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Rajjoub R, Arroyave JS, Zaidat B, Ahmed W, Mejia MR, Tang J, Kim JS, Cho SK. ChatGPT and its Role in the Decision-Making for the Diagnosis and Treatment of Lumbar Spinal Stenosis: A Comparative Analysis and Narrative Review. Global Spine J 2024; 14:998-1017. [PMID: 37560946 PMCID: PMC11192138 DOI: 10.1177/21925682231195783] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2023] Open
Abstract
STUDY DESIGN Comparative Analysis and Narrative Review. OBJECTIVE To assess and compare ChatGPT's responses to the clinical questions and recommendations proposed by The 2011 North American Spine Society (NASS) Clinical Guideline for the Diagnosis and Treatment of Degenerative Lumbar Spinal Stenosis (LSS). We explore the advantages and disadvantages of ChatGPT's responses through an updated literature review on spinal stenosis. METHODS We prompted ChatGPT with questions from the NASS Evidence-based Clinical Guidelines for LSS and compared its generated responses with the recommendations provided by the guidelines. A review of the literature was performed via PubMed, OVID, and Cochrane on the diagnosis and treatment of lumbar spinal stenosis between January 2012 and April 2023. RESULTS 14 questions proposed by the NASS guidelines for LSS were uploaded into ChatGPT and directly compared to the responses offered by NASS. Three questions were on the definition and history of LSS, one on diagnostic tests, seven on non-surgical interventions and three on surgical interventions. The review process found 40 articles that were selected for inclusion that helped corroborate or contradict the responses that were generated by ChatGPT. CONCLUSIONS ChatGPT's responses were similar to findings in the current literature on LSS. These results demonstrate the potential for implementing ChatGPT into the spine surgeon's workplace as a means of supporting the decision-making process for LSS diagnosis and treatment. However, our narrative summary only provides a limited literature review and additional research is needed to standardize our findings as means of validating ChatGPT's use in the clinical space.
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Affiliation(s)
- Rami Rajjoub
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Juan Sebastian Arroyave
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bashar Zaidat
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Wasil Ahmed
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mateo Restrepo Mejia
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Justin Tang
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jun S. Kim
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samuel K. Cho
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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2
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Abstract
An expanding array of image-guided spine interventions have the potential to provide immediate and effective pain relief. Innovations in spine intervention have proceeded rapidly, with clinical adoption of new techniques at times occurring before the development of bodies of evidence to establish efficacy. Although new spine interventions have been evaluated by clinical trials, acceptance of results has been hindered by controversies regarding trial methodology. This article explores controversial aspects of four categories of image-guided interventions for painful conditions: spine interventions for postdural puncture headache resulting from prior lumbar procedures, epidural steroid injections for cervical and lumbar radiculopathy, interventions for facet and sacroiliac joint pain, and vertebral augmentations for compression fractures. For each intervention, we summarize the available literature, with an emphasis on persistent controversies, and discuss how current areas of disagreement and challenge may shape future research and innovation. Despite the ongoing areas of debate regarding various aspects of these procedures, effective treatments continue to emerge and show promise for aiding relief of a range of debilitating conditions.
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3
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Curatolo M, Rundell SD, Gold LS, Suri P, Friedly JL, Nedeljkovic SS, Deyo RA, Turner JA, Bresnahan BW, Avins AL, Kessler L, Heagerty PJ, Jarvik JG. Long-term effectiveness of epidural steroid injections after new episodes of low back pain in older adults. Eur J Pain 2022; 26:1469-1480. [PMID: 35604636 PMCID: PMC9296573 DOI: 10.1002/ejp.1975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/21/2022] [Accepted: 05/14/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is limited research on the long-term effectiveness of epidural steroid injections (ESI) in older adults despite the high prevalence of back and leg pain in this age group. We tested the hypotheses that older adults undergoing ESI, compared to patients not receiving ESI: 1) have worse pain, disability and quality of life ("outcomes") pre-ESI, 2) have improved outcomes after ESI, and 3) have improved outcomes due to a specific ESI effect. METHODS We prospectively studied patients ≥65 years old presenting to primary care with new episodes of back pain in three US healthcare systems (BOLD registry). Outcomes were leg and back pain intensity, disability and quality of life, assessed at baseline and 3-, 6-, 12- and 24-month follow-ups. We categorized participants as: 1) ESI within 6 months from the index visit (n=295); 2) no ESI within 6 months (n=4,809); 3) no ESI within 6 months, propensity-score matched to group 1 (n=483). We analyzed the data using linear regression and Generalized Estimating Equations. RESULTS Pain intensity, disability and quality of life at baseline were significantly worse at baseline in ESI patients (group 1) than in group 2. The improvement from baseline to 24 months in all outcomes was statistically significant for group 1. However, no statistically significant differences were observed between outcome trajectories for the propensity-score matched groups 1 and 3. CONCLUSIONS Older adults treated with ESI have long-term improvement. However, the improvement is unlikely the result of a specific ESI effect.
