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Outcomes/Effectiveness Research

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Two-thirds of adults report improved functioning and quality of life following surgery for low back pain

A new community-based study led by surgeons in private practice in Washington State shows that two-thirds of patients with degenerative changes, herniated disc, instability, or spinal stenosis were satisfied with their improved functioning and quality of life following surgery for low back pain. The Back Pain Outcomes Assessment Team, supported by the Agency for Healthcare Research and Quality (HS06344 and HS08194), surveyed 281 adults before back surgery and again 1 year later. Patients were asked preoperatively about their symptoms, sociodemographic factors, and preoperative clinical signs and postsurgically about their functioning and treatment satisfaction. The study was led by principal investigator Richard A. Deyo, M.D., M.P.H., of the University of Washington.

Sixty-five percent of back surgery patients reported much better functioning, 64 percent reported a great improvement in quality of life, and 68 percent had a very positive opinion about their treatment outcome. The following factors were associated with worse patient outcomes: older age, previous low back surgery, workers' compensation coverage, and consultation with an attorney before surgery. The negative influence of financial compensation and litigation on recovery has been shown in previous studies and is a controversial issue in the treatment of low back problems. The design of the current study could not determine whether compensation or litigation caused outcomes to be worse or whether patients with worse conditions were more likely to seek compensation and litigation.

Orthopedists and neurosurgeons performed the back surgeries, which ranged from laminectomy and discectomy to fusion. Patients undergoing a fusion procedure were more likely to report good outcomes. But because of the small number of patients, varied diagnoses, and possible selection bias, these fusion-related findings should be interpreted cautiously, according to Dr. Deyo.

See "Patient-oriented outcomes from low back surgery: A community-based study," by Victoria M. Taylor, M.D., M.P.H., Dr. Deyo, Marcia Ciol, Ph.D., and others, in the October 2000 Spine 25(19), pp. 2445-2452.

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