operable due to the risk of severe complications that is not captured by this analysis. While future research should investigate economic outcomes at extended follow up times, these findings support the cost effectiveness of ASD surgery at all frailty states.
Collapse
|
|
36
|
Hu ZL, Li HY, Chang X, Li YY, Liu CH, Gao XX, Zhai Y, Chen YX, Li CQ. Exosomes derived from stem cells as an emerging therapeutic strategy for intervertebral disc degeneration. World J Stem Cells 2020; 12:803-813. [PMID: 32952860 PMCID: PMC7477652 DOI: 10.4252/wjsc.v12.i8.803] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/09/2020] [Accepted: 07/05/2020] [Indexed: 02/06/2023] Open
Abstract
Intervertebral disc (IVD) degenerative diseases are a common problem in the world, and they cause substantial social and economic burdens for people. The current methods for treating IVD degenerative diseases mainly include surgery and conservative treatment, which cannot fundamentally restore the normal structure of the disc. With continuous research on the mechanism of degeneration and the development of regenerative medicine, rapid progress has been made in the field of regenerative medicine regarding the use of stem cell-derived exosomes, which are active biological substances used in intercellular communication, because they show a strong effect in promoting tissue regeneration. The study of exosomes in the field of IVD degeneration has just begun, and many surprising achievements have been made. This paper mainly reviews the biological characteristics of exosomes and highlights the current status of exosomes in the field of IVD degeneration, as well as future developments regarding exosomes.
Collapse
Affiliation(s)
- Zhi-Lei Hu
- Department of Orthopedics, Xinqiao Hospital, Army Military Medical University, Chongqing 400037, China
| | - Hai-Yin Li
- Department of Orthopedics, Xinqiao Hospital, Army Military Medical University, Chongqing 400037, China
| | - Xian Chang
- Department of Orthopedics, Xinqiao Hospital, Army Military Medical University, Chongqing 400037, China
| | - Yue-Yang Li
- Department of Orthopedics, Xinqiao Hospital, Army Military Medical University, Chongqing 400037, China
| | - Chen-Hao Liu
- Department of Orthopedics, Xinqiao Hospital, Army Military Medical University, Chongqing 400037, China
| | - Xiao-Xin Gao
- Department of Orthopedics, Xinqiao Hospital, Army Military Medical University, Chongqing 400037, China
| | - Yu Zhai
- Department of Orthopedics, Xinqiao Hospital, Army Military Medical University, Chongqing 400037, China
| | - Yu-Xuan Chen
- Center of Traumatic Orthopedics, People's Liberation Army 990 Hospital, Xinyang 46400, Henan Province, China
| | - Chang-Qing Li
- Department of Orthopedics, Xinqiao Hospital, Army Military Medical University, Chongqing 400037, China
| |
Collapse
|
|
37
|
Wang SJ, Zhang SB, Yi YY, Xu HW, Wu DS. Estimation of the ideal correction of lumbar lordosis to prevent reoperation for symptomatic adjacent segment disease after lumbar fusion in older people. BMC Musculoskelet Disord 2020; 21:429. [PMID: 32620112 PMCID: PMC7334849 DOI: 10.1186/s12891-020-03463-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/24/2020] [Indexed: 11/16/2022] Open
Abstract
Background Symptomatic adjacent segment disease (ASDis) is a major complication following spinal fusion. Sagittal spinopelvic imbalance may contribute to the development of ASDis. However, the exact ideal correction of lumbar lordosis (LL) is unknown for different ages of people to prevent ASDis. The purpose of this study was to estimate the ideal correction of LL required to prevent symptomatic ASDis requiring revision surgery in patients of various ages, and to determine the radiographic risk factors for ASDis. Methods 468 patients who underwent lumbar fusion between January 2014 and December 2016, were enrolled in the present study. The patients were classified into the ASDis and N-ASD group. These two matched groups were compared regarding surgery-related factors and radiographic features. Multivariate logistic regression analysis was used to evaluate the risk factors for ASDis. Results Sixty-two patients (13.25%) underwent reoperation for ASDis during a mean follow-up duration of 38.07 months. Receiver operating characteristic curve analysis showed that the postoperative LL - preoperative LL (△LL) cutoff value was 11.7°for the development of ASDis. Logistic regression analysis revealed that the risk factors for symptomatic ASDis were a smaller LL angle, △LL > 12°, and PI-LL > 10° (p < 0.05). For patients > 60 years, the incidence of ASDis was higher in patients with a LL correction of ≥10° and a lumbar-pelvic mismatch (PI-LL) of > 20°. Conclusions The significant predictors of the occurrence of ASDis were a smaller LL angle, △LL > 12°, and PI-LL > 10°. However, in patients older than 60 years, the incidence of ASDis after lumbar fusion was higher in those with a LL correction of ≥10° and PI-LL of > 20°. More attention should be paid to patient age and the angle of correction of LL before lumbar fusion.
