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Buser Z, Meisel HJ, Agarwal N, Wu Y, Jain A, van Hooff M, Alini M, Yoon ST, Wang JC, Santesso N. Development of an International AO Spine Guideline for the Use of Osteobiologics in Anterior Cervical Fusion and Decompression (AO-GO). Global Spine J 2024; 14:14S-23S. [PMID: 38421327 PMCID: PMC10913912 DOI: 10.1177/21925682231201601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
STUDY DESIGN Methodological study for guideline development. OBJECTIVE AO Spine Guideline for Using Osteobiologics (AO-GO) project for spine degenerative pathologies was an international, multidisciplinary collaborative initiative to identify and evaluate evidence on existing use of osteobiologics in Anterior Cervical Fusion and Decompression (ACDF). The aim was to formulate precisely defined, clinically relevant and internationally applicable guidelines ensuring evidence-based, safe and effective use of osteobiologics, considering regional preferences and cost-effectiveness. METHODS Guideline was completed in two phases: Phase 1- evidence synthesis; Phase 2- recommendation development based on the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. In Phase 1, key questions identified by a panel of experts were addressed in a series of systematic reviews of randomized and non-randomized studies. In Phase 2, the GRADE approach was used to formulate a series of recommendations, including expert panel discussions via web calls and face-to-face meetings. DISCUSSION AO-GO aims to bridge an important gap between evidence and use of osteobiologics in spine fusion surgeries. Owing to differences in osteobiologics preparation and functional characteristics, regulatory requirements for approval may vary, therefore it is highly likely that these products enter market without quality clinical trials. With a holistic approach the guideline aims to facilitate evidence-based, patient-oriented decision-making processes in clinical practice, thus stimulating further evidence-based studies regarding osteobiologics usage in spine surgeries. In Phase 3, the guideline will be disseminated and validated using prospectively collected clinical data in a separate effort of the AO Spine Knowledge Forum Degenerative in a global multicenter clinical study.
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Affiliation(s)
- Zorica Buser
- Department of Orthopedic Surgery, Grossman School of Medicine, NYU, NY, USA
| | | | - Neha Agarwal
- Neurosurgery, BG Klinikum Bergmannstrost Halle, Halle, Germany
| | - Yabin Wu
- AO Foundation, Davos, Switzerland
| | - Amit Jain
- Johns Hopkins Medicine, Baltimore, MD, USA
| | - Miranda van Hooff
- Department of Orthopaedic Surgery, Radboudumc, Nijmegen, Netherlands
| | - Mauro Alini
- AO Research Institute, AO Foundation, Davos, Switzerland
| | - Sangwook Tim Yoon
- Orthopedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Jeffrey C Wang
- Department of Orthopedic Surgery, Keck School of Medicine, USC, Los Angeles, CA, USA
| | - Nancy Santesso
- McMaster University Department of Health Research Methods Evidence and Impact, Hamilton, ON, Canada
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Katsos K, Johnson SE, Ibrahim S, Bydon M. Current Applications of Machine Learning for Spinal Cord Tumors. Life (Basel) 2023; 13:life13020520. [PMID: 36836877 PMCID: PMC9962966 DOI: 10.3390/life13020520] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/01/2023] [Accepted: 02/06/2023] [Indexed: 02/16/2023] Open
Abstract
Spinal cord tumors constitute a diverse group of rare neoplasms associated with significant mortality and morbidity that pose unique clinical and surgical challenges. Diagnostic accuracy and outcome prediction are critical for informed decision making and can promote personalized medicine and facilitate optimal patient management. Machine learning has the ability to analyze and combine vast amounts of data, allowing the identification of patterns and the establishment of clinical associations, which can ultimately enhance patient care. Although artificial intelligence techniques have been explored in other areas of spine surgery, such as spinal deformity surgery, precise machine learning models for spinal tumors are lagging behind. Current applications of machine learning in spinal cord tumors include algorithms that improve diagnostic precision by predicting genetic, molecular, and histopathological profiles. Furthermore, artificial intelligence-based systems can assist surgeons with preoperative planning and surgical resection, potentially reducing the risk of recurrence and consequently improving clinical outcomes. Machine learning algorithms promote personalized medicine by enabling prognostication and risk stratification based on accurate predictions of treatment response, survival, and postoperative complications. Despite their promising potential, machine learning models require extensive validation processes and quality assessments to ensure safe and effective translation to clinical practice.
