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Benefits and Harms of Interventions With Surgery Compared to Interventions Without Surgery for Musculoskeletal Conditions : A Systematic Review With Meta-analysis

SKOU, SØREN T. ; Poulsen, Erik ; Bricca, Alessio ; Dideriksen, Mette ; Lohmander, L. Stefan LU orcid ; ROOS, EWA M. LU and JUHL, CARSTEN B. (2022) In Journal of Orthopaedic and Sports Physical Therapy 52(6). p.312-344
Abstract

OBJECTIVE: To estimate the benefits and harms of interventions with and without surgery for musculoskeletal (MSK) conditions. DESIGN: Intervention systematic review with meta-analysis of randomized controlled trials (RCTs). LITERATURE SEARCH: MEDLINE, EMBASE, CINAHL, Web of Science, and CENTRAL, all up to January 7, 2021. STUDY SELECTION CRITERIA: RCTs (English, German, Danish, Swedish, and Norwegian) of interventions with and without surgery conducted in any setting for any non-fracture MSK condition in adults (mean age: 18+ years) evaluating the outcomes on a continuous (benefits) or count (harms) scale. Outcomes were pain, self-reported physical function, quality of life, serious adverse events (SAEs), and death at 1 year. DATA... (More)

OBJECTIVE: To estimate the benefits and harms of interventions with and without surgery for musculoskeletal (MSK) conditions. DESIGN: Intervention systematic review with meta-analysis of randomized controlled trials (RCTs). LITERATURE SEARCH: MEDLINE, EMBASE, CINAHL, Web of Science, and CENTRAL, all up to January 7, 2021. STUDY SELECTION CRITERIA: RCTs (English, German, Danish, Swedish, and Norwegian) of interventions with and without surgery conducted in any setting for any non-fracture MSK condition in adults (mean age: 18+ years) evaluating the outcomes on a continuous (benefits) or count (harms) scale. Outcomes were pain, self-reported physical function, quality of life, serious adverse events (SAEs), and death at 1 year. DATA SYNTHESIS: Random-effects metaanalyses for MSK conditions where there were data from at least 2 trials. RESULTS: One hundred RCTs (n = 12 645 patients) across 28 different conditions at 9 body sites were included. For 9 out of 13 conditions with data on pain (exceptions include some spine conditions), 11 out of 11 for function, and 9 out of 9 for quality of life, there were no clinically relevant differences (standardized mean difference of 0.50 or above) between interventions with and without surgery. For 13 out of 16 conditions with data on SAEs and 16 out of 16 for death, there were no differences in harms. Only 6 trials were at low risk of bias. CONCLUSION: The low certainty of evidence does not support recommending surgery over nonsurgical alternatives for most MSK conditions with available RCTs. Further high-quality RCTs may change this conclusion.

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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
exercise, orthopedics, placebos, randomized controlled trials, surgery, therapeutics
in
Journal of Orthopaedic and Sports Physical Therapy
volume
52
issue
6
pages
33 pages
publisher
J O S P T, Alliance Group Communications
external identifiers
  • scopus:85131271146
  • pmid:35647883
ISSN
0190-6011
DOI
10.2519/jospt.2022.11075
language
English
LU publication?
yes
id
cfb63791-c91e-450f-9af5-a8e021395f27
date added to LUP
2022-09-23 09:45:39
date last changed
2024-06-12 03:43:15
@article{cfb63791-c91e-450f-9af5-a8e021395f27,
  abstract     = {{<p>OBJECTIVE: To estimate the benefits and harms of interventions with and without surgery for musculoskeletal (MSK) conditions. DESIGN: Intervention systematic review with meta-analysis of randomized controlled trials (RCTs). LITERATURE SEARCH: MEDLINE, EMBASE, CINAHL, Web of Science, and CENTRAL, all up to January 7, 2021. STUDY SELECTION CRITERIA: RCTs (English, German, Danish, Swedish, and Norwegian) of interventions with and without surgery conducted in any setting for any non-fracture MSK condition in adults (mean age: 18+ years) evaluating the outcomes on a continuous (benefits) or count (harms) scale. Outcomes were pain, self-reported physical function, quality of life, serious adverse events (SAEs), and death at 1 year. DATA SYNTHESIS: Random-effects metaanalyses for MSK conditions where there were data from at least 2 trials. RESULTS: One hundred RCTs (n = 12 645 patients) across 28 different conditions at 9 body sites were included. For 9 out of 13 conditions with data on pain (exceptions include some spine conditions), 11 out of 11 for function, and 9 out of 9 for quality of life, there were no clinically relevant differences (standardized mean difference of 0.50 or above) between interventions with and without surgery. For 13 out of 16 conditions with data on SAEs and 16 out of 16 for death, there were no differences in harms. Only 6 trials were at low risk of bias. CONCLUSION: The low certainty of evidence does not support recommending surgery over nonsurgical alternatives for most MSK conditions with available RCTs. Further high-quality RCTs may change this conclusion. </p>}},
  author       = {{SKOU, SØREN T. and Poulsen, Erik and Bricca, Alessio and Dideriksen, Mette and Lohmander, L. Stefan and ROOS, EWA M. and JUHL, CARSTEN B.}},
  issn         = {{0190-6011}},
  keywords     = {{exercise; orthopedics; placebos; randomized controlled trials; surgery; therapeutics}},
  language     = {{eng}},
  number       = {{6}},
  pages        = {{312--344}},
  publisher    = {{J O S P T, Alliance Group Communications}},
  series       = {{Journal of Orthopaedic and Sports Physical Therapy}},
  title        = {{Benefits and Harms of Interventions With Surgery Compared to Interventions Without Surgery for Musculoskeletal Conditions : A Systematic Review With Meta-analysis}},
  url          = {{http://dx.doi.org/10.2519/jospt.2022.11075}},
  doi          = {{10.2519/jospt.2022.11075}},
  volume       = {{52}},
  year         = {{2022}},
}