{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T18:03:31Z","timestamp":1777658611081,"version":"3.51.4"},"reference-count":37,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2025,2,25]],"date-time":"2025-02-25T00:00:00Z","timestamp":1740441600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,2,25]],"date-time":"2025-02-25T00:00:00Z","timestamp":1740441600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research UK","doi-asserted-by":"crossref","award":["NIHR134859"],"award-info":[{"award-number":["NIHR134859"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Australian National Health and Medical Research Council","award":["GA268233"],"award-info":[{"award-number":["GA268233"]}]},{"name":"An Australian National Health and Medical Research Council","award":["ID: 2018182"],"award-info":[{"award-number":["ID: 2018182"]}]},{"name":"Orthopaedic Research UK (combined with British Association of Spine Surgeons and British Scoliosis Society) and Innovate UK"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Global Spine Journal"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Cross-sectional Survey.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The objective of this study was to describe clinicians\u2019 decision-making regarding suitability of patient cases for lumbar fusion surgery or conservative care and the level of equipoise to randomise participants into a randomised controlled trial (RCT).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>An online survey distributed via Australian professional networks to clinicians involved in low back pain care, collected data on clinical discipline, clinical experience, practice setting and preferred care of five patient case vignettes (ranging in age, pain duration, BMI, imaging findings, neurological signs\/symptoms). Clinicians were asked about preferred clinical care and willingness to randomise each case.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 101 respondents (31 orthopaedic surgeons, 17 neurosurgeons, 50 allied health professionals (AHPs), 1 pain physician, 1 nurse), 44% worked in public health services only, 36.4% in both public and private, 19.2% in private only. 46.5% had over 20 years clinical experience. Conservative care was preferred for all cases (83.1%\u201390.9%). Surgeons preferred an anterior approach to lumbar fusion (range 40.6%\u201368.4%). On average 51.9% (range: 47%\u201355%) indicated willingness to randomise cases, with orthopaedic (61.5%) and neurosurgeons (64.9%) more willing than AHPs (44.4%). Willingness to randomise was highest in younger cases with shorter pain duration, no neurological symptoms\/signs and localised degeneration, and lowest when cases had high BMI, longer pain duration, and inadequate conservative management. Willingness to randomise was higher in those in private (70.3%) vs public health care services (43.6%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Over half of respondents reported willingness to randomise cases, indicating sufficient clinical equipoise for a future RCT.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21925682251323865","type":"journal-article","created":{"date-parts":[[2025,2,25]],"date-time":"2025-02-25T18:02:14Z","timestamp":1740506534000},"page":"3311-3322","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Healthcare Professionals\u2019 Decision-Making Regarding Lumbar Fusion Surgery or Conservative Care for Adults With Severe, Persistent Low Back Pain: An Australian Cross-Sectional Survey Using Case Vignettes"],"prefix":"10.1177","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2681-3101","authenticated-orcid":false,"given":"Peter","family":"Window","sequence":"first","affiliation":[{"name":"STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Health, Brisbane, QLD, Australia"},{"name":"Physiotherapy Department, Royal Brisbane and Women\u2019s Hospital, Brisbane, QLD, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eniola","family":"Bada","sequence":"additional","affiliation":[{"name":"Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew G.","family":"Stovell","sequence":"additional","affiliation":[{"name":"Orthopaedic Department, Royal Brisbane and Women\u2019s Hospital, Brisbane, QLD, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sashin","family":"Ahuja","sequence":"additional","affiliation":[{"name":"Orthopaedic Department, University Hospital of Wales, Cardiff, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David J.","family":"Beard","sequence":"additional","affiliation":[{"name":"Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, The University of Oxford, Oxford, UK"},{"name":"NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adrian","family":"Gardner","sequence":"additional","affiliation":[{"name":"Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK"},{"name":"Aston University, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nadine E.","family":"Foster","sequence":"additional","affiliation":[{"name":"STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Health, Brisbane, QLD, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,2,25]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(18)32279-7"},{"key":"e_1_3_5_3_2","volume-title":"Musculoskeletal conditions and comorbidity in Australia","author":"Australian Institute of Health and Welfare","year":"2019","unstructured":"Australian Institute of Health and Welfare. Musculoskeletal conditions and comorbidity in Australia. Arthritis series no.25. Cat. no. PHE 241. Canberra: AIHW; 2019."},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.111271"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.2519\/jospt.2017.7415"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(18)30480-x"},{"key":"e_1_3_5_7_2","volume-title":"Low Back Pain and Sciatica in over 16s: Assessment and Management","author":"National Institute for Health and Care Excellence: Guidelines","year":"2016","unstructured":"National Institute for Health and Care Excellence: Guidelines. Low Back Pain and Sciatica in over 16s: Assessment and Management. National Institute for Health and Care Excellence (NICE). 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