Estimating individualized treatment effects using a risk-modeling approach: an application to epidural steroid injections for lumbar spinal stenosis

Liu, Pinyan; Wu, Y.; Xiao, Zuoxiang; Gold, Laura S.; Heagerty, Patrick J.; Annaswamy, Thiru M.; Friedly, Janna; Turner, Judith A.; Jarvik, Jeffrey G.; Suri, Pradeep

doi:10.1097/j.pain.0000000000002768

Cited by 3 publications

(3 citation statements)

References 35 publications

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“…Another potential limitation of the study is that the findings with regards to feasibility and effectiveness may not generalize to settings outside the VA health care system, as patients in VA settings generally have higher levels of disability and psychological comorbidity than in civilian health care. [21] We have recently shown that procedural treatment effects on disability outcomes in CLBP can be larger in subgroups of people with higher predicted levels of disability, [23] leaving open the possibility that treatment effects in non-VA settings may be smaller than those in the current study. A specific limitation related to activity tracker-evaluated step counts was that post-MBB improvements in step counts were noted for many participants as compared to their pre-MBB steps, and these improvements had not returned to pre-MBB levels for some participants prior to randomization (even though pain intensity levels had returned to an intensity sufficient to warrant LRFA and were ≥4 on the NRS scale on the day of randomization).…”

Section: Discussionmentioning

confidence: 69%

Combining Procedural and Behavioral Treatments for Chronic Low Back Pain: A Pilot Feasibility Randomized Controlled Trial

Tanus

Nishio

Williams

et al. 2023

Preprint

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Individual treatments for chronic low back pain (CLBP) have small magnitude effects. Combining different types of treatments may produce larger effects. This study used a 2x2 factorial randomized controlled trial (RCT) design to combine procedural and behavioral treatments for CLBP. The study aims were to: (1) assess feasibility of conducting a factorial RCT of these treatments; and (2) estimate individual and combined treatment effects of (a) lumbar radiofrequency ablation (LRFA) of the dorsal ramus medial branch nerves (vs. a simulated LRFA control procedure) and (b) Activity Tracker-Informed Video-Enabled Cognitive Behavioral Therapy program for CLBP (AcTIVE-CBT) (vs. an educational control treatment) on back-related disability at 3 months post-randomization. Participants (n=13) were randomized in a 1:1:1:1 ratio. Feasibility goals included an enrollment proportion ≥30%, a randomization proportion ≥80%, and a ≥80% proportion of randomized participants completing the 3-month Roland-Morris Disability Questionnaire (RMDQ) primary outcome endpoint. An intent-to-treat analysis was used. The enrollment proportion was 62%, the randomization proportion was 81%, and all randomized participants completed the primary outcome. Though not statistically significant, there was a beneficial, moderate-magnitude effect of LRFA vs. control on 3-month RMDQ (-3.25 RMDQ points; 95% CI: -10.18, 3.67). There was a significant, beneficial, large-magnitude effect of AcTIVE-CBT vs. control (-6.29, 95% CI: -10.97, -1.60). Though not statistically significant, there was a beneficial, large effect of LRFA+AcTIVE-CBT vs. control (-8.37; 95% CI: -21.47, 4.74). We conclude that it is feasible to conduct an RCT combining procedural and behavioral treatments for CLBP.

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Section: Discussionmentioning

confidence: 69%

Combining Procedural and Behavioral Treatments for Chronic Low Back Pain: A Pilot Feasibility Randomized Controlled Trial

Tanus

Nishio

Williams

et al. 2023

Preprint

Self Cite

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“…Primary life quality instruments are useful to estimate a population's four primary quality of live domains [3,8,9]. The EQ-5D-3L [5] has been utilized to measure life quality for various medical and psychological disorders [10].…”

