Predictors of non-pharmacological, non-surgical treatment utilization prior to thoracolumbar spine surgery in Manitoba: A Canadian spine outcomes research network (CSORN) study.
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Current evidence for back pain management supports a stepwise approach to care; beginning with non-pharmacological, non-surgical treatment, progressing to pharmacotherapy, with surgery as a last resort. The present study utilized the Canadian Spine Outcomes Research Network (CSORN) data registry for Manitobans receiving elective spine surgery to understand current clinical practice patterns. The first objective was to determine the proportion of elective spine surgery patients who engage in non-pharmacological, non-surgical treatment prior to undergoing elective thoracolumbar spine surgery. The second objective was to investigate potential predictors for non-pharmacological, non-surgical treatment engagement amongst CSORN patients eligible for thoracolumbar spine surgery. The study utilized a retrospective cohort design among elective thoracolumbar spine surgery patients in Manitoba, Canada. Binary logistic regression was used to identify if: 1) patient characteristics; 2) pain and disability measures; 3) and frequency of prescription narcotic use predict engagement with non-pharmacological, non-surgical treatment prior to undergoing elective thoracolumbar spine surgery. The analysis revealed that 41.7% of CSORN patients from Manitoba reported minimal-to-no engagement with non-pharmacological, non-surgical treatment in the six-months prior to undergoing elective thoracolumbar spine surgery. The final logistic model revealed four statistically significant predictors: 1) 61-90 years of age (odds ratio [OR] 4.6, 95% confidence interval [CI] 2.0 – 10.7, p= .000); 2) Oswestry disability index score >60% (OR 3.5, 95% CI 1.4 – 9.2, p= .010; 3) 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) were significant independent predictors for minimal-to-no engagement with non-pharmacological, non-surgical treatment prior to undergoing elective thoracolumbar spine surgery. The study revealed that the stepwise approach to back pain management in Manitoba is not optimal. Concerted efforts are required to understand why biological females at birth, patients of older age, those that are overweight or obese, and perceive themselves as debilitated are less likely to engage in non-pharmacological, non-surgical treatment prior to elective thoracolumbar spine surgery in Manitoba, Canada. Further refinement of the CSORN data collected is required to better understand Manitoba’s spine pain population.
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