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Biomedical subjects

William A Abdu

Publications and source records attributed to William A Abdu.

11 recordsLinked to original sources
PubMed2006

Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT): a randomized trial.

CONTEXT: Lumbar diskectomy is the most common surgical procedure performed for back and leg symptoms in US patients, but the efficacy of the procedure relative to nonoperative care remains controversial. OBJECTIVE: To assess the efficacy of surgery for lumbar intervertebral disk herniation. DESIGN, SETTING, AND PATIENTS: The Spine Patient Outcomes Research Trial, a randomized clinical trial enrolling patients between March 2000 and November 2004 from 13 multidisciplinary spine clinics in 11 US states. Patients were 501 surgical candidates (mean age, 42 years; 42% women) with imaging-confirmed lumbar intervertebral disk herniation and persistent signs and symptoms of radiculopathy for at least 6 weeks. INTERVENTIONS: Standard open diskectomy vs nonoperative treatment individualized to the patient. MAIN OUTCOME MEASURES: Primary outcomes were changes from baseline for the Medical Outcomes Study 36-item Short-Form Health Survey bodily pain and physical function scales and the modified Oswestry Disability Index (American Academy of Orthopaedic Surgeons MODEMS version) at 6 weeks, 3 months, 6 months, and 1 and 2 years from enrollment. Secondary outcomes included sciatica severity as measured by the Sciatica Bothersomeness Index, satisfaction with symptoms, self-reported improvement, and employment status. RESULTS: Adherence to assigned treatment was limited: 50% of patients assigned to surgery received surgery within 3 months of enrollment, while 30% of those assigned to nonoperative treatment received surgery in the same period. Intent-to-treat analyses demonstrated substantial improvements for all primary and secondary outcomes in both treatment groups. Between-group differences in improvements were consistently in favor of surgery for all periods but were small and not statistically significant for the primary outcomes. CONCLUSIONS: Patients in both the surgery and the nonoperative treatment groups improved substantially over a 2-year period. Because of the large numbers of patients who crossed over in both directions, conclusions about the superiority or equivalence of the treatments are not warranted based on the intent-to-treat analysis. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00000410.

Adult↗
PubMed2006

The impact of comorbidities on the change in short-form 36 and oswestry scores following lumbar spine surgery.

STUDY DESIGN: This is an observational study of 3482 patients undergoing lumbar spine surgery from the National Spine Network. OBJECTIVES: To explore the influence of medical and psychosocial comorbidities on the change in Short-form 36 (SF-36) general health survey and condition-specific Oswestry Disability Index (ODI) scores in patients undergoing lumbar spine surgery. SUMMARY OF BACKGROUND DATA: It remains unclear as to which type of health instrument is more appropriate for monitoring improvement in patients who undergo lumbar spine surgery. Most clinicians would suspect that comorbidities (medical and psychosocial) play a significant role in the outcome of spine patients. Yet, it has been difficult to quantify specifically the impact of comorbidities on the responsiveness of traditional health status instruments for spine patients. METHODS: Analysis of variance was performed to assess the difference in the change in survey scores across comorbidity groups for the population of National Spine Network patients who had undergone lumbar spine surgical intervention and completed 3-month and 1-year follow-up surveys. Multiple linear regressions were used to identify the most influential individual comorbidities on the change scores. RESULTS: Comorbidities had a significant impact on the change in scores at 3 months and 1 year. The average change in bodily pain, physical function, physical component summary scores of the SF-36, as well as ODI scores decreased in response to surgery as the number of comorbidities increased. Psychosocial comorbidities such as an active compensation case, self-rated poor health, and smoking exerted large effects on the change in survey scores after surgery (P < 0.003). Medical disorders such as headaches, depression, and nervous system disorders were also highly influential (P < 0.05). CONCLUSIONS: The negative impact of medical and psychosocial comorbidities on the change in SF-36 general health survey and condition-specific ODI scores, despite spine surgery, highlights the need for researchers and clinicians to consider these comorbidities when using these, and perhaps all, health survey instruments and interpreting these scores after surgery. Contrary to current assumptions regarding condition-specific health surveys, medical and psychosocial comorbidities similarly affect the generic SF-36 and condition-specific ODI. Further studiesare needed to determine if spine surgery outcomes can be improved by specifically addressing potentially modifiable comorbidities, which negatively impact survey scores, or whether comorbidity burden should play a role in the selection process for surgical intervention. Failure to incorporate consideration of medical and psychosocial comorbidities into preoperative discussions can be a failure to allow our patients (and ourselves) to have realistic expectations and, consequently, the best possible outcome from their treatment choice.

Aged↗
PubMed2006

Can condition-specific health surveys be specific to spine disease? An analysis of the effect of comorbidities on baseline condition-specific and general health survey scores.

