Marital status, absence of joint symptoms, and worsening symptoms affect treatment effect
FRIDAY, Jan. 13 (HealthDay News) -- Surgery is more effective than nonoperative treatment for patients with intervertebral disc herniation (IDH), with marital status, joint problems, and symptom trend at baseline identified as significant modifiers of treatment effect, according to a study published in the Jan. 15 issue of Spine.
Adam Pearson, M.D., of Dartmouth Medical School in Lebanon, N.H., and colleagues conducted a prospective randomized controlled trial and an observational cohort study to investigate specific modifiers of the treatment effect of surgery for IDH. The study included 788 patients who underwent discectomy and 404 patients treated with nonoperative care.
The researchers found that, compared with patients treated with nonoperative care, all subgroups treated with discectomy experienced a significantly greater improvement. On multivariate analysis, three independent modifiers of treatment-effect were identified: being married, absence of joint problems, and worsening symptoms at baseline. Compared to being single with stable symptoms at baseline, married patients with worsening symptoms experienced the greatest treatment effects.
"IDH patients who met strict inclusion criteria improved more with surgery than with nonoperative treatment, regardless of specific characteristics. However, being married, without joint problems, and worsening symptom trend at baseline were associated with a greater treatment effect," the authors write.
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