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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
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1 to 25 of 50 Research Studies Displayed
Greenberg JK, Olsen MA, Poe J
Administrative data are unreliable for ranking hospital performance based on serious complications after spine fusion.
The authors evaluated the extent to which a metric of serious complications determined from administrative data can reliably profile hospital performance in spine fusion surgery. They found that a metric of serious complications was unreliable for benchmarking cervical fusion outcomes and only modestly reliable for thoracolumbar fusion. They concluded that, when assessed using administrative datasets, these measures appeared to be inappropriate for high-stakes applications, such as public reporting or pay-for-performance.
AHRQ-funded; HS027075; HS019455.
Citation:
Greenberg JK, Olsen MA, Poe J .
Administrative data are unreliable for ranking hospital performance based on serious complications after spine fusion.
Spine 2021 Sep 1;46(17):1181-90. doi: 10.1097/brs.0000000000004017..
Keywords:
Surgery, Provider Performance, Hospitals, Adverse Events, Back Health and Pain
Overstreet DS, Michl AN, Penn TM
Temporal summation of mechanical pain prospectively predicts movement-evoked pain severity in adults with chronic low back pain.
The objective of this study was to determine whether quantitative sensory tests of endogenous pain inhibition and facilitation prospectively predict movement-evoked pain and chronic low back pain severity self-reported on a validated questionnaire. Through surveys using the Brief Pain Inventory-Short Form, findings suggested that a pro-nociceptive pain modulatory balance characterized by enhanced pain facilitation may be an important driver of movement-evoked pain severity and poor physical function in individuals with chronic low back pain.
AHRQ-funded; HS013852.
Citation:
Overstreet DS, Michl AN, Penn TM .
Temporal summation of mechanical pain prospectively predicts movement-evoked pain severity in adults with chronic low back pain.
BMC Musculoskelet Disord 2021 May 10;22(1):429. doi: 10.1186/s12891-021-04306-5..
Keywords:
Back Health and Pain, Pain, Chronic Conditions, Diagnosis
Kim HS, Ciolino JD, Lancki N
A prospective observational study of emergency department-initiated physical therapy for acute low back pain.
The purpose of this study was to compare patient-reported outcomes in patients receiving emergency department-initiated physical therapy and patients receiving usual care for acute low back pain. Findings showed that emergency department-initiated physical therapy for low back pain was associated with greater improvement in functioning and lower use of high-risk medications over 3 months.
AHRQ-funded; HS023011.
Citation:
Kim HS, Ciolino JD, Lancki N .
A prospective observational study of emergency department-initiated physical therapy for acute low back pain.
Phys Ther 2021 Mar 3;101(3). doi: 10.1093/ptj/pzaa219..
Keywords:
Emergency Department, Back Health and Pain, Pain, Chronic Conditions
Fenton JJ, Jerant A, Franks P
Watchful waiting as a strategy to reduce low-value spinal imaging: study protocol for a randomized trial.
This paper describes the protocol that will be used for an upcoming randomized control trial to determine the effectiveness of teaching clinicians how to advise watchful waiting when patients request low-value spinal imaging for acute low back pain. The authors will recruit 8-10 primary care and urgent care clinics in Sacramento, California. The study will last 3-6 months and during this time clinicians in the intervention group with receive 3 visits with standardized patient instructors (SPIs) portraying patients with acute back pain. The SPIs will instruct clinicians in a 3-step model emphasizing trust, empathic communication, and negotiation of a watchful waiting approach. The primary outcome looked for will a decreased post-intervention rate of spinal imaging among actual patients with acute back pain compared to the rate of imaging during the baseline period. Secondary outcomes will include use of targeted communication techniques during a follow-up visit with an SP.
AHRQ-funded; HS026415.
Citation:
Fenton JJ, Jerant A, Franks P .
Watchful waiting as a strategy to reduce low-value spinal imaging: study protocol for a randomized trial.
Trials 2021 Feb 27;22(1):167. doi: 10.1186/s13063-021-05106-x..
Keywords:
Back Health and Pain, Pain, Chronic Conditions, Imaging, Diagnostic Safety and Quality, Clinician-Patient Communication, Communications
Fritz JM, Lane E, McFadden M
Physical therapy referral from primary care for acute back pain with sciatica : a randomized controlled trial.