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Affiliation(s)
- Konstantinos Katsos
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55902, USA
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55902, USA
| | - Sarah E. Johnson
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55902, USA
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55902, USA
| | - Sufyan Ibrahim
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55902, USA
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55902, USA
| | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55902, USA
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55902, USA
- Correspondence:
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Haselager P, Schraffenberger H, Thill S, Fischer S, Lanillos P, van de Groes S, van Hooff M. Reflection Machines: Supporting Effective Human Oversight Over Medical Decision Support Systems. Camb Q Healthc Ethics 2023:1-10. [PMID: 36624620 DOI: 10.1017/s0963180122000718] [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: 01/11/2023]
Abstract
Human decisions are increasingly supported by decision support systems (DSS). Humans are required to remain "on the loop," by monitoring and approving/rejecting machine recommendations. However, use of DSS can lead to overreliance on machines, reducing human oversight. This paper proposes "reflection machines" (RM) to increase meaningful human control. An RM provides a medical expert not with suggestions for a decision, but with questions that stimulate reflection about decisions. It can refer to data points or suggest counterarguments that are less compatible with the planned decision. RMs think against the proposed decision in order to increase human resistance against automation complacency. Building on preliminary research, this paper will (1) make a case for deriving a set of design requirements for RMs from EU regulations, (2) suggest a way how RMs could support decision-making, (3) describe the possibility of how a prototype of an RM could apply to the medical domain of chronic low back pain, and (4) highlight the importance of exploring an RM's functionality and the experiences of users working with it.
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Affiliation(s)
- Pim Haselager
- Donders Institute for Brain, Cognition and Behaviour, Department of AI, Radboud University, Nijmegen, The Netherlands
| | | | - Serge Thill
- Donders Institute for Brain, Cognition and Behaviour, Department of AI, Radboud University, Nijmegen, The Netherlands
| | - Simon Fischer
- Donders Institute for Brain, Cognition and Behaviour, Department of AI, Radboud University, Nijmegen, The Netherlands
| | - Pablo Lanillos
- Donders Institute for Brain, Cognition and Behaviour, Department of AI, Radboud University, Nijmegen, The Netherlands
| | | | - Miranda van Hooff
- Health Sciences, Radboud UMC, Nijmegen, The Netherlands
- St Maartenskliniek, Nijmegen, The Netherlands
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Farhadi F, Barnes MR, Sugito HR, Sin JM, Henderson ER, Levy JJ. Applications of artificial intelligence in orthopaedic surgery. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 4:995526. [PMID: 36590152 PMCID: PMC9797865 DOI: 10.3389/fmedt.2022.995526] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
The practice of medicine is rapidly transforming as a result of technological breakthroughs. Artificial intelligence (AI) systems are becoming more and more relevant in medicine and orthopaedic surgery as a result of the nearly exponential growth in computer processing power, cloud based computing, and development, and refining of medical-task specific software algorithms. Because of the extensive role of technologies such as medical imaging that bring high sensitivity, specificity, and positive/negative prognostic value to management of orthopaedic disorders, the field is particularly ripe for the application of machine-based integration of imaging studies, among other applications. Through this review, we seek to promote awareness in the orthopaedics community of the current accomplishments and projected uses of AI and ML as described in the literature. We summarize the current state of the art in the use of ML and AI in five key orthopaedic disciplines: joint reconstruction, spine, orthopaedic oncology, trauma, and sports medicine.
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Affiliation(s)
- Faraz Farhadi
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States,Radiology and Imaging Sciences, National Institutes of Health (NIH), Bethesda, United States,Correspondence: Faraz Farhadi Joshua J. Levy
| | - Matthew R. Barnes
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Harun R. Sugito
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Jessica M. Sin
- Department of Radiology, Dartmouth Health, Lebanon, United States
| | - Eric R. Henderson
- Department of Orthopaedics, Dartmouth Health, Lebanon, United States
| | - Joshua J. Levy
- Department of Pathology and Laboratory Medicine, Dartmouth Health, Lebanon, NH, United States,Correspondence: Faraz Farhadi Joshua J. Levy
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An Evolution Gaining Momentum—The Growing Role of Artificial Intelligence in the Diagnosis and Treatment of Spinal Diseases. Diagnostics (Basel) 2022; 12:diagnostics12040836. [PMID: 35453884 PMCID: PMC9025301 DOI: 10.3390/diagnostics12040836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/23/2022] [Accepted: 03/28/2022] [Indexed: 11/17/2022] Open
Abstract
In recent years, applications using artificial intelligence have been gaining importance in the diagnosis and treatment of spinal diseases. In our review, we describe the basic features of artificial intelligence which are currently applied in the field of spine diagnosis and treatment, and we provide an orientation of the recent technical developments and their applications. Furthermore, we point out the possible limitations and challenges in dealing with such technological advances. Despite the momentary limitations in practical application, artificial intelligence is gaining ground in the field of spine treatment. As an applying physician, it is therefore necessary to engage with it in order to benefit from those advances in the interest of the patient and to prevent these applications being misused by non-medical partners.
