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    An evidence-based medicine process to determine outcomes after cervical spine trauma: what surgeons should be telling their patients

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    Authors
    Lewkonia, Peter
    DiPaola, Christian P.
    Schouten, Rowan
    Noonan, Vanessa
    Dvorak, Marcel
    Fisher, Charles G.
    UMass Chan Affiliations
    Department of Orthopedics and Physical Rehabilitation
    Document Type
    Journal Article
    Publication Date
    2012-08-15
    Keywords
    Cervical Vertebrae
    *Evidence-Based Medicine
    Humans
    Physician-Patient Relations
    Quality of Life
    Spinal Fractures
    Spinal Injuries
    Treatment Outcome
    Orthopedics
    Rehabilitation and Therapy
    
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    Link to Full Text
    http://dx.doi.org/10.1097/BRS.0b013e31825b2c10
    Abstract
    STUDY DESIGN: A systematic review of the available medical literature from 1980 to 2010 was conducted and combined with expert opinion from a recent survey of experts regarding cervical spine fractures. Using an objective, hierarchical approach, the best available evidence is presented for health-related quality-of-life outcomes for these injuries. OBJECTIVE: To provide an evidence-based set of guidelines for cervical spine injuries in order to reduce variability in the information given to patients and their families. SUMMARY OF BACKGROUND DATA: Patients' expectations regarding quality-of-life outcomes are highly dependent on the information provided by surgeons early in the treatment course. Our previous work has demonstrated that there is substantial variability in what surgeons tell patients regarding outcomes of cervical spine injuries, thus patients' expectations will differ and outcomes vary. METHODS: Four common cervical spine injuries (C1 burst, Hangman fracture, odontoid fracture, and unilateral facet fracture) treated both surgically and nonsurgically were considered. We assessed the evidence regarding 5 health-related quality-of-life outcomes: time to return to work, activity level, hospital stay, the proportion of patients who are pain free and patients who have regained full range of motion at 1 year after the injury. RESULTS: Published outcome data were available for most injuries. Using consensus expert opinion and the literature, answers to each question were achieved. Overall, expert opinion was relatively homogeneous across injury types, suggesting that experts do not distinguish between specific injuries when advising patients of expected outcomes such as pain. CONCLUSION: By overcoming gaps in the literature with consensus expert opinion, our study provides surgeons and others with evidence-based medicine guidelines for patient-centered outcomes after cervical spine injury. This information can be presented to patients to frame expectations of typical outcomes during and after treatment to optimize patient care and quality of life.
    Source
    Spine (Phila Pa 1976). 2012 Aug 15;37(18):E1140-7. doi: 10.1097/BRS.0b013e31825b2c10. Link to article on publisher's site
    DOI
    10.1097/BRS.0b013e31825b2c10
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/42933
    PubMed ID
    22565383
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1097/BRS.0b013e31825b2c10
    Scopus Count
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    UMass Chan Faculty and Researcher Publications
    Orthopedics and Physical Rehabilitation Publications

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