Patient factors that influence decision making: Randomization versus observational nonoperative versus observational operative treatment for adult symptomatic lumbar scoliosis

Brian J Neuman, Christine Baldus, Lukas P. Zebala, Michael P. Kelly, Christopher Shaffrey, Charles Edwards, Tyler Koski, Frank Schwab, Steven Glassman, Stefan Parent, Stephen Lewis, Lawrence G. Lenke, Jacob M. Buchowski, Justin S. Smith, Charles H. Crawford, Han Jo Kim, Virginia Lafage, Jon Lurie, Leah Carreon, Keith H. Bridwell

Research output: Contribution to journalArticle

Abstract

Study Design. A prospective study with randomized and observational cohorts. Objective. The aim of this study was to determine baseline variables affecting adult symptomatic lumbar scoliosis (ASLS) decision making to participate in randomization (RAND), observational nonsurgical (OBS-NS), or observational surgical (OBS-S) cohorts. Summary of Background Data. Multiple factors play a key role in a patient's decision to be randomized or to choose an OBS-NS or OBS-S course for ASLS. Studies evaluating these factors are limited. Methods. Eligible candidates (patients with ASLS and no prior spinal fusion deformity surgery) from 9 centers participated in a RAND, OBS-NS, or OBS-S cohort study. Baseline variables (demographics, socioeconomics, patient-reported outcomes [PROs], Functional Treadmill Test, radiographs) were analyzed. Results. Two hundred ninety-five patients were enrolled: 67 RAND, 115 OBS-NS, 113 OBS-S. Subanalysis of older patients (60-80 years) found 54% of OBS-NS had college degrees compared with 82% of RAND and 71% of OBS-S (P=0.010). Patients deciding to be part of a RAND cohort have similar clinical characteristics to the OBS-S cohort. OBS-S had more symptomatic spinal stenosis (57% vs. 39%, P=0.029) and worse scores than OBS-NS on the basis of PROs (Back Pain Numerical Rating Scale [NRS 6.3 vs. 5.5, P=0.007]; Scoliosis Research Society [SRS] Pain [2.8 vs. 3.0, P=0.018], Function [3.1 vs. 3.4, P=0.019] and Self-Image [2.7 vs. 3.1, P=0.002]; Oswestry Disability Index (ODI) [36.9 vs. 31.8, P=0.029]; post-Treadmill back [5.8 vs. 4.4, P=0.002] and leg [4.3 vs. 3.1, P=0.037] pain NRS and larger lumbar coronal Cobb angles (56.5 degrees vs. 48.8 degrees, P

Original languageEnglish (US)
Pages (from-to)E349-E358
JournalSpine
Volume41
Issue number6
DOIs
StatePublished - Mar 4 2016

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Scoliosis
Random Allocation
Decision Making
Therapeutics
Pain
Spinal Stenosis
Spinal Fusion
Back Pain
Exercise Test
Leg
Cohort Studies
Demography
Prospective Studies
Research
Patient Reported Outcome Measures

Keywords

  • Adult lumbar scoliosis
  • Nonsurgical treatment
  • Patient-reported outcomes
  • Randomized trial
  • Surgical treatment

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Patient factors that influence decision making : Randomization versus observational nonoperative versus observational operative treatment for adult symptomatic lumbar scoliosis. / Neuman, Brian J; Baldus, Christine; Zebala, Lukas P.; Kelly, Michael P.; Shaffrey, Christopher; Edwards, Charles; Koski, Tyler; Schwab, Frank; Glassman, Steven; Parent, Stefan; Lewis, Stephen; Lenke, Lawrence G.; Buchowski, Jacob M.; Smith, Justin S.; Crawford, Charles H.; Kim, Han Jo; Lafage, Virginia; Lurie, Jon; Carreon, Leah; Bridwell, Keith H.

In: Spine, Vol. 41, No. 6, 04.03.2016, p. E349-E358.

