Lumbar Disc Herniation in the Spine Patient Outcomes Research Trial: Does Educational Attainment Impact Outcome?
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. To assess the influence of education level on outcomes for treatment of lumbar disc herniation. Educa...
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| Veröffentlicht in: | Spine (Philadelphia, Pa. 1976) Pa. 1976), 2011-12, Vol.36 (26), p.2324-2332 |
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| container_title | Spine (Philadelphia, Pa. 1976) |
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| creator | OLSON, Patrick R LURIE, Jon D FRYMOYER, John WALSH, Thomas ZHAO, Wenyan MORGAN, Tamara S ABDU, William A WEINSTEIN, James N |
| description | 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.
To assess the influence of education level on outcomes for treatment of lumbar disc herniation.
Educational attainment has been demonstrated to have an inverse relationship with pain perception, comorbidities, and mortality.
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.
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.
Patients with higher educational attainment demonstrated significantly greater improvement with nonoperative treatment while educational attainment was not associated with surgical outcomes. |
| doi_str_mv | 10.1097/BRS.0b013e31820bfb9a |
| format | Article |
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To assess the influence of education level on outcomes for treatment of lumbar disc herniation.
Educational attainment has been demonstrated to have an inverse relationship with pain perception, comorbidities, and mortality.
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.
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.
Patients with higher educational attainment demonstrated significantly greater improvement with nonoperative treatment while educational attainment was not associated with surgical outcomes.</description><identifier>ISSN: 0362-2436</identifier><identifier>EISSN: 1528-1159</identifier><identifier>DOI: 10.1097/BRS.0b013e31820bfb9a</identifier><identifier>PMID: 21311402</identifier><identifier>CODEN: SPINDD</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Adult ; Biological and medical sciences ; Cerebrospinal fluid. Meninges. Spinal cord ; Cohort Studies ; Disability Evaluation ; Diseases of the osteoarticular system ; Diseases of the spine ; Educational Status ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disc - pathology ; Intervertebral Disc - physiopathology ; Intervertebral Disc Displacement - surgery ; Intervertebral Disc Displacement - therapy ; Lumbar Vertebrae ; Male ; Medical sciences ; Middle Aged ; Nervous system (semeiology, syndromes) ; Neurology ; Outcome Assessment (Health Care) - methods ; Outcome Assessment (Health Care) - statistics & numerical data ; Pain Measurement - methods ; Pain Measurement - statistics & numerical data ; Surveys and Questionnaires ; Time Factors</subject><ispartof>Spine (Philadelphia, Pa. 1976), 2011-12, Vol.36 (26), p.2324-2332</ispartof><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c340t-82d1a5882fdfe609b167a13ca3cf4ac538da61df4c56597275af0a60bd1b3dd23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25335787$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21311402$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>OLSON, Patrick R</creatorcontrib><creatorcontrib>LURIE, Jon D</creatorcontrib><creatorcontrib>FRYMOYER, John</creatorcontrib><creatorcontrib>WALSH, Thomas</creatorcontrib><creatorcontrib>ZHAO, Wenyan</creatorcontrib><creatorcontrib>MORGAN, Tamara S</creatorcontrib><creatorcontrib>ABDU, William A</creatorcontrib><creatorcontrib>WEINSTEIN, James N</creatorcontrib><title>Lumbar Disc Herniation in the Spine Patient Outcomes Research Trial: Does Educational Attainment Impact Outcome?</title><title>Spine (Philadelphia, Pa. 1976)</title><addtitle>Spine (Phila Pa 1976)</addtitle><description>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.
To assess the influence of education level on outcomes for treatment of lumbar disc herniation.
Educational attainment has been demonstrated to have an inverse relationship with pain perception, comorbidities, and mortality.
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.
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.
Patients with higher educational attainment demonstrated significantly greater improvement with nonoperative treatment while educational attainment was not associated with surgical outcomes.</description><subject>Adult</subject><subject>Biological and medical sciences</subject><subject>Cerebrospinal fluid. Meninges. Spinal cord</subject><subject>Cohort Studies</subject><subject>Disability Evaluation</subject><subject>Diseases of the osteoarticular system</subject><subject>Diseases of the spine</subject><subject>Educational Status</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Intervertebral Disc - pathology</subject><subject>Intervertebral Disc - physiopathology</subject><subject>Intervertebral Disc Displacement - surgery</subject><subject>Intervertebral Disc Displacement - therapy</subject><subject>Lumbar Vertebrae</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Nervous system (semeiology, syndromes)</subject><subject>Neurology</subject><subject>Outcome Assessment (Health Care) - methods</subject><subject>Outcome Assessment (Health Care) - statistics & numerical data</subject><subject>Pain Measurement - methods</subject><subject>Pain Measurement - statistics & numerical