This study examined whether early physical therapy (EPT) use in sciatica patients of less than 90 days duration reduces disability compared to usual care (UC) alone. A cohort of 220 adult sciatica patients ages 18 to 60 at two healthcare systems in Salt Lake City, Utah were randomly assigned to the control or EPT. Half (110) were given EPT, 1 education session, and then referred to 4 weeks of physical therapy including exercise and manual therapy. The other 110 were provided usual care. Outcomes were measured using the Oswestry Disability Index (OSW) after 6 months. Secondary outcomes were pain intensity, patient-reported treatment success, health care use or missed workdays. The EPT group were more likely to self-report less back pain after 5 weeks as well as treatment success after 1 year than the UC care group. There were no significant differences in health care use or missed workdays with the 2 groups.
AHRQ-funded; HS022641.
Citation:
Fritz JM, Lane E, McFadden M .
Physical therapy referral from primary care for acute back pain with sciatica : a randomized controlled trial.
Ann Intern Med 2021 Jan;174(1):8-17. doi: 10.7326/m20-4187..
Keywords:
Back Health and Pain, Neurological Disorders, Pain, Rehabilitation, Primary Care, Outcomes, Patient-Centered Outcomes Research, Comparative Effectiveness, Evidence-Based Practice
Nayfe R, Chansard M, Hynan LS
Comparison of patient-reported outcomes measurement information system and legacy instruments in multiple domains among older veterans with chronic back pain.
This study evaluated construct (convergent and discriminant) validity and time to complete NIH's Patient Reported Outcomes Measurement Information System (PROMIS) as compared to legacy instruments. Results showed that, given time efficiency of using PROMIS, along with strong construct validity, PROMIS instruments are a practical choice for measuring multidimensional patient-reported outcomes in older Veterans with chronic low back pain for both research and clinical purposes.
AHRQ-funded; HS022418.
Citation:
Nayfe R, Chansard M, Hynan LS .
Comparison of patient-reported outcomes measurement information system and legacy instruments in multiple domains among older veterans with chronic back pain.
BMC Musculoskelet Disord 2020 Sep 8;21(1):598. doi: 10.1186/s12891-020-03587-6..
Keywords:
Elderly, Veterans, Back Health and Pain, Pain, Chronic Conditions, Patient-Centered Outcomes Research, Research Methodologies
Rundell SD, Resnik L, Heagerty PJ
Performance of the Functional Comorbidity Index (FCI) in prognostic models for risk adjustment in patients with back pain.
The Functional Comorbidity Index (FCI) is a comorbidity measure associated with physical function and may contribute to risk adjustment models in rehabilitation settings, but an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) of the FCI has not been tested in outpatient settings. The purpose of this cohort study was to examine the ability of an ICD-9-CM- based FCI to predict function, health-related quality of life, and overall health care use.
AHRQ-funded; HS01922201; HS022972.
Citation:
Rundell SD, Resnik L, Heagerty PJ .
Performance of the Functional Comorbidity Index (FCI) in prognostic models for risk adjustment in patients with back pain.
Pm r 2020 Sep;12(9):891-98. doi: 10.1002/pmrj.12315..
Keywords:
Back Health and Pain, Pain, Chronic Conditions, Quality of Life, Rehabilitation
Rundell SD, Resnik L, Heagerty PJ
Comparing the performance of comorbidity indices in predicting functional status, health-related quality of life, and total health care use in older adults with back pain.
The purpose of this prospective cohort study was to determine how well the functional comorbidity index (FCI) predicted outcomes in older adults with back pain compared to Quan's modification of the Charlson comorbidity index (Quan-Charlson comorbidity index) and the Elixhauser comorbidity index. The investigators concluded that all indices performed similarly in predicting outcomes. The authors indicated that there is still a need to develop better function-based risk-adjustment models that improve prediction of functional outcomes versus standard comorbidity indices.
AHRQ-funded; HS019222; HS022972.
Citation:
Rundell SD, Resnik L, Heagerty PJ .
Comparing the performance of comorbidity indices in predicting functional status, health-related quality of life, and total health care use in older adults with back pain.
J Orthop Sports Phys Ther 2020 Mar;50(3):143-48. doi: 10.2519/jospt.2020.8764..
Keywords:
Elderly, Back Health and Pain, Pain, Chronic Conditions, Quality of Life, Healthcare Utilization, Health Status
Aroke EN, Jackson P, Overstreet DS
Race, social status, and depressive symptoms: a moderated mediation analysis of chronic low back pain interference and severity.
