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Commentary: Lessons and limitations of population-based research
The Spine Journal 12 (2012) 196
Commentary
Commentary: Lessons and limitations of population-based research David A. Wong, MD, MSc, FRCS(C)* Denver Spine, 7800 East Orchard Rd, Suite 100, Greenwood Village, CO 80111, USA Received 23 February 2012; accepted 26 February 2012
COMMENTARY ON: Battie MC, Jones CA, Schopflocher DP, Hu RW. Health-related quality of life and comorbidities associated with lumbar spinal stenosis. Spine J 2012;12:189–95 (in this issue).
The article by Dr Battie et al. [1] illustrates several notable issues for readers of The Spine Journal. As national expenditures for health care are restricted [2], reimbursement decisions will be made by politicians, health-care economists, and government policymakers based on population-based data such as that contained in the article. Competition for health-care dollars will drive more studies comparing the health-related quality of life between interventions (eg, stenosis decompression vs. joint arthroplasty). Spine physicians need to become familiar with such population-based methodologies to compete in the new health-care system. Limitations of population-based methodologies should also be noted. The authors describe the difficulty in defining criteria for specific diagnoses for population-based surveys. Inappropriate inclusion or exclusion can lead to unreliable data to base decisions on. The survey instruments also may have limited usefulness for measuring health status for spine patients. Several of the eight attributes used in the Health Utilities Index 3 in the article do not directly reflect spine health (eg, vision, hearing, and speech). Thus, comparing the illness burden of lumbar spinal stenosis with other problems such as
DOI of original article: 10.1016/j.spinee.2011.11.009. FDA device/drug status: Not applicable. Author disclosures: DAW: Royalties: Lippincott (A); Stock Ownership: Denver Integrated Imaging North (A), Neurotech/CervIOM (20%), Huron SHores LLC (50%), Greenwood ASC (B); Consulting: Anulex (B), Allosource (B), DeRoyal (B); Speaking/Teaching Arrangements: Synthes (B); Scientific Advisory Board: United Healthcare (B); Grants: Anulex (C, Paid directly to institution/employer), Cervitch/Nuvasive (B, Paid directly to institution/employer). 1529-9430/$ - see front matter Ó 2012 Elsevier Inc. All rights reserved. doi:10.1016/j.spinee.2012.02.033
diabetes, heart disease, and stroke based on similar Health Utilities Index 3 global scores may not be appropriate. Furthermore, the richness of the database collected reflects/limits the strength of the association between the index diagnosis (in this case lumbar spinal stenosis) and the associated comorbidities (hypertension, arthritis, migraines, and incontinence). For example, hypertension was associated with lumbar spinal stenosis, but there were no weight/body mass index data collected to check that both stenosis and hypertension in fact had a stronger mechanical association because of obesity. Analysis of the article by Battie et al. will assist spine physicians in their educational efforts to understand the implications and limitations of population-based studies.
References [1] Battie MC, Jones CA, Schopflocher DP, Hu RW. Health-related quality of life and comorbidities associated with lumbar spinal stenosis. Spine J 2012;12:189–95. [2] Luo X, Pietrobon R, Sun S, et al. Estimates and patterns of direct health care expenditures among individuals with back pain in the United States. Spine 2004;29:79–86.
The disclosure key can be found on the Table of Contents and at www. TheSpineJournalOnline.com. * Corresponding author. Denver Spine, 7800 East Orchard Rd, Suite 100, Greenwood Village, CO 80111, USA. Tel.: (303) 783-1300; fax: (303) 783-1200. E-mail address: [email protected] (D.A. Wong)
Commentary
Commentary: Lessons and limitations of population-based research David A. Wong, MD, MSc, FRCS(C)* Denver Spine, 7800 East Orchard Rd, Suite 100, Greenwood Village, CO 80111, USA Received 23 February 2012; accepted 26 February 2012
COMMENTARY ON: Battie MC, Jones CA, Schopflocher DP, Hu RW. Health-related quality of life and comorbidities associated with lumbar spinal stenosis. Spine J 2012;12:189–95 (in this issue).
The article by Dr Battie et al. [1] illustrates several notable issues for readers of The Spine Journal. As national expenditures for health care are restricted [2], reimbursement decisions will be made by politicians, health-care economists, and government policymakers based on population-based data such as that contained in the article. Competition for health-care dollars will drive more studies comparing the health-related quality of life between interventions (eg, stenosis decompression vs. joint arthroplasty). Spine physicians need to become familiar with such population-based methodologies to compete in the new health-care system. Limitations of population-based methodologies should also be noted. The authors describe the difficulty in defining criteria for specific diagnoses for population-based surveys. Inappropriate inclusion or exclusion can lead to unreliable data to base decisions on. The survey instruments also may have limited usefulness for measuring health status for spine patients. Several of the eight attributes used in the Health Utilities Index 3 in the article do not directly reflect spine health (eg, vision, hearing, and speech). Thus, comparing the illness burden of lumbar spinal stenosis with other problems such as
DOI of original article: 10.1016/j.spinee.2011.11.009. FDA device/drug status: Not applicable. Author disclosures: DAW: Royalties: Lippincott (A); Stock Ownership: Denver Integrated Imaging North (A), Neurotech/CervIOM (20%), Huron SHores LLC (50%), Greenwood ASC (B); Consulting: Anulex (B), Allosource (B), DeRoyal (B); Speaking/Teaching Arrangements: Synthes (B); Scientific Advisory Board: United Healthcare (B); Grants: Anulex (C, Paid directly to institution/employer), Cervitch/Nuvasive (B, Paid directly to institution/employer). 1529-9430/$ - see front matter Ó 2012 Elsevier Inc. All rights reserved. doi:10.1016/j.spinee.2012.02.033
diabetes, heart disease, and stroke based on similar Health Utilities Index 3 global scores may not be appropriate. Furthermore, the richness of the database collected reflects/limits the strength of the association between the index diagnosis (in this case lumbar spinal stenosis) and the associated comorbidities (hypertension, arthritis, migraines, and incontinence). For example, hypertension was associated with lumbar spinal stenosis, but there were no weight/body mass index data collected to check that both stenosis and hypertension in fact had a stronger mechanical association because of obesity. Analysis of the article by Battie et al. will assist spine physicians in their educational efforts to understand the implications and limitations of population-based studies.
References [1] Battie MC, Jones CA, Schopflocher DP, Hu RW. Health-related quality of life and comorbidities associated with lumbar spinal stenosis. Spine J 2012;12:189–95. [2] Luo X, Pietrobon R, Sun S, et al. Estimates and patterns of direct health care expenditures among individuals with back pain in the United States. Spine 2004;29:79–86.
The disclosure key can be found on the Table of Contents and at www. TheSpineJournalOnline.com. * Corresponding author. Denver Spine, 7800 East Orchard Rd, Suite 100, Greenwood Village, CO 80111, USA. Tel.: (303) 783-1300; fax: (303) 783-1200. E-mail address: [email protected] (D.A. Wong)