Open AccessTreatment of Osteoporotic Vertebral Compression Fractures: Applicability of Appropriateness Criteria in Clinical Practice
Author(s) -
Herman Stoevelaar
Publication year - 2016
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj/2016.19.e113
Subject(s) - medicine , observational study , appropriateness criteria , vertebral compression fracture , orthopedic surgery , physical therapy , magnetic resonance imaging , quality of life (healthcare) , osteoporosis , surgery , radiology , nursing
Background: Appropriate treatment choice for osteoporotic vertebral compression fractures(OVCF) is challenging due to patient heterogeneity. Using the RAND/UCLA method, aninternational multidisciplinary expert panel established patient-specific criteria for the choicebetween non-surgical management (NSM), vertebroplasty (VP), and balloon kyphoplasty (BKP).Objectives: To assess the applicability of the appropriateness criteria in real-life practice.Study Design: Prospective observational study.Setting: Eight practices of experts who participated in the panel study, including 2interventional radiologists, one internal medicine specialist, 2 neurosurgeons, and 3 orthopedic/trauma surgeons. Practices were located in Belgium, Germany, Italy, Switzerland, and theUnited Kingdom.Methods: Using an online data capture program, participants documented the clinical profile(age, gender, previous VCFs, time since fracture, magnetic resonance imaging (MRI) findings,evolution of symptoms, impact of symptoms on quality of life, spinal deformity, ongoingfracture process, and presence of pulmonary dysfunction) and treatment choice for consecutivepatients who consulted them for OVCF.Results: In total 426 patients were included. BKP was the most frequently chosen treatmentoption (49%), followed by VP (34%) and NSM (14%). When compared with the panelrecommendations, inappropriate treatment choices were rare (5% for NSM, 2% for VP, nonefor BKP). Treatment choice was strongly associated with the clinical variables used in the panelstudy.Differences in treatment decisions between interventional radiologists and surgeons werelargely determined by differences in patient characteristics, with time of clinical presentationbeing the dominant factor.Limitation: The study population was restricted to the practices of the participants of thepanel study.Conclusion: This international, multi-specialty utilization review showed excellent applicabilityof, and good adherence with RAND/UCLA-based recommendations on treatment choice inOVCF.Key words: Appropriateness criteria, utilization review, RAND/UCLA AppropriatenessMethod, balloon kyphoplasty, non-surgical management, osteoporosis, vertebral compressionfractures, vertebroplasty