Does Workers’ Compensation Status Affect Outcomes after Lumbar Spine Surgery? A Systematic Review and Meta-Analysis

Russo, Fabrizio; Salvatore, Sergio De; Ambrosio, Luigi; Vadalà, Gianluca; Fontana, Luca; Papalia, Rocco; Rantanen, Jorma; Iavicoli, Sergio; Denaro, Vincenzo

doi:10.3390/ijerph18116165

Cited by 46 publications

(21 citation statements)

References 74 publications

(262 reference statements)

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“…An example among the studies in our review is the Turner et al (2010) study that recruited workers’ compensation recipients [ 42 ]. Patients treated under compensation schemes may respond less well to pain therapy [ 48 , 49 , 50 ], including SCS [ 51 ], than uncompensated patients. Being aware of such characteristics aids the understanding of NNT estimates that may appear anomalous.…”

Section: Nnt Interpretationmentioning

confidence: 99%

Concept of the Number Needed to Treat for the Analysis of Pain Relief Outcomes in Patients Treated with Spinal Cord Stimulation

Bailey-Classen¹,

Parikh²,

Adimi

et al. 2022

Biomedicines

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In the rapidly evolving field of spinal cord stimulation (SCS), measures of treatment effects are needed to help understand the benefits of new therapies. The present article elaborates the number needed to treat (NNT) concept and applies it to the SCS field. We reviewed the basic theory of the NNT, its calculation method, and its application to historical controlled trials of SCS. We searched the literature for controlled studies with ≥20 implanted SCS patients with chronic axial back and/or leg pain followed for ≥3 months and a reported responder rate defined as ≥50% pain relief. Relevant data necessary to estimate the NNT were extracted from the included articles. In total, 12 of 1616 records were eligible for inclusion. The records reported 10 clinical studies, including 7 randomized controlled trials, 2 randomized crossover trials, and 1 controlled cohort study. The studies investigated traditional SCS and more recently developed SCS modalities, including 10 kHz SCS. In conclusion, the NNT estimate may help SCS stakeholders better understand the effect size difference between compared treatments; however, interpretation of any NNT should take into account its full context. In addition, comparisons across trials of different therapies should be avoided since they are prone to interpretation biases.

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Section: Nnt Interpretationmentioning

confidence: 99%

Concept of the Number Needed to Treat for the Analysis of Pain Relief Outcomes in Patients Treated with Spinal Cord Stimulation

Bailey-Classen¹,

Parikh²,

Adimi

et al. 2022

Biomedicines

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“…3,4 In lumbar spine surgery specifically, a meta-analysis by Russo et al found that WC patients had higher postoperative pain, decreased postoperative satisfaction, and delays in return to work (RTW) when compared with their non-WC counterparts. 5 To compound this, separate data have shown an increase in all-cause mortality associated with disability among WC patients with lower back injuries. 6 Although obesity has not been shown to cause considerable change in short-term outcomes following lumbar fusion, longer-term results demonstrate inferior complication rates and back pain recovery with increased need for pain relief among morbidly obese patients.…”

Section: Introductionmentioning

confidence: 99%

Impact of Body Mass Index on Postsurgical Outcomes for Workers’ Compensation Patients Undergoing Minimally Invasive Transforaminal Lumbar Interbody Fusion