Collapse
Affiliation(s)
- Shan-Jin Wang
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150# Jimo RD, Pudong New Area, Shanghai, 200120, China
| | - Shu-Bao Zhang
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150# Jimo RD, Pudong New Area, Shanghai, 200120, China
| | - Yu-Yang Yi
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150# Jimo RD, Pudong New Area, Shanghai, 200120, China
| | - Hao-Wei Xu
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150# Jimo RD, Pudong New Area, Shanghai, 200120, China.
| | - De-Sheng Wu
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150# Jimo RD, Pudong New Area, Shanghai, 200120, China
| |
Collapse
|
|
38
|
Barnett PG, Jacobs JC, Jarvik JG, Chou R, Boothroyd D, Lo J, Nevedal A. Assessment of Primary Care Clinician Concordance With Guidelines for Use of Magnetic Resonance Imaging in Patients With Nonspecific Low Back Pain in the Veterans Affairs Health System. JAMA Netw Open 2020; 3:e2010343. [PMID: 32658287 PMCID: PMC7358914 DOI: 10.1001/jamanetworkopen.2020.10343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
IMPORTANCE Magnetic responance imaging (MRI) of the lumbar spine that is not concordant with treatment guidelines for low back pain represents an unnecessary cost for US health plans and may be associated with adverse effects. Use of MRI in the US Department of Veterans Affairs (VA) primary care clinics remains unknown. OBJECTIVE To assess the use of MRI scans during the first 6 weeks (early MRI scans) of episodes of nonspecific low back pain in VA primary care sites and to determine if historical concordance can identify clinicians and sites that are the least concordant with guidelines. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study of electronic health records from 944 VA primary care sites from the 3 years ending in 2016. Data were analyzed between January 2017 and August 2019. Participants were patients with new episodes of nonspecific low back pain and the primary care clinicians responsible for their care. EXPOSURES MRI scans. MAIN OUTCOMES AND MEASURES The proportion of early MRI scans at VA primary care clinics was assessed. Clinician concordance with published guidelines over 2 years was used to select clinicians expected to have low concordance in a third year. RESULTS A total of 1 285 405 new episodes of nonspecific low back pain from 920 547 patients (mean [SD] age, 56.7 [15.8] years; 93.6% men) were attributed to 9098 clinicians (mean [SD] age, 52.1 [10.1] years; 55.7% women). An early MRI scan of the lumbar spine was performed in 31 132 of the episodes (2.42%; 95% CI, 2.40%-2.45%). Historical concordance was better than a random draw in selecting the 10% of clinicians who were subsequently the least concordant with published guidelines. For primary care clinicians, the area under the receiver operating characteristic curve was 0.683 (95% CI, 0.658-0.701). For primary care sites, the area was under this curve was 0.8035 (95% CI, 0.754-0.855). The 10% of clinicians with the least historical concordance were responsible for just 19.2% of the early MRI scans performed in the follow-up year. CONCLUSIONS AND RELEVANCE VA primary care clinics had low rates of use of early MRI scans. A history of low concordance with imaging guidelines was associated with subsequent low concordance but with limited potential to select clinicians most in need of interventions to implement guidelines.
