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AHRQ Research Studies Date
Topics
- Adverse Events (2)
- (-) Back Health and Pain (12)
- Chronic Conditions (1)
- Comparative Effectiveness (3)
- Diagnostic Safety and Quality (1)
- Education: Curriculum (1)
- Elderly (1)
- Electronic Health Records (EHRs) (1)
- Emergency Department (1)
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- Healthcare Costs (2)
- Healthcare Utilization (1)
- Health Information Technology (HIT) (1)
- Health Services Research (HSR) (1)
- Imaging (1)
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- Opioids (1)
- Orthopedics (1)
- Outcomes (3)
- Pain (5)
- Patient-Centered Outcomes Research (2)
- Patient Adherence/Compliance (1)
- Patient Experience (1)
- Patient Safety (1)
- Practice Patterns (1)
- Primary Care (1)
- Quality Improvement (1)
- Risk (1)
- Surgery (2)
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
1 to 12 of 12 Research Studies DisplayedKim HS, Strickland KJ, Seitz AL
Patient perspectives on seeking emergency care for acute low back pain and access to physical therapy in the emergency department.
This study’s purpose was to explore patient perspectives on visiting the emergency department (ED) for low back pain to inform a more patient-centered approach to emergency care. The authors conducted focus group discussions and individual interviews among patients visiting an urban academic ED for acute low back pain. They recruited participants from an ongoing prospective study of 101 patients receiving either ED-initiated physical therapy or usual care. They conducted 4 focus group discussions among 18 participants (median age 46.5 years, 66.7% women, 61.1% Black) and individual interviews with 27 participants (median age 45 years, 55.6% women, 44.4% White). They identified 5 summary themes: (1) the decision to seek emergency care for low back pain is motivated by severe pain, resulting disability, and fears about a catastrophic diagnosis, (2) participants sought various goals from their ED visit but emphasized the primacy of pain control, (3) participants were reluctant to use pain medications but also acknowledged their benefit, (4) participants perceived a number of benefits from direct access to an ED physical therapist in the ED, and (5) participation in physical therapy ultimately facilitated recovery, but the pain was a barrier to performing exercises.
AHRQ-funded; HS023011; HS027426.
Citation: Kim HS, Strickland KJ, Seitz AL .
Patient perspectives on seeking emergency care for acute low back pain and access to physical therapy in the emergency department.
Ann Emerg Med 2023 Aug; 82(2):154-63. doi: 10.1016/j.annemergmed.2022.12.028..
Keywords: Emergency Department, Back Health and Pain, Pain
Ayers DC, Zheng H, Yang W
How back pain affects patient satisfaction after primary total knee arthroplasty.
This study looked at patient-reported outcomes (PROs) for patients with back pain (BP) who underwent total knee arthroscopy (TKA) surgery for pre- and postoperatively. This multicenter cohort study included 9,057 patients undergoing primary unilateral TKA who were enrolled in FORCE-TJ. Back pain (BP) intensity was assessed using the Oswestry back disability index (ODI) pain intensity questionnaire, with BP severity then classified into 4 categories. PROs were collected preoperatively and postoperatively after 1 year including the Knee injury and Osteoarthritis Outcome Score (KOOS) (total score, pain, Activities of Daily Living (ADL), and Quality of Life (QOL), Short-Form health survey 36-item (SF-36) Physical Component Score (PCS), and Mental Component Score (MCS)). At 1 year a total of 18.3% TKA patients were dissatisfied. At the time of surgery, a total of 4,765 patients (52.6%) reported back pain, divided into mild BP (24.9%), moderate (20.3%), and severe (7.2%). Severe back pain was significantly associated with patient dissatisfaction at 1 year after TKA. The predictive variables for dissatisfaction include age [odds ratio (OR) for younger patients <65 years versus older patients ≥65 years], educational level [OR for post high school versus less], smoking [OR for nonsmoker versus current smoker)], and Charlson comorbidity index [OR for CCI ≥2 versus 0]. The authors recommend surgeons consider a spine evaluation in patients who have severe BP prior to TKA.
AHRQ-funded; HS018910.
Citation: Ayers DC, Zheng H, Yang W .
How back pain affects patient satisfaction after primary total knee arthroplasty.
J Arthroplasty 2023 Jun; 38(6s):S103-s08. doi: 10.1016/j.arth.2023.03.072..
Keywords: Back Health and Pain, Pain, Pain, Patient Experience, Orthopedics, Surgery
Ganguli I, Ying W, Shakley T
Cascade services and spending following low-value imaging for uncomplicated low back pain among commercially insured adults.
The purpose of this study was to examine the impact of low-value imaging on cascade services and spending in commercially-insured adults with uncomplicated acute low back pain. The researchers analyzed medical claims from Blue Cross Blue Shield of Massachusetts members aged 18-50 years who received a 2018 diagnosis of uncomplicated low back pain, for which imaging was considered inappropriate according to the National Committee for Quality Assurance Healthcare Effectiveness Data and Information Set (HEDIS) criteria. In 2018, 30,892 members were eligible for low-value imaging. Of these, 6009 (19.5%) received low-value imaging: 5091 (16.5%) X-ray and 787 (2.5%) MRI. The study found that when compared to patients without low-value imaging, those with low-value X-ray or MRI had higher adjusted probabilities of receiving cascade services and greater adjusted total spending at 3, 6, and 12 months. These results were robust to falsification testing. Members with high deductible health plans (HDHP) had higher narrowly defined cascade-associated out-of-pocket spending than those in other plans. The most common sources of narrowly defined cascade-associated spending were physical therapy, office visits, radiology studies, laboratory studies, and surgery.
J Gen Intern Med 2023 Mar;38(4):1102-05. doi: 10.1007/s11606-022-07829-2
Citation: Ganguli I, Ying W, Shakley T .
Cascade services and spending following low-value imaging for uncomplicated low back pain among commercially insured adults.
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Keywords: Imaging, Back Health and Pain, Pain, Healthcare Costs
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