Spinal Fusion Surgery Use Among Adults with Low Back Pain Enrolled in a Digital Musculoskeletal Program: an Observational Study

Overview

Journal BMC Musculoskelet Disord

Publisher Biomed Central

Specialties Orthopedics
Physiology

Date 2024 Jul 5

PMID 38970032

Authors

Sandhya Yadav

Laura S Gold

Qasim Hassan Zaidi

Raymond Hwang

Louie Lu

Grace Wang

Affiliations

Soon will be listed here.

Abstract

Objectives: To compare 12-month spinal fusion surgery rates in the setting of low back pain among digital musculoskeletal (MSK) program participants versus a comparison cohort who only received usual care.

Study Design: Retrospective cohort study with propensity score matched comparison cohort using commercial medical claims data representing over 100 million commercially insured lives.

Methods: All study subjects experienced low back pain between January 2020 and December 2021. Digital MSK participants enrolled in the digital MSK low back program between January 2020 and December 2021. Non-participants had low back pain related physical therapy (PT) between January 2020 and December 2021. Digital MSK participants were matched to non-participants with similar demographics, comorbidities and baseline MSK-related medical care use. Spinal fusion surgery rates at 12 months post participation were compared.

Results: Compared to non-participants, digital MSK participants had lower rates of spinal fusion surgery in the post-period (0.7% versus 1.6%; p < 0.001). Additionally, in the augmented inverse probability weighting (AIPW) model, digital MSK participants were found to have decreased odds of undergoing spinal fusion surgery (adjusted odds ratio: 0.64, 95% CI: 0.51-0.81).

Conclusions: This study provides evidence that participation in a digital MSK program is associated with a lower rate of spinal fusion surgery.

References

van Walraven C, Austin P, Jennings A, Quan H, Forster A . A modification of the Elixhauser comorbidity measures into a point system for hospital death using administrative data. Med Care. 2009; 47(6):626-33. DOI: 10.1097/MLR.0b013e31819432e5. View

Safari R, Jackson J, Sheffield D . Digital Self-Management Interventions for People With Osteoarthritis: Systematic Review With Meta-Analysis. J Med Internet Res. 2020; 22(7):e15365. PMC: 7428148. DOI: 10.2196/15365. View

Seron P, Oliveros M, Gutierrez-Arias R, Fuentes-Aspe R, Torres-Castro R, Merino-Osorio C . Effectiveness of Telerehabilitation in Physical Therapy: A Rapid Overview. Phys Ther. 2021; 101(6). PMC: 7928601. DOI: 10.1093/ptj/pzab053. View

Latif-Zade T, Tucci B, Verbovetskaya D, Bialkin E, Ng B, Heddon S . Systematic Review Shows Tele-Rehabilitation Might Achieve Comparable Results to Office-Based Rehabilitation for Decreasing Pain in Patients with Knee Osteoarthritis. Medicina (Kaunas). 2021; 57(8). PMC: 8398992. DOI: 10.3390/medicina57080764. View

Du S, Liu W, Cai S, Hu Y, Dong J . The efficacy of e-health in the self-management of chronic low back pain: A meta analysis. Int J Nurs Stud. 2020; 106:103507. DOI: 10.1016/j.ijnurstu.2019.103507. View

Verla T, Adogwa O, Toche U, Farber S, Petraglia 3rd F, Murphy K . Impact of Increasing Age on Outcomes of Spinal Fusion in Adult Idiopathic Scoliosis. World Neurosurg. 2015; 87:591-7. PMC: 4961209. DOI: 10.1016/j.wneu.2015.10.061. View

Fritz J, Lurie J, Zhao W, Whitman J, Delitto A, Brennan G . Associations between physical therapy and long-term outcomes for individuals with lumbar spinal stenosis in the SPORT study. Spine J. 2013; 14(8):1611-21. PMC: 3997631. DOI: 10.1016/j.spinee.2013.09.044. View

Salimy M, Humphrey T, Katakam A, Melnic C, Heng M, Bedair H . Which Factors Are Considered by Patients When Considering Total Joint Arthroplasty? A Discrete-choice Experiment. Clin Orthop Relat Res. 2022; 481(3):427-437. PMC: 9928758. DOI: 10.1097/CORR.0000000000002358. View

. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020; 396(10258):1204-1222. PMC: 7567026. DOI: 10.1016/S0140-6736(20)30925-9. View

10.