Collapse
Affiliation(s)
- Paul G. Barnett
- Veterans Affairs Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California
| | - Josephine C. Jacobs
- Veterans Affairs Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California
| | - Jeffrey G. Jarvik
- Department of Radiology, University of Washington, Seattle
- Department of Neurological Surgery, University of Washington, Seattle
- Department of Health Services, University of Washington, Seattle
| | - Roger Chou
- Department of Clinical Epidemiology and Medical Informatics, Oregon Health & Science University, Portland
- Department of Medicine, Oregon Health & Science University, Portland
| | - Derek Boothroyd
- Quantitative Research Unit, Stanford University Medical School, Stanford, California
| | - Jeanie Lo
- Veterans Affairs Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California
| | - Andrea Nevedal
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California
| |
Collapse
|
|
39
|
Magel J, Kim J, Fritz JM, Freburger JK. Time Between an Emergency Department Visit and Initiation of Physical Therapist Intervention: Health Care Utilization and Costs. Phys Ther 2020; 100:1782-1792. [PMID: 32478851 PMCID: PMC7530572 DOI: 10.1093/ptj/pzaa100] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 05/26/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The aim of this study was to examine the association between the length of time between an emergency department (ED) visit and the subsequent initiation of physical therapist intervention for low back pain (LBP) on 1-year LBP-related health care utilization (ie, surgery, advanced imaging, injections, long-term opioid use, ED visits) and costs. METHODS This retrospective cohort study focused on individuals who consulted the ED for an initial visit for LBP. Claims from a single statewide, all-payers database were used. LBP-related health care use and costs for the 12 months after the ED visit were extracted. Poisson and general linear models weighted with inverse probability treatment weights were used to compare the outcomes of patients who attended physical therapy early or delayed after the ED visit. RESULTS Compared with the delayed physical therapy group (n = 94), the early physical therapy group (n = 171) had a lower risk of receiving lumbar surgery (relative risk [RR] = 0.47, 95% CI = 0.26-0.86) and advanced imaging (RR = 0.72, 95% CI = 0.55-0.95), and they were less likely to have long-term opioid use (RR = 0.45, 95% CI = 0.28-0.76). The early physical therapy group incurred lower costs (mean = $3,806, 95% CI = $1,998-$4,184) than those in the delayed physical therapy group (mean = $8,689, 95% CI = $4,653-$12,727). CONCLUSION Early physical therapy following an ED visit was associated with a reduced risk of using some types of health care and reduced health care costs in the 12 months following the ED visit. IMPACT STATEMENT The ED is an entry point into the health care system for patients with LBP. Until now, the impact of the length of time between an ED visit and physical therapy for LBP has not been well understood. This study shows that swift initiation of physical therapy following an ED visit for LBP is associated with lower LBP-related health utilization for some important outcomes and lower LBP-related health care costs.
Collapse
Affiliation(s)
- John Magel
- Address all correspondence to Dr Magel at:
| | - Jaewhan Kim
- Department of Physical Therapy and Athletic Training, University of Utah
| | | | - Janet K Freburger
- Department of Physical Therapy, School of Health & Rehabilitation Sciences, University of Pittsburg, Pittsburgh, Pennsylvania
| |
Collapse
|
|
40
|
Zhang JJY, Lee KS. Letter: Cost-Effectiveness Research in Neurosurgery: We Can and We Must. Neurosurgery 2020; 86:E587-E588. [PMID: 32078673 DOI: 10.1093/neuros/nyaa044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- John J Y Zhang
- Yong Loo Lin School of Medicine National University of Singapore Singapore
| | - Keng Siang Lee
- Bristol Medical School Faculty of Health Sciences University of Bristol Bristol, United Kingdom
| |
Collapse
|
|
41
|
Louis CJ, Herrera CNS, Garrity BM, McDonough CM, Cabral H, Saper RB, Kazis LE. Association of Initial Provider Type on Opioid Fills for Individuals With Neck Pain. Arch Phys Med Rehabil 2020; 101:1407-1413. [PMID: 32437688 DOI: 10.1016/j.apmr.2020.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 04/02/2020] [Accepted: 04/07/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine whether the initial care provider for neck pain was associated with opioid use for individuals with neck pain. DESIGN Retrospective cohort study. SETTING Marketscan research databases. PARTICIPANTS Patients (N=427,966) with new-onset neck pain from 2010-2014. MAIN OUTCOME MEASURES Opioid use was defined using retail pharmacy fills. We performed logistic regression analysis to assess the association between initial provider and opioid use. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using bootstrapping logistic models. We performed propensity score matching as a robustness check on our findings. RESULTS Compared to patients with neck pain who saw a primary health care provider, patients with neck pain who initially saw a conservative therapist were 72%-91% less likely to fill an opioid prescription in the first 30 days, and between 41%-87% less likely to continue filling prescriptions for 1 year. People with neck pain who initially saw emergency medicine physicians had the highest odds of opioid use during the first 30 days (OR, 3.58; 95% CI, 3.47-3.69; P<.001). CONCLUSIONS A patient's initial clinical contact for neck pain may be an important opportunity to influence subsequent opioid use. Understanding more about the roles that conservative therapists play in the treatment of neck pain may be key in unlocking new ways to lessen the burden of opioid use in the United States.
