Specific treatment of problems of the spine (STOPS): design of a randomised controlled trial comparing specific physiotherapy versus advice for people with subacute low back disorders

<p>Abstract</p> <p>Background</p> <p>Low back disorders are a common and costly cause of pain and activity limitation in adults. Few treatment options have demonstrated clinically meaningful benefits apart from advice which is recommended in all international guidelines. Clinical heterogeneity of participants in clinical trials is hypothesised as reducing the likelihood of demonstrating treatment effects, and sampling of more homogenous subgroups is recommended. We propose five subgroups that allow the delivery of specific physiotherapy treatment targeting the pathoanatomical, neurophysiological and psychosocial components of low back disorders. The aim of this article is to describe the methodology of a randomised controlled trial comparing specific physiotherapy treatment to advice for people classified into five subacute low back disorder subgroups.</p> <p>Methods/Design</p> <p>A multi-centre parallel group randomised controlled trial is proposed. A minimum of 250 participants with subacute (6 weeks to 6 months) low back pain and/or referred leg pain will be classified into one of five subgroups and then randomly allocated to receive either physiotherapy advice (2 sessions over 10 weeks) or specific physiotherapy treatment (10 sessions over 10 weeks) tailored according to the subgroup of the participant. Outcomes will be assessed at 5 weeks, 10 weeks, 6 months and 12 months following randomisation. Primary outcomes will be activity limitation measured with a modified Oswestry Disability Index as well as leg and back pain intensity measured on separate 0-10 Numerical Rating Scales. Secondary outcomes will include a 7-point global rating of change scale, satisfaction with physiotherapy treatment, satisfaction with treatment results, the Sciatica Frequency and Bothersomeness Scale, quality of life (EuroQol-5D), interference with work, and psychosocial risk factors (Orebro Musculoskeletal Pain Questionnaire). Adverse events and co-interventions will also be measured. Data will be analysed according to intention to treat principles, using linear mixed models for continuous outcomes, Mann Whitney U tests for ordinal outcomes, and Chi-square, risk ratios and risk differences for dichotomous outcomes.</p> <p>Discussion</p> <p>This trial will determine the difference in outcomes between specific physiotherapy treatment tailored to each of the five subgroups versus advice which is recommended in guidelines as a suitable treatment for most people with a low back disorder.</p> <p>Trial registration</p> <p>Australia and New Zealand Clinical Trials Register (ANZCTR): <a href="http://www.anzctr.org.au/ACTRN12609000834257.aspx">ACTRN12609000834257</a>.</p

How shall we all live together?: Meta-analytical review of the mutual intercultural relations in plural societies project

Living together in culturally plural societies poses numerous challenges for members of ethnocultural groups and for the larger society. An important goal of these societies is to achieve positive intercultural relations among all their peoples. Successful management of these relations depends on many factors including a research-based understanding of the historical, political, economic, religious and psychological features of the groups that are in contact. The core question is ‘how we shall we all live together?’ In the project reported in this paper (Mutual Intercultural Relations in Plural Societies; MIRIPS), we seek to provide such research by reviewing three core psychological hypotheses of intercultural relations (multiculturalism, contact and integration) in 21 culturally plural societies. The main goal of the project is to evaluate these hypotheses across societies within the MIRIPS project in order to identify if there are some basic psychological principles that underlie intercultural relations panculturally. If there are, the eventual goal is to employ the findings to propose some policies and programmes that may improve the quality of intercultural relationship globally. An internal meta-analysis using the MIRIPS project data showed that the empirical findings from these societies generally support the validity of the three hypotheses. Implications for the development of policies and programmes to enhance the quality of intercultural relations are discussed

How shall we all live together?: Meta‐analytical review of the mutual intercultural relations in plural societies project

Living together in culturally plural societies poses numerous challenges for members of ethnocultural groups and for the larger society. An important goal of these societies is to achieve positive intercultural relations among all their peoples. Successful management of these relations depends on many factors including a research-based understanding of the historical, political, economic, religious and psychological features of the groups that are in contact. The core question is ‘how we shall we all live together?’ In the project reported in this paper (Mutual Intercultural Relations in Plural Societies; MIRIPS), we seek to provide such research by reviewing three core psychological hypotheses of intercultural relations (multiculturalism, contact and integration) in 21 culturally plural societies. The main goal of the project is to evaluate these hypotheses across societies within the MIRIPS project in order to identify if there are some basic psychological principles that underlie intercultural relations panculturally. If there are, the eventual goal is to employ the findings to propose some policies and programmes that may improve the quality of intercultural relationship globally. An internal meta-analysis using the MIRIPS project data showed that the empirical findings from these societies generally support the validity of the three hypotheses. Implications for the development of policies and programmes to enhance the quality of intercultural relations are discussed