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PAPERS: Oliver Rivero-Arias, Helen Campbell, Alastair Gray, Jeremy Fairbank, Helen Frost, James Wilson-MacDonald for the Spine Stabilisation Trial Group Surgical stabilisation of the spine compared with a programme of intensive rehabilitation for the management of patients with chronic low back pain: cost utility analysis based on a randomised controlled trial BMJ 2005; 330: 1239 [Abstract] [Full text]

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Surgical stabilisation of the spine trial may under-estimate treatment effect

Philip Sell   (2 June 2005)

Surgical stabilisation of the spine trial may under-estimate treatment effect 2 June 2005
Philip Sell, Consultant orthopaedic Surgeon University Hospitals of Leicester Send response to journal: Re: Surgical stabilisation of the spine trial may under-estimate treatment effect	What a pleasure to see a practical trial of such an important health care issue published where it has the potential to produce change in practice. The authors are to be lauded for their efforts. The trial in 15 centres had experienced surgeons selecting suitability for the study, and because of their experience they had no learning curve in the surgery limb. The majority of the functional restoration programs (FRP's) were on the other hand newly staffed and set up specifically for the trial. It may well be that there is a learning experience to the functional restoration programs that results in the trial under-estimating the treatment effect of FRP and over-estimating the value (albeit limited) of surgery. Competing interests: None declared