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Thread: Incorrect statement in Clear preprint

  1. #1
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    Incorrect statement in Clear preprint

    Morningstar and Stitzel, in press, in Journal of Pediatric, Maternal, and Family Health - Chiropractic

    According the second author, this journal article is a commentary on Cobb angle. It contains the following statement:

    "Despite these reported corrections, as many as 40% of these patients will be classified as permanently disabled as a result of the surgery, yet the Cobb angle is reduced.11"
    Reference 11 is:

    Danielsson AJ, Nachemson AL. Radiographic findings and curve progression 22 years after treatment for adolescent idiopathic scoliosis. Spine 2001;26:515-525.

    I have just carefully read Danielsson and Nachemson (2001). There is nothing in there that talks about permanent disability due to surgery, not to mention 40%. Quite the opposite, they conclude,
    "The surgical complication rate was low, and very few complications needing intervention have occurred, even after more than 20 years since treatment."
    This statement about 40% disability rate for surgery did NOT come from Danielsson and Nachemson (2001). Hopefully the reviewers, if any, will catch it. Also, Morningstar/Stitzel should try to get this error corrected before publication or issue an errata paper if the paper has been published.
    Sharon, mother of identical twin girls with scoliosis

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    It might be interesting to check out some of the other references in the paper.

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    There is a paper, I don't recall which one, in which they had odd results like that. Roughly, the results were that, although people reported better scores after surgery, a large percentage (something like 40%) qualified for disability.

    So, it may be that they just pointed to the wrong paper, but there is a reserach paper that says that. We talked about it at some point on the forum, but I can't recall where.

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    They may have been trying to reference this one. Also a Danielson et al. But it's 2006 in Spine. Spinal range of motion, muscle endurance, and back pain and function at least 20 years after fusion or brace treatment for adolescent idiopathic scoliosis: a case-control study. PMID: 16449899

    It's a pretty good study. I don't know if it says 40% but it wouldn't surprise me if there is some level of disability. I'm not sure what rate the healthy population is.

    Do you have a link/pdf to the Morningstar paper?
    Last edited by skevimc; 01-27-2010 at 12:04 PM.

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    It comes from the following 2002 paper concerning Harrington Rod patients. It's not relevant to patients today, because the main problems faced by people with Harrington Rods were to do with flatback/sagittal imbalance when fused into the lumbar area, and modern instrumentation allows for the preservation of the natural lordosis.

    "“On average, 16 years after surgery, 40% of surgery patient are permanently handicapped for the rest of their lives”

    - Long-term results of quality of life in patients with idiopathic scoliosis after Harrington instrumentation and their relevance for expert evidence. Gotze C, Slomka A, Gotze HG, Potsl W, Liljenqvist U, Stienbeck J. Z Orthop Ihre Grensgeb 2002 Sep-Oct, 140

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    Thanks, Toni, that's the one I was thinking of.

    Also, I suspect it has to do with some country-specific disability laws which likely don't have international application.

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    Quote Originally Posted by skevimc View Post
    Do you have a link/pdf to the Morningstar paper?

    It's on this site/thread:

    http://www.fixscoliosis.com/forum/th...urements/page2

    Post #17.
    Sharon, mother of identical twin girls with scoliosis

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    Quote Originally Posted by hdugger View Post
    Thanks, Toni, that's the one I was thinking of.

    Also, I suspect it has to do with some country-specific disability laws which likely don't have international application.
    Yes I thought of that too. Sweden is arguably the best country in the world for standard of living. That is due to it being one of the most atheistic countries in the world and can focus on real human suffering.

    But the real potential problem with the statistic is that it has to be compared to a population of folks with surgical range scoliosis who did not get the surgery. What is their disability rate? Is it close to 100%? How many died due to scoliosis-related sequelae?

    It is highly misleading to mention that statistic absent some idea of how disabled a non-surgical control group is. I hope the original paper made this comparison. But even if they didn't, it is misleading (at best) to use the statistic as has been done in the Morningstar/Stitzel article. I realize chiros are not trained in research but at some point it just gets too ridiculous.
    Last edited by Pooka1; 01-27-2010 at 02:26 PM.
    Sharon, mother of identical twin girls with scoliosis

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    Quote Originally Posted by tonibunny View Post
    It comes from the following 2002 paper concerning Harrington Rod patients. It's not relevant to patients today, because the main problems faced by people with Harrington Rods were to do with flatback/sagittal imbalance when fused into the lumbar area, and modern instrumentation allows for the preservation of the natural lordosis.

    "“On average, 16 years after surgery, 40% of surgery patient are permanently handicapped for the rest of their lives”

    - Long-term results of quality of life in patients with idiopathic scoliosis after Harrington instrumentation and their relevance for expert evidence. Gotze C, Slomka A, Gotze HG, Potsl W, Liljenqvist U, Stienbeck J. Z Orthop Ihre Grensgeb 2002 Sep-Oct, 140
    Thanks for chasing that down, Toni.

