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Appears in Collections:Faculty of Health Sciences and Sport Journal Articles
Peer Review Status: Refereed
Title: Randomised controlled trial to compare surgical stabilisation of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain: The MRC spine stabilisation trial
Authors: Fairbank, Jeremy C T
Frost, Helen
Wilson-MacDonald, James
Yu, Ly-Mee
Barker, Karen
Collins, Rory
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Issue Date: 26-May-2005
Publisher: BMJ Publishing Group
Citation: Fairbank JCT, Frost H, Wilson-MacDonald J, Yu L, Barker K & Collins R (2005) Randomised controlled trial to compare surgical stabilisation of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain: The MRC spine stabilisation trial, BMJ, 330 (7502), pp. 1233-1239.
Abstract: Objectives To assess the clinical effectiveness of surgical stabilisation (spinal fusion) compared with intensive rehabilitation for patients with chronic low back pain.  Design Multicentre randomised controlled trial.  Setting 15 secondary care orthopaedic and rehabilitation centres across the United Kingdom.  Participants 349 participants aged 18-55 with chronic low back pain of at least one year's duration who were considered candidates for spinal fusion.  Intervention Lumbar spine fusion or an intensive rehabilitation programme based on principles of cognitive behaviour therapy.  Main outcome measure The primary outcomes were the Oswestry disability index and the shuttle walking test measured at baseline and two years after randomisation. The SF-36 instrument was used as a secondary outcome measure.  Results 176 participants were assigned to surgery and 173 to rehabilitation. 284 (81%) provided follow-up data at 24 months. The mean Oswestry disability index changed favourably from 46.5 (SD 14.6) to 34.0 (SD 21.1) in the surgery group and from 44.8 (SD14.8) to 36.1 (SD 20.6) in the rehabilitation group. The estimated mean difference between the groups was –4.1 (95% confidence interval –8.1 to –0.1, P = 0.045) in favour of surgery. No significant differences between the treatment groups were observed in the shuttle walking test or any of the other outcome measures.  Conclusions Both groups reported reductions in disability during two years of follow-up, possibly unrelated to the interventions. The statistical difference between treatment groups in one of the two primary outcome measures was marginal and only just reached the predefined minimal clinical difference, and the potential risk and additional cost of surgery also need to be considered. No clear evidence emerged that primary spinal fusion surgery was any more beneficial than intensive rehabilitation.
Type: Journal Article
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Rights: Publisher is open-access. Open access publishing allows free access to and distribution of published articles where the author retains copyright of their work by employing a Creative Commons attribution licence. Proper attribution of authorship and correct citation details should be given. Published in BMJ 2005;330:1233
Affiliation: Nuffield Orthopaedic Centre
NMAHP Research
Nuffield Orthopaedic Centre
University of Oxford
Nuffield Orthopaedic Centre
Oxford University Hospitals Trust NHS

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