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Bronfort G, Maiers M, Schulz C, Leininger B, Westrom K, Angstman G, Evans R. Multidisciplinary integrative care versus chiropractic care for low back pain: a randomized clinical trial. Chiropr Man Therap 2022; 30:10. [PMID: 35232482 PMCID: PMC8886833 DOI: 10.1186/s12998-022-00419-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low back pain (LBP) is influenced by interrelated biological, psychological, and social factors, however current back pain management is largely dominated by one-size fits all unimodal treatments. Team based models with multiple provider types from complementary professional disciplines is one way of integrating therapies to address patients' needs more comprehensively. METHODS This parallel group randomized clinical trial conducted from May 2007 to August 2010 aimed to evaluate the relative clinical effectiveness of 12 weeks of monodisciplinary chiropractic care (CC), versus multidisciplinary integrative care (IC), for adults with sub-acute and chronic LBP. The primary outcome was pain intensity and secondary outcomes were disability, improvement, medication use, quality of life, satisfaction, frequency of symptoms, missed work or reduced activities days, fear avoidance beliefs, self-efficacy, pain coping strategies and kinesiophobia measured at baseline and 4, 12, 26 and 52 weeks. Linear mixed models were used to analyze outcomes. RESULTS 201 participants were enrolled. The largest reductions in pain intensity occurred at the end of treatment and were 43% for CC and 47% for IC. The primary analysis found IC to be significantly superior to CC over the 1-year period (P = 0.02). The long-term profile for pain intensity which included data from weeks 4 through 52, showed a significant advantage of 0.5 for IC over CC (95% CI 0.1 to 0.9; P = 0.02; 0 to 10 scale). The short-term profile (weeks 4 to 12) favored IC by 0.4, but was not statistically significant (95% CI - 0.02 to 0.9; P = 0.06). There was also a significant advantage over the long term for IC in some secondary measures (disability, improvement, satisfaction and low back symptom frequency), but not for others (medication use, quality of life, leg symptom frequency, fear avoidance beliefs, self-efficacy, active pain coping, and kinesiophobia). Importantly, no serious adverse events resulted from either of the interventions. CONCLUSIONS Participants in the IC group tended to have better outcomes than the CC group, however the magnitude of the group differences was relatively small. Given the resources required to successfully implement multidisciplinary integrative care teams, they may not be worthwhile, compared to monodisciplinary approaches like chiropractic care, for treating LBP. Trial registration NCT00567333.
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Affiliation(s)
- Gert Bronfort
- University of Minnesota, Mayo Building C504, 420 Delaware Street SE, Minneapolis, MN, 55455, USA
| | - Michele Maiers
- Northwestern Health Sciences University, 2501 W. 84th Street, Bloomington, MN, 55431, USA
| | - Craig Schulz
- University of Minnesota, Mayo Building C504, 420 Delaware Street SE, Minneapolis, MN, 55455, USA.
