1172 Journal Reports / The Spine Journal 12 (2012) 1170–1172

The effect of required physiatrist consultation on surgery rates for

back pain. Fox J, Haig AJ, Todey B, Challa S. Spine (Phila Pa 1976)

2012 Nov 7. [Epub ahead of print]

STUDY DESIGN: Prospective trial with insurance database and surveys.

OBJECTIVE: This study was developed to determine whether an insurer

rule requiring physiatrist consultation before nonurgent surgical consulta-

tion would affect surgery referrals and surgery rates.

SUMMARY OF BACKGROUND DATA: Spine surgery rates are highly

variable by region and increasing without evidence of a concordant decrease

in the burden of disease. Efforts to curb misuse of surgery have not shown

large changes, especially across different provider groups. As nonsurgical

spine experts, physiatrists might provide patients with a different perspec-

tive on treatment options.

METHODS: In 2007, the insurer required patients with nonurgent spine

surgical consultations in a geographic region to first have a single visit with

a physiatrist, who received extra compensation for the assessment. Surgical

consultation and surgical rates results were compared between 2006–2007

and 2008–2010. An automated telephone survey of patients evaluated by

physiatrists was performed to assess patient satisfaction.

RESULTS: Physiatry referrals increased 70%, surgical referrals decreased

48%, and the total number of spine operations dropped 25%, with concom-

itant decreased overall cost. While spinal fusion rates dropped, the percent-

age of fusion operations increased from 55% to 63% of all surgeries. Of 740

patients surveyed (48% response rate), 74% were satisfied or very satisfied

with the physiatry consultation.Only 40%of patientswho hadprevious spine

surgery were satisfied. Although surgical rates decreased at all regional hos-

pitals and all surgical groups, there were substantial shifts in market share.

CONCLUSION: Mandatory physiatrist consultation prior to surgical con-

sultation resulted in decreased surgical rates and continued patient satisfac-

tion across a large region.

PMID: 23138405 [PubMed - as supplied by publisher. Available at: http://

www.ncbi.nlm.nih.gov/pubmed/23138405].

Reprinted with permission from: Fox J, Haig AJ, Todey B, Challa S. The

effect of required physiatrist consultation on surgery rates for back pain.

Spine (Phila Pa 1976) 2012 Nov 7. [Epub ahead of print].

http://dx.doi.org/10.1016/j.spinee.2012.11.039

Fear avoidance beliefs predict disability in older adults with chronic

low back pain. Camacho-Soto A, Sowa GA, Perera S, Weiner DK.

PM R 2012;4(7):493–7

OBJECTIVES: To determine whether fear avoidance beliefs (FABs) in

older adults with chronic low back pain (CLBP) are significantly associ-

ated with gait speed decline and/or self-report of greater disability.

DESIGN: Cross-sectional analysis.

SETTING: An academic medical center (single site).

PARTICIPANTS: Two hundred English-speaking participants aged 65

years and older with CLBP every day or almost every day of moderate

or greater intensity for $3 months.

MAIN OUTCOME MEASUREMENTS: The physical activity portion

of the FAB questionnaire assessed FABs. Disability was measured with

gait speed and the Roland Morris Questionnaire. Covariates measured in-

cluded age, gender, body mass index, chronic disease (Cumulative Illness

Rating Scale), depression (Geriatric Depression Scale), and pain (McGill

Pain Questionnaire Short Form).

RESULTS: FABs were significantly associated with the Roland Morris

Questionnaire (P!.0001) and gait speed (P5.002) after controlling for

all covariates.

CONCLUSION: FABs related to physical activity in older adults with

CLBP were significantly associated with both self-reported and perfor-

mance-based disability after controlling for known confounders. Previous

studies have reported similar associations between self-reported measures

of disabling back pain and FABs. Ours is the first study to examine the re-

lationship between FAB and gait speed, a powerful predictor of morbidity

and mortality. Future work should examine whether targeting fear avoid-

ance in addition to other psychosocial measures in older adults with CLBP

improves gait speed and functional independence.

Copyright � 2012 American Academy of Physical Medicine and Rehabil-

itation. Published by Elsevier Inc. All rights reserved.

PMID: 22516436 [PubMed - in process. Available at: http://www.ncbi.

nlm.nih.gov/pubmed/22516436].

Reprinted from: Camacho-Soto A, Sowa GA, Perera S, Weiner DK. Fear

avoidance beliefs predict disability in older adults with chronic low back

pain. PM R 2012;4(7):493–7, with permission from American Academy

of Physical Medicine and Rehabilitation (AAPM&R).

http://dx.doi.org/10.1016/j.spinee.2012.11.040

Acupuncture in patients with acute low back pain: a multicentre

randomised controlled clinical trial. Vas J, Aranda JM, Modesto M,

et al. Pain 2012;153(9):1883–9. Epub 2012 Jul 4

Reviews of the efficacy of acupuncture as a treatment for acute low back

pain have concluded that there is insufficient evidence for its efficacy and

that more research is needed to evaluate it. A multicentre randomized con-

trolled trial was conducted at 4 primary-care centres in Spain to evaluate

the effects of acupuncture in patients with acute nonspecific low back pain

in the context of primary care. A total of 275 patients with nonspecific

acute low back pain (diagnosed by their general practitioner) were re-

cruited and assigned randomly to 4 different groups: conventional treat-

ment either alone or complemented by 5 sessions over a 2-week period

of true acupuncture, sham acupuncture, or placebo acupuncture per patient.

Patients were treated from February 2006 to January 2008. The primary

outcome was the reduction in Roland Morris Disability Questionnaire

scores of 35% or more after 2weeks’ treatment. The patients in the 3 types

of acupuncture groups were blinded to the treatments, but those who re-

ceived conventional treatment alone were not. In the analysis adjusted

for the total sample (true acupuncture relative risk 5.04, 95% confidence

interval 2.24–11.32; sham acupuncture relative risk 5.02, 95% confidence

interval 2.26–11.16; placebo acupuncture relative risk 2.57, 95% confi-

dence interval 1.21–5.46), as well as for the subsample of occupationally

active patients, all 3 modalities of acupuncture were better than conven-

tional treatment alone, but there was no difference among the 3 acupunc-

ture modalities, which implies that true acupuncture is not better than sham

or placebo acupuncture.

Copyright � 2012 International Association for the Study of Pain. Pub-

lished by Elsevier B.V. All rights reserved.

PMID: 22770838 [PubMed - in process. Available at: http://www.ncbi.

nlm.nih.gov/pubmed/22770838].

Reprinted from: Vas J, Aranda JM, Modesto M, et al. Acupuncture in pa-

tients with acute low back pain: a multicentre randomised controlled clin-

ical trial. Pain 2012;153(9):1883–9. Epub 2012 Jul 4. This abstract has

been reproduced with permission of the International Association for the

Study of Pain� (IASP�). The abstract may not be reproduced for any other

purpose without permission.

http://dx.doi.org/10.1016/j.spinee.2012.11.041