Collapse
Affiliation(s)
- Christopher J Louis
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Carolina-Nicole S Herrera
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Brigid M Garrity
- Department of Health Law, Policy, and Management, Health Outcomes Unit, Boston University School of Public Health, Boston, Massachusetts
| | - Christine M McDonough
- Department of Physical Therapy and Orthopedic Surgery, University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Robert B Saper
- Department of Family Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Lewis E Kazis
- Department of Health Law, Policy, and Management, Health Outcomes Unit, Boston University School of Public Health, Boston, Massachusetts.
| |
Collapse
|
|
42
|
Madinei S, Alemi MM, Kim S, Srinivasan D, Nussbaum MA. Biomechanical Evaluation of Passive Back-Support Exoskeletons in a Precision Manual Assembly Task: "Expected" Effects on Trunk Muscle Activity, Perceived Exertion, and Task Performance. HUMAN FACTORS 2020; 62:441-457. [PMID: 31934773 DOI: 10.1177/0018720819890966] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To assess the efficacy of two different passive back-support exoskeleton (BSE) designs, in terms of trunk muscle activity, perceived low-back exertion, and task performance. BACKGROUND BSEs have the potential to be an effective intervention for reducing low-back physical demands, yet little is known about the impacts of different designs in work scenarios requiring varying degrees of symmetric and asymmetric trunk bending during manual assembly tasks. METHOD Eighteen participants (gender balanced) completed lab-based simulations of a precision manual assembly task using a "grooved pegboard." This was done in 26 different conditions (20 unsupported; 6 supported, via a chair), which differed in vertical height, horizontal distance, and orientation. RESULTS Using both BSEs reduced metrics of trunk muscle activity in many task conditions (≤47% reductions when using BackX™ and ≤24% reductions when using Laevo™). Such reductions, though, were more pronounced in the conditions closer to the mid-sagittal plane and differed between the two BSEs tested. Minimal effects on task completion times or ratings of perceived exertion were found for both BSEs. CONCLUSION Our findings suggest that using passive BSEs can be beneficial for quasi-static manual assembly tasks, yet their beneficial effects can be task specific and specific to BSE design approaches. Further work is needed, though, to better characterize this task specificity and to assess the generalizability of different BSE design approaches in terms of physical demands, perceived exertion, and task performance. APPLICATION These results can help guide the choice and application of passive BSE designs for diverse work scenarios involving nonneutral trunk postures.
Collapse
|
|
43
|
Wintermark M, Willis MH, Hom J, Franceschi AM, Fotos JS, Mosher T, Cruciata G, Reuss T, Horton R, Fredericks N, Burleson J, Haines B, Bruno M. Everything Every Radiologist Always Wanted (and Needs) to Know About Clinical Decision Support. J Am Coll Radiol 2020; 17:568-573. [DOI: 10.1016/j.jacr.2020.03.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/26/2019] [Accepted: 03/19/2020] [Indexed: 12/18/2022]
|
|
44
|
Alabdulkarim SA, Farhan AM, Ramadan MZ. Development and Investigation of a Wearable Aid for a Load Carriage Task. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030749. [PMID: 31991625 PMCID: PMC7037516 DOI: 10.3390/ijerph17030749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/16/2020] [Accepted: 01/21/2020] [Indexed: 12/04/2022]
Abstract
Anterior load carriage tasks are common and can lead to musculoskeletal disorders such as lower back pain. The objectives of this study were to develop a wearable carriage aid and examine its effectiveness on physical demands while considering the potential moderating influence of the carried load. The study consisted of two within-subject factors: device and load. For the former, two levels were tested: with and without the device worn. For the latter, two loads were examined: 15 and 30% of each individual’s body mass. Sixteen participants walked on a treadmill for five minutes at a constant speed for each condition. Physical demands were quantified using objective (EMG-based) and subjective (discomfort) measures. Wearing the device reduced static and median anterior deltoid, trapezius, and biceps brachii muscle activations. Increasing the carried load increased most physical demand measures. Two significant Device×Load interactions were observed; for the anterior deltoid and trapezius median activation measures, the influence of increasing load was lower when the device was worn. While slightly increasing perceived discomfort in the lower back, wearing the device reduced shoulder, neck, and hand/wrist discomfort. While the study demonstrated a potential for the device, future work is required under more realistic and diverse testing conditions.
