Looking Beyond Patient Averages: Steps Towards Personalized Care
For those struggling with back pain, surgery can go a long way to improving their quality of life – but that isn’t the result for everyone.
“While the research is starting to show spine surgery is becoming better and better at improving outcomes and improving quality of life for patients, there are patients in our practice that are still struggling after a technically successful operation,” said Dr. Neil Manson, a Saint John orthopaedic surgeon.
Dr. Manson is part of a research team that wanted to learn why some patients reacted well to surgery and others did not, when on paper they seemed like perfect candidates.
Using data from The Canadian Spine Outcomes and Research Network (CSORN), their research focused on more than 500 patients who received surgery for degenerative stenosis, a type of spinal disease.
“Common wisdom tells us that the surgery is considered to be quite successful as far as surgeries go, but that opinion is based on statistical models that tend to map the average outcome that’s experienced by patients,” said Dr. Jeffrey Hebert, a professor with the Faculty of Kinesiology at the University of New Brunswick. “But many patients don’t fit the average profile.”
Through their research, the team first wanted to map the amount of pain and pain-related disability experienced by patients from before they received the surgery up until two years after.
They discovered patients experienced three distinct pain and disability trajectories. The first group was virtually pain-free, another had noticeable improvement though not as much as the first group, while a third group experienced little to no improvement from surgery.
From there, the research team investigated if there were characteristics about the patients or the surgery itself that could predict the outcome experienced by individual patients.
They found that if the patient had depression or was at risk for depression, had other underlying health problems, had long-standing pain, or had to wait longer for surgery, they were less likely to see improvements after surgery. Conversely, a patient who exercised regularly or received treatment from a chiropractor or a physiotherapist before surgery was more likely to experience a good or excellent outcome with the operation.
The results of their research are providing useful information to both physicians and patients.
“We always look for things our physicians can do, things that are in our patient’s health history that we can address pre-operatively, or things that can be addressed systemically, such as wait times, to improve care,” said Erin Bigney from Horizon Health Network, who is Head of Research at the Canada East Spine Centre. “That’s why we started this trajectory study, so we can know, for each individual patient, what their risks are and what are their chances of success.”
Their goal is always to find the best possible outcome for their patients.
“We should never put someone through the challenge of an operation if it’s not going to make them better. Even if they’re the perfect surgical candidate,” said Dr. Manson.
He said his biggest takeaway from this project is, “We can’t hang our hats solely on our standard medical approach. There has to be more to it. There has to be a component of addressing the health of the entire patient.”
Dr. Hebert agrees, noting, “It’s misguided to consider all patients as being average.” Instead, as their research has shown, patients need to be viewed as individuals.
Though the research project had no direct funders, the Canada East Spine Centre pays for its projects to be open access publications, meaning physicians and patients can read the papers at no cost. This is supported through community donations to the Canada East Spine Centre Research Fund, administered through the Saint John Regional Hospital Foundation. The publications from this project are available in the journals PLOS One and Spine.
The New Brunswick Health Research Foundation played a role as well, said Dr. Hebert, as they support his position as research chair in musculoskeletal health.
Taking a team approach to research projects like this one results in new information that can have a positive impact on the surgical community and patients alike.
“We’re really privileged here in New Brunswick to have these opportunities to collaborate with a wide range of high calibre scientists and physicians,” said Bigney.
Besides Dr. Manson, Dr. Hebert and Bigney, the research team for this project consisted of Dr. Edward Abraham, a Saint John orthopaedic surgeon, Dr. Niels Wedderkopp, an orthopaedic surgeon with Hospital of South West Jutland, the Canada East Spine Centre’s team which included Eden Richardson, Dana El-Mughayyar, Mariah Darling and Amanda Vandewint, along with the following CSORN contributing surgeons: Hamilton Hall, Charles Fisher, Raja Rampersaud, Kenneth Thomas, Bradley Jacobs, Michael Johnson, Jerome Paquet, Najmedden Attabib, Peter Jarzem, Eugene Wai, Parham Rasoulinejad, Henry Ahn, Andrew Nataraj and Alexandra Stratton.
Banner photo: Dr. Edward Abraham, Amanda Vandewint, Erin Bigney, Eden Richardson, Dana El-Mughayyar, Dr. Neil Manson. Image: submitted.
This story is sponsored by the New Brunswick Health Research Foundation.