Conservative Care in Lumbar Spine Surgery Trials: A Descriptive Literature Review

Publication date: Available online 26 August 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Aaron J. Yang, Rogelio A. Coronado, Lilian Hoffecker, Chan Gao, Kelly Saurwein, Danielle Shoreman, Adam S. Hoffberg, Venu Akuthota
ObjectiveTo evaluate the degree to which conservative care and failure was specifically defined in studies comparing non-operative treatment versus surgery for low back pain (LBP) conditions in adults.Data SourcesA comprehensive literature search was conducted by an experienced librarian using MEDLINE (PubMed), EMBASE, Google Scholar, and CENTRAL (the Cochrane Central Register of Controlled Trials) from January 2003 to June 2014. Endnote bibliographic management application was utilized to remove duplicates and organize the citations.Study SelectionProspective, randomized or cohort trials comparing surgery versus conservative intervention for patients with LBP conditions. Study selection was conducted by two independent reviewers.Data ExtractionThree independent reviewers extracted data from each article using a structured data extraction form. Data extracted included type of study, participant characteristics, sample size, description, and duration of conservative care, and whether failed conservative care criterion was defined.Data SynthesisA total of 852 unique records were screened for eligibility, and of those, 72 articles were identified for further full text review. Thirty-four full texts were excluded based on the exclusion criteria and 38 articles, representing 20 unique studies, were included for qualitative synthesis. Fifteen of the 20 studies defined the duration of conservative care. Only three studies defined the dosage of physical therapy sessions including total number of visits and visit duration. Two studies described medication usage including the duration and type. No studies specifically defined what constituted failed conservative therapy.ConclusionsThis literature review suggests conservative care is poorly defined in randomized trials which can lead to ambiguity of research procedures and unclear guidelines for clinicians. Future studies should increase transparency and explicitly define conservative care.



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