| | - Brent Leininger
- University of Minnesota, Mayo Building C504, 420 Delaware Street SE, Minneapolis, MN, 55455, USA
| | - Kristine Westrom
- University of Minnesota, Mayo Building C504, 420 Delaware Street SE, Minneapolis, MN, 55455, USA
| | - Greg Angstman
- St. Elizabeth's Medical Center-Wabasha, 1000 1st Dr NW, Austin, MN, USA
| | - Roni Evans
- University of Minnesota, Mayo Building C504, 420 Delaware Street SE, Minneapolis, MN, 55455, USA
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Roseen EJ, Gerlovin H, Felson DT, Delitto A, Sherman KJ, Saper RB. Which Chronic Low Back Pain Patients Respond Favorably to Yoga, Physical Therapy, and a Self-care Book? Responder Analyses from a Randomized Controlled Trial. PAIN MEDICINE (MALDEN, MASS.) 2021; 22:165-180. [PMID: 32662833 PMCID: PMC7861465 DOI: 10.1093/pm/pnaa153] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To identify baseline characteristics of adults with chronic low back pain (cLBP) that predict response (i.e., a clinically important improvement) and/or modify treatment effect across three nonpharmacologic interventions. DESIGN Secondary analysis of a randomized controlled trial. SETTING Academic safety net hospital and seven federally qualified community health centers. SUBJECTS Adults with cLBP (N = 299). METHODS We report patient characteristics that were predictors of response and/or modified treatment effect across three 12-week treatments: yoga, physical therapy [PT], and a self-care book. Using preselected characteristics, we used logistic regression to identify predictors of "response," defined as a ≥30% improvement in the Roland Morris Disability Questionnaire. Then, using "response" as our outcome, we identified baseline characteristics that were treatment effect modifiers by testing for statistical interaction (P < 0.05) across two comparisons: 1) yoga-or-PT vs self-care and 2) yoga vs PT. RESULTS Overall, 39% (116/299) of participants were responders, with more responders in the yoga-or-PT group (42%) than the self-care (23%) group. There was no difference in proportion responding to yoga (48%) vs PT (37%, odds ratio [OR] = 1.5, 95% confidence interval = 0.88 - 2.6). Predictors of response included having more than a high school education, a higher income, employment, few depressive symptoms, lower perceived stress, few work-related fear avoidance beliefs, high pain self-efficacy, and being a nonsmoker. Effect modifiers included use of pain medication and fear avoidance beliefs related to physical activity (both P = 0.02 for interaction). When comparing yoga or PT with self-care, a greater proportion were responders among those using pain meds (OR = 5.3), which differed from those not taking pain meds (OR = 0.94) at baseline. We also found greater treatment response among those with lower (OR = 7.0), but not high (OR = 1.3), fear avoidance beliefs around physical activity. CONCLUSIONS Our findings revealed important subgroups for whom referral to yoga or PT may improve cLBP outcomes.
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Affiliation(s)
- Eric J Roseen
- Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
- Department of Rehabilitation Science, Massachusetts General Hospital Institute of Health Professions, Boston, Massachusetts, USA
| | - Hanna Gerlovin
- Slone Epidemiology Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - David T Felson
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Anthony Delitto
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Karen J Sherman
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Robert B Saper
- Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
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Bardi F, Bakker M, Kenkhuis MJA, Ranchor AV, Bakker MK, Elvan A, Birnie E, Bilardo CM. Psychological outcomes, knowledge and preferences of pregnant women on first-trimester screening for fetal structural abnormalities: A prospective cohort study. PLoS One 2021; 16:e0245938. [PMID: 33503072 PMCID: PMC7840026 DOI: 10.1371/journal.pone.0245938] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 01/10/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The primary aim of this study is to investigate the impact of a 13-week anomaly scan on the experienced levels of maternal anxiety and well-being. Secondly, to explore women's knowledge on the possibilities and limitations of the scan and the preferred timing of screening for structural abnormalities. MATERIAL AND METHODS In a prospective-cohort study conducted between 2013-2015, pregnant women in the North-Netherlands underwent a 13-week anomaly scan. Four online-questionnaires (Q1, Q2, Q3 and Q4) were completed before and after the 13- and the 20-week anomaly scans. In total, 1512 women consented to participate in the study and 1118 (74%) completed the questionnaires at Q1, 941 (64%) at Q2, 807 (55%) at Q3 and 535 (37%) at Q4. Psychological outcomes were measured by the state-trait inventory-scale (STAI), the patient's positive-negative affect (PANAS) and ad-hoc designed questionnaires. RESULTS Nine-nine percent of women wished to be informed as early as possible in pregnancy about the absence/presence of structural abnormalities. In 87% of women levels of knowledge on the goals and limitations of the 13-week anomaly scan were moderate-to-high. In women with a normal 13-week scan result, anxiety levels decreased (P < .001) and well-being increased over time (P < .001). In women with false-positive results (n = 26), anxiety levels initially increased (STAI-Q1: 39.8 vs. STAI-Q2: 48.6, P = 0.025), but later decreased around the 20-week anomaly scan (STAI-Q3: 36.4 vs. STAI-Q4: 34.2, P = 0.36). CONCLUSIONS The 13-week scan did not negatively impact the psychological well-being of pregnant women. The small number of women with screen-positive results temporarily experienced higher anxiety after the scan but, in false-positive cases, anxiety levels normalized again when the abnormality was not confirmed at follow-up scans. Finally, most pregnant women have moderate-to-high levels of knowledge and strongly prefer early screening for fetal structural abnormalities.
