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

Søren T. Skou*, Erik Poulsen, Alessio Bricca, Mette Dideriksen, L. Stefan Lohmander, Ewa M. Roos, Carsten B. Juhl

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

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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 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.
Original languageEnglish
JournalJournal of Orthopaedic and Sports Physical Therapy
Volume52
Issue number6
Pages (from-to)312-344
ISSN0190-6011
DOIs
Publication statusPublished - 1. Jun 2022

Keywords

  • Adolescent
  • Adult
  • Humans
  • Musculoskeletal Diseases/surgery
  • Pain
  • Quality of Life
  • placebos
  • therapeutics
  • exercise
  • orthopedics
  • randomized controlled trials
  • surgery

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