Article

OBJECTIVE: To evaluate the degree to which conservative care and failure were
specifically defined in studies comparing nonoperative treatment versus surgery
for low back pain (LBP) conditions in adults. DATA SOURCES: A comprehensive
literature search was conducted by an experienced librarian using MEDLINE (PubMed), Embase, Google Scholar, and CENTRAL from January 2003 to June 2014.
Endnote bibliographic management application was used to remove duplicates and
organize the citations. STUDY SELECTION: Prospective, randomized, or cohort
trials comparing surgery versus conservative intervention for patients with LBP
conditions. Study selection was conducted by 2 independent reviewers. DATA
EXTRACTION: Three independent reviewers extracted data from each article using a
structured data extraction form. Data extracted included type of study,
participant characteristics, sample size, description, and duration of
conservative care and whether failed conservative care criterion was defined.
DATA SYNTHESIS: A total of 852 unique records were screened for eligibility; of
those, 72 articles were identified for further full-text review. Thirty-four full
texts were excluded based on the exclusion criteria, and 38 articles,
representing 20 unique studies, were included for qualitative synthesis. Fifteen
of the 20 studies defined the duration of conservative care. Only 3 studies
defined the dosage of physical therapy sessions, including total number of visits
and visit duration. Two studies described medication usage, including the
duration and type. No studies specifically defined what constituted failed
conservative therapy. CONCLUSIONS: This literature review suggests conservative
care is poorly defined in randomized trials, which can lead to ambiguity of
research procedures and unclear guidelines for clinicians. Future studies should
increase transparency and explicitly define conservative care.
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Langue : ANGLAIS