Title: Spine Pain Intervention to Enhance Care Quality and Reduce Expenditure (SPINE CARE)
Funded by Stanford Clinical Excellence Research Center, PIs: Milstein, Stanford and Choudhry, Harvard
Low back and neck pain are among the leading causes of medical visits, lost productivity and disability. There is an urgent need to identify effective and efficient ways of helping patients with acute spine pain while guiding practitioners towards high-value care. This multi-center pragmatic trial will randomize patients with acute spine pain to one of three treatment strategies, Identify, Coordinate and Enhanced decision making (ICE) care model, Individualized Postural Therapy, and usual care. SPINE-CARE trial is a collaboration between Stanford, Harvard, and Vanderbilt University Medical Center. (https://clinicaltrials.gov/ct2/show/NCT03083886)
Title: Comparative Effectiveness of Postoperative Management for Degenerative Spinal Conditions
Funded by the Patient-Centered Outcomes Research Institute (PCORI), PI: Archer, Vanderbilt Publications
The United States has the highest rate of lumbar spine surgery in the world, with rates increasing over 200% in the last decade. These surgeries account for over $1 billion spent annually by Medicare. Despite surgical advances, up to 40% of older adults have persistent pain, disability and functional limitations. We have found that psychosocial factors, such as fear of movement, are risk factors for increased pain and disability following lumbar spine surgery. Brief cognitive-behavioral therapy and self-management treatments have proven effective for reducing psychosocial risk factors. However, these treatments are unavailable or insufficiently adapted for postoperative care.
This multi-center randomized controlled trial will randomize patients undergoing spine surgery to cognitive behavioral-based physical therapy (CBPT) program or an education program. Patients will be followed for 1 year following surgery to assess pain, disability, physical activity, physical function, and general health. (https://clinicaltrials.gov/ct2/show/NCT02184143
Title: The Effect of an Early Home Exercise Program on Outcomes after Cervical Spine Surgery
Funded by Cervical Spine Research Society, PI: Coronado, Vanderbilt
Degenerative cervical spine conditions such as spinal stenosis and cervical disk disease are the most common reasons for fusion surgery. Anterior cervical discectomy and fusion (ACDF) surgery is the most commonly performed cervical spine surgery. An estimated 771,932 individuals underwent ACDF surgery between 1994 and 2004 in the U.S. Total hospital costs associated with ACDF surgery exceed $17,000 per admission. Despite an increase in surgery, up to 65% of patients show poor outcomes in long-term disability, quality of life, and functioning.
This randomized controlled trial examines the efficacy and safety of an early home exercise program (HEP) for improving disability, pain, general health, and physical activity compared to usual care after ACDF surgery for degenerative cervical spine disease. (https://clinicaltrials.gov/ct2/show/NCT02720172)