Abstract
Objective
To evaluate the degree to which conservative care and failure were specifically defined
in studies comparing nonoperative treatment versus surgery for low back pain (LBP)
conditions in adults.
Data Sources
A comprehensive literature search was conducted by an experienced librarian using
MEDLINE (PubMed), Embase, Google Scholar, and CENTRAL from January 2003 to June 2014.
Endnote bibliographic management application was used to remove duplicates and organize
the citations.
Study Selection
Prospective, randomized, or cohort trials comparing surgery versus conservative intervention
for patients with LBP conditions. Study selection was conducted by 2 independent reviewers.
Data Extraction
Three independent reviewers extracted data from each article using a structured data
extraction form. Data extracted included type of study, participant characteristics,
sample size, description, and duration of conservative care and whether failed conservative
care criterion was defined.
Data Synthesis
A total of 852 unique records were screened for eligibility; of those, 72 articles
were identified for further full-text review. Thirty-four full texts were excluded
based on the exclusion criteria, and 38 articles, representing 20 unique studies,
were included for qualitative synthesis. Fifteen of the 20 studies defined the duration
of conservative care. Only 3 studies defined the dosage of physical therapy sessions,
including total number of visits and visit duration. Two studies described medication
usage, including the duration and type. No studies specifically defined what constituted
failed conservative therapy.
Conclusions
This literature review suggests conservative care is poorly defined in randomized
trials, which can lead to ambiguity of research procedures and unclear guidelines
for clinicians. Future studies should increase transparency and explicitly define
conservative care.
Keywords
List of abbreviations:
LBP (low back pain)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: August 27, 2016
Footnotes
Current affiliation for Coronado, Department of Physical Therapy and Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, TX.
Disclosures: none.
Identification
Copyright
© 2016 by the American Congress of Rehabilitation Medicine