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Affiliation(s)
- M Curatolo
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA.,The University of Washington Clinical Learning, , Evidence and Research (CLEAR) Center for Musculoskeletal Disorders
| | - S D Rundell
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA.,Department of Neurological Surgery, University of Washington, Seattle, WA.,The University of Washington Clinical Learning, , Evidence and Research (CLEAR) Center for Musculoskeletal Disorders
| | - L S Gold
- Department of Radiology, University of Washington, Seattle, WA.,The University of Washington Clinical Learning, , Evidence and Research (CLEAR) Center for Musculoskeletal Disorders
| | - P Suri
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA.,The University of Washington Clinical Learning, , Evidence and Research (CLEAR) Center for Musculoskeletal Disorders
| | - J L Friedly
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA.,The University of Washington Clinical Learning, , Evidence and Research (CLEAR) Center for Musculoskeletal Disorders
| | - S S Nedeljkovic
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, and Spine Unit, Harvard Vanguard Medical Associates, Boston, MA
| | - R A Deyo
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA.,The University of Washington Clinical Learning, , Evidence and Research (CLEAR) Center for Musculoskeletal Disorders
| | - J A Turner
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA.,The University of Washington Clinical Learning, , Evidence and Research (CLEAR) Center for Musculoskeletal Disorders
| | - B W Bresnahan
- Department of Radiology, University of Washington, Seattle, WA.,The University of Washington Clinical Learning, , Evidence and Research (CLEAR) Center for Musculoskeletal Disorders
| | - A L Avins
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - L Kessler
- Department of Health Systems and Population Health, University of Washington, Seattle, WA.,The University of Washington Clinical Learning, , Evidence and Research (CLEAR) Center for Musculoskeletal Disorders
| | - P J Heagerty
- Department of Family Medicine, Oregon Health and Science University, Portland, OR.,The University of Washington Clinical Learning, , Evidence and Research (CLEAR) Center for Musculoskeletal Disorders
| | - J G Jarvik
- Department of Radiology, University of Washington, Seattle, WA.,Department of Neurological Surgery, University of Washington, Seattle, WA.,The University of Washington Clinical Learning, , Evidence and Research (CLEAR) Center for Musculoskeletal Disorders
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4
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Trivedi M, Mathew J. Interventional Treatments for Cancer Pain. Cancer Treat Res 2021; 182:175-201. [PMID: 34542883 DOI: 10.1007/978-3-030-81526-4_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Interventional pain management is a subspecialty of medicine devoted to the use of invasive techniques such as joint injections, nerve blocks/or neurolysis, neuromodulation, and epidural and selective nerve blocks to provide diagnosis and treatment of pain syndromes unresponsive to conventional medical management.
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Affiliation(s)
- Manisha Trivedi
- Division of Interventional Pain Management, Department of Supportive Care Medicine, City of Hope National Medical Center, 1500 E Duarte Rd, Duarte, CA, 91010, USA.
| | - Jaisha Mathew
- Division of Interventional Pain Management, Department of Supportive Care Medicine, City of Hope National Medical Center, 1500 E Duarte Rd, Duarte, CA, 91010, USA
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5
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Analysis of Subdural Injection During Lumbar Interlaminar Epidural Injection in Failed Back Surgery Syndrome. J Clin Med 2020; 9:jcm9103132. [PMID: 32998267 PMCID: PMC7599714 DOI: 10.3390/jcm9103132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 09/02/2020] [Accepted: 09/22/2020] [Indexed: 11/16/2022] Open
Abstract
Persistent or recurrent back and leg pain following spinal surgery, known as failed back surgery syndrome (FBSS), significantly limits daily life activities. A lumbar epidural injection can reduce adhesions, inflammation, and nerve compression, although the epidural space can be distorted due to dura mater and epidural tissues changes after spinal surgery. This study analyzed subdural injection during lumbar epidural injection in FBSS patients. We retrospectively analyzed data from 155 patients who received a lumbar interlaminar epidural injection to manage FBSS. We grouped the patients based on the injected contrast medium appearance in the subdural (group S) or epidural spaces (group E) in fluoroscopic contrast images. Demographic, clinical, surgical and fluoroscopic data were recorded and evaluated, as were the pain scores before and after injection. There were 59 patients (38.1%) in the subdural group. Injection distance from the surgery level differed between the groups. Risk of subdural injection at level 1 distance from the surgery level had an odds ratio of 0.374, and at level ≥2, it was 0.172, when compared to level 0. Subdural incidence differed with the distance from surgical site. Physicians should strive to reduce subdural incidence when the injection is planned at surgery site in FBSS.
