Nonoperative Management of the Adult Spinal Deformity Patient: A Biopsychosocial Intervention Versus Care-as-usual - A Comparative Treatment-Based Cohort Study With One-Year Follow-Up

Abstract

Study design Comparative Cohort Study. Objectives The aim of this study was to compare a biopsychosocial intervention for chronic low back pain to unimodal, biomedically focused care-as-usual in symptomatic, conservatively managed adult spinal deformity (ASD) patients. Methods A comparative cohort study of a biopsychosocial intervention cohort (n=95) and a care-as-usual cohort (n=95). Inclusion criteria of both cohorts: age >= 18, no surgical indication, Oswestry Disability Index (ODI)>20, coronal Cobb angle >= 20, idiopathic (AdIS) or degenerative (de novo) scoliosis (DN), baseline and one-year follow-up ODI data. Primary outcome: functional status (ODIv2.1a). Secondary outcomes: pain intensity (NPRS) and quality of life (SF36-PCS and SF36-MCS). Clinical relevance: minimal important clinical change (MCIC; improvement in ODI >= 10 points), patient acceptable symptom state (PASS; ODI <= 22). Results At one-year follow-up the patients in the biopsychosocial intervention cohort showed significantly greater improvement in functional status (ODI) compared to the care-as-usual cohort (z=-3.97, p=<.001). Clinical relevance in terms of functional status: 49% of the patients in the biopsychosocial intervention cohort reached MCIC and 34% reached a PASS, compared to 23% and 15% respectively in the care-as-usual cohort. All secondary outcomes followed a similar pattern: greater improvement in the biopsychosocial intervention cohort. Conclusion This study shows clinically relevant and significantly greater improvement in function, pain, and quality of life in the biopsychosocial intervention cohort, compared to the unimodal, biomedically focused care-as-usual cohort at one-year follow-up. Targeting biopsychosocial factors offers a promising option in terms of improving outcome in nonoperative care for ASD patients with predominant back pain symptoms.