Original article
Factors associated with non-pharmacological, non-operative treatment utilization prior to thoracolumbar spine surgery in Manitoba: A Canadian Spine Outcomes Research Network (CSORN) study

https://doi.org/10.1016/j.msksp.2022.102695Get rights and content

Highlights

  • Managing chronic low back pain non-operatively is recommended prior to surgery.

  • 41.7% of patients had minimal non-operative engagement before spine surgery.

  • Older age, female sex, high ODI & BMI scores, predicted less conservative care use.

Abstract

Background

Evidence for managing chronic low back pain suggests beginning with non-invasive treatments and having surgery as a last resort. Currently, no studies examine treatment engagement for back pain in the six-months preceding elective spine surgery assessment.

Objectives

This study aims to: 1) determine the engagement in non-pharmacological, non-operative treatment before elective thoracolumbar spine surgery (ETSS) assessment in XXXXXXXX; and 2) investigate potential factors associated with engagement in this population.

Design

Retrospective cohort design.

Methods

Canadian Spine Outcomes Research Network (CSORN) registry data were analyzed to compare groups who reported minimal engagement in non-pharmacological, non-operative treatment before ETSS assessment to those who engaged. Binary logistic regression was used to identify factors associated with engagement.

Results

A total of 144 patients qualified, 41.7% reported minimal engagement with non-pharmacological, non-operative treatment in the six-months preceding ETSS assessment. Four statistically significant factors associated with minimal engagement were identified: 1) 61–90 years of age (odds ratio [OR] 4.6, 95% confidence interval [CI] 2.0–10.7, p < .001); 2) Oswestry disability index (ODI) score >60% (OR 3.5, 95% CI 1.4–9.2, p = .010; 3) body mass index (BMI) score 25–29.9 (OR 6.7, 95% CI 2.2–20.9, p < .001) and BMI 30 (OR 4.2, 95% CI 1.4–12.2, p = .009); and 4) female biological sex (OR 2.4, 95% CI 1.0–5.6, p = .039.

Conclusions

In total, 41.7% of CSORN patients had minimal engagement with non-pharmacological, non-operative treatment in the six-months prior to ETSS assessment in XXXXXXXX. Factors associated with minimal engagement included: older age, high disability, increased BMI, and female biological sex.

Section snippets

Design

The authors performed a retrospective analysis of the CSORN data registry in XXXXXXXX, Canada to determine associated factors for chiropractic and/or physiotherapy engagement amongst CSORN patients eligible for ETSS.

Data collection

The primary objective of CSORN is to track patient socio-demographic data and outcomes across Canada. The CSORN registry captures data to answer questions relating to current practices in spine care. Patients are granted access to provide responses via initial paper-based patient

Results

Male patients represented approximately half (54.2%) of eligible CSORN patients in the XXXXXXXX database. While there was a wide range of patient ages (minimum age 22 years old, maximum 86 years old), the mean age was 52.5 years (SD = 17.7). Patients self-reported their height and weight, and BMI was subsequently calculated. The average BMI was 29.8 (SD = 6.3), based on 144 unique respondents, which is considered overweight (CDC., 2017; WHO). The average NRS reported was 6.7 (SD = 2.6)

Discussion

The present study revealed that 41.7% of CSORN patients in XXXXXXXX, Canada were progressing towards ETSS assessment despite displaying minimal-to-no engagement with non-pharmacological, non-operative treatment first. This is contrary to the generally accepted recommendation that a trial of non-pharmacological, non-operative treatment should precede elective spine surgery (Porchet et al., 1999; Airaksinen et al., 2006; Beyer et al., 2016). A similar pattern of disconnect with utilization of

Conclusion

The management of back pain continues to be problematic and challenging for clinicians. The creation of CPGs may have helped to steer clinicians toward evidence-based practice, but adoption of the guidelines remains challenging. The current study found 41.7% of CSORN patients had minimal engagement with non-pharmacological, non-operative treatment in the six-months prior to ETSS assessment in XXXXXXXX. Patients who had higher odds of minimal-to-no engagement in the six-months leading up to ETSS

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Declaration of competing interest

The authors report no conflict of interest. The authors alone are responsible for the content and composition of the manuscript.

Acknowledgements

The authors wish to thank the administration, board and patients of the XXXXXXXXX and the XXXXXXXXXX for their encouragement to pursue this project.

The proposed study was approved by the XXXXXXXXXXXX Health Research Ethics Board (HREB).

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