Collapse
|
|
45
|
Garrity BM, McDonough CM, Ameli O, Rothendler JA, Carey KM, Cabral HJ, Stein MD, Saper RB, Kazis LE. Unrestricted Direct Access to Physical Therapist Services Is Associated With Lower Health Care Utilization and Costs in Patients With New-Onset Low Back Pain. Phys Ther 2020; 100:107-115. [PMID: 31665461 DOI: 10.1093/ptj/pzz152] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 05/12/2019] [Accepted: 08/02/2019] [Indexed: 11/14/2022]
Abstract
BACKGROUND Low back pain (LBP) is one of the most prevalent conditions for which patients seek physical therapy in the United States. The American Physical Therapy Association categorizes direct access to physical therapist services into 3 levels: limited, provisional, and unrestricted. OBJECTIVE The objective of this study was to evaluate the association of level of access to physical therapist services with LBP-related health care utilization and costs. DESIGN This was a retrospective cohort study of patients with new-onset LBP between 2008 and 2013; data were from OptumLabs Data Warehouse. METHODS We identified 59,670 individuals who were 18 years old or older, who had new-onset LBP, and who had commercial or Medicare Advantage insurance through a private health plan. We examined 2 samples. The first was health care utilization among individuals who saw a physical therapist first in states with either unrestricted access or provisional access. The second was LBP-related costs among individuals who saw either a physical therapist or a primary care physician first. RESULTS Individuals who saw a physical therapist first in states with provisional access had significantly higher measures of health care utilization within 30 days, including plain imaging and frequency of physician visits, than individuals who saw a physical therapist first in states with unrestricted access. Compared with individuals who saw a primary care physician first, pooled across provisional-access and unrestricted-access states, those who saw a physical therapist first in provisional-access states had 25% higher relative costs at 30 days and 32% higher relative costs at 90 days, whereas those who saw a physical therapist first in unrestricted-access states had 13% lower costs at 30 days and 32% lower costs at 90 days. LIMITATIONS This was a claims-based study with limited information on patient characteristics, including severity and duration of pain. CONCLUSIONS Short-term LBP-related health care utilization and costs were lower for individuals in unrestricted-access states than in provisional-access states.
