Can supervise: YES
Anderson, DB, Ferreira, ML, Harris, IA, Davis, GA, Stanford, R, Beard, D, Li, Q, Jan, S, Mobbs, RJ, Maher, CG, Yong, R, Zammit, T, Latimer, J & Buchbinder, R 2019, 'SUcceSS, SUrgery for Spinal Stenosis: protocol of a randomised, placebo-controlled trial.', BMJ open, vol. 9, no. 2, pp. e024944-e024944.View/Download from: Publisher's site
INTRODUCTION:Central lumbar spinal stenosis (LSS) is a common cause of pain, reduced function and quality of life in older adults. Current management of LSS includes surgery to decompress the spinal canal and alleviate symptoms. However, evidence supporting surgical decompression derives from unblinded randomised trials with high cross-over rates or cohort studies showing modest benefits. This protocol describes the design of the SUrgery for Spinal Stenosis (SUcceSS) trial -the first randomised placebo-controlled trial of decompressive surgery for symptomatic LSS. METHODS AND ANALYSIS:SUcceSS will be a prospectively registered, randomised placebo-controlled trial of decompressive spinal surgery. 160 eligible participants (80 participants/group) with symptomatic LSS will be randomised to either surgical spinal decompression or placebo surgical intervention. The placebo surgical intervention is identical to surgical decompression in all other ways with the exception of the removal of any bone or ligament. All participants and assessors will be blinded to treatment allocation. Outcomes will be assessed at baseline and at 3, 6, 12 and 24 months. The coprimary outcomes will be function measured with the Oswestry Disability Index and the proportion of participants who have meaningfully improved their walking capacity at 3 months postrandomisation. Secondary outcomes include back pain intensity, lower limb pain intensity, disability, quality of life, anxiety and depression, neurogenic claudication score, perceived recovery, treatment satisfaction, adverse events, reoperation rate and rehospitalisation rate. Those who decline to be randomised will be invited to participate in a parallel observational cohort. Data analysis will be blinded and by intention to treat. A trial-based cost-effectiveness analysis will determine the potential incremental cost per quality-adjusted life year gained. ETHICS AND DISSEMINATION:Ethics approval has been granted by the NSW Health (refere...
Anderson, DB, Mathieson, S, Eyles, J, Maher, CG, Van Gelder, JM, Tomkins-Lane, CC, Ammendolia, C, Bella, V & Ferreira, ML 2019, 'Measurement properties of walking outcome measures for neurogenic claudication: a systematic review and meta analysis.', The spine journal : official journal of the North American Spine Society, vol. 19, no. 8, pp. 1378-1396.View/Download from: Publisher's site
BACKGROUND CONTEXT:Selecting a walking outcome measure for neurogenic claudication requires knowledge of its measurement properties. PURPOSE:To systematically review and appraise the literature on the measurement properties of walking outcome measures for patients with neurogenic claudication. STUDY DESIGN:A systematic review and meta-analysis. METHODS:A systematic search was conducted on the following seven databases: PubMed, PsychINFO, Web of Science, Embase, CINAHL, MEDLINE, and Cochrane Central Register of Controlled Trials. Clinical studies that assessed a measurement property of a walking outcome measure for patients with neurogenic claudication were selected. The methodological quality of studies was assessed using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist. Measurement property results were assessed using the adapted criteria from Terwee et al. (2007). RESULTS:Twelve studies that evaluated 15 separate walking outcome measures were included. Out of the 12 studies included, half had poor methodological quality. Four measures had acceptable test-retest reliability: the self-paced walking test (intraclass correlation coefficient, or ICC was 0.98, 95% CI: 0.95-0.99), Physical Function Scale (PFS) (pooled analysis ICC = 0.79, 95% CI: 0.77-0.89), PFS walk item (ICC = 0.81, 95% CI: 0.68-0.89), and Oswestry Disability Index (ODI) walk item (ICC = 0.86, 95% CI: 0.76-0.92). Responsiveness was assessed on five walking outcome measures, and three had adequate responsiveness: the ODI walk item (Area under the Curve, or AUC, was 0.76, SD 0.15), Treadmill test (AUC = 0.70), and PFS (AUC = 0.77, SD 0.14). A meta-analysis demonstrated the PFS had adequate test retest reliability (pooled ICC = 0.79, 95% CI: 0.77-0.89) and internal consistency (pooled Cronbach's αlpha (α) = 0.84, 95% CI: 0.81-0.86), but not criterion validity (pooled correlation coefficient = -0.59, 95% CI: -0.71, -0.45). Measures that recorded adequa...