STUDY DESIGN: This is an observational cross-sectional study of 26,290 patients seen and evaluated in the 25 centers of the National Spine Network. OBJECTIVE: To explore the correlation between medical and psychosocial comorbidities, and baseline Short-Form 36 Health Status questionnaire (SF-36) and Oswestry Disability Index (ODI) (Musculoskeletal Outcomes Data Evaluation and Management Systems version with scales reversed so that a score of 100 represents no disability, and a score of 0 represents severe disability) scores in spine patients. SUMMARY OF BACKGROUND DATA: It remains unclear whether general health questionnaires or condition-specific surveys are superior for evaluating spine patients (Spine 2000;25:3100-3). Most clinicians would suspect that comorbidities (medical and psychosocial) play a significant role in the presentation, treatment, and outcome of spine patients. Yet, it has been difficult to quantify specifically the association of comorbidities with traditional health status instrument scores for spine patients. METHODS: Initial visit (baseline) health questionnaires were analyzed. Patients were stratified according to the number of self-reported comorbidities. Analysis of variance was performed to assess the difference in mean health status across comorbidity groups. Multiple linear regressions were used to identify the most influential individual comorbidities on baseline functional survey scores. RESULTS: There is an associated decrease in baseline physical component summary (PCS) (from the SF-36) and ODI scores with the addition of each comorbidity. For the range of zero to > or =7 comorbidities, the PCS score decreases from 33.3 to 23.2 (P < 0.001). The average baseline ODI score for patients with zero comorbidities was 62.4, decreasing to 42.0 in the group with > or =7 comorbidities (P < 0.001). The strongest association was seen with the medical comorbidities of smoking, frequent headaches, osteoarthritis, and osteoporosis (P < 0.001). However, the association with psychosocial comorbidities(e.g., self-rated health, active compensation case, depression) (P < 0.001) was higher for both health status measures. Health status measures in patients with lumbar problems show that these patients are more impacted by their disease than patients with cervical or thoracic spine problems (P < 0.001), although the correlation with comorbidities is smaller for the lumbar group (P < 0.001). CONCLUSION: Traditional medical comorbidities correlate with both SF-36 (e.g., PCS) general health survey scores as well as disease-specific ODI scores. However, psychosocial comorbidities such as poor self-rated health (SF-1), an active compensation case, and low education level have a higher association than traditional medical comorbidities on these health status measures. The results show that the type of survey (disease-specific e.g., ODI, vs. generic e.g., SF-36) used may be less important than the need to assess and control for psychosocial and medical comorbidities when any patient-reported health survey is used in the spine population.

Adult↗
PubMed2006

Descriptive epidemiology and prior healthcare utilization of patients in the Spine Patient Outcomes Research Trial's (SPORT) three observational cohorts: disc herniation, spinal stenosis, and degenerative spondylolisthesis.

STUDY DESIGN: Prospective observational cohorts. OBJECTIVE: To describe sociodemographic and clinical features, and nonoperative (medical) resource utilization before enrollment, in patients who are candidates for surgical intervention for intervertebral disc herniation (IDH), spinal stenosis (SpS), and degenerative spondylolisthesis (DS) according to SPORT criteria. SUMMARY OF BACKGROUND DATA: Intervertebral disc herniation, spinal stenosis, and degenerative spondylolisthesis with stenosis are the three most common diagnoses of low back and leg symptoms for which surgery is performed. There is a paucity of descriptive literature examining large patient cohorts for the relationships among baseline characteristics and medical resource utilization with these three diagnoses. METHODS: The Spine Patient Outcomes Research Trial (SPORT) conducts three randomized and three observational cohort studies of surgical and nonsurgical treatments for patients with IDH, SpS, and DS. Baseline data include demographic information, prior treatments received, and functional status measured by SF-36 and the Oswestry Disability Index (ODI-AAOS/Modems version). The data presented represent all 1,411 patients (743 IDH, 365 SpS, 303 DS) enrolled in the SPORT observational cohorts. Multiple logistic regression was used to generate independent predictors of utilization adjusted for sociodemographic variables, diagnosis, and duration of symptoms. RESULTS: The average age was 41 years for the IDH group, 64 years for the SpS group, and 66 years for the DS group. At enrollment, IDH patients presented with the most pain as reported on the SF-36 (BP 26.3 vs. 33.2 SpS and 33.8 DS) and were the most impaired (ODI 51 vs. 42.3 SpS and 41.5 DS). IDH patients used more chiropractic treatment (42% vs. 33% SpS and 26% DS), had more Emergency Department (ED) visits (21% vs. 7% SpS and 4% DS), and used more opiate analgesics (49% vs. 29% SpS and 27% DS). After adjusting for age, gender, diagnosis, education, race, duration of symptoms, and compensation, Medicaid patients used significantly more opiate analgesics (58% Medicaid vs. 41% no insurance, 42% employer, 33% Medicare, and 32% private) and had more ED visits compared with other insurance types (31% Medicaid vs. 22% no insurance, 16% employer, 3% Medicare, and 11% private). CONCLUSION: IDH patients appear to have differences in sociodemographics, resource utilization, and functional impairment when compared with the SpS/DS patients. In addition, the differences in resource utilization for Medicaid patients may reflect differences in access to care. The data provided from these observational cohorts will serve as an important comparison to the SPORT randomized cohorts in the future.

Adult↗
PubMed2005

Point of view.

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Cervical Vertebrae↗
PubMed2005

The rate and variation of referrals to behavioral medicine services for patients reporting poor mental health in the national spine network.

