Randomized controlled trials in industrial low back pain relating to return to work. Part 2. Discogenic low back pain

Scheer, Steven J.; Radack, Kenneth L.; O’Brien, David R.

doi:10.1016/s0003-9993(96)90147-1

Cited by 38 publications

(25 citation statements)

References 60 publications

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“…For example, Yorimitisu et al [68] found that only 40% of patients returned to their presciatica activity levels after discectomy, while McGregor and Hughes [50] reported minimal or limited improvement in function after decompression. Occupational outcomes vary in different series but, overall, approximately 20% of patients go on to long-term incapacity [58,60].…”

Section: Introductionmentioning

confidence: 99%

The development of an evidence-based patient booklet for patients undergoing lumbar discectomy and un-instrumented decompression

et al. 2006

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Post-operative management after lumbar surgery is inconsistent leading to uncertainty amongst surgeons and patients about post-operative restrictions, reactivation, and return to work. This study aimed to review the evidence on post-operative management, with a view to developing evidence-based messages for a patient booklet on post-operative management after lumbar discectomy or un-instrumented decompression. A systematic literature search produced a best-evidence synthesis of information and advice on post-operative restrictions, activation, rehabilitation, and expectations about outcomes. Evidence statements were extracted and developed into patient-centred messages for an educational booklet. The draft text was evaluated by peer and patient review. The literature review found little evidence for post-operative activity restrictions, and a strong case for an early active approach to postoperative management. The booklet was built around key messages derived from the literature review and aimed to reduce uncertainty, promote positive beliefs, encourage early reactivation, and provide practical advice on self-management. Feedback from the evaluations were favourable from both review groups, suggesting that this evidence-based approach to management is acceptable and it has clinical potential.

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Section: Introductionmentioning

confidence: 99%

The development of an evidence-based patient booklet for patients undergoing lumbar discectomy and un-instrumented decompression

et al. 2006

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“…The remaining 58 reviews were retrieved and read in full by both authors. Seven were excluded because they were not written in English [8][9][10][11][12][13][14], five because they presented the evidence from systematic reviews only without any primary data from referenced clinical trials [15][16][17][18][19], 12 because they presented evidence from less than two referenced clinical trials [20][21][22][23][24][25][26][27][28][29][30][31] with or without additional data from systematic reviews, and four because they reached no conclusion about the effectiveness or efficacy of spinal manipulation for back pain or a specific type of back pain [32][33][34][35]. Following discussion between reviewers, agreement over which studies to include was again 100%.…”

Section: Resultsmentioning

confidence: 99%

Sources of bias in reviews of spinal manipulation for back pain

Canter

Ernst

2005

Wien Klin Wochenschr

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The effectiveness of spinal manipulation as a treatment for back pain remains uncertain and controversial. This is because of methodological weakness in many of the published clinical trials and also because of markedly opposing interpretations of the primary data by different reviewers. We have systematically assessed a representative sample of recent reviews on this topic. Reviews were included in the analysis if they were published between 1993 and March 2004, were listed in PubMed with an abstract and categorised as a review or meta-analysis, and were written in English. They were also required to present the evidence from at least two referenced clinical trials of spinal manipulation for back pain and to reach a conclusion about the effectiveness of the intervention. Each review was evaluated for methodological quality. Twenty-nine reviews met the inclusion criteria. Sixteen reached an overall positive conclusion, 7 a negative conclusion and 6 a neutral conclusion regarding therapeutic effectiveness. There were statistically significant pairwise correlations between each of the three factors: direction of conclusion, methodological quality and authorship by osteopaths or chiropracters. This indicates an association between authorship by osteopaths or chiropractors and low methodological quality and positive conclusion. We conclude that the outcomes of reviews of this subject are strongly influenced by both scientific rigour and profession of authors. The effectiveness of spinal manipulation for back pain is less certain than many reviews suggest; most high quality reviews reach negative conclusions.

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“…We used Fisher's exact test, 2 analyses, Mann-Whitney U test, and Student's t test to compare between the prednisone and control groups at each measurement time. The Wilcoxon signed-rank test was used to make intragroup comparisons of measures obtained at specified intervals from baseline.…”

Section: Discussionmentioning

confidence: 99%

“…1,[3][4][5][6][7][8] Patients with intractable pain or progressive neurologic symptoms usually receive an epidural injection of steroid drugs and, if necessary, decompressive laminectomy or diskectomy. 2,8,9 Fifty percent of patients with sciatica recover within 6 weeks and 90% recover within 12 weeks. 4,8 Despite being a mostly self-limiting condition, sciatica results in tremendous loss to our society in terms of decreased productivity, disability, and treatment costs.…”

mentioning

confidence: 99%

Oral Steroids in Initial Treatment of Acute Sciatica

Holve¹,

Barkan²

2008

The Journal of the American Board of Family Medicine

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Objective: Many physicians use prednisone to treat acute sciatica with the hope of speeding recovery. There is little clinical evidence to support this practice. Our objective was to determine whether early administration of oral prednisone affects parameters related to recovery from acute sciatica.Methods: In this double-blind, controlled clinical trial, 27 patients were sequentially assigned to receive either a 9-day tapering course of prednisone (n ‫؍‬ 13) or placebo (n ‫؍‬ 14) within 1 week of developing sciatic symptoms. Patients and investigators were blinded to the drug administered. Follow-up assessment was done weekly for 1 month and then monthly for 5 months.Results: Prednisone and control groups showed no statistically significant differences in physical findings, use of nonsteroidal anti-inflammatory drugs or narcotic medications, or rates of patients returning to work at any time interval studied. Compared with controls, patients who received prednisone had more rapid rates of improvement from baseline in pain, mental well-being, and disability scores. These changes were subtle but statistically significant. Patients who received prednisone tended to receive fewer epidural injections for pain.Conclusions: Early administration of oral steroid medication in patients with acute sciatica had no significant effect on most parameters studied. It did, however, lead to slightly more rapid rates of improvement in pain, mental well-being, and disability scores. The impact of oral steroids on other outcomes is suggested by this study, but its small sample size limited its statistical power. Sciatica (lumbosacral radiculopathy) is a common problem seen by primary care physicians and is diagnosed in approximately 1% of all patients who present with acute low back pain.1,2 Traditional treatment includes pain medication (acetaminophen, nonsteroidal anti-inflammatory agents [NSAIDs], or narcotic agents); activity as tolerated; and time. 1,[3][4][5][6][7][8] Patients with intractable pain or progressive neurologic symptoms usually receive an epidural injection of steroid drugs and, if necessary, decompressive laminectomy or diskectomy. 2,8,9 Fifty percent of patients with sciatica recover within 6 weeks and 90% recover within 12 weeks. 4,8 Despite being a mostly self-limiting condition, sciatica results in tremendous loss to our society in terms of decreased productivity, disability, and treatment costs. These costs are incurred both during the initial episode and over the long term.

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Randomized controlled trials in industrial low back pain relating to return to work. Part 2. Discogenic low back pain

Cited by 38 publications

References 60 publications

The development of an evidence-based patient booklet for patients undergoing lumbar discectomy and un-instrumented decompression

The development of an evidence-based patient booklet for patients undergoing lumbar discectomy and un-instrumented decompression

Sources of bias in reviews of spinal manipulation for back pain

Oral Steroids in Initial Treatment of Acute Sciatica

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