JAMA: Nocebo effect and Viscerosomatic Amplification...

[drusso]

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The Potential Adverse Influence of Physicians’ Words

Providing test results of dubious clinical significance also can lead to increased symptoms. For example, in a randomized study of acute low back pain, one group (n = 210) underwent spine imaging, whereas the other group (n = 211) did not. A treatment plan of conservative medical management was implemented in both groups. At 3-month follow-up, the former group had significantly more pain, greater functional impairment, and more physician visits.4 The problems involved in conveying equivocal test results or anatomical abnormalities of unknown clinical significance (“incidentalomas”) are likely to increase in importance as the volume and resolution of diagnostic testing accelerate.

 

[DrCommonSense]

The Potential Adverse Influence of Physicians’ Words

Providing test results of dubious clinical significance also can lead to increased symptoms. For example, in a randomized study of acute low back pain, one group (n = 210) underwent spine imaging, whereas the other group (n = 211) did not. A treatment plan of conservative medical management was implemented in both groups. At 3-month follow-up, the former group had significantly more pain, greater functional impairment, and more physician visits.4 The problems involved in conveying equivocal test results or anatomical abnormalities of unknown clinical significance (“incidentalomas”) are likely to increase in importance as the volume and resolution of diagnostic testing accelerate.

Were the two groups equal in terms of functional assessment, VAS, psychiatric history, age, comorbidities, etc at the beginning of this study?

Could easily be the group that was less functional at the beginning was the ones that got more testing.

 

[Ducttape]

if you had fully read the articles and followed the links, then you would have read the below...

Assignment to treatment group—Randomisation was by individual participant. At the baseline interview the research nurse opened a sealed envelope containing the treatment group allocation. Block randomisation (using blocks of 20) was used to ensure equality of numbers between the two groups. A member of the research team (KF) who was not involved in assigning the participants to treatment group generated the allocation schedule. Participants and research nurses were not blinded to treatment group. In addition the study included a preference arm for participants in which those who did not consent to randomisation could choose whether to have radiography or not.

also, no selection bias was made of the characteristics you ask, because identification of back pain was the sole criteria to get enrolled in the study.

 

[lobelsteve]

101n likes this.


I like that he is back.

 

[Aether2000]

Kewl! 101 is back!

 

[drusso]

101n likes this.


I like that he is back.

...it's like he really never left...

 

[DrCommonSense]

if you had fully read the articles and followed the links, then you would have read the below...




also, no selection bias was made of the characteristics you ask, because identification of back pain was the sole criteria to get enrolled in the study.

Lack of control for the aforementioned characteristics biases the study.

That is why studies are supposed to "control" for confounding variables.

 

[SSdoc33]

Kewl! 101 is back!

addicts always have relapses.....

 

[Ducttape]

Lack of control for the aforementioned characteristics biases the study.

That is why studies are supposed to "control" for confounding variables.

One can argue that the way they performed this study was a method of controlling for confounding variables- no questions pertaining VAS etc were introduced prior to initiation of study.

I only have issue with the study in that those variables should have been reported as part of the results of the study. I don’t see that information on the article I read.