Lumbar Stenosis Prognostic Subgroups for Personalizing Care and Treatment (PROSPECTS)
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Project Summary/Abstract The overall objective of this project is to develop and evaluate a clinically useful predictive model of long-term function in older patients initiating non-surgical care for symptomatic lumbar spinal stenosis. Lumbar spinal stenosis is a common cause of low back pain and its associated disability among older adults, but there is little data on prognosis to guide clinical trial design and clinical decision making. Using a prospective, inception cohort study design, we will identify prognostic trajectories that can be easily applied clinically and describe each group's phenotype using baseline variables. We will then develop and estimate the performance of a model to predict patients' 12-month physical function. We will enroll adults aged 50 years and older initiating non-surgical care for symptomatic lumbar spinal stenosis. Participants will be recruited from The Duke Spine Clinic and UW Medicine spine clinics. Baseline characteristics and candidate predictor variables, selected a priori, will be measured after the index visit using patient-reported information from telephone interviews and electronic medical record data. Back-related outcomes will be measured using a phone interview at 3, 6, and 12 months after the initial visit. Healthcare and medication use during the six months after the new visit will be measured using the electronic medical record and patient questionnaires. This design will provide the highest level of evidence to date for the prognosis of patients with symptomatic lumbar spinal stenosis not receiving surgery. A parsimonious, accurate, and clinically useful prognostic model can be used to guide participant selection for future clinical trials, as an adjustment or modification variable in studies comparing different treatments, and can lead to new tailored treatment approaches for individuals with symptomatic lumbar spinal stenosis. Ultimately, this line of research has substantial potential to improve the effectiveness and value of care for patients with symptomatic lumbar spinal stenosis. Tailored treatment pathways for older adults with symptomatic lumbar spinal stenosis in non-surgical settings are currently non-existent, but they have shown great promise in other back pain populations, such as non-specific back pain in primary care settings.
