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Ho EKY, Mobbs RJ, van Gelder JM, Harris IA, Davis G, Stanford R, Beard DJ, Maher CG, Prior J, Knox M, Anderson DB, Buchbinder R, Ferreira ML. Challenges of conducting a randomised placebo-controlled trial of spinal surgery: the SUcceSS trial of lumbar spine decompression. Trials 2023; 24:794. [PMID: 38057932 PMCID: PMC10698887 DOI: 10.1186/s13063-023-07772-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/01/2023] [Indexed: 12/08/2023] Open
Abstract
Although placebo-controlled trials are considered the gold standard for evaluating the efficacy of healthcare interventions, they can be perceived to be controversial and challenging to conduct for surgical treatments. The SUcceSS trial is the first placebo-controlled trial of lumbar decompression surgery for symptomatic lumbar canal stenosis. The SUcceSS trial has experienced common issues affecting the implementation of randomised placebo-controlled surgery trials, accentuated by the COVID-19 pandemic. Using the SUcceSS trial as an example, we discuss key challenges and mitigation strategies specific to the conduct of a randomised placebo-controlled surgical trial. Overall, the key lessons learned were (i) involving key stakeholders early and throughout the trial design phase may increase clinician and patient willingness to participate in a placebo-controlled trial of surgical interventions, (ii) additional resources (e.g. budget, staff time) are likely required to successfully operationalise trials of this nature, (iii) the level of placebo fidelity, timing of randomisation relative to intervention delivery, and nuances of the surgical procedure under investigation should be considered carefully. Findings are based on one example of a placebo-controlled surgical trial; however, researchers may benefit from employing or building from the strategies described and lessons learned when designing or implementing future trials of this nature.
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Affiliation(s)
- Emma Kwan-Yee Ho
- The University of Sydney, Sydney Musculoskeletal Health, Charles Perkins Centre, Faculty of Medicine and Health, School of Health Sciences, Sydney, NSW, 2050, Australia.
- The University of Sydney, Sydney Musculoskeletal Health and the Kolling Institute, Faculty of Medicine and Health, School of Health Sciences, Northern Sydney Local Health District, St Leonards, NSW, 2065, Australia.
| | - Ralph Jasper Mobbs
- NeuroSpine Surgery Reserach Group (NSURG), Sydney, NSW, 2031, Australia
- Prince of Wales Hospital, Barker Street, Randwick, NSW, 2031, Australia
- School of Medicine, University of New South Wales, Sydney, Australia
| | - James Montague van Gelder
- Department of Neurosurgery, Concord Repatriation General Hospital, Concord, NSW, 2139, Australia
- Sydney Spine Institute, Burwood, NSW, 2134, Australia
| | - Ian Andrew Harris
- South West Sydney Clinical Campuses, School of Clinical Medicine, UNSW Medicine & Health, University of New South Wales, Sydney, NSW, 2170, Australia
| | - Gavin Davis
- Neurosurgery, Cabrini & Austin Hospitals; and School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3800, Australia
| | - Ralph Stanford
- Prince of Wales Hospital, Barker Street, Randwick, NSW, 2031, Australia
| | - David John Beard
- The University of Sydney, Sydney Musculoskeletal Health, Charles Perkins Centre, Faculty of Medicine and Health, School of Health Sciences, Sydney, NSW, 2050, Australia
- NHMRC CTC, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | | | - Joanna Prior
- The University of Sydney, School of Health Sciences, Faculty of Medicine and Health, Sydney, NSW, 2050, Australia
| | - Michael Knox
- The University of Sydney, Sydney Musculoskeletal Health and the Kolling Institute, Faculty of Medicine and Health, School of Health Sciences, Northern Sydney Local Health District, St Leonards, NSW, 2065, Australia
| | - David Barrett Anderson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3800, Australia
| | - Rachelle Buchbinder
- Musculoskeletal Health and Wiser Health Care Units, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Manuela Loureiro Ferreira
- The University of Sydney, Sydney Musculoskeletal Health and the Kolling Institute, Faculty of Medicine and Health, School of Health Sciences, Northern Sydney Local Health District, St Leonards, NSW, 2065, Australia
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