2,583 research outputs found

    Multisite peripheral joint pain: a cross-sectional study of prevalence and impact on general health, quality of life, pain intensity and consultation behaviour

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    Background Research into musculoskeletal conditions often focusses on pain at single sites, such as the knee, yet several studies have previously reported the high prevalence of multiple sites of musculoskeletal pain. The most common form of musculoskeletal condition is arthritis, with osteoarthritis (OA) the most common cause of joint pain in adults 45 years and over. However, there is limited recognition of the prevalence of multisite peripheral joint pain in those either living with or at risk of OA, therefore this study set out to estimate the prevalence of multisite peripheral joint pain in adults 45 years and older, and its impact on several dimensions of health. Methods A cross-sectional population survey was mailed to adults (n = 28,443) aged 45 years and over from eight general practices in the North West Midlands, United Kingdom (UK). Prevalence rates were established for multisite peripheral joint pain (pain in two or more sites; hands, hips, knees, feet). Impact was measured for general health (SF-12 MCS & PCS), QoL (EQ-5D), pain intensity (0-10 numerical ratings scale) and the number of consultations with a range of health care professionals. Results Of 15,083 responders (53%), multisite peripheral joint pain was reported by 54%. Peripheral joint pain was present in n = 11,928, of which 68% reported pain in multiple sites. Multisite peripheral joint pain was shown to be significantly associated with reduced physical (Mean difference = −5.9 95% CI -6.3,-5.5) and mental (−2.8 95% CI -3.2,-2.4) components of the SF-12, reduced QoL (−0.14 95% CI -0.15, −0.13), increased pain (+0.70 95% CI 0.62, 0.79) and increased odds of consultations with GPs (OR 2.4 95% CI 2.2, 2.6) and practice nurses (OR 2.6 (95% CI 2.1, 3.2) when compared to single site pain. Conclusions Multisite peripheral joint pain is prevalent in the population in adults 45 years and over and has a significant negative impact on several dimensions of health. Health care professionals should consider joint pain beyond the index site in order to address holistic management

    Tunneling-percolation origin of nonuniversality: theory and experiments

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    A vast class of disordered conducting-insulating compounds close to the percolation threshold is characterized by nonuniversal values of transport critical exponent t, in disagreement with the standard theory of percolation which predicts t = 2.0 for all three dimensional systems. Various models have been proposed in order to explain the origin of such universality breakdown. Among them, the tunneling-percolation model calls into play tunneling processes between conducting particles which, under some general circumstances, could lead to transport exponents dependent of the mean tunneling distance a. The validity of such theory could be tested by changing the parameter a by means of an applied mechanical strain. We have applied this idea to universal and nonuniversal RuO2-glass composites. We show that when t > 2 the measured piezoresistive response \Gamma, i. e., the relative change of resistivity under applied strain, diverges logarithmically at the percolation threshold, while for t = 2, \Gamma does not show an appreciable dependence upon the RuO2 volume fraction. These results are consistent with a mean tunneling dependence of the nonuniversal transport exponent as predicted by the tunneling-percolation model. The experimental results are compared with analytical and numerical calculations on a random-resistor network model of tunneling-percolation.Comment: 13 pages, 12 figure

    Implementation of musculoskeletal Models of Care in primary care settings: Theory, practice, evaluation and outcomes for musculoskeletal health in high-income economies

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    Musculoskeletal conditions represent one of the largest causes of years lived with disability in high-income economies. These conditions are predominantly managed in primary care settings, and yet, there is a paucity of evidence on which approaches work well in increasing the uptake of best practice and in closing the evidence-to-practice gap. Increasingly, musculoskeletal models of service delivery (as components of models of care) such as integrated care, stratified care and therapist-led care have been tested in primary health care pathways for joint pain in older adults, for low back pain and for arthritis. In this chapter, we discuss why implementation of these models is important for primary care and how models are implemented using three case examples: we review implementation theory, principles and outcomes; we consider the role of health economic evaluation; and we propose key evidence gaps in this field. We propose the following research priorities for this area: investigating the generalisability of models of care across, for example, urban and rural settings, and for different musculoskeletal conditions; increasing support for self-management; understanding the importance of context in choosing a model of care; detailing how implementation has been undertaken; and evaluation of implementation and its impact

    Exercise for lower limb osteoarthritis : systematic review incorporating trial sequential analysis and network meta-analysis

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    Objective: To determine whether there is sufficient evidence to conclude that exercise interventions are more effective than no exercise control and to compare the effectiveness of different exercise interventions in relieving pain and improving function in patients with lower limb osteoarthritis. Data sources: Nine electronic databases searched from inception to March 2012. Study selection: Randomised controlled trials comparing exercise interventions with each other or with no exercise control for adults with knee or hip osteoarthritis. Data extraction: Two reviewers evaluated eligibility and methodological quality. Main outcomes extracted were pain intensity and limitation of function. Trial sequential analysis was used to investigate reliability and conclusiveness of available evidence for exercise interventions. Bayesian network meta-analysis was used to combine both direct (within trial) and indirect (between trial) evidence on treatment effectiveness. Results: 60 trials (44 knee, two hip, 14 mixed) covering 12 exercise interventions and with 8218 patients met inclusion criteria. Sequential analysis showed that as of 2002 sufficient evidence had been accrued to show significant benefit of exercise interventions over no exercise control. For pain relief, strengthening, flexibility plus strengthening, flexibility plus strengthening plus aerobic, aquatic strengthening, and aquatic strengthening plus flexibility, exercises were significantly more effective than no exercise control. A combined intervention of strengthening, flexibility, and aerobic exercise was also significantly more effective than no exercise control for improving limitation in function (standardised mean difference −0.63, 95% credible interval −1.16 to −0.10). Conclusions: As of 2002 sufficient evidence had accumulated to show significant benefit of exercise over no exercise in patients with osteoarthritis, and further trials are unlikely to overturn this result. An approach combining exercises to increase strength, flexibility, and aerobic capacity is likely to be most effective in the management of lower limb osteoarthritis. The evidence is largely from trials in patients with knee osteoarthritis
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