Short-term Improvements in Disability Mediate Patient Satisfaction After Epidural Corticosteroid Injections for Symptomatic Lumbar Spinal Stenosis. Issue 17 (1st September 2015)

• Record Type: Journal Article
• Authors: Suri, Pradeep; Pashova, Hristina; Heagerty, Patrick J.; Jarvik, Jeffrey G.; Turner, Judith A.; Comstock, Bryan A.; Bauer, Zoya; Annaswamy, Thiru M.; Nedeljkovic, Srdjan S.; Wasan, Ajay D.; Friedly, Janna L.
• Is Part Of: Spine. Volume 40:Issue 17(2015)
• Publication Date: 2015-09-01
• Subjects: glucocorticoid -- transforaminal -- interlaminar -- neurogenic -- claudication -- radiculopathy -- randomized controlled trial -- low back pain -- outcomes; Spine -- Abnormalities -- Periodicals; Spine -- Diseases -- Periodicals; Spine -- Surgery -- Periodicals; 616.73005
• DOI: 10.1097/BRS.0000000000001000
• Languages: English
• ISSNs: 0362-2436

Abstract

Abstract : Study Design: Secondary analysis of data from a double-blind randomized controlled trial. Objective: To identify mediators of the effect of lumbar epidural injections of corticosteroid plus lidocaine on patient satisfaction at 6 weeks postinjection in patients with lumbar spinal stenosis. We hypothesized that short-term (⩽3 wk) change in leg pain would be a significant mediator of satisfaction. Summary of Background Data: No prior studies have identified mediators of effects of epidural injections on patient satisfaction with treatment of lumbar spinal stenosis. Methods: We used mediation analysis methods to examine selected intermediate variables (adverse events and change in leg pain, back pain, disability, depression, and fatigue at 3 wk) as potential mediators of the effect of lumbar epidural injections of corticosteroid plus lidocaine on patient satisfaction with treatment. We used the overall satisfaction item from the Swiss Spinal Stenosis Questionnaire as our primary outcome to measure patient satisfaction with the injection procedure at 6 weeks. Results: Among 400 patients randomized to receive epidural injections with corticosteroid plus lidocaine or with lidocaine alone, 369 had complete data for the satisfaction outcome and potential mediators and served as the analysis sample. Contrary to our expectations, 3-week change in leg pain intensity did not have significant mediation effects on patient satisfaction. Three-week change in disability as measured by the Roland-Morris Disability Questionnaire was a significant mediator of the effects of lumbar epidural corticosteroid injections on patient satisfaction at 6 weeks, explaining 48% to 60% of the treatment effect on satisfaction. Changes in pain intensity in the leg and back together explained very little of the treatment effect on satisfaction beyond the information contributed by disability change alone. We did not find other intermediate variables to be mediators of patient satisfaction. Conclusion: These findings support the current approach of examining disability as a primary patient-reported outcome in comparative effectiveness studies of lumbar spinal stenosis. Level of Evidence: 2 Abstract : In this analysis of data from patients with symptomatic lumbar spinal stenosis in a randomized trial, 3-week change in disability mediated the effects of lumbar epidural corticosteroid injections on patient-reported satisfaction with treatment.