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Affiliation(s)
- Francesca Bardi
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- * E-mail:
| | - Merel Bakker
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Monique J. A. Kenkhuis
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Adelita V. Ranchor
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marian K. Bakker
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ayten Elvan
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Erwin Birnie
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Caterina M. Bilardo
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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Artificial intelligence facilitates decision-making in the treatment of lumbar disc herniations. 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 2020; 30:2176-2184. [PMID: 33048249 DOI: 10.1007/s00586-020-06613-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 09/05/2020] [Accepted: 09/22/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Apart from patients with severe neurological deficits, it is not clear whether surgical or conservative treatment of lumbar disc herniations is superior for the individual patient. We investigated whether deep learning techniques can predict the outcome of patients with lumbar disc herniation after 6 months of treatment. METHODS The data of 60 patients were used to train and test a deep learning algorithm with the aim to achieve an accurate prediction of the ODI 6 months after surgery or the start of conservative therapy. We developed an algorithm that predicts the ODI of 6 randomly selected test patients in tenfold cross-validation. RESULTS A 100% accurate prediction of an ODI range could be achieved by dividing the ODI scale into 12% sections. A maximum absolute difference of only 3.4% between individually predicted and actual ODI after 6 months of a given therapy was achieved with our most powerful model. The application of artificial intelligence as shown in this work also allowed to compare the actual patient values after 6 months with the prediction for the alternative therapy, showing deviations up to 18.8%. CONCLUSION Deep learning in the supervised form applied here can identify patients at an early stage who would benefit from conservative therapy, and on the contrary avoid painful and unnecessary delays for patients who would profit from surgical therapy. In addition, this approach can be used in many other areas of medicine as an effective tool for decision-making when choosing between opposing treatment options, despite small patient groups.
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Maissan F, Pool J, de Raaij E, Wittink H, Ostelo R. Treatment based classification systems for patients with non-specific neck pain. A systematic review. Musculoskelet Sci Pract 2020; 47:102133. [PMID: 32148328 DOI: 10.1016/j.msksp.2020.102133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 02/02/2020] [Accepted: 02/15/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We aimed to identify published classification systems with a targeted treatment approach (treatment-based classification systems (TBCSs)) for patients with non-specific neck pain, and assess their quality and effectiveness. DESIGN Systematic review. DATA SOURCES MEDLINE, CINAHL, EMBASE, PEDro and the grey literature were systematically searched from inception to December 2019. STUDY APPRAISAL AND SYNTHESIS The main selection criterium was a TBCS for patients with non-specific neck pain with physiotherapeutic interventions. For data extraction of descriptive data and quality assessment we used the framework developed by Buchbinder et al. We considered as score of ≤3 as low quality, a score between 3 and 5 as moderate quality and a score ≥5 as good quality. To assess the risk of bias of studies concerning the effectiveness of TBCSs (only randomized clinical trials (RCTs) were included) we used the PEDro scale. We considered a score of ≥ six points on this scale as low risk of bias. RESULTS Out of 7664 initial references we included 13 studies. The overall quality of the TBCSs ranged from low to moderate. We found two RCTs, both with low risk of bias, evaluating the effectiveness of two TBCSs compared to alternative treatments. The results showed that both TBCSs were not superior to alternative treatments. CONCLUSION Existing TBCSs are, at best, of moderate quality. In addition, TBCSs were not shown to be more effective than alternatives. Therefore using these TBCSs in daily practice is not recommended.
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Affiliation(s)
- Francois Maissan
- Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, Utrecht, the Netherlands; Department of Health Sciences, VU University, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, Amsterdam UMC, Amsterdam, Amsterdam Movement Sciences, the Netherlands.
