Dissemination and Adoption of Comparative Effectiveness Research Findings When Findings Challenge Current Practices. Study Design Characteristics


SPORT was launched in March 2000 to compare the outcomes of surgical and nonsurgical treatment for patients with lumbar intervertebral disk herniation, spinal stenosis, or degenerative spondylolisthesis (Weinstein, Lurie, et al., 2006; Weinstein, Lurie, et al., 2007; Weinstein, Tosteson, et al., 2008)

The spinal stenosis trial compared posterior decompressive laminectomy with usual care, which included physical therapy, education or counseling with home exercise instruction, and treatment with nonsteroidal anti-inflammatory drugs, if tolerated (Weinstein, Tosteson, et al., 2008). The specific type of treatment in the nonsurgical group was left to the discretion of each physician, because of the likelihood of patient heterogeneity in preferences and response to these treatments and limited data on the efficacy of individual nonsurgical treatments. Inclusion criteria required that patients have a history of neurogenic claudication or radicular leg symptoms for at least 12 weeks. As such, the trial was considered to have enrolled a relatively severely affected population.

The trial included both a randomized cohort and an observational cohort (for patients who met eligibility criteria but who refused to be randomized). Outcomes were assessed in both cohorts over a two-year follow-up period.

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