et al. 2022

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Background: Increased morbidity associated with obesity imposes a greater financial burden on companies that provide insurance to their employees. Few studies have investigated the relationship between body mass index (BMI) and patientreported outcome measures (PROMs) for minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) in the workers' compensation (WC) population.Methods: WC patients who underwent a primary, single-level MIS TLIF were included/grouped according to BMI: nonobese (<30 kg/m 2 ); obese I (≥30, <35 kg/m 2 ); severe + morbid (≥35). PROMs were collected pre-and postoperatively: visual analog scale (VAS), Oswestry Disability Index (ODI), 12-Item Short Form (SF-12) physical composite score (PCS), and Patient-Reported Outcome Measurement Information System physical function (PROMIS-PF). BMI predictive power grouping on PROMs was evaluated using simple linear regression. Established minimum clinically important difference values were used to compute achievement rates across PROMs using logistic regression.Results: A total of 116 nonobese, 70 obese I, and 61 severe + morbid patients were included. Demographics among BMI grouping significantly differed in gender, hypertensive status, and American Society of Anesthesiologists score (P ≤ 0.037, all). Operative time was significantly different in perioperative values among BMI grouping (P ≤ 0.001). Increased BMI was significantly associated with greater VAS back at 12 weeks and 2 years (P ≤ 0.026, all), greater ODI preoperatively at 12 weeks and 6 months (P ≤ 0.015, all), and decreased PROMIS-PF at 12 weeks (P ≤ 0.011, all). Mean PROMs between obese I and severe + morbid cohorts differed in SF-12 PCS at 12 weeks, only (P = 0.050). ODI overall was the only parameter for which minimum clinically important difference was achieved among BMI cohorts (P ≤ 0.023).Conclusion: WC patients with increased BMI were more likely to develop significant back pain and disability at numerous postoperative timepoints compared with nonobese individuals. Our findings highlight the weight management importance within WC population to minimize back pain and disability following MIS TLIF, but provide a sense of reassurance with comparable clinical improvement regardless of BMI.Clinical Relevance: When considering the effect of weight, surgeons may incorporate these findings in managing patient expectations in the WC population undergoing lumbar spine surgery.Level of Evidence: 3.

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“…Therefore, the prevention of work absenteeism due to LBP recurrence has become a public and occupational health priority worldwide [ 12 ]. The treatments for non-specific LBP usually consisted of non-surgical procedures, such as physical exercise, cognitive behavioral therapy, and pharmacological treatment [ 13 , 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

The Effects of Workplace Interventions on Low Back Pain in Workers: A Systematic Review and Meta-Analysis

Russo

Papalia

Vadalà

et al. 2021

IJERPH

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This systematic review and meta-analysis aimed to analyze the effects of workplace interventions (WI) on clinical outcomes related to low back pain (LBP) in a worker population, and to assess socio-economic parameters as participants on sick leave, days of sick leave, and return to work following WI. A systematic literature search was performed to select randomized clinical trials that investigated the effectiveness of WI on return to work, sick leave, and working capacity of workers affected by nonspecific LBP. Fourteen articles were included in the review and meta-analysis. The meta-analysis showed improvements in pain (p = 0.004), disability (p = 0.0008), fear-avoidance for psychical activity (p = 0.004), and quality of life (p = 0.001 for physical scale and p = 0.03 for mental scale) for patients who underwent WI compared to controls. Moreover, the pain reduction following WI was statistically significant in the healthcare workers’ group (p = 0.005), but not in the other workers’ group. The participants on sick leave and the number of days of sick leave decreased in the WI group without statistical significance (p = 0.85 and p = 0.10, respectively). Finally, LBP recurrence was significantly reduced in the WI group (p = 0.006). WI led to a significant improvement of clinical outcomes in a workers’ population affected by LBP.

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Does Workers’ Compensation Status Affect Outcomes after Lumbar Spine Surgery? A Systematic Review and Meta-Analysis

Cited by 46 publications

References 74 publications

Concept of the Number Needed to Treat for the Analysis of Pain Relief Outcomes in Patients Treated with Spinal Cord Stimulation

Concept of the Number Needed to Treat for the Analysis of Pain Relief Outcomes in Patients Treated with Spinal Cord Stimulation

Impact of Body Mass Index on Postsurgical Outcomes for Workers’ Compensation Patients Undergoing Minimally Invasive Transforaminal Lumbar Interbody Fusion

The Effects of Workplace Interventions on Low Back Pain in Workers: A Systematic Review and Meta-Analysis

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