Details of HTA project
Last updated: 31 August 2010 - Next update due: 7 September 2010
Research type: |
Secondary Research (e.g. systematic review) |
Project title: |
Management strategies for sciatica |
Project ref: |
06/79/01 |
Cost: |
£258,234 |
Chief Investigator : |
Dr Nefyn H Williams, Clinical Senior Lecturer, Department Primary Care and Public Health, Cardiff University |
Start Date: |
March 2008 |
Estimated date of publication in HTA journal series: |
May 2011. This project is at the editorial review stage. Delays in the review process can cause the forecast publication date to be delayed. |
Plain English Summary |
A systematic review is proposed that will identify the most effective and cost-effective ways of managing sciatica. It will identify all of the high quality studies examining manual, medical or surgical treatments for patients with a clinical diagnosis of sciatica. Results concerning pain, physical function, mental health, health service activity and costs will be extracted. The results will be combined using a method that not only allows direct comparison of treatments in the same study, but also indirect comparison of treatments between studies (Mixed Treatment Comparison). Finally an economic model will be built that will compare the value for money of the health improvements across a range of treatments. We do not have any ethical concerns about this review. The team consists of researchers experienced in systematic reviews (NW, RL, MH, KB, AS), undertaking direct and indirect comparisons (AS), and economic models (CP, DF). Costs are requested to fund a full-time and a 0.3 FTE research assistant for 18 months to perform the systematic review, and a full-time research assistant for 12 months to perform the economic model. Costs are also requested to pay consultancy fees for KB who is an expert in back pain research, and AS for assistance with the method combining the direct and indirect comparisons; fees for a course on this method for three of the researchers; and travel expenses for courses and meetings. The views of service users will be represented by IR and another service user, who will contribute to a small advisory group. |
Project Abstract: |
Previous systematic reviews have made direct comparisons between a variety of surgical and non-surgical treatments for sciatica, and found insufficient evidence to advise bed rest, keeping active, analgesia, intramuscular steroid injection or traction. They have found more evidence for invasive treatments such as epidural steroid injection, chemonucleolysis and lumbar discectomy, but none have made indirect comparisons across separate trials or examined cost-effectiveness. A systematic review of the literature will be undertaken to assess the effectiveness and cost-effectiveness of different management strategies for sciatica. For the assessment of effectiveness, randomised and non-randomised controlled trials, as well as controlled observational studies will be included. For the assessment of cost-effectiveness, economic evaluations conducted alongside trials, modelling studies and analyses of administrative databases will be included if they compare two or more treatments and consider both costs and consequences. Any manual, medical, or surgical treatment for sciatica will be included, compared with any control intervention, whether placebo, no treatment, usual care or some other form of treatment. We anticipate that the review will find a diverse set of studies that will differ according to: treatment type, patient population, degree of disability, length of symptoms, diagnostic criteria and outcomes measured. Included studies are likely to examine individual treatments given in isolation, rather than sequential, stepwise treatment provision. Meta-analysis will be conducted for each treatment comparison, for which there are compatible multiple studies, for each outcome measure. Meta-regression will attempt to explain heterogeneity between studies. All studies which form a closed network will be synthesised using a mixed treatment comparison (MTC) method. We will construct an appropriate probabilistic decision analytic model to assess the cost-effectiveness of different management strategies. This model will inform clinical practice and commissioning in the UK NHS, and will identify areas for future research. |
Project Protocol: |
Project protocol (pdf format, 283 kbytes) |
URL of this page: |
http://www.hta.ac.uk/1687 |
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