Bailey J, Agarwal V, Zheng P, Smuck M, Fredericson M, Kennedy D . Digital Care for Chronic Musculoskeletal Pain: 10,000 Participant Longitudinal Cohort Study. J Med Internet Res. 2020; 22(5):e18250. PMC: 7248800. DOI: 10.2196/18250. View

11.

Reisener M, Pumberger M, Shue J, Girardi F, Hughes A . Trends in lumbar spinal fusion-a literature review. J Spine Surg. 2021; 6(4):752-761. PMC: 7797794. DOI: 10.21037/jss-20-492. View

12.

Wang G, Yang M, Hong M, Krauss J, Bailey J . Clinical outcomes one year after a digital musculoskeletal (MSK) program: an observational, longitudinal study with nonparticipant comparison group. BMC Musculoskelet Disord. 2022; 23(1):237. PMC: 8914456. DOI: 10.1186/s12891-022-05188-x. View

13.

Deng H, Yue J, Ordaz A, Suen C, Sing D . Elective lumbar fusion in the United States: national trends in inpatient complications and cost from 2002-2014. J Neurosurg Sci. 2019; 65(5):503-512. DOI: 10.23736/S0390-5616.19.04647-2. View

14.

Kurz C . Augmented Inverse Probability Weighting and the Double Robustness Property. Med Decis Making. 2021; 42(2):156-167. PMC: 8793316. DOI: 10.1177/0272989X211027181. View

15.

Mecklenburg G, Smittenaar P, Erhart-Hledik J, Perez D, Hunter S . Effects of a 12-Week Digital Care Program for Chronic Knee Pain on Pain, Mobility, and Surgery Risk: Randomized Controlled Trial. J Med Internet Res. 2018; 20(4):e156. PMC: 5943627. DOI: 10.2196/jmir.9667. View

16.

Suso-Marti L, La Touche R, Herranz-Gomez A, Angulo-Diaz-Parreno S, Paris-Alemany A, Cuenca-Martinez F . Effectiveness of Telerehabilitation in Physical Therapist Practice: An Umbrella and Mapping Review With Meta-Meta-Analysis. Phys Ther. 2021; 101(5). PMC: 7928612. DOI: 10.1093/ptj/pzab075. View

17.

Kim P, Kurokawa R, Itoki K . Technical advancements and utilization of spine surgery--international disparities in trend-dynamics between Japan, Korea, and the USA. Neurol Med Chir (Tokyo). 2010; 50(9):853-8. DOI: 10.2176/nmc.50.853. View

18.

Valentijn P, Tymchenko L, Jacobson T, Kromann J, Biermann C, AlMoslemany M . Digital Health Interventions for Musculoskeletal Pain Conditions: Systematic Review and Meta-analysis of Randomized Controlled Trials. J Med Internet Res. 2022; 24(9):e37869. PMC: 9490534. DOI: 10.2196/37869. View

19.

Fornari M, Robertson S, Pereira P, Zileli M, Anania C, Ferreira A . Conservative Treatment and Percutaneous Pain Relief Techniques in Patients with Lumbar Spinal Stenosis: WFNS Spine Committee Recommendations. World Neurosurg X. 2020; 7:100079. PMC: 7322792. DOI: 10.1016/j.wnsx.2020.100079. View

20.

Chen T, Or C, Chen J . Effects of technology-supported exercise programs on the knee pain, physical function, and quality of life of individuals with knee osteoarthritis and/or chronic knee pain: A systematic review and meta-analysis of randomized controlled trials. J Am Med Inform Assoc. 2020; 28(2):414-423. PMC: 7883981. DOI: 10.1093/jamia/ocaa282. View