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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
26 to 50 of 58 Research Studies DisplayedGraves JM, Fulton-Kehoe D, Jarvik JG
Impact of an advanced imaging utilization review program on downstream health care utilization and costs for low back pain.
Investigators researched the impact of imaging tests such as magnetic resonance imaging (MRI) for lower back pain (LBP) on utilization and duration of workers’ compensation claims. Claims from 76,119 Washington State workers with LBP from 2006 to 2014 were used to see if a policy that implemented prospective utilization review (UR) for early MRI increased costs per claim, disability duration and the proportion of workers who received benefits. Results showed there were noticeable effects from MRI tests, but not computed tomography or surgery utilization.
AHRQ-funded; HS019222.
Citation: Graves JM, Fulton-Kehoe D, Jarvik JG .
Impact of an advanced imaging utilization review program on downstream health care utilization and costs for low back pain.
Med Care 2018 Jun;56(6):520-28. doi: 10.1097/mlr.0000000000000917..
Keywords: Back Health and Pain, Healthcare Utilization, Imaging, Pain
Gold LS, Hansen RN, Avins AL
Associations of early opioid use with patient-reported outcomes and health care utilization among older adults with low back pain.
The objective of this study was to compare outcomes and health care utilization of older patients who did versus did not fill opioid prescriptions within 90 days of initiating care for low back pain. Among older patients with new back pain visits, filling 2 or more opioid prescriptions within 90 days of the visit was associated with similar back pain-related outcomes but increased likelihood of filling opioid prescriptions 18 to 24 months later compared with matched patients who did not fill early opioid prescriptions.
AHRQ-funded; HS019222; HS022972.
Citation: Gold LS, Hansen RN, Avins AL .
Associations of early opioid use with patient-reported outcomes and health care utilization among older adults with low back pain.
Clin J Pain 2018 Apr;34(4):297-305. doi: 10.1097/ajp.0000000000000557.
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Keywords: Back Health and Pain, Elderly, Healthcare Utilization, Patient-Centered Outcomes Research, Opioids
Tapp SJ, Martin BI, Tosteson TD
Understanding the value of minimally invasive procedures for the treatment of lumbar spinal stenosis: the case of interspinous spacer devices.
Minimally invasive lumbar spinal stenosis procedures have uncertain long-term value. This study sought to characterize factors affecting the long-term cost-effectiveness of such procedures using interspinous spacer devices ("spacers") relative to decompression surgery as a case study.
AHRQ-funded; HS018405.
Citation: Tapp SJ, Martin BI, Tosteson TD .
Understanding the value of minimally invasive procedures for the treatment of lumbar spinal stenosis: the case of interspinous spacer devices.
Spine J 2018 Apr;18(4):584-92. doi: 10.1016/j.spinee.2017.08.246..
Keywords: Back Health and Pain, Healthcare Costs, Healthcare Costs, Surgery
Skolasky RL, Maggard AM, Wegener ST
Telephone-based intervention to improve rehabilitation engagement after spinal stenosis surgery: a prospective lagged controlled trial.
A prospective interventional trial was conducted, to compare the effectiveness of health behavior change counseling with usual care to improve health outcomes after lumbar spine surgical procedures. The investigators found that health behavior change counseling improved health outcomes during the first 12 months after the surgical procedure through changes in rehabilitation engagement.
AHRQ-funded; HS017990.
Citation: Skolasky RL, Maggard AM, Wegener ST .
Telephone-based intervention to improve rehabilitation engagement after spinal stenosis surgery: a prospective lagged controlled trial.
J Bone Joint Surg Am 2018 Jan 3;100(1):21-30. doi: 10.2106/jbjs.17.00418..
Keywords: Back Health and Pain, Comparative Effectiveness, Evidence-Based Practice, Patient-Centered Outcomes Research, Rehabilitation, Surgery
Rundell SD, Gold LS, Hansen RN
Impact of co-morbidities on resource use and adherence to guidelines among commercially insured adults with new visits for back pain.
The purpose of this study was to assess if co-morbidity is associated with higher use of back-related care and adherence to back pain guidelines. The investigators found that co-morbidity burden and the presence of specific chronic conditions, such as musculoskeletal conditions, were associated with high long-term use of back-related care and care inconsistent with guidelines.
AHRQ-funded; HS022982.
Citation: Rundell SD, Gold LS, Hansen RN .
Impact of co-morbidities on resource use and adherence to guidelines among commercially insured adults with new visits for back pain.
J Eval Clin Pract 2017 Dec;23(6):1218-26. doi: 10.1111/jep.12763..