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Gudin J, Kaufman AG, Datta S. Are Opioids Needed to Treat Chronic Low Back Pain? A Review of Treatment Options and Analgesics in Development. J Pain Res 2020; 13:1007-1022. [PMID: 32523371 PMCID: PMC7234959 DOI: 10.2147/jpr.s226483] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 02/19/2020] [Indexed: 12/29/2022] Open
Abstract
The continued prevalence of chronic low back pain (CLBP) is a testament to our lack of understanding of the potential causes, leading to significant treatment challenges. CLBP is the leading cause of years lived with disability and the fifth leading cause of disability-adjusted life-years. No single non-pharmacologic, pharmacologic, or interventional therapy has proven effective as treatment for the majority of patients with CLBP. Although non-pharmacologic therapies are generally helpful, they are often ineffective as monotherapy and many patients lack adequate access to these treatments. Noninvasive treatment measures supported by evidence include physical and chiropractic therapy, yoga, acupuncture, and non-opioid and opioid pharmacologic therapy; data suggest a moderate benefit, at most, for any of these therapies. Until our understanding of the pathophysiology and treatment of CLBP advances, clinicians must continue to utilize rational multimodal treatment protocols. Recent Centers for Disease Control and Prevention guidelines for opioid prescribing recommend that opioids not be utilized as first-line therapy and to limit the doses when possible for fear of bothersome or dangerous adverse effects. In combination with the current opioid crisis, this has caused providers to minimize or eliminate opioid therapy when treating patients with chronic pain, leaving many patients suffering despite optimal nonopioid therapies. Therefore, there remains an unmet need for effective and tolerable opioid receptor agonists for the treatment of CLBP with improved safety properties over legacy opioids. There are several such agents in development, including opioids and other agents with novel mechanisms of action. This review critiques non-pharmacologic and pharmacologic treatment modalities for CLBP and examines the potential of novel opioids and other analgesics that may be a useful addition to the treatment options for patients with chronic pain.
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Affiliation(s)
- Jeffrey Gudin
- Department of Anesthesiology, Rutgers New Jersey Medical School, Newark, NJ, USA.,Department of Anesthesiology, Englewood Hospital and Medical Center, Englewood, NJ, USA
| | - Andrew G Kaufman
- Department of Anesthesiology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Samyadev Datta
- Department of Anesthesiology, Rutgers New Jersey Medical School, Newark, NJ, USA.,Center for Pain Management, Hackensack, NJ, USA
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7
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Johnson SM, Hutchins T, Peckham M, Anzai Y, Ryals E, Davidson HC, Shah L. Effects of implementing evidence-based appropriateness guidelines for epidural steroid injection in chronic low back pain: the EAGER (Esi Appropriateness GuidElines pRotocol) study. BMJ Open Qual 2020; 8:e000772. [PMID: 31909212 PMCID: PMC6937044 DOI: 10.1136/bmjoq-2019-000772] [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: 07/16/2019] [Revised: 11/19/2019] [Accepted: 11/28/2019] [Indexed: 11/18/2022] Open
Abstract
Objective Chronic low back pain is very common and often treated with epidural steroid injections (ESIs). As ESI referrals had been rapidly increasing at our Veterans’ Administration hospital, we were concerned that they were supplanting more comprehensive care. The objective was to determine how referral patterns and multidisciplinary care might change with the implementation of evidence-based guidelines. Methods In this retrospective observational study, multidisciplinary evidence-based guidelines were implemented in 2014 (EAGER: Esi Appropriateness GuidElines pRotocol) as part of the ordering process for an ESI. Time series analysis was performed to assess the primary outcome of subspecialty referral pattern, that is, the number of patients receiving referrals to ancillary services which might serve to provide a more comprehensive approach to their back pain. Secondary outcomes included patient-level changes (ie, body mass index, number of injections, opioid use), which were compared before and after protocol implementation. Results Comparing preimplementation and postimplementation protocol periods, referrals to physical medicine/rehabilitation increased 11.7% (p=0.003) per year and integrative health increased 2.1% (p<0.001) per year among the 2294 individual patients who received ESI through the neurointerventional radiology service. Of 100 randomly selected patients for patient-level analysis, the median body mass index decreased from 31.57 to 30.22 (p=<0.001) and the mean number of injections decreased from 1.76 to 0.73 (p<0.001). The percentage of patients using oral opioid analgesics decreased from 72% to 49% (p=<0.001). Conclusion Implementation of evidence-based guidelines for ESI referral helps guide patients into a more comprehensive care pathway for chronic low back pain and is correlated with patient-level changes such as decreased body mass index and decreased opioid usage.