data</subject><subject>Surveys and Questionnaires</subject><subject>Time Factors</subject><issn>0362-2436</issn><issn>1528-1159</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkUtv1DAURi0EotPCP0DIG9RViq-dOAkLUF-0lUYqasvauvGDMUqcYCdI_Pu6dDo8Vpauz_l85Y-QN8COgLX1-5Ob2yPWMRBWQMNZ57oWn5EVVLwpAKr2OVkxIXnBSyH3yH5K3xljUkD7kuxxEAAl4ysyrZehw0jPfNL00sbgcfZjoD7QeWPp7eSDpV_yzIaZXi-zHgeb6I1NFqPe0Lvosf9Az8Y8PDeL_i1jT4_nGX0YHqSrYUK9cz-9Ii8c9sm-3p4H5Ovn87vTy2J9fXF1erwutCjZXDTcAFZNw51xVrK2A1kjCI1CuxJ1JRqDEowrdSWrtuZ1hY6hZJ2BThjDxQH5-Jg7Ld1gjc6rROzVFP2A8Zca0at_b4LfqG_jTyWA1aJmOeBwGxDHH4tNsxryH9m-x2DHJakWoBUNlDKT5SOp45hStG73CjD10JXKXan_u8ra27833ElP5WTg3RbApLF3EYP26Q9XCVHVTS3uAcN4oJ0</recordid><startdate>20111215</startdate><enddate>20111215</enddate><creator>OLSON, Patrick R</creator><creator>LURIE, Jon D</creator><creator>FRYMOYER, John</creator><creator>WALSH, Thomas</creator><creator>ZHAO, Wenyan</creator><creator>MORGAN, Tamara S</creator><creator>ABDU, William A</creator><creator>WEINSTEIN, James N</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20111215</creationdate><title>Lumbar Disc Herniation in the Spine Patient Outcomes Research Trial: Does Educational Attainment Impact Outcome?</title><author>OLSON, Patrick R ; LURIE, Jon D ; FRYMOYER, John ; WALSH, Thomas ; ZHAO, Wenyan ; MORGAN, Tamara S ; ABDU, William A ; WEINSTEIN, James N</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c340t-82d1a5882fdfe609b167a13ca3cf4ac538da61df4c56597275af0a60bd1b3dd23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adult</topic><topic>Biological and medical sciences</topic><topic>Cerebrospinal fluid. Meninges. Spinal cord</topic><topic>Cohort Studies</topic><topic>Disability Evaluation</topic><topic>Diseases of the osteoarticular system</topic><topic>Diseases of the spine</topic><topic>Educational Status</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Intervertebral Disc - pathology</topic><topic>Intervertebral Disc - physiopathology</topic><topic>Intervertebral Disc Displacement - surgery</topic><topic>Intervertebral Disc Displacement - therapy</topic><topic>Lumbar Vertebrae</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Nervous system (semeiology, syndromes)</topic><topic>Neurology</topic><topic>Outcome Assessment (Health Care) - methods</topic><topic>Outcome Assessment (Health Care) - statistics & numerical data</topic><topic>Pain Measurement - methods</topic><topic>Pain Measurement - statistics & numerical data</topic><topic>Surveys and Questionnaires</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>OLSON, Patrick R</creatorcontrib><creatorcontrib>LURIE, Jon D</creatorcontrib><creatorcontrib>FRYMOYER, John</creatorcontrib><creatorcontrib>WALSH, Thomas</creatorcontrib><creatorcontrib>ZHAO, Wenyan</creatorcontrib><creatorcontrib>MORGAN, Tamara S</creatorcontrib><creatorcontrib>ABDU, William A</creatorcontrib><creatorcontrib>WEINSTEIN, James N</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Spine (Philadelphia, Pa. 1976)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>OLSON, Patrick R</au><au>LURIE, Jon D</au><au>FRYMOYER, John</au><au>WALSH, Thomas</au><au>ZHAO, Wenyan</au><au>MORGAN, Tamara S</au><au>ABDU, William A</au><au>WEINSTEIN, James N</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Lumbar Disc Herniation in the Spine Patient Outcomes Research Trial: Does Educational Attainment Impact Outcome?</atitle><jtitle>Spine (Philadelphia, Pa. 1976)</jtitle><addtitle>Spine (Phila Pa 1976)</addtitle><date>2011-12-15</date><risdate>2011</risdate><volume>36</volume><issue>26</issue><spage>2324</spage><epage>2332</epage><pages>2324-2332</pages><issn>0362-2436</issn><eissn>1528-1159</eissn><coden>SPINDD</coden><abstract>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.
To assess the influence of education level on outcomes for treatment of lumbar disc herniation.
Educational attainment has been demonstrated to have an inverse relationship with pain perception, comorbidities, and mortality.
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.
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.
Patients with higher educational attainment demonstrated significantly greater improvement with nonoperative treatment while educational attainment was not associated with surgical outcomes.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>21311402</pmid><doi>10.1097/BRS.0b013e31820bfb9a</doi><tpages>9</tpages></addata></record> |
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| identifier | ISSN: 0362-2436 |
| ispartof | Spine (Philadelphia, Pa. 1976), 2011-12, Vol.36 (26), p.2324-2332 |
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| source | MEDLINE; Journals@Ovid Complete |
| subjects | Adult Biological and medical sciences Cerebrospinal fluid. Meninges. Spinal cord Cohort Studies Disability Evaluation Diseases of the osteoarticular system Diseases of the spine Educational Status Female Follow-Up Studies Humans Intervertebral Disc - pathology Intervertebral Disc - physiopathology Intervertebral Disc Displacement - surgery Intervertebral Disc Displacement - therapy Lumbar Vertebrae Male Medical sciences Middle Aged Nervous system (semeiology, syndromes) Neurology Outcome Assessment (Health Care) - methods Outcome Assessment (Health Care) - statistics & numerical data Pain Measurement - methods Pain Measurement - statistics & numerical data Surveys and Questionnaires Time Factors |
| title | Lumbar Disc Herniation in the Spine Patient Outcomes Research Trial: Does Educational Attainment Impact Outcome? |
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