Keywords: Back Health and Pain, Guidelines, Health Services Research (HSR), Healthcare Utilization, Patient Adherence/Compliance
Bhise V, Meyer AND, Singh H
Errors in diagnosis of spinal epidural abscesses in the era of electronic health records.
With this study, the investigators set out to identify missed opportunities in diagnosis of spinal epidural abscesses to outline areas for process improvement. The investigators found that despite wide availability of clinical data, errors in diagnosis of spinal epidural abscesses were common and involved inadequate history, physical examination, and test ordering. They suggested that solutions should include renewed attention to basic clinical skills.
AHRQ-funded; HS022087.
Citation: Bhise V, Meyer AND, Singh H .
Errors in diagnosis of spinal epidural abscesses in the era of electronic health records.
Am J Med 2017 Aug;130(8):975-81. doi: 10.1016/j.amjmed.2017.03.009..
Keywords: Adverse Events, Back Health and Pain, Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Information Technology (HIT), Medical Errors, Patient Safety
Makris UE, Alvarez CA, Wei W
Association of statin use with risk of back disorder diagnoses.
Statins may increase vulnerability to myalgias and contribute to the myopathic component often experienced with back pain. This study’s goal was to examine the association of statin use with the risk of back disorder diagnoses. Researchers retrieved health care data for patients enrolled in TRICARE in the San Antonio military area. The overall cohort included 60,455 patients. Two treatment groups were identified: Statin users who recently received a first-time prescription for a statin and had been taking it for 120 days or more; statin non-users who never used statins and current users before they were prescribed statins. The study concludes that statin use is associated with increased likelihood of back disorder diagnoses.
AHRQ-funded; HS022418.
Citation: Makris UE, Alvarez CA, Wei W .
Association of statin use with risk of back disorder diagnoses.
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Keywords: Back Health and Pain, Medication, Pain, Patient-Centered Outcomes Research, Risk
Hanley K, Zabar S, Altshuler L
Opioid vs nonopioid prescribers: variations in care for a standardized acute back pain case.
This paper describes the design and use of an opioid-related unannounced standardized patient case (USP) used in a residency curriculum. Researchers designed and fielded an unannounced standardized patient case involving a patient with acute back pain who requested Vicodin (5/325 mg). They described residents' case management and examined whether their management decisions, including opioid prescribing, were related to their core clinical skills. The case designers found that most Vicodin prescribers did not follow prescribing guidelines, and demonstrated better communication and assessment skills than the nonprescribers. Results suggest the need to guide residents in using a systematic approach to prescribing opioids safely and to develop an acceptable alternative pain management plan when they decide against prescribing.
AHRQ-funded; HS021176.
Citation: Hanley K, Zabar S, Altshuler L .
Opioid vs nonopioid prescribers: variations in care for a standardized acute back pain case.
Subst Abus 2017 Jul-Sep;38(3):324-29. doi: 10.1080/08897077.2017.1319894..
Keywords: Back Health and Pain, Education: Curriculum, Opioids, Practice Patterns
Patel NK, Moses RA, Martin BI
Validation of using claims data to measure safety of lumbar fusion surgery.
The researchers report the accuracy of a claims-based approach for reporting repeat surgery compared with medical records abstraction as the "gold standard." They found that claims-based ascertainment of safety at a single institution was very accurate. However, accuracy depended on careful attention to the timing of outcomes, as well as the definitions and coding of repeat surgery, including how orthopedic device removal codes are classified.
AHRQ-funded; HS021695.
Citation: Patel NK, Moses RA, Martin BI .
Validation of using claims data to measure safety of lumbar fusion surgery.
Spine 2017 May 1;42(9):682-91. doi: 10.1097/brs.0000000000001879.
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Keywords: Adverse Events, Back Health and Pain, Quality Improvement, Outcomes, Surgery
Chou R, Deyo R, Friedly J
Nonpharmacologic therapies for low back pain: a systematic review for an American College of Physicians clinical practice guideline.
The researchers systematically reviewed the current evidence on nonpharmacologic therapies for acute or chronic nonradicular or radicular low back pain. They found that several nonpharmacologic therapies for primarily chronic low back pain are associated with small to moderate, usually short-term effects on pain; findings include new evidence on mind-body interventions.
AHRQ-funded; 290201200014I.
Citation: Chou R, Deyo R, Friedly J .
Nonpharmacologic therapies for low back pain: a systematic review for an American College of Physicians clinical practice guideline.
Ann Intern Med 2017 Apr 4;166(7):493-505. doi: 10.7326/m16-2459.