Anderson, DB, Mobbs, RJ, Eyles, J, Meyer, SE, Machado, GC, Davis, GA, Harris, IA, Buchbinder, R & Ferreira, ML 2019, 'Barriers to participation in a placebo-surgical trial for lumbar spinal stenosis', Heliyon, vol. 5, no. 5.View/Download from: Publisher's site
© 2019 Background: Placebo-controlled trials are an important tool when assessing the efficacy of spinal surgical procedures. The most common spinal surgical procedure in older adults is decompression for lumbar spinal stenosis. Before conducting a placebo-surgical trial on decompression surgery, an investigation of patients' willingness to participate in a placebo-controlled trial of decompression surgery and barriers to participation were explored. Materials: An online survey. Methods: Descriptive analyses of demographic and clinical data, and participants' willingness to participate in a placebo-surgical trial. Logistic regression was used to examine potential predictors of willingness to participate. Two independent researchers performed a coded framework analysis of patients' barriers to participation. Results: 68 patients were invited and 63 participants completed the survey (91.3% response, mean (SD) age 69.5 (10.9) years, 52% females), 71% suffered from moderate to very severe pain. Ten participants (15.9%) were willing to participate in a placebo-controlled trial. Being married was associated with decreased odds of participating (OR: 0.2; 95% CI, 0.05 to 0.8; P = 0.03), while the main barriers were a lack of information about the procedure, reassurance of a positive outcome with participation, and concerns about the risks and benefits of placebo surgery. Conclusions: A minority of patients with lumbar spinal stenosis were willing to participate in a placebo-controlled trial of surgery. The identified barriers indicate that educating eligible patients about: the need for placebo-surgical trials, the personal risks and benefits of participation, and the importance and potential benefits of placebo trials to others, may be crucial to ensure adequate recruitment into the placebo-controlled surgical trial. Conclusions should be read cautiously however, given the small sample size present in this study.
Chakravorty, A, Mobbs, RJ, Anderson, DB, Rooke, K, Phan, K, Yoong, N, Maharaj, M & Choy, WJ 2019, 'The role of wearable devices and objective gait analysis for the assessment and monitoring of patients with lumbar spinal stenosis: systematic review.', BMC musculoskeletal disorders, vol. 20, no. 1.View/Download from: Publisher's site
BACKGROUND:The purpose of this systematic review was to evaluate the accuracy and reliability of wearable devices for objective gait measurement of Lumbar Spinal Stenosis (LSS) patients, with a focus on relevant gait metrics. METHODS:Systematic searches were conducted of five electronic databases to identify studies that assessed gait metrics by wearable or portable technology. Data was collected according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement guidelines. RESULTS:Four articles were identified for inclusion in this review. The objectives, methodology and quality of the studies varied. No single gait metric was investigated in all four studies, making comparison difficult. The most relevant metrics reported included gait cycle, gait velocity, step length and cadence, which were reported in two studies. Two studies explored gait symmetry. Differences between LSS patients and normal healthy subjects are demonstrable using wearable technology. CONCLUSIONS:The measurements of gait cycle, cadence, step length, gait velocity, and number of steps with wearable devices can be used in the gait measurement of LSS patients for initial assessment, and objective outcomes following interventions. However, data and analysis are limited, and further studies are necessary to comment on reliability.