The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Jan 2016
Comparative Study Observational StudyThe Effect of Workers' Compensation Status on Outcomes of Cervical Disc Arthroplasty: A Prospective, Comparative, Observational Study.
Receiving Workers' Compensation benefits has been associated with inferior outcomes after lumbar fusion. The purpose of our study was to compare the outcomes of cervical disc arthroplasty between patients receiving and those not receiving Workers' Compensation. ⋯ Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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J Bone Joint Surg Am · Jan 2016
Comparative StudyDiabetes Is Related to Worse Patient-Reported Outcomes at Two Years Following Spine Surgery.
Diabetes has been associated with poor outcomes following elective spine surgery. The purpose of our study was to determine if diabetes predicts worse patient-reported outcomes at two years postoperatively and to evaluate the effect of perioperative blood glucose levels and control on patient-reported outcomes in patients with diabetes. ⋯ Diabetes was associated with worse patient-reported outcomes when patients with diabetes were compared with patients without diabetes at two years following elective spine surgery. Although patients with diabetes improved when compared from baseline to the time following elective spine surgery, they did not improve to the same extent as patients without diabetes in the ODI or NDI and EQ-5D scores. Providers may use this information to counsel patients with diabetes on expectations following spine surgery.
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J Bone Joint Surg Am · Dec 2015
ReviewIs There Truly "No Significant Difference"? Underpowered Randomized Controlled Trials in the Orthopaedic Literature.
Randomized controlled trials (RCTs) are considered the gold standard in evidence-based medicine. Underpowered RCTs that describe comparative outcomes without significance are of questionable benefit. The present study hypothesizes that a substantial proportion of RCTs in the orthopaedic literature that do not note significant differences between groups are inadequately powered. ⋯ If an RCT lacks adequate statistical power to identify a clinically meaningful absence of a difference between groups, there is an unacceptable risk of inappropriately failing to reject the null hypothesis. The present study found that a sizable proportion of RCTs in orthopaedic surgery in which the null hypothesis is rejected are inadequately powered. Researchers should consider this when designing clinical trials, and journal editors and reviewers should be wary of underpowered RCTs when considering manuscripts for publication.
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J Bone Joint Surg Am · Dec 2015
Multicenter StudyAn Independent Evaluation of the Validity of a DNA-Based Prognostic Test for Adolescent Idiopathic Scoliosis.
ScoliScore is a DNA-based prognostic test, designed and used to help to predict the risk of curve progression in patients with adolescent idiopathic scoliosis. The role of this test in clinical practice remains unclear as the published results of the ScoliScore have not been validated independently. The purpose of this study was to determine if the ScoliScore effectively predicted the risk of curve progression in patients with mild and moderate adolescent idiopathic scoliosis in two urban academic medical centers. ⋯ ScoliScores did not differ between patients with and without curve progression, and the negative and positive predictive values were lower in our study than in the previously published validation study by the developers of the test. This may be due to differences in our test population, genetic variability, or failure of patients in the non-progression group to follow up.
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J Bone Joint Surg Am · Dec 2015
Multicenter Study Clinical TrialA Clinical Prediction Rule for Functional Outcomes in Patients Undergoing Surgery for Degenerative Cervical Myelopathy: Analysis of an International Prospective Multicenter Data Set of 757 Subjects.
Cervical spondylotic myelopathy (CSM) is a progressive spinal condition that is often managed surgically. Knowledge of important predictors of surgical outcome can provide decision support to surgeons and enable them to effectively manage their patients' expectations. The purpose of this study was to identify the most important clinical predictors of surgical outcome in patients with CSM using data from two multinational prospective studies. ⋯ Patients were more likely to achieve a score of ≥16 (indicating minimal impairment) if they were younger, had milder preoperative myelopathy, did not smoke, had fewer and less severe comorbidities, did not present with impaired gait, and had shorter symptom duration.