Collapse
Affiliation(s)
- Brigid M Garrity
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street, Talbot 5 West (532), Boston, MA 02118 (USA)
| | - Christine M McDonough
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Omid Ameli
- Department of Health Law, Policy and Management, Boston University School of Public Health; OptumLabs Visiting Scholar, Cambridge, Massachusetts; and OptumLabs, Cambridge, Massachusetts
| | - James A Rothendler
- Department of Health Law, Policy and Management, Boston University School of Public Health
| | - Kathleen M Carey
- Department of Health Law, Policy and Management, Boston University School of Public Health
| | - Howard J Cabral
- Department of Biostatistics, Boston University School of Public Health
| | - Michael D Stein
- Department of Health Law, Policy and Management, Boston University School of Public Health
| | - Robert B Saper
- Department of Family Medicine, Boston Medical Center, Boston, Massachusetts; and Department of Health Law, Policy and Management, Boston University School of Public Health
| | - Lewis E Kazis
- Department of Health Law, Policy and Management, Boston University School of Public Health
| |
Collapse
|
|
46
|
Lee SW, Shen J, Kim SJ, Chun SY, Kim P, Riaz J, Yoo JW, Hwang J. US Trends of Opioid-use Disorders and Associated Factors Among Hospitalized Patients With Spinal Conditions and Treatment From 2005 to 2014. Spine (Phila Pa 1976) 2020; 45:124-133. [PMID: 31851144 PMCID: PMC6924939 DOI: 10.1097/brs.0000000000003183] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 06/06/2019] [Accepted: 06/17/2019] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Serial cross-sectional study utilizing the National Inpatient Sample (NIS) 2005 to 2014. OBJECTIVE The aim of this study was to examine the trends of opioid-use disorders among hospitalized patients with spinal conditions and treatment and to identify its contributing factors. SUMMARY OF BACKGROUND DATA The opioid is widely used in chronic spinal conditions, and misuse of prescriptions is the main culprit of the opioid crisis. Cannabis, the most commonly utilized illicit drug, has recently been substituted for opioid despite increasing cannabis-use emergency room visits. There is limited information on opioid-use disorders, the association with cannabis, and other contributing factors. METHODS We analyzed the 2005 to 2014 NIS data that identified opioid-use disorders among hospitalized patients with cervical and lumbar spinal conditions and treatment using the International Classification of Disease, Ninth Revision-Clinical Modification codes for opioid abuse, dependence, poisoning, and cervical and lumbar spinal diseases and procedures. The compound annual growth rate (CAGR) was used to quantify trends of opioid-use disorders among hospitalized patients. Multilevel and multivariable regression analyses were performed to determine their contributing factors. RESULTS The number of hospitalizations with spinal conditions and treatment increased from 2005 to 2011, then decreased between 2011 and 2014 with an overall decrease in length of stay, resulting in the CAGR of -1.60% (P < .001). Almost 3% (2.93%, n = 557,423) of hospitalized patients with spinal conditions and treatment were diagnosed as opioid-use disorders and its CAGR was 6.47% (P < .0001). Opioid-use disorders were associated with cannabis-use disorders (odds ratio 1.714), substance use, mental health condition, younger age, white race, male sex, higher household income, and public insurance or uninsured. CONCLUSION This study suggests that opioid-use disorders are increasing among hospitalized patients with spinal conditions and treatment and associated with several demographic, and socioeconomic factors, including cannabis-use disorders. LEVEL OF EVIDENCE 3.
Collapse
Affiliation(s)
- Se Won Lee
- Department of Physical Medicine and Rehabilitation, Mountain View Hospital, Las Vegas, NV
| | - Jay Shen
- Department of Health Care Administration and Policy, School of Public Health, University of Nevada Las Vegas, Las Vegas, NV
| | - Sun Jung Kim
- Department of Health Administration and Management, Soonchunhyang University, Asan, Chungcheongnam-do, Korea
| | - Sung-Youn Chun
- Department of Health Care Administration and Policy, School of Public Health, University of Nevada Las Vegas, Las Vegas, NV
| | - Pearl Kim
- Department of Health Care Administration and Policy, School of Public Health, University of Nevada Las Vegas, Las Vegas, NV
| | - Jahan Riaz
- Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas, NV
| | - Ji Won Yoo
- Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas, NV
| | - Jinwook Hwang
- Department of Health Care Administration and Policy, School of Public Health, University of Nevada Las Vegas, Las Vegas, NV
- Department of Cardiovascular and Thoracic Surgery, Korea University Medical Center, Ansan Hospital, Ansan, Gyeonggi-do, South Korea
| |
Collapse
|
|
47
|
