Spine
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Review
Fusion versus nonoperative care for chronic low back pain: do psychological factors affect outcomes?
Systematic review. ⋯ Recommendation 1: Chronic LBP patients with depression, neuroticism, and certain personality disorders should preferentially be treated nonoperatively. Strength of recommendation: Weak. Recommendation 2: Consider the use of a validated psychological screening questionnaire such as the BDI, FABQ, DRAM, ZDI or STAI, when treating patients with CLBP. Strength of recommendation: Weak.
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Randomized Controlled Trial Multicenter Study Comparative Study
ISSLS prize winner: Function After Spinal Treatment, Exercise, and Rehabilitation (FASTER): a factorial randomized trial to determine whether the functional outcome of spinal surgery can be improved.
This was a multicenter, factorial, randomized, controlled trial on the postoperative management of spinal surgery patients, with randomization stratified by surgeon and operative procedure. ⋯ This study found that neither intervention had a significant impact on long-term outcome.
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Randomized Controlled Trial Multicenter Study Comparative Study
Function after spinal treatment, exercise, and rehabilitation: cost-effectiveness analysis based on a randomized controlled trial.
Cost-effectiveness analysis alongside a factorial randomized controlled trial. ⋯ Cost-effectiveness evidence does not support use of booklet over no booklet or rehabilitation over no rehabilitation for the postoperative management of patients after spinal surgery.
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Systematic review. ⋯ The spine care community needs to develop (or update) high-quality treatment guidelines. The process should be transparent, methodologically rigorous, and consistent with the Appraisal of Guidelines Research and Evaluation and Institute of Medicine recommendations. This effort should be collaborative across specialty/society groups and would benefit from patient and public input. Payer policies and treatment guidelines need to be transparent and based on the highest quality evidence available. Clinicians from specialty/society groups, guideline developers and policy makers should collaborate on their development. This process would also benefit from public and patient input.
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Systematic review of literature focused on heterogeneity of treatment effect analysis. ⋯ We recommend optimizing the management of medical co-morbidities and smoking cessation before considering surgical fusion in CLBP patients. Strength of recommendation: Weak.