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Affiliation(s)
- Scott M Johnson
- Radiology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Troy Hutchins
- Radiology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Miriam Peckham
- Radiology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Yoshimi Anzai
- Radiology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Elizabeth Ryals
- Radiology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - H Christian Davidson
- Radiology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA.,Radiology, George E Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah, USA
| | - Lubdha Shah
- Radiology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
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8
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Labaran LA, Puvanesarajah V, Rao SS, Chen D, Shen FH, Jain A, Hassanzadeh H. Recent Preoperative Lumbar Epidural Steroid Injection Is an Independent Risk Factor for Incidental Durotomy During Lumbar Discectomy. Global Spine J 2019; 9:807-812. [PMID: 31819845 PMCID: PMC6882093 DOI: 10.1177/2192568219833656] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
STUDY DESIGN Retrospective review. OBJECTIVE To investigate the association between lumbar epidural steroid injection (LESI) and incidental durotomy (ID) in patients with a diagnosis of disc herniation undergoing a primary discectomy. METHODS A Medicare patient database was queried for patients between the ages of 65 and 85 years who underwent a primary lumbar discectomy for a diagnosis of lumbar disc herniation or degeneration from 2008 to 2014. Our main cohort of 64 849 patients was then divided into 2 groups: patients who experienced a dural tear (N = 2369) and our matched (age, gender, and history of diabetes) control cohort of patients who did not (N = 62 480). All patients who had a history of LESI were further identified and stratified into 4 subgroups by duration between LESI and discectomy (<3 months, 3-6 months, 6 months to 1 year, and overall), and a comparison of the relative incidence of ID was made among these subgroups. A multivariate logistic regression analysis was employed to determine the relationship between LESI and ID. RESULTS Overall incidence of ID was 3.7%. There was a significant difference in incidence of LESI (27.1% vs 35.0%, P < .001) between our control and ID groups. An adjusted odds ratio (OR) showed that prior LESI within 3 to 6 months (OR 1.47, 95% CI 1.20-1.81, P < .001) and within less than 3 months (OR 1.46, 95% CI 1.24-1.72, P < .001) of surgery were significantly associated with ID. CONCLUSION LESI increases the risk of ID in patients who undergo a subsequent lumbar discectomy within 6 months of injection.
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Affiliation(s)
| | | | | | - Dennis Chen
- University of Virginia, Charlottesville, VA, USA
| | | | - Amit Jain
- Johns Hopkins Hospital, Baltimore, MD, USA
| | - Hamid Hassanzadeh
- University of Virginia, Charlottesville, VA, USA,Hamid Hassanzadeh, Department of Orthopaedic Surgery, University of Virginia, Box 800159 HSC, Charlottesville, VA 22908, USA.
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9
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Clinical and imaging characteristics of patients with extreme low back pain or sciatica referred for spinal injection. Neuroradiology 2019; 61:881-889. [PMID: 31101947 DOI: 10.1007/s00234-019-02222-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 05/06/2019] [Indexed: 12/29/2022]
Abstract
PURPOSE To analyze the causes of pain, imaging characteristics, and therapeutic effect of spinal injection in patients with extreme low back pain or sciatica. METHODS We analyzed 381 consecutive patients with extreme low back pain or sciatica visiting our spinal intervention center between January and December 2017. Clinical and imaging characteristics were analyzed. The treatment response, defined as a numerical pain rating scale decrease of ≥ 30%, was measured. Fisher's exact test was performed to identify the association between the injection response and subsequent lumbar surgery rate. RESULTS The most frequent cause of pain was spinal stenosis, followed by herniated intervertebral disc, facet osteoarthritis, and osteoporotic compression fracture. A herniated intervertebral disc was the most common disorder in patients < 50 years of age, while spinal stenosis was the most common in patients ≥ 50 years of age. Women comprised 66.4% of the study population. The majority of lumbar pathologies occurred below L3/4. Spinal injection was found to be effective in 44.2% of cases. Those who responded to the injection showed a significantly lower rate of lumbar surgery within 6 months (P = 0.004). CONCLUSIONS Those with extreme low back pain or sciatica had clinical and imaging characteristics similar to those with typical low back pain referred for spinal injection. Spinal injection could be an effective method of pain control for patients with extreme low back pain or sciatica.
