Abstract
Objective
To investigate the effect of adding segmental epidural steroid injections (SESIs)
to usual care compared with usual care alone on quality of life and cost utility in
lumbosacral radicular syndrome (LRS) in general practice.
Design
A pragmatic randomized controlled trial. Results were analyzed using mixed models.
Setting
Primary care.
Participants
Patients (N=50) in the acute phase of LRS.
Interventions
One epidural injection containing 80mg of triamcinolone in normal saline.
Main Outcome Measure
Back pain at 4 weeks after the start of the treatment.
Results
Both groups experienced a significant increase in quality of life in (especially)
the physical domains of the Medical Outcomes Study 36-Item Short-Form Health Survey.
The intervention group scored significantly better than the control group at certain
time points in the physical domain. The differences were small. The cost-utility analysis
showed that with a negligible loss of utility (3d in perfect health), societal costs
(193,354 euros per quality-adjusted life year lost) would be saved because of more
productivity in the intervention group.
Conclusions
Although the beneficial effects of SESIs are small and the natural course of LRS is
predominantly favorable, we think decision makers can consider implementing SESIs
in daily practice with the purpose of saving resources. Caution must be taken, and
further research should be directed at identifying patient subgroups who might benefit
from SESIs, with additional focus on (costs of) complications and adverse effects.
Keywords
List of abbreviations:
CI (confidence interval), EQ-5D (EuroQol–5 Dimensions), GP (general practitioner), LRS (lumbosacral radicular syndrome), QALY (quality-adjusted life year), SESI (segmental epidural steroid injection), SF-36 (Medical Outcomes Study 36-Item Short-Form Health Survey), SF-6D (Short-Form–6 Dimensions)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: November 08, 2014
Footnotes
The Netherlands National Trial Register Clinical Trial Registration No.: NTR342.
Disclosures: none.
Identification
Copyright
© 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