Clin J Pain 2020 Sep;36(9):658-66. doi: 10.1097/ajp.0000000000000849.
Citation:
Aroke EN, Jackson P, Overstreet DS .
Race, social status, and depressive symptoms: a moderated mediation analysis of chronic low back pain interference and severity.
Clin J Pain 2020 Sep;36(9):658-66. doi: 10.1097/ajp.0000000000000849.
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Keywords:
Back Health and Pain, Chronic Conditions, Pain, Racial / Ethnic Minorities
O'Reilly-Jacob M, Perloff J, Buerhaus P
Comparing the rates of low-value back images ordered by physicians and nurse practitioners for Medicare beneficiaries in primary care.
This study measures the rates of low-value back images ordered by primary care physicians and nurse practitioners for Medicare beneficiaries, and there was no detectable difference between the two groups in 2012 and 2013.
AHRQ-funded; HS00062.
Citation:
O'Reilly-Jacob M, Perloff J, Buerhaus P .
Comparing the rates of low-value back images ordered by physicians and nurse practitioners for Medicare beneficiaries in primary care.
Nurs Outlook 2019 Nov - Dec;67(6):713-24. doi: 10.1016/j.outlook.2019.05.005..
Keywords:
Imaging, Value, Back Health and Pain, Primary Care, Imaging, Pain
Colloca L, Lee SE, Luhowy MN
Relieving acute pain (RAP) study: a proof-of-concept protocol for a randomised, double-blind, placebo-controlled trial
This study hypothesizes that dose-extending placebos can be an effective treatment in relieving clinical acute pain in trauma patients who take opioids. Publishing this study protocol will enable researchers and funding bodies to stay up to date in their fields by providing exposure to research activity that may not be otherwise widely publicized.
AHRQ-funded; HS022135.
Citation:
Colloca L, Lee SE, Luhowy MN .
Relieving acute pain (RAP) study: a proof-of-concept protocol for a randomised, double-blind, placebo-controlled trial
BMJ Open 2019 Nov 11;9(11):e030623. doi: 10.1136/bmjopen-2019-030623..
Keywords:
Back Health and Pain, Pain, Chronic Conditions, Opioids, Medication
Garrity B, Berry Crofton, C
Parent-to-parent advice on considering spinal fusion in children with neuromuscular scoliosis.
The purpose of this study was to convey advice from families whose children recently underwent spinal fusion to families whose children are under consideration for initial spinal fusion for neuromuscular scoliosis and to providers who counsel families on this decision. Results showed that parents of children who had recently undergone spinal fusion had strong perceptions about what information to convey to families considering surgery, which may improve communication between future parents and physicians. Further investigation is needed to assess how best to incorporate the wisdom and experiences of parent peers into shared decisionmaking and preparation for spinal fusion in children with neuromuscular scoliosis.
AHRQ-funded; HS024453.
Citation:
Garrity B, Berry Crofton, C .
Parent-to-parent advice on considering spinal fusion in children with neuromuscular scoliosis.
J Pediatr 2019 Oct;213:149-54. doi: 10.1016/j.jpeds.2019.05.055..
Keywords:
Decision Making, Patient and Family Engagement, Caregiving, Children/Adolescents, Back Health and Pain, Surgery
Brodney S, Fowler FJ, Barry MJ
Comparison of three measures of shared decision making: SDM Process_4, CollaboRATE, and SURE scales.
This study compared 3 different shared decision making (SDM) aids for patients facing surgery for hip or knee osteoarthritis, lumbar herniated disc or lumber spinal stenosis (backs). Patients were surveys after they used one of the following patient decision aids (PDAs): SMD Process_4, CollaboRATE, or SURE. The sample size was 649 with a mean age of 63.3 years, 51% female, and 60% were college educated. Most patients (69%) were facing hip or knee surgery. Results showed that the PDAs did aid patients – especially for hips/knees and were different for each PDA.
AHRQ-funded; HS025718.
Citation:
Brodney S, Fowler FJ, Barry MJ .
Comparison of three measures of shared decision making: SDM Process_4, CollaboRATE, and SURE scales.
Med Decis Making 2019 Aug;39(6):673-80. doi: 10.1177/0272989x19855951..