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Schneider MJ, Ammendolia C, Murphy DR, Glick RM, Hile E, Tudorascu DL, Morton SC, Smith C, Patterson CG, Piva SR. Comparative Clinical Effectiveness of Nonsurgical Treatment Methods in Patients With Lumbar Spinal Stenosis: A Randomized Clinical Trial. JAMA Netw Open 2019; 2:e186828. [PMID: 30646197 PMCID: PMC6324321 DOI: 10.1001/jamanetworkopen.2018.6828] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
IMPORTANCE Lumbar spinal stenosis (LSS) is the most common reason for spine surgery in older US adults. There is an evidence gap about nonsurgical LSS treatment options. OBJECTIVE To explore the comparative clinical effectiveness of 3 nonsurgical interventions for patients with LSS. DESIGN, SETTING, AND PARTICIPANTS Three-arm randomized clinical trial of 3 years' duration (November 2013 to June 2016). Analysis began in August 2016. All interventions were delivered during 6 weeks with follow-up at 2 months and 6 months at an outpatient research clinic. Patients older than 60 years with LSS were recruited from the general public. Eligibility required anatomical evidence of central canal and/or lateral recess stenosis (magnetic resonance imaging/computed tomography) and clinical symptoms associated with LSS (neurogenic claudication; less symptoms with flexion). Analysis was intention to treat. INTERVENTIONS Medical care, group exercise, and manual therapy/individualized exercise. Medical care consisted of medications and/or epidural injections provided by a physiatrist. Group exercise classes were supervised by fitness instructors in senior community centers. Manual therapy/individualized exercise consisted of spinal mobilization, stretches, and strength training provided by chiropractors and physical therapists. MAIN OUTCOMES AND MEASURES Primary outcomes were between-group differences at 2 months in self-reported symptoms and physical function measured by the Swiss Spinal Stenosis questionnaire (score range, 12-55) and a measure of walking capacity using the self-paced walking test (meters walked for 0 to 30 minutes). RESULTS A total of 259 participants (mean [SD] age, 72.4 [7.8] years; 137 women [52.9%]) were allocated to medical care (88 [34.0%]), group exercise (84 [32.4%]), or manual therapy/individualized exercise (87 [33.6%]). Adjusted between-group analyses at 2 months showed manual therapy/individualized exercise had greater improvement of symptoms and physical function compared with medical care (-2.0; 95% CI, -3.6 to -0.4) or group exercise (-2.4; 95% CI, -4.1 to -0.8). Manual therapy/individualized exercise had a greater proportion of responders (≥30% improvement) in symptoms and physical function (20%) and walking capacity (65.3%) at 2 months compared with medical care (7.6% and 48.7%, respectively) or group exercise (3.0% and 46.2%, respectively). At 6 months, there were no between-group differences in mean outcome scores or responder rates. CONCLUSIONS AND RELEVANCE A combination of manual therapy/individualized exercise provides greater short-term improvement in symptoms and physical function and walking capacity than medical care or group exercises, although all 3 interventions were associated with improvements in long-term walking capacity. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01943435.
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Affiliation(s)
- Michael J. Schneider
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Carlo Ammendolia
- Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Donald R. Murphy
- Department of Family Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Ronald M. Glick
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Physical Medicine Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Elizabeth Hile
- College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City
| | - Dana L. Tudorascu
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sally C. Morton
- Department of Statistics, College of Science, Virginia Polytechnic Institute and State University, Blacksburg
| | - Clair Smith
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Charity G. Patterson
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sara R. Piva
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
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11
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Kienbacher G. Interventionelle Schmerztherapie an der Wirbelsäule. MANUELLE MEDIZIN 2018. [DOI: 10.1007/s00337-017-0351-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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