STUDY DESIGN: Descriptive analysis of cross-sectional data collected prospectively in 20 National Spine Network (NSN) centers. OBJECTIVES: First, to summarize clinical and demographic characteristics of patients likely to need servicesfor psychosocial concerns. Second, to determine the rate and variability of referrals for behavioral medicine interventions (BMED) across the NSN. SUMMARY OF BACKGROUND DATA: The prevalence of mental distress resulting from or coexisting with spinal pain is unclear. There is evidence that psychological treatments, particularly BMED, can aid the recovery of patients with symptoms of mental distress. METHODS: From 1998 to 2001, 28,349 patients presenting to NSN centers completed the SF-36 General Health Survey. Patients were dichotomized by the mental component summary (MCS) score into two groups: 1) those scoring 35. Clinicians recorded a "treatment plan" comprised of a standard array of treatment options. For patients scoring <or=35 on the MCS, the rate and variation of referrals to BMED was assessed. RESULTS: Baseline health status scores were lower across all SF-36 scales for the patients scoring an MCS <or= 35. For mentally distressed patients, the overall average referral rate for any BMED service for patients scoring MCS <or= 35 was 11.8%. The rate varied across NSN sites from 0 to 41%. CONCLUSION: With only 11.8% of mentally distressed NSN patients receiving a referral for any form of BMED, it appears that a large proportion of eligible patients are not receiving a potentially beneficial treatment. Wide variation across centers may indicate an inability to adequately assess mental distress via the usual clinical interview and examination for spinal conditions or a lack of consensus regarding BMED's availability and utility.

Behavioral Medicine↗
PubMed2003

Point of view.

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Bone Transplantation↗
PubMed2002

Multiple independent, sequential, and spontaneously resolving lumbar intervertebral disc herniations: a case report.

STUDY DESIGN: A case report is presented. OBJECTIVE: To highlight the potential for spontaneous resolution of large extruded intervertebral lumbar disc herniations in a patient with three independent herniations. SUMMARY OF BACKGROUND DATA: The most effective methods of treatment for lumbar intervertebral disc herniations remain in question. This is partly because the potential for intrinsic spontaneous resolution is not understood, and because many believe that large extruded lumbar intervertebral disc herniations require surgical intervention. This case report addresses both issues. METHODS: A case is reported and the literature is reviewed. RESULTS: In the patient described, multiple independent lumbar intervertebral disc herniations resolved spontaneously both clinically and radiographically with nonoperative treatment. CONCLUSIONS: Not only is the question concerning the cause of disc herniation unresolved, but the best methods of treatment also are generally unclear. This case report documents a patient with the intrinsic capability not only to herniate multiple lumbar intervertebral discs, but also to resolve them clinically and anatomically. Extruded lumbar intervertebral disc herniations may be treated without surgery, as highlighted by this case report. The immunohistologic pathomechanism for resorption remains unclear.

Adult↗
PubMed2002

Association between obesity and functional status in patients with spine disease.

STUDY DESIGN: A cross-sectional study of 15,974 patients with spine disease from 26 members of the National Spine Network. OBJECTIVES: To use functional status measures and clinical parameters to evaluate the association between obesity and health status among patients with spine conditions. SUMMARY OF BACKGROUND DATA: With 22.5% of Americans overweight, obesity is a significant health concern. However, the functional impact caused by obesity in spine patients remains unknown. METHODS: Functional status was measured on 15,974 patients on an initial visit using a general physical health measure (SF-36 Physical Component Summary score) and a disease-specific measure (Oswestry Disability Index). Obesity was measured using body mass index (kg/m2). Patients were categorized into four groups according to body mass index: normal range (<25.0 kg/m2, n = 5732), Grade 1 obesity (25.0-29.9 kg/m2, n = 5845), Grade 2 obesity (30.0-39.9 kg/m2, n = 3836), and Grade 3 obesity (>/=40.0 kg/m2, n = 561). The associations between SF-36 Physical Component Summary and Oswestry Disability Index scores and body mass index were evaluated in a multivariate linear regression model. Clinical presentation data were derived from patient and clinician reports and were compared across body mass index categories. RESULTS: In the four obesity categories, the PCS scores were 32.6 (normal range body mass index), 30.8 (Grade 1), 28.2 (Grade 2), and 25.9 (Grade 3) (P < 0.001). The SF-36 Physical Component Summary score of the general U.S. population is 50.0. The Oswestry Disability Index scores across the four body mass index groups were 39.0, 41.6, 46.6, and 52.2, respectively (P < 0.001). Compared with nonobese patients, obese patients were more likely to have radicular pain and neurologic signs (P < 0.01). Furthermore, obese patients had more comorbidities and were more likely to be receiving worker's compensation. After adjusting for clinical and demographic factors, each increased level of obesity was associated with a 1-1.5-point worsening in both the SF-36 Physical Component Summary and Oswestry Disability Index scales (P < 0.05). CONCLUSIONS: General and disease-specific functional health status was significantly worse for patients with a higher body mass index. Obese patients also displayed more severe pain symptoms than nonobese spine patients.

Body Mass Index↗