Keywords:
Decision Making, Surgery, Arthritis, Back Health and Pain
Kim HS, Kaplan SH, McCarthy DM
A comparison of analgesic prescribing among ED back and neck pain visits receiving physical therapy versus usual care.
Researchers used a retrospective cohort study to examine whether physical therapy (PT) is associated with lower analgesic prescribing in the emergency department (ED) setting. They found that, in this single center study, ED back and neck pain visits receiving PT were no less likely to receive an opioid prescription and were more likely to receive a benzodiazepine than visits receiving usual care. They conclude that, although prior studies demonstrated that PT may reduce opioid utilization in the subsequent year, these results indicated that analgesic prescribing is not reduced at the initial ED encounter.
AHRQ-funded; HS023011.
Citation:
Kim HS, Kaplan SH, McCarthy DM .
A comparison of analgesic prescribing among ED back and neck pain visits receiving physical therapy versus usual care.
Am J Emerg Med 2019 Jul;37(7):1322-26. doi: 10.1016/j.ajem.2018.10.009..
Keywords:
Opioids, Medication, Practice Patterns, Emergency Department, Patient-Centered Outcomes Research, Pain, Back Health and Pain, Outcomes, Evidence-Based Practice
Martin BI, Mirza SK, Spina N
Trends in lumbar fusion procedure rates and associated hospital costs for degenerative spinal diseases in the United States, 2004 to 2015.
This study analyzed trends in lumbar fusion procedure rates for degenerative spinal diseases in the US from 2004 to 2015 as well as associated hospital costs. Spinal fusion is considered an appropriate procedure for spinal deformity and instability, but has limited evidence of effectiveness for primary disc herniation and spinal stenosis without instability. The analysis showed that aggregate hospital costs increased 177% during the analysis period with disc degeneration, herniation and stenosis accounted for 42.3% of the elective surgery. The largest increases in the elective surgery were for spondylolisthesis and scoliosis and has slightly decreased for those procedures with less evidence of effectiveness.
AHRQ-funded; HS024714.
Citation:
Martin BI, Mirza SK, Spina N .
Trends in lumbar fusion procedure rates and associated hospital costs for degenerative spinal diseases in the United States, 2004 to 2015.
Spine 2019 Mar 1;44(5):369-76. doi: 10.1097/brs.0000000000002822..
Keywords:
Back Health and Pain, Healthcare Cost and Utilization Project (HCUP), Healthcare Costs, Healthcare Utilization, Surgery
Jarvik JG, Gold LS, Tan K
Long-term outcomes of a large, prospective observational cohort of older adults with back pain.
The study’s primary goals were to report 2-year outcomes of older adults initiating primary care for back pain and to examine the relative importance of patient factors vs. medical interventions in predicting 2-year disability and pain. The investigators found that baseline patient factors were more important than early interventions in explaining disability and pain after 2 years.
AHRQ-funded; HS019222; HS022972.
Citation:
Jarvik JG, Gold LS, Tan K .
Long-term outcomes of a large, prospective observational cohort of older adults with back pain.
Spine J 2018 Jan 29;18(9):1540-51. doi: 10.1016/j.spinee.2018.01.018..
Keywords:
Back Health and Pain, Elderly, Patient-Centered Outcomes Research
Milani CJ, Rundell SD, Jarvik JG
Associations of race and ethnicity with patient-reported outcomes and health care utilization among older adults initiating a new episode of care for back pain.
The purpose of this study was to characterize associations of self-reported race/ethnicity with back pain (BP) patient-reported outcomes and health care utilization among older adults with a new episode of care for BP. The investigators found that Blacks and Hispanics had slightly less improvement in BP-related functional limitations over time, and less spine-related health care utilization, as compared to whites and non-Hispanics, respectively. The authors suggested that residual confounding may explain some of the association between race/ethnicity and health outcomes.
AHRQ-funded; HS019222; HS022972.
Citation:
Milani CJ, Rundell SD, Jarvik JG .
Associations of race and ethnicity with patient-reported outcomes and health care utilization among older adults initiating a new episode of care for back pain.
Spine 2018 Jul 15;43(14):1007-17. doi: 10.1097/brs.0000000000002499..
Keywords:
Back Health and Pain, Elderly, Healthcare Utilization, Outcomes, Racial / Ethnic Minorities
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.
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
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, Value
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
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, Diagnosis, Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Information Technology (HIT), Medical Errors, Patient Safety
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
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