Silverman LI, Dulatova G, Tandeski T, Erickson IE, Lundell B, Toplon D, Wolff T, Howard A, Chintalacharuvu S, Foley KT. In vitro and in vivo evaluation of discogenic cells, an investigational cell therapy for disc degeneration. Spine J 2020; 20:138-149. [PMID: 31442616 DOI: 10.1016/j.spinee.2019.08.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 08/13/2019] [Accepted: 08/14/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND/CONTEXT Disc degeneration (DD) is a significant driver of low back pain and few treatments exist to treat the pain and disability associated with the disease. PURPOSE Our group has developed a method to generate therapeutic discogenic cells as a potential treatment for symptomatic DD. These cells are derived and modified from adult nucleus pulposus cells. In this study, we evaluated the characteristics, mode of action, and in vivo efficacy and safety of these cells prior to human clinical testing. STUDY DESIGN Privately funded in vitro studies and in vivo preclinical models were used in this study. METHODS Discogenic cells generated from different adult human donors were evaluated for surface marker expression profile, matrix deposition and tumorigenic potential. Discogenic cells were then injected subcutaneously into nude mice to assess cell survival and possible extracellular matrix production in vivo. Finally, a rabbit model of DD was used to evaluate the therapeutic potential of discogenic cells after disc injury. RESULTS We found that discogenic cells have a consistent surface marker profile, are multipotent for mesenchymal lineages, and produce extracellular matrix consisting of aggrecan, collagen 1 and collagen 2. Cells did not show abnormal karyotype after culturing and did not form tumor-like aggregates in soft agar. After subcutaneous implantation in a nude mouse model, the human discogenic cells were found to have generated regions rich with extracellular matrix over the course of 4 months, with no signs of tumorigenicity. Intradiscal injection of human discogenic cells in a rabbit model of DD caused an increase in disc height and improvement of tissue architecture relative to control discs or injection of vehicle alone (no cells) with no signs of toxicity. CONCLUSIONS This study demonstrates that intradiscal injection of discogenic cells may be a viable treatment for human degenerative disc disease. The cells produce extracellular matrix that may rebuild the depleting tissue within degenerating discs. Also, the cells do not pose any significant safety concerns. CLINICAL SIGNIFICANCE Human clinical testing of discogenic cells combined with a sodium hyaluronate carrier is ongoing in multiple randomized, controlled, double-blinded studies in the United States (clinicaltrials.gov identifier NCT03347708) and Japan (clinicaltrials.gov identifier NCT03955315).
Collapse
Affiliation(s)
- Lara Ionescu Silverman
- DiscGenics, Inc, 5940 W Harold Gatty Dr, Salt Lake City, UT 84116, USA; Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA.
| | - Galina Dulatova
- DiscGenics, Inc, 5940 W Harold Gatty Dr, Salt Lake City, UT 84116, USA
| | - Terry Tandeski
- DiscGenics, Inc, 5940 W Harold Gatty Dr, Salt Lake City, UT 84116, USA
| | - Isaac E Erickson
- DiscGenics, Inc, 5940 W Harold Gatty Dr, Salt Lake City, UT 84116, USA
| | | | - David Toplon
- WuXi AppTec, 2540 Executive Drive, St. Paul, MN 55120, USA
| | - Tricia Wolff
- Covance Laboratories, 671 S. Meridian Rd, Greenfield, IN, USA
| | - Antwain Howard
- Covance Laboratories, 671 S. Meridian Rd, Greenfield, IN, USA
| | | | - Kevin T Foley
- DiscGenics, Inc, 5940 W Harold Gatty Dr, Salt Lake City, UT 84116, USA; Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA; Semmes-Murphey Clinic, 6325 Humphreys Blvd, Memphis, TN, USA
| |
Collapse
|
|
48
|
Abstract
As exponential expansion of computing capacity converges with unsustainable health care spending, a hopeful opportunity has emerged: the use of artificial intelligence to enhance health care quality and safety. These computer-based algorithms can perform the intricate and extremely complex mathematical operations of classification or regression on immense amounts of data to detect intricate and potentially previously unknown patterns in that data, with the end result of creating predictive models that can be utilized in clinical practice. Such models are designed to distinguish relevant from irrelevant data regarding a particular patient; choose appropriate perioperative care, intervention or surgery; predict cost of care and reimbursement; and predict future outcomes on a variety of anchored measures. If and when one is brought to fruition, an artificial intelligence platform could serve as the first legitimate clinical decision-making tool in spine care, delivering on the value equation while serving as a source for improving physician performance and promoting appropriate, efficient care in this era of financial uncertainty in health care.