Research output: Contribution to journalArticle

Neuman, BJ, Baldus, C, Zebala, LP, Kelly, MP, Shaffrey, C, Edwards, C, Koski, T, Schwab, F, Glassman, S, Parent, S, Lewis, S, Lenke, LG, Buchowski, JM, Smith, JS, Crawford, CH, Kim, HJ, Lafage, V, Lurie, J, Carreon, L & Bridwell, KH 2016, 'Patient factors that influence decision making: Randomization versus observational nonoperative versus observational operative treatment for adult symptomatic lumbar scoliosis', Spine, vol. 41, no. 6, pp. E349-E358. https://doi.org/10.1097/BRS.0000000000001222
Neuman, Brian J ; Baldus, Christine ; Zebala, Lukas P. ; Kelly, Michael P. ; Shaffrey, Christopher ; Edwards, Charles ; Koski, Tyler ; Schwab, Frank ; Glassman, Steven ; Parent, Stefan ; Lewis, Stephen ; Lenke, Lawrence G. ; Buchowski, Jacob M. ; Smith, Justin S. ; Crawford, Charles H. ; Kim, Han Jo ; Lafage, Virginia ; Lurie, Jon ; Carreon, Leah ; Bridwell, Keith H. / Patient factors that influence decision making : Randomization versus observational nonoperative versus observational operative treatment for adult symptomatic lumbar scoliosis. In: Spine. 2016 ; Vol. 41, No. 6. pp. E349-E358.
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AU - Neuman, Brian J

AU - Baldus, Christine

AU - Zebala, Lukas P.

AU - Kelly, Michael P.

AU - Shaffrey, Christopher

AU - Edwards, Charles

AU - Koski, Tyler

AU - Schwab, Frank

AU - Glassman, Steven

AU - Parent, Stefan

AU - Lewis, Stephen

AU - Lenke, Lawrence G.

AU - Buchowski, Jacob M.

AU - Smith, Justin S.

AU - Crawford, Charles H.

AU - Kim, Han Jo

AU - Lafage, Virginia

AU - Lurie, Jon

AU - Carreon, Leah

AU - Bridwell, Keith H.

PY - 2016/3/4

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N2 - Study Design. A prospective study with randomized and observational cohorts. Objective. The aim of this study was to determine baseline variables affecting adult symptomatic lumbar scoliosis (ASLS) decision making to participate in randomization (RAND), observational nonsurgical (OBS-NS), or observational surgical (OBS-S) cohorts. Summary of Background Data. Multiple factors play a key role in a patient's decision to be randomized or to choose an OBS-NS or OBS-S course for ASLS. Studies evaluating these factors are limited. Methods. Eligible candidates (patients with ASLS and no prior spinal fusion deformity surgery) from 9 centers participated in a RAND, OBS-NS, or OBS-S cohort study. Baseline variables (demographics, socioeconomics, patient-reported outcomes [PROs], Functional Treadmill Test, radiographs) were analyzed. Results. Two hundred ninety-five patients were enrolled: 67 RAND, 115 OBS-NS, 113 OBS-S. Subanalysis of older patients (60-80 years) found 54% of OBS-NS had college degrees compared with 82% of RAND and 71% of OBS-S (P=0.010). Patients deciding to be part of a RAND cohort have similar clinical characteristics to the OBS-S cohort. OBS-S had more symptomatic spinal stenosis (57% vs. 39%, P=0.029) and worse scores than OBS-NS on the basis of PROs (Back Pain Numerical Rating Scale [NRS 6.3 vs. 5.5, P=0.007]; Scoliosis Research Society [SRS] Pain [2.8 vs. 3.0, P=0.018], Function [3.1 vs. 3.4, P=0.019] and Self-Image [2.7 vs. 3.1, P=0.002]; Oswestry Disability Index (ODI) [36.9 vs. 31.8, P=0.029]; post-Treadmill back [5.8 vs. 4.4, P=0.002] and leg [4.3 vs. 3.1, P=0.037] pain NRS and larger lumbar coronal Cobb angles (56.5 degrees vs. 48.8 degrees, P

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KW - Adult lumbar scoliosis

KW - Nonsurgical treatment

KW - Patient-reported outcomes

KW - Randomized trial

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