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Keywords: Back Health and Pain, Chronic Conditions, Comparative Effectiveness, Outcomes, Evidence-Based Practice
Chou R, Deyo R, Friedly J
Systemic pharmacologic therapies for low back pain: a systematic review for an American College of Physicians clinical practice guideline.
The authors reviewed the current evidence on systemic pharmacologic therapies for acute or chronic nonradicular or radicular low back pain. They found that several systemic medications for low back pain are associated with small to moderate, primarily short-term effects on pain. New evidence suggests that acetaminophen is ineffective for acute low back pain, and duloxetine is associated with modest effects for chronic low back pain.
AHRQ-funded; 290201200014I.
Citation: Chou R, Deyo R, Friedly J .
Systemic pharmacologic therapies for low back pain: a systematic review for an American College of Physicians clinical practice guideline.
Ann Intern Med 2017 Apr 4;166(7):480-92. doi: 10.7326/m16-2458.
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Keywords: Back Health and Pain, Medication, Comparative Effectiveness, Outcomes, Evidence-Based Practice
Fritz JM, Kim M, Magel JS
Cost-effectiveness of primary care management with or without early physical therapy for acute low back pain: economic evaluation of a randomized clinical trial.
The objective of this study was to compare costs and cost-effectiveness of usual primary care management for patients with acute low back pain with or without the addition of early physical therapy. The authors suggest that their results support early physical therapy as cost-effective relative to usual primary care after 1 year for patients with acute, nonspecific lower back pain.
AHRQ-funded; HS018672.
Citation: Fritz JM, Kim M, Magel JS .
Cost-effectiveness of primary care management with or without early physical therapy for acute low back pain: economic evaluation of a randomized clinical trial.
Spine 2017 Mar;42(5):285-90. doi: 10.1097/brs.0000000000001729..
Keywords: Back Health and Pain, Healthcare Costs, Pain, Primary Care
Makris UE, Edwards TC, Lavallee DC
Patient priority weighting of the Roland Morris Disability Questionnaire does not change results of the lumbar epidural steroid injections for spinal stenosis trial.
The researchers reevaluated whether outcomes for older adults receiving epidural steroid injections with or without corticosteroid improve after using patient-prioritized Roland-Morris Disability Questionnaire (RDQ) items. Their findings provide additional evidence that epidural injection of corticosteroid + lidocaine offered minimal or no short-term benefit as compared with epidural injection of lidocaine alone for older adults with lumbar spinal stenosis.
AHRQ-funded; HS019222; HS022418.
Citation: Makris UE, Edwards TC, Lavallee DC .
Patient priority weighting of the Roland Morris Disability Questionnaire does not change results of the lumbar epidural steroid injections for spinal stenosis trial.
Spine 2017 Jan;42(1):42-48. doi: 10.1097/brs.0000000000001647.
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Keywords: Comparative Effectiveness, Patient-Centered Outcomes Research, Elderly, Back Health and Pain, Medication
Fritz JM, Rundell SD, Dougherty P
Deconstructing chronic low back pain in the older adult-step by step evidence and expert-based recommendations for evaluation and treatment. Part vi: Lumbar spinal stenosis.
This article is the sixth in a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults. It focuses on the evaluation and management of lumbar spinal stenosis (LSS), the most common condition for which older adults undergo spinal surgery. It concluded that lumbar spinal stenosis exists not uncommonly in older adults with CLBP and management often can be accomplished without surgery.
AHRQ-funded; HS022982.
Citation: Fritz JM, Rundell SD, Dougherty P .
Deconstructing chronic low back pain in the older adult-step by step evidence and expert-based recommendations for evaluation and treatment. Part vi: Lumbar spinal stenosis.
Pain Med 2016 Mar;17(3):501-10. doi: 10.1093/pm/pnw011..
Keywords: Back Health and Pain, Elderly, Chronic Conditions, Treatments, Surgery
Tan A, Zhou J, Kuo YF
Variation among primary care physicians in the use of imaging for older patients with acute low back pain.
The authors sought to estimate the variation among primary care providers (PCPs) in the use of diagnostic imaging for older patients with non-specific acute low back pain. They used Texas Medicare claims data and tracked whether each patient received lumbar imaging within 4 weeks of the initial visit. They found that the specific physician seen by a patient accounted for 25 % of the variability in whether imaging was performed and that the use of imaging by individual physicians was stable over time.
AHRQ-funded; HS022134.
Citation: Tan A, Zhou J, Kuo YF .
Variation among primary care physicians in the use of imaging for older patients with acute low back pain.
J Gen Intern Med 2016 Feb;31(2):156-63. doi: 10.1007/s11606-015-3475-3.
