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Avoiding UnSPORTsmanlike Conduct

David R. Flum, MD, MPH

JAMA. 2006;296:2483-2485.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

In this issue of JAMA, 2 articles^1-2 report results of the Spine Patient Outcomes Research Trial (SPORT). One study is a multicenter trial¹ of patients with persistent disk-related pain and neurologic symptoms randomized to undergo diskectomy or receive usual care (most often, patient education, anti-inflammatory medication, and physical therapy, alone or in combination). Because the investigators expected high rates of refusal of randomization based on the differential risk of these 2 treatment strategies, they developed a parallel observational study of patients who qualified for the randomized trial but refused randomization.² Patients in both the randomized trial and the observational cohort study were similar in almost all characteristics and were followed up in a similar fashion for 2 years.

The SPORT randomized trial had such a high proportion of patients who crossed over between treatment strategies (45%-60%) and such a significant degree of missing data . . . [Full Text of this Article]

Author Affiliations: Department of Surgery, University of Washington, Seattle. Dr Flum (daveflum@u.washington.edu) is Contributing Editor, JAMA.

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