Document Detail

Lumbar disc herniation in the Spine Patient Outcomes Research Trial: does educational attainment impact outcome?
MedLine Citation:
PMID:  21311402     Owner:  NLM     Status:  MEDLINE    
STUDY DESIGN: Randomized trial with concurrent observational cohort. A total of 1171 patients were divided into subgroups by educational attainment: high school or less, some college, and college degree or above.
OBJECTIVE: To assess the influence of education level on outcomes for treatment of lumbar disc herniation.
SUMMARY OF BACKGROUND DATA: Educational attainment has been demonstrated to have an inverse relationship with pain perception, comorbidities, and mortality.
METHODS: The Spine Patient Outcomes Research Trial enrolled surgical candidates (imaging-confirmed disc herniation with at least 6 weeks of persistent signs and symptoms of radiculopathy) from 13 multidisciplinary spine clinics in 11 US states. Treatments were standard open discectomy versus nonoperative treatment. Outcomes were changes from baseline for 36-Item Short Form Health Survey (SF-36), bodily pain (BP), and physical function (PF) scales and the modified Oswestry Disability Index (ODI) at 6 weeks, 3 months, 6 months, and yearly through 4 years.
RESULTS: Substantial improvement was seen in all patient cohorts. Surgical outcomes did not differ by level of education. For nonoperative outcomes, however, higher levels of education were associated with significantly greater overall improvement over 4 years in BP (P = 0.007), PF (P = 0.001), and ODI (P = 0.003). At 4 years a "dose-response" type relationship was shown for BP (high school or less = 25.5, some college = 31, and college graduate or above = 36.3, P = 0.004) and results were similar for PF and ODI. The success of nonoperative treatment in the more educated cohort resulted in an attenuation of the relative benefit of surgery.
CONCLUSION: Patients with higher educational attainment demonstrated significantly greater improvement with nonoperative treatment while educational attainment was not associated with surgical outcomes.
Patrick R Olson; Jon D Lurie; John Frymoyer; Thomas Walsh; Wenyan Zhao; Tamara S Morgan; William A Abdu; James N Weinstein
Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial    
Journal Detail:
Title:  Spine     Volume:  36     ISSN:  1528-1159     ISO Abbreviation:  Spine     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-12-14     Completed Date:  2012-05-11     Revised Date:  2013-06-30    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2324-32     Citation Subset:  IM    
Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.
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MeSH Terms
Cohort Studies
Disability Evaluation
Educational Status
Follow-Up Studies
Intervertebral Disc / pathology*,  physiopathology
Intervertebral Disc Displacement / surgery*,  therapy*
Lumbar Vertebrae
Middle Aged
Outcome Assessment (Health Care) / methods*,  statistics & numerical data
Pain Measurement / methods,  statistics & numerical data
Time Factors
Grant Support
P60 AR048094/AR/NIAMS NIH HHS; P60 AR048094-05/AR/NIAMS NIH HHS; U01 AR045444/AR/NIAMS NIH HHS; U01 AR045444-13/AR/NIAMS NIH HHS

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