Section: Introductionmentioning

confidence: 99%

Development of a Pain Quality of Life Measure

2024

Chron Pain Manag

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Purpose: A chronic pain quality of life (CPQL) measure was developed to assess the primary life quality domains (PLQD): Physical Health, Social Support, Psychological Health, and Vocational/Economic Status. Valid evaluation of chronic pain patients is essential to assess treatment outcome. Unfortunately, many studies use the VAS to assess CPQL which yields invalid results, other studies utilize measures that evaluate a general CPQL domain. Method: 273 chronic pain patients recruited from pain clinics responded to the Pain Quality of Life Measure (PQLM), along with seven validating questionnaires. Healthy individuals completed the PQLM twice, one month apart, to assess test-retest reliability. Results: Factor analysis yielded seven (CPQL) domains: General Health/Pain, Empathetic Social Support, Housing/Transportation, Psychological Status, Ill Health, Financial/Legal Difficulties, and General Social Support. These factors demonstrated a good conceptual fit with the four PLQD. The PQLM demonstrated a high coefficient Alpha (.957), excellent validity (-.227 to -.842), and good test-retest correlations (.514 to .908), indicating the PQLM has excellent parametric features. Conclusion: The PQLM provided seven CPQL factors congruent with the primary life quality domains. Future CPQL research for chronic pain individuals should utilize the PQLM or similar multiple domain questionnaires to validly assess (PLQD).

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“…18,53 For example, recent studies have used machine learning to promote individualized LSS treatment and to predict the LSS development. 54,55 Second, increasing evidence shows that low physical activity is closely related to LBP, although the causation and dose effects remain uncertain. [56][57][58] Further studies should determine the optimal dosages of physical activity for both populations.…”

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confidence: 99%

Trends of Low Back Pain Research in Older and Working-Age Adults from 1993 to 2023: A Bibliometric Analysis

Zheng,

Kawchuk,

Bussières

et al. 2023

JPR

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Although the number of publications focusing on low back pain in older adults (LBP-O) and working-age adults (LBP-W) has been growing for decades, comparative research trends in these two populations, which may help to guide future investigation, have not been rigorously explored. This analysis aimed to describe publication patterns and trends of research targeting LBP-O and LBP-W over the last three decades. Peer-reviewed LBP-O and LBP-W articles published between 1993 and 2023 were retrieved from the Web of Science, which provided the details of annual publication volume, and prominent journals/countries/institutions. The relationship between the annual publication volumes and years was analyzed by Spearman correlation analysis. The hot topics and emerging trends were analyzed by VOSviewer and CiteSpace, respectively. A total of 4217 LBP-O-related and 50,559 LBP-W-related documents were included. The annual publication volumes of LBP-O and LBP-W articles increased over the years (r=0.995 to 0.998, p<0.001). The United States had the highest number of prominent institutions publishing relevant articles. The most prolific journal for LBP-O (5.4%) and LBP-W-related (6.1%) papers is the journal "Spine". Cognitive behavioral therapy, intervertebral disc (IVD) degeneration, physiotherapy, physical activity, and walking were the recent hot topics and physical activity was an emerging trend in LBP-O, while surgery and IVD degeneration (also a hot topic) were emerging trends in LBP-W. This study highlights the paucity of LBP-O-related research in the past. The United States and the journal Spine stand out in LBP research. The research trend of physical activity in LBP-O is consistent with the recognized importance of physical activity for older adults in general, and for managing LBP-O in particular. Conversely, the emerging trends of surgery and intervertebral disc degeneration in LBP-W research highlight a focus on the biomedical model of LBP despite LBP being a biopsychosocial condition.

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Estimating individualized treatment effects using a risk-modeling approach: an application to epidural steroid injections for lumbar spinal stenosis

Abstract: Supplemental Digital Content is Available in the Text.A “risk-modeling” approach was used in randomized controlled trials of back pain to examine heterogeneity of treatment effect guided by the Predictive Approaches to Treatment effect Heterogeneity Statement framework.

Cited by 3 publications

References 35 publications

Combining Procedural and Behavioral Treatments for Chronic Low Back Pain: A Pilot Feasibility Randomized Controlled Trial

Combining Procedural and Behavioral Treatments for Chronic Low Back Pain: A Pilot Feasibility Randomized Controlled Trial

Development of a Pain Quality of Life Measure

Trends of Low Back Pain Research in Older and Working-Age Adults from 1993 to 2023: A Bibliometric Analysis

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