| | - Jan Pool
- Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, Utrecht, the Netherlands
| | - Edwin de Raaij
- Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, Utrecht, the Netherlands; Department of Health Sciences, VU University, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, Amsterdam UMC, Amsterdam, Amsterdam Movement Sciences, the Netherlands
| | - Harriet Wittink
- Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, Utrecht, the Netherlands
| | - Raymond Ostelo
- Department of Health Sciences, VU University, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, Amsterdam UMC, Amsterdam, Amsterdam Movement Sciences, the Netherlands
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Rajendran D, Beazley J, Bright P. Shared decision making by United Kingdom osteopathic students: an observational study using the OPTION-12 instrument. Chiropr Man Therap 2019; 27:42. [PMID: 31516693 PMCID: PMC6727529 DOI: 10.1186/s12998-019-0260-0] [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: 11/06/2018] [Accepted: 05/29/2019] [Indexed: 11/29/2022] Open
Abstract
Background At the crux of patient centred care is Shared Decision Making (SDM), which benefits patient and practitioner. Despite external pressures, studies indicate that SDM remains poorly practised across a variety of healthcare professions. The degree of SDM engagement within United Kingdom osteopathic undergraduate teaching clinics is currently unknown. Methods In 2014 we used the reliable and validated OPTION-12 (O12) instrument to calculate a score that reflected the degree of SDM utility in one United Kingdom Osteopathic Educational Institute’s teaching clinic. We also aimed to compare these scores with those previously obtained for physiotherapists working within the United Kingdom’s National Health Service. Student-patient initial and follow-up encounters were audio recorded, transcribed and scored using the O12. Comparisons between the following O12 scores were performed: the Osteopathic Educational Institute’s 4th and 3rd year students; the Osteopathic Educational Institute’s student’s initial and follow-up patient encounters; the Osteopathic Educational Institute’s students and National Health Service physiotherapists. Results We analysed 35.5 h of transcribed data from 30 student-patient encounters (7 initial: 23 follow-up). An O12 score of 0.6% (range 0–10.4%) was calculated. No significant differences were found between year groups or encounter types. Significant differences were found compared to National Health Service physiotherapist (score = 24.4%): (U = 144, z = 4.25, p < 0.0005); although both scores are below the 60% threshold for competent SDM behaviour. Conclusions Undergraduate osteopaths did not appear to engage in competent SDM behaviours, implying traditional and paternalistic styles of decision making that align with results from other manual therapy professions. Students in this study did not practise competent SDM behaviours. Effective educational strategies are required to ensure SDM behaviours reach competent levels.
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Affiliation(s)
- Dévan Rajendran
- Research Department, European School of Osteopathy, Boxley House, The Street, Boxley, Kent, ME14 3DZ United Kingdom
| | - Jane Beazley
- Research Department, European School of Osteopathy, Boxley House, The Street, Boxley, Kent, ME14 3DZ United Kingdom
| | - Philip Bright
- Research Department, European School of Osteopathy, Boxley House, The Street, Boxley, Kent, ME14 3DZ United Kingdom
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Galbusera F, Casaroli G, Bassani T. Artificial intelligence and machine learning in spine research. JOR Spine 2019; 2:e1044. [PMID: 31463458 PMCID: PMC6686793 DOI: 10.1002/jsp2.1044] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 01/31/2019] [Accepted: 01/31/2019] [Indexed: 12/21/2022] Open
Abstract
Artificial intelligence (AI) and machine learning (ML) techniques are revolutionizing several industrial and research fields like computer vision, autonomous driving, natural language processing, and speech recognition. These novel tools are already having a major impact in radiology, diagnostics, and many other fields in which the availability of automated solution may benefit the accuracy and repeatability of the execution of critical tasks. In this narrative review, we first present a brief description of the various techniques that are being developed nowadays, with special focus on those used in spine research. Then, we describe the applications of AI and ML to problems related to the spine which have been published so far, including the localization of vertebrae and discs in radiological images, image segmentation, computer-aided diagnosis, prediction of clinical outcomes and complications, decision support systems, content-based image retrieval, biomechanics, and motion analysis. Finally, we briefly discuss major ethical issues related to the use of AI in healthcare, namely, accountability, risk of biased decisions as well as data privacy and security, which are nowadays being debated in the scientific community and by regulatory agencies.
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Affiliation(s)
- Fabio Galbusera
- Laboratory of Biological Structures MechanicsIRCCS Istituto Ortopedico GaleazziMilanItaly
| | - Gloria Casaroli
- Laboratory of Biological Structures MechanicsIRCCS Istituto Ortopedico GaleazziMilanItaly
| | - Tito Bassani
- Laboratory of Biological Structures MechanicsIRCCS Istituto Ortopedico GaleazziMilanItaly
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Why wait to address high-risk cases of acute low back pain? A comparison of stepped, stratified, and matched care. Pain 2019; 159:2437-2441. [PMID: 29905653 DOI: 10.1097/j.pain.0000000000001308] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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