    The only honest way to use that statistic is as follows:

    1. qualify that it applies only to Sweden (if true)
    2. qualify that it applies only to outmoded instrumentation that isn't used today
    3. qualify that it applies almost exclusively to lumbar fusions (as is very likely to be true)
    4. qualify that it needs to be compared to a matched control group of unfused scoliosis patients with similar curves and have the disability rate quantified for that group also.

    Absent appropriate qualifications, the quote is misleading in the extreme. Hopefully the reviewers, if any, will suggest removing the statement if they are concerned about intellectual honesty.
    Last edited by Pooka1; 01-27-2010 at 03:07 PM.
    Sharon, mother of identical twin girls with scoliosis

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    Quote Originally Posted by tonibunny View Post
    It comes from the following 2002 paper concerning Harrington Rod patients. It's not relevant to patients today, because the main problems faced by people with Harrington Rods were to do with flatback/sagittal imbalance when fused into the lumbar area, and modern instrumentation allows for the preservation of the natural lordosis.
    I wish new members who ask this forum about CLEAR (and more so, the existing members who blindly defend them - sans results), would pull their heads out of the sand and consider this stellar example of their tactics.

    CLEAR *knows* the information is outdated, but it suits their purpose: It's one thing to be ignorant, and quite another to lie.

    It's already been said too many times to count, but I don't know how these guys sleep at night.
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    Quote Originally Posted by txmarinemom View Post
    I wish new members who ask this forum about CLEAR (and more so, the existing members who blindly defend them - sans results), would pull their heads out of the sand and consider this stellar example of their tactics.

    CLEAR *knows* the information is outdated, but it suits their purpose: It's one thing to be ignorant, and quite another to lie.

    It's already been said too many times to count, but I don't know how these guys sleep at night.
    Morningstar, I think, is on the evidence-based chiro bandwagon. That's why this statement is perplexing because it seems designed to mislead.

    The heart of research is not a model or an equation... it is intellectual honesty.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
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    "We are all African."

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    Quote Originally Posted by Pooka1 View Post
    Hopefully the reviewers, if any, will suggest removing the statement if they are concerned about intellectual honesty.
    That's a good one. Also, if the article is in that format, it's probably done being edited.

    Quote Originally Posted by Pooka1 View Post
    Morningstar, I think, is on the evidence-based chiro bandwagon. ...
    I want to believe this. I really do. I honestly am pulling for them and hope they publish good reports.

    But I agree with the rest of you that they are clearly cherry picking articles in order to drive home their message of "surgery is bad and surgeons are using obsolete methods to push people in to surgery". The stupid part about this, other than being untrue, is that this surgical statistic adds nothing to their basic argument. It's not a commentary about the 'evils' of surgery. It's a commentary about the usefulness of Cobb's angle.

    This comment, however, almost saves the commentary. I stress the almost part.

    Since chiropractors are particularly focused on obtaining radiographic evidence of treatment success, the profession at large should use radiographic analytical methods that provide more information on the presenting three-dimensional spine and spinal disorder. We as a profession should also consider using a wide array of radiographic, functional, and index based outcomes to get a complete picture of patient progress.
    I hope that this will encourage/drive/push/demand that chiro's publish x-ray data with future reports. Of course this says nothing for patient selection, long-term follow-ups or possible negative results.

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    Quote Originally Posted by skevimc View Post
    But I agree with the rest of you that they are clearly cherry picking articles in order to drive home their message of "surgery is bad and surgeons are using obsolete methods to push people in to surgery". The stupid part about this, other than being untrue, is that this surgical statistic adds nothing to their basic argument. It's not a commentary about the 'evils' of surgery. It's a commentary about the usefulness of Cobb's angle.
    Good point. It's almost like they try to work that 40% disability stat into every article on every subject. If it was relevant and honest, that would be okay. Of course it is never relevant or honest.

    I hope that this will encourage/drive/push/demand that chiro's publish x-ray data with future reports. Of course this says nothing for patient selection, long-term follow-ups or possible negative results.
    Other than the nonsense, and other than it being a penetrating glimpse into the obvious for medical folks not to only use Cobb angle, it's a step in the right direct away from the blind leading the blind leading the naked over there in chiroland.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
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    "We are all African."

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    From the disability paper in question:

    "Five patients (6.1 %) complained of chronic back pain. 33 patients (40 %) were legally defined in their rate of disability as severely handicapped patients."

    So, only 5 patients had chronic back pain, but 33 patients were disabled? I suspect they didn't control for other disabilities.

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    Quote Originally Posted by LindaRacine View Post
    From the disability paper in question:

    "Five patients (6.1 %) complained of chronic back pain. 33 patients (40 %) were legally defined in their rate of disability as severely handicapped patients."

    So, only 5 patients had chronic back pain, but 33 patients were disabled? I suspect they didn't control for other disabilities.
    It'll be hard to tell because the article is written in German.

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