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Keywords: Back Health and Pain, Elderly, Imaging, Primary Care, Practice Patterns
Chimenti PC, Drinkwater CJ, Li W
Factors associated with early improvement in low back pain after total hip arthroplasty: A multi-center prospective cohort analyses.
This study identified factors associated with an improvement in low back pain (LBP) at six-month follow-up after total hip arthroplasty (THA). It found that among patients reporting severe or moderate LBP preoperatively, 56 percent improved 6 months after surgery. Patients without improvement were more likely to be on Medicare, have a high school education or less, have household income less than $45,000 and have one or more comorbid conditions.
AHRQ-funded; HS018910.
Citation: Chimenti PC, Drinkwater CJ, Li W .
Factors associated with early improvement in low back pain after total hip arthroplasty: A multi-center prospective cohort analyses.
J Arthroplasty 2016 Jan;31(1):176-9. doi: 10.1016/j.arth.2015.07.028.
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Keywords: Back Health and Pain, Arthritis, Surgery, Patient-Centered Outcomes Research, Registries
Berliner E
AHRQ Author: Berliner E
Multisociety letter to the Agency for Healthcare Research and Quality: serious methodological flaws plague technology assessment on pain management injection therapies for low back pain.
The recent publication of an AHRQ report on Pain Management Injection Therapies for Low Back Pain has raised significant concerns for physicians who utilize injection procedures to treat patients suffering with pain and functional limitations resulting from spinal pathology. The authors are concerned that the methodology used by the report cannot and does not make such determinations, and that the conclusions may lead to egregious denial of access to these procedures for many patients suffering from low back pain.
AHRQ-authored.
Citation: Berliner E .
Multisociety letter to the Agency for Healthcare Research and Quality: serious methodological flaws plague technology assessment on pain management injection therapies for low back pain.
Pain Med 2016 Jan;17(1):10-15. doi: 10.1111/pme.12934..
Keywords: Back Health and Pain, Care Management, Chronic Conditions, Evidence-Based Practice, Health Services Research (HSR), Pain, Research Methodologies
Turner JA, Comstock BA, Standaert CJ
Can patient characteristics predict benefit from epidural corticosteroid injections for lumbar spinal stenosis symptoms?
The study’s aim was to identify patient characteristics associated with benefits from epidural injections of corticosteroid with lidocaine versus epidural injections of lidocaine only for lumbar spinal stenosis symptoms. It found that among 21 baseline patient characteristics examined, none, including clinician rated spinal stenosis severity, were consistent predictors of benefit from epidural injections of lidocain corticosteroid versus lidocaine only.
AHRQ-funded; HS019222; HS022972.
Citation: Turner JA, Comstock BA, Standaert CJ .
Can patient characteristics predict benefit from epidural corticosteroid injections for lumbar spinal stenosis symptoms?
Spine J 2015 Nov;15(11):2319-31. doi: 10.1016/j.spinee.2015.06.050..
Keywords: Patient-Centered Outcomes Research, Shared Decision Making, Medication, Back Health and Pain, Chronic Conditions
Jarvik JG, Comstock BA, James KT
Lumbar Imaging with Reporting of Epidemiology (LIRE)--protocol for a pragmatic cluster randomized trial.
The researchers will conduct a pragmatic cluster randomized clinical trial to test the hypothesis that inserting data on the prevalence of incidental imaging findings into lumbar spine imaging reports for studies ordered by primary care providers will reduce subsequent spine-related interventions. Their primary outcome will be spine-related intervention intensity based on Relative Value Units (RVUs) during the following year.
AHRQ-funded; HS022982.
Citation: Jarvik JG, Comstock BA, James KT .
Lumbar Imaging with Reporting of Epidemiology (LIRE)--protocol for a pragmatic cluster randomized trial.
Contemp Clin Trials 2015 Nov;45(Pt B):157-63. doi: 10.1016/j.cct.2015.10.003.
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Keywords: Imaging, Back Health and Pain, Patient-Centered Outcomes Research
Fritz JM, Magel JS, McFadden M
Early physical therapy vs usual care in patients with recent-onset low back pain: a randomized clinical trial.
This study evaluated whether early physical therapy (manipulation and exercise) is more effective than usual care in improving disability for patients with LBP fitting a decision rule. It concluded that among adults with recent-onset LBP, early physical therapy resulted in statistically significant improvement in disability, but the improvement was modest and did not achieve the minimum clinically important difference compared with usual care.
AHRQ-funded; HS018672.
Citation: Fritz JM, Magel JS, McFadden M .
Early physical therapy vs usual care in patients with recent-onset low back pain: a randomized clinical trial.
JAMA 2015 Oct 13;314(14):1459-67. doi: 10.1001/jama.2015.11648..
