{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T22:28:46Z","timestamp":1773181726352,"version":"3.50.1"},"reference-count":36,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2019,7,9]],"date-time":"2019-07-09T00:00:00Z","timestamp":1562630400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001826","name":"ZonMw","doi-asserted-by":"publisher","award":["80\u201084300\u201098\u201071005"],"award-info":[{"award-number":["80\u201084300\u201098\u201071005"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Physiotherapy Res Intl"],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>The general consensus is that surgical treatment is advised when conservative methods fail in patients with lumbosacral radicular syndrome (LRS). Preliminary evidence from our pilot study indicates that combination therapy (mechanical diagnosis therapy and transforaminal epidural injections) can prevent surgical treatment in patients on the waiting list for surgery. The pilot study lacked a control group, and therefore, firm conclusions pertaining to effects could not be made. This study aims to determine if combination therapy, performed while being on the waiting list for lumbar herniated disc surgery, is effective and cost\u2010effective compared with usual care (i.e., no intervention while being on the waiting list) among patients with a magnetic resonance imaging (MRI)\u2010confirmed indication for a lumbar herniated disc surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A randomized controlled trial will be conducted with an economic evaluation. Patients aged 18 and above with incapacitating LRS, with leg pain and an MRI confirmed indication for lumbar disc hernia surgery, will be recruited from seven Dutch hospitals. While being on the waiting list for lumbar herniated disc surgery, patients will be randomized to either the combination therapy or usual care group. The primary outcome measure is the number of patients undergoing lumbar disc surgery during 12\u2010month follow\u2010up. Secondary outcomes include back and leg pain intensity (numeric pain rating scale), physical functioning (Roland Morris Disability Questionnaires\u201023), self\u2010perceived recovery (global perceived effect), and health\u2010related quality of life (EuroQol Five Dimensions Health Questionnaire (EQ\u20105D\u20105L) and 12\u2010Item Short Form Health Survey (SF\u201012)). For the economic evaluation, societal and health care costs will be measured. Measurements moments are baseline, 1, 2, 4, 6, 9, and 12\u00a0months. Data will be analysed according to the intention\u2010to\u2010treat principle.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>No randomized controlled trials have evaluated the effectiveness and cost\u2010effectiveness of combination therapy compared with usual care in patients with an indication for lumbar herniated disc surgery, which emphasizes the importance of this study.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pri.1796","type":"journal-article","created":{"date-parts":[[2019,7,9]],"date-time":"2019-07-09T11:18:13Z","timestamp":1562671093000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Cost\u2010effectiveness of combination therapy (Mechanical Diagnosis and Treatment and Transforaminal Epidural Steroid Injections) among patients with an indication for a Lumbar Herniated Disc surgery: Protocol of a randomized controlled trial"],"prefix":"10.1002","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6471-1432","authenticated-orcid":false,"given":"Elizabeth N.","family":"Mutubuki","sequence":"first","affiliation":[{"name":"Department of Health Sciences, Faculty of Science, Amsterdam Movement Sciences Vrije Universiteit Amsterdam Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hans","family":"van Helvoirt","sequence":"additional","affiliation":[{"name":"Stichting Rugpoli Delden The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johanna M.","family":"van Dongen","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Faculty of Science, Amsterdam Movement Sciences Vrije Universiteit Amsterdam Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carmen L.A.","family":"Vleggeert\u2010Lankamp","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Leiden University Medical Centre Leiden The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank J.P.M.","family":"Huygen","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Centre of Pain Medicine Erasmus MC Rotterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maurits W.","family":"van Tulder","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Faculty of Science, Amsterdam Movement Sciences Vrije Universiteit Amsterdam Amsterdam The Netherlands"},{"name":"Department of Physiotherapy &amp; Occupational Therapy Aarhus University Hospital Aarhus Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hanneke A.H.J.","family":"Klopper\u2010Kes","sequence":"additional","affiliation":[{"name":"Stichting Rugpoli Delden The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raymond W.J.G.","family":"Ostelo","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Faculty of Science, Amsterdam Movement Sciences Vrije Universiteit Amsterdam Amsterdam The Netherlands"},{"name":"Department of Epidemiology and Biostatistics, Amsterdam Movement Sciences VU University Medical Center Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,7,9]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1227\/NEU.0b013e318214a98c"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-198108000-00001"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X9001000308"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524-4733.2006.00123.x"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199405310-00001"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000001117"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.7326\/M15-0934"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/papr.12000"},{"key":"e_1_2_5_10_1","doi-asserted-by":"crossref","DOI":"10.1093\/oso\/9780198529446.001.0001","volume-title":"Methods for the economic evaluation of health care programmes","author":"Drummond M. 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