Collapse
|
|
49
|
Measuring the performance of patient-specific solutions for minimally invasive transforaminal lumbar interbody fusion surgery. J Clin Neurosci 2019; 71:43-50. [PMID: 31843436 DOI: 10.1016/j.jocn.2019.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 10/07/2019] [Accepted: 11/09/2019] [Indexed: 01/12/2023]
Abstract
Pre-surgical planning using 3D-printed BioModels enables the preparation of a "patient-specific" kit to assist instrumented spinal fusion surgery. This approach has the potential to decrease operating time while also offering logistical benefits and cost savings for healthcare. We report our experience with this method in 129 consecutive patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) over 27 months at a single centre and performed by a single surgeon. Patient imaging and surgical planning software were used to manufacture a 3D-printed patient-specific MIS TLIF kit for each patient consisting of a 1:1 scale spine BioModel, stereotactic K-wire guide, osteotomy guide, and retractors. Pre-selected pedicle screws, rods, and cages were sourced and supplied with the patient-specific kit. Additional implants were available on-shelf to address a size discrepancy between the kit implant and intraoperative measurements. Each BioModel was used pre-operatively for surgical planning, patient consent and education. The BioModel was sterilised for intraoperative reference and navigation purposes. Efficiency measures included operating time (153 ± 44 min), sterile tray usage (14 ± 3), fluoroscopy screening time (57.2 ± 23.7 s), operative waste (19 ± 8 L contaminated, 116 ± 30 L uncontaminated), and median hospital stay (4 days). The pre-selected kit implants exactly matched intraoperative measurements for 597/639 pedicle screws, 249/258 rods, and 46/148 cages. Pedicle screw placement accuracy was 97.8% (625/639) on postoperative CT. Complications included one intraoperative dural tear, no blood products administered, and six reoperations. Our experience demonstrates a viable application of patient-specific 3D-printed solutions and provides a benchmark for studies of efficiency in spinal fusion surgery.
Collapse
|
|
50
|
Herman PM, Lavelle TA, Sorbero ME, Hurwitz EL, Coulter ID. Are Nonpharmacologic Interventions for Chronic Low Back Pain More Cost Effective Than Usual Care? Proof of Concept Results From a Markov Model. Spine (Phila Pa 1976) 2019; 44:1456-1464. [PMID: 31095119 PMCID: PMC6779140 DOI: 10.1097/brs.0000000000003097] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Markov model. OBJECTIVE Examine the 1-year effectiveness and cost-effectiveness (societal and payer perspectives) of adding nonpharmacologic interventions for chronic low back pain (CLBP) to usual care using a decision analytic model-based approach. SUMMARY OF BACKGROUND DATA Treatment guidelines now recommend many safe and effective nonpharmacologic interventions for CLBP. However, little is known regarding their effectiveness in subpopulations (e.g., high-impact chronic pain patients), nor about their cost-effectiveness. METHODS The model included four health states: high-impact chronic pain (substantial activity limitations); no pain; and two others without activity limitations, but with higher (moderate-impact) or lower (low-impact) pain. We estimated intervention-specific transition probabilities for these health states using individual patient-level data from 10 large randomized trials covering 17 nonpharmacologic therapies. The model was run for nine 6-week cycles to approximate a 1-year time horizon. Quality-adjusted life-year weights were based on six-dimensional health state short form scores; healthcare costs were based on 2003 to 2015 Medical Expenditure Panel Survey data; and lost productivity costs used in the societal perspective were based on reported absenteeism. Results were generated for two target populations: (1) a typical baseline mix of patients with CLBP (25% low-impact, 35% moderate-impact, and 40% high-impact chronic pain) and (2) high-impact chronic pain patients. RESULTS From the societal perspective, all but two of the therapies were cost effective (<$50,000/quality-adjusted life-year) for a typical patient mix and most were cost saving. From the payer perspective fewer were cost saving, but the same number was cost-effective. Assuming all patients in the model have high-impact chronic pain increases the effectiveness and cost-effectiveness of most, but not all, therapies indicating that substantial benefits are possible in this subpopulation. CONCLUSION Modeling leverages the evidence produced from clinical trials to provide more information than is available in the published studies. We recommend modeling for all existing studies of nonpharmacologic interventions for CLBP. LEVEL OF EVIDENCE 4.
Collapse
Affiliation(s)
| | - Tara A Lavelle
- Center for the Evaluation of Value and Risk in Health, Institute of Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
- RAND Corporation, Boston, MA
| | | | - Eric L Hurwitz
- Office of Public Health Studies, University of Hawaii, Mānoa, Honolulu, HI
| | | |
Collapse
|