Are Randomized Trials Better? Comparison of Baseline Covariate Balance of a Propensity Score-Balanced Lumbar Spine IDE Trial and Comparable RCTs.
Publication Title
Global Spine J
Document Type
Article
Publication Date
1-27-2025
Keywords
washington; swedish; swedish neurosci
Abstract
STUDY DESIGN: Prospective Observational Propensity Score.
OBJECTIVES: Randomization may lead to bias when the treatment is unblinded and there is a strong patient preference for treatment arms (such as in spinal device trials). This report describes the rationale and methods utilized to develop a propensity score (PS) model for an investigational device exemption (IDE) trial (NCT03115983) to evaluate decompression and stabilization with an investigational dynamic sagittal tether (DST) vs decompression and Transforaminal Lumbar Interbody Fusion (TLIF) for patients with symptomatic grade I lumbar degenerative spondylolisthesis with spinal stenosis.
METHODS: Twenty-five baseline covariates were selected for their expected relationship to patient outcomes or enrollment bias. Subclassification by PS quintiles was used to design a sample of investigational DST patients and TLIF controls with excellent covariate balance in which to estimate causal treatment effects. Additionally, balance in PS covariates was compared to available matching covariates from seven randomized spine IDE trials.
RESULTS: The PS subclassification design resulted in excellent balance across baseline covariates, as evidenced by small standardized mean differences and no significant between group differences after accounting for the PS design (all
CONCLUSION: The PS subclassification design achieved excellent covariate balance between DST investigational and TLIF control participants. This PS designed sample shows covariate balance similar to that observed in published studies in which patients were randomized to investigational or control arms.Clinical trial registered with https://www.clinicaltrials.gov (NCT03115983).
Area of Special Interest
Neurosciences (Brain & Spine)
Area of Special Interest
Orthopedics & Sports Medicine
Specialty/Research Institute
Neurosciences
Specialty/Research Institute
Orthopedics
Specialty/Research Institute
Surgery
DOI
10.1177/21925682251316287