Keywords: Back Health and Pain, Comparative Effectiveness, Outcomes, Patient-Centered Outcomes Research
Chou R, Hashimoto R, Friedly J
Epidural corticosteroid injections for radiculopathy and spinal stenosis: a systematic review and meta-analysis.
The researchers reviewed evidence on the benefits and harms of epidural corticosteroid injections in adults with radicular low back pain or spinal stenosis of any duration. They concluded that epidural corticosteroid injections for radiculopathy were associated with immediate reductions in pain and function. However, benefits were small and not sustained, and there was no effect on long-term surgery risk.
AHRQ-funded; 290201200014I.
Citation: Chou R, Hashimoto R, Friedly J .
Epidural corticosteroid injections for radiculopathy and spinal stenosis: a systematic review and meta-analysis.
Ann Intern Med 2015 Sep 1;163(5):373-81. doi: 10.7326/m15-0934.
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Keywords: Medication, Back Health and Pain, Chronic Conditions, Comparative Effectiveness, Evidence-Based Practice
Suri P, Pashova H, Heagerty PJ
Short-term improvements in disability mediate patient satisfaction after epidural corticosteroid injections for symptomatic lumbar spinal stenosis.
The researchers sought to identify mediators of the effect of lumbar epidural injections of corticosteroid plus lidocaine on patient satisfaction at 6 weeks postinjection in patients with lumbar spinal stenosis. Three-week change in disability was a significant mediator of the effects of lumbar epidural corticosteroid injections on patient satisfaction at 6 weeks, explaining 48 percent to 60 percent of the treatment effect on satisfaction.
AHRQ-funded; HS019222; HS022972.
Citation: Suri P, Pashova H, Heagerty PJ .
Short-term improvements in disability mediate patient satisfaction after epidural corticosteroid injections for symptomatic lumbar spinal stenosis.
Spine 2015 Sep 01;40(17):1363-70. doi: 10.1097/brs.0000000000001000.
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Keywords: Medication, Patient-Centered Outcomes Research, Back Health and Pain, Patient Experience
Deyo RA, Bryan M, Comstock BA
Trajectories of symptoms and function in older adults with low back disorders.
The researchers sought to determine whether there are distinct trajectories of back pain and function among older adults and to identify characteristics that distinguish among patients with substantially different prognoses. They found that, although most patients remained relatively stable over a year, latent class analysis identified small groups with major improvement in pain, function, or both.
AHRQ-funded; HS019222.
Citation: Deyo RA, Bryan M, Comstock BA .
Trajectories of symptoms and function in older adults with low back disorders.
Spine 2015 Sep 1;40(17):1352-62. doi: 10.1097/brs.0000000000000975.
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Keywords: Data, Elderly, Back Health and Pain, Chronic Conditions, Outcomes
Rundell SD, Gellhorn AC, Comstock BA
Clinical outcomes of early and later physical therapist services for older adults with back pain.
The purpose of this study was to compare clinical outcomes of patients receiving early or later PT services with those not receiving PT among older adults presenting to primary care for a new visit for back pain. It found that among older adults early referral to PT resulted in no or minimal differences in pain, function, or health-related quality at 3, 6, or 12 months compared with a matched group that did not receive early PT.
AHRQ-funded; HS019222.
Citation: Rundell SD, Gellhorn AC, Comstock BA .
Clinical outcomes of early and later physical therapist services for older adults with back pain.
Spine J 2015 Aug;15(8):1744-55. doi: 10.1016/j.spinee.2015.04.001..
Keywords: Back Health and Pain, Elderly, Primary Care, Comparative Effectiveness, Patient-Centered Outcomes Research
Skolasky RL, Maggard AM, Li D
Health behavior change counseling in surgery for degenerative lumbar spinal stenosis. Part I: improvement in rehabilitation engagement and functional outcomes.
This study examined whether a brief motivational interviewing-based health behavior change counseling (HBCC) intervention increased patient participation in physical therapy and/or home exercise programs (HEPs), reduced disability, and improved health status after surgery for degenerative lumbar spinal stenosis. It found that HBCC can improve outcomes after spine surgery through improved rehabilitation participation.
AHRQ-funded; HS017990.
Citation: Skolasky RL, Maggard AM, Li D .
Health behavior change counseling in surgery for degenerative lumbar spinal stenosis. Part I: improvement in rehabilitation engagement and functional outcomes.
Arch Phys Med Rehabil 2015 Jul;96(7):1200-7. doi: 10.1016/j.apmr.2015.03.009..
Keywords: Back Health and Pain, Surgery, Patient Adherence/Compliance