Treatment of XXXX : Applicability of Appropriateness Criteria in Clinical Practice.

@entity1 @entity174 @entity3814 @entity358 @entity85
BACKGROUND: Appropriate treatment choice for @entity3814 ( @entity3814 ) is challenging due to @entity1 heterogeneity. Using the RAND/UCLA method, an international multidisciplinary expert panel established @entity1 -specific criteria for the choice between non-surgical management (NSM), vertebroplasty (VP), and balloon kyphoplasty (BKP). OBJECTIVES: To assess the applicability of the appropriateness criteria in real-life practice. STUDY DESIGN: Prospective observational study. SETTING: Eight practices of experts who participated in the panel study, including 2 interventional radiologists, one internal medicine specialist, 2 neurosurgeons, and 3 orthopedic/trauma surgeons. Practices were located in Belgium, Germany, Italy, Switzerland, and the United Kingdom. METHODS: Using an online data capture program, @entity1 documented the clinical profile (age, gender, previous VCFs, time since @entity174 , magnetic resonance imaging (MRI) findings, evolution of symptoms, impact of symptoms on quality of life, @entity85 , ongoing @entity174 process, and presence of @entity358 ) and treatment choice for consecutive @entity1 who consulted them for @entity3814 . RESULTS: In total 426 @entity1 were included. BKP was the most frequently chosen treatment option (49%), followed by VP (34%) and NSM (14%). When compared with the panel recommendations, inappropriate treatment choices were rare (5% for NSM, 2% for VP, none for BKP). Treatment choice was strongly associated with the clinical variables used in the panel study. Differences in treatment decisions between interventional radiologists and surgeons were largely determined by differences in @entity1 characteristics, with time of clinical presentation being the dominant factor. LIMITATION: The study population was restricted to the practices of the @entity1 of the panel study. CONCLUSION: This international, multi-specialty utilization review showed excellent applicability of, and good adherence with RAND/UCLA-based recommendations on treatment choice in @entity3814 .
