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Volume 357:1255-1256 September 20, 2007 Number 12
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Surgical versus Nonsurgical Treatment for Back Pain

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by Deyo, R. A.
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by Weinstein, J. N.
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To the Editor: Weinstein et al. (May 31 issue)1 report an immoderate example of a pragmatic trial. In their study, the nonsurgical group received heterogeneous treatments involving a combination of at least 3 treatments from a pool of more than 50 therapies, whereas the surgical interventions involving decompression with or without fusion, and with or without instrumentation, added such variability that the study results are limited.1,2 The authors suggest that the pragmatic nature of the trial increases the generalizability of the study results. However, the major limitation (the lack of description and standardization of the interventions) compromises the internal and . . . [Full Text of this Article]



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