The Multidisciplinary Clinical Research Center (MCRC) is a center grant funded by the National Institute of Arthritis, Musculoskeletal and Skin Diseases (NIAMS). The center aims to facilitate musculoskeletal research both within and outside the University of Washington. This Center is focused on spine and upper extremity disorders because they are both common and disabling in the working age population. The centers project's focus, in particular, on back-pain, neck pain, and carpal tunnel syndrome, all of which are conditions that result in substantial work loss and high costs in the workplace. Furthermore, all are associated with controversy regarding diagnostic criteria and optimal treatment. The center is addressing optimal diagnostic approaches in evaluating treatment options for these conditions. In addition, it is examining characteristics of patients and medical care that predict getting poor outcomes. These predictors include both physical and psychosocial factors.
The center's work is particularly focused towards four initial projects. The first of these is a randomized trial that tests the efficacy surgical intervention compared to optimal rehabilitation for patients with mild to moderate carpal tunnel syndrome. In addition, it will examine a new diagnostic technique, Magnetic Resonance Neurography. The second project is focused on patients with low back pain and degenerative discs. In an observational cohort study, it will characterize the outcomes of patients who are treated surgically or non-surgically or one or two disk degeneration associated with low back pain but without features of radiculopathy. The third project makes use of existing state and national survey and medical claims databases to examine patterns of surgical treatment and outcome. In particular, this project addresses rates of back surgery; rates of re-operation; and the growth of ambulatory surgery. The fourth project is designed to determine the feasibility of combining CT and MR images of the neck. This is largely a mathematical and computer programming challenge to determine if these two imaging techniques can be usefully combined. The hope is that the combined images might replace the need for mylography, an invasive test that requires the injection of dye into spinal canal and carries some risk of side effects.
The center also features a methodology core of faculty, programmers and physicians with specific aims:
The MCRC is a unit of the University of Washington, School of Medicine, and Division of General Internal Medicine. The MCRC has a large network of research relationships including the Seattle Veteran's Administration Medical Center, Benaroya Research Center (at Virginia Mason Medical Center), Swedish Medical Center, Providence Medical Center, Washington State Department of Health, University of Washington Physicians Network, and multiple other partners.
Richard A. Deyo, MD, MPH
Jeffrey G. Jarvik, MD, MPH
Patrick Heagerty, PhD
Michael Kliot, MD
Andrew Dailey, MD
David Haynor, MD, PhD
Darryl Gray MD, ScD
Judith Turner, PhD
Branko Kopjar, MD, PhD
Leighton Chan, MD, MPH
Lawrence Robinson, MD
Thomas Trumble, MD
A brief summary of each of the research projects in the MCRC, along with key people involved in the project, can be accessed by following the links listed below:
The primary goal is to study the effectiveness of surgery for patients with mild to moderate carpal tunnel syndrome. An important secondary goal is to study the ability of MRI to predict patient outcomes. We have designed a randomized controlled trial nested within a cohort study.
Discogenic back pain is a controversial diagnosis that often leads to aggressive surgical treatment. This study uses a prospective cohort design to better define the outcomes of spinal fusion for presumed discogenic pain and to compare them with outcomes of patients who have degenerated discs but no surgery.
Recent technical changes in spine surgery, including new spinal implants and a shift towards ambulatory surgery may affect surgical rates and re-operation rates for lumbar spine surgery. This project uses national and state databases examine whether surgical rates continue to rise, and if the introduction of interbody fusion cages resulted in acceleration of surgery rates. We will also examine surgical rates among the elderly, examine surgery rates for spinal stenosis, and examine whether or not re-operation rates are increasing over time, and finally to determine if certain surgical procedures are associated with unusually high rates of re-operations.
The research study involves imaging techniques of the upper back and neck. New computer software allows us to combine magnetic resonance images (MRI) with computer tomography images (CT) to make a "fused" image. The purpose of this study is to find out if the "fused" image can replace a myelogram.
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Comparative Effectiveness, Cost and Outcomes Research Center