Clinical and cost effectiveness of a corticosteroid injection versus exercise therapy for shoulder pain in general practice: protocol for a randomised controlled trial (SIX Study).

INTRODUCTION: Shoulder pain is common and the prognosis is often unfavourable. Dutch guidelines on the treatment of shoulder pain in primary care recommend a corticosteroid injection or a referral to exercise therapy, if initial pain management fails and pain persists. However, evidence of the effectiveness of a corticosteroid injection compared with exercise therapy, especially in the long term, is limited. This trial will assess the clinical effectiveness and cost effectiveness of a corticosteroid injection compared with physiotherapist-led exercise therapy over 12 months follow-up in patients with shoulder pain in primary care. METHODS AND ANALYSIS: The SIX Study is a multicentre, pragmatic randomised clinical trial in primary care. A total of 213 patients with shoulder pain, aged ≥18 years presenting in general practice will be included. Patients will be randomised (1:1) into two groups: a corticosteroid injection or 12 sessions of physiotherapist-led exercise therapy. The effect of the allocated treatment will be assessed through questionnaires at 6 weeks and after 3, 6, 9 and 12 months. The primary outcome is patient's reported shoulder pain-intensity and function, measured with the Shoulder Pain and Disability Index, over 12 months follow-up. Secondary outcomes include cost effectiveness, pain-intensity, function, health-related quality of life, sleep quality, patient's global perceived effect, work absence, healthcare utilisation and adverse events. Between group differences will be evaluated using a repeated measurements analysis with linear effects models. A cost-utility analysis will be performed to assess the cost effectiveness using quality-adjusted life years from a medical and societal perspective. ETHICS AND DISSEMINATION: This study was approved by the Medical Ethics Committee of Erasmus MC University Medical Center Rotterdam (MEC 2020-0300). All participants will give written informed consent prior to data collection. The results from this study will be disseminated in international journals and implemented in the primary care guidelines on shoulder pain. TRIAL REGISTRATION NUMBER: Dutch Trial Registry (NL8854)

Back Complaints in the Elders (BACE); design of cohort studies in primary care: an international consortium

Background: Although back complaints are common among older people, limited information is available in the literature about the clinical course of back pain in older people and the identification of older persons at risk for the transition from acute back complaints to chronic back pain. The aim of this study is to assess the course of back complaints and identify prognostic factors for the transition from acute back complaints to chronic back complaints in older people who visit a primary health care physician. Methods/design. The design is a prospective cohort study with one-year follow-up. There will be no interference with usual care. Patients older than 55 years who consult a primary health care physician with a new episode of back complaints will be included in this study. Data will be collected using a questionnaire, physical examination and X-ray at baseline, and follow-up questionnaires afte

Patellofemoral pain in general practice:the incidence and management

BackgroundPatellofemoral pain (PFP) is a nontraumatic knee problem primarily observed in physically active adolescents. The objective of this study was to determine the incidence and management of PFP in children and adolescents in general practiceMethodsA retrospective cohort study was conducted using a regional primary care database containing full electronic health records of over 300,000 patients. Patients with a new PFP diagnosis between the years 2013 and 2019 were extracted using a search algorithm based on International Classification of Primary Health Care coding and search terms in free text. Data on the management of PFP were manually checked and analysed. In addition, a sub-analysis for chronic and nonchronic PFP patients was performed.ResultsThe mean incidence of PFP over the study period was 3.4 (95% CI 3.2–3.6) per 1,000 person years in the age group of 7–24 years. Girls had a higher incidence rate (4.6 [95% CI 4.3–5.0]) compared to boys (2.3 [95% CI 2.1–2.5]). Peak incidence was at age 13 years for both sexes. The most commonly applied management strategy was advice (55.1%), followed by referral to physiotherapy (28.2%), analgesics prescription (10.4%), and referral to the orthopaedic surgeon (8.9%). No differences were found in age, sex, and treatment between chronic and nonchronic PFP patients.ConclusionsThe average Dutch general practitioner sees approximately 1.4 new child or adolescent with PFP per year. Overall management strategies were in concordance with current Dutch general practice guideline on nontraumatic knee problems. More insight should be gained in the population with chronic complaints

Hoort lumbale MRI thuis in de eerste lijn?

De Schepper E. Usefulness of lumbar MRI in general practice. Huisarts Wet 2017;60(1):21-3. General practitioners (GPs) in the Netherlands can now refer patients for MRI of the lumbar spine, but as yet there are no data on its use. For this reason, this cohort study investigated the use of lumbar MRI by Dutch GPs. One of the most striking findings was that at the time of referral most patients had had lasting symptoms and complaints for a long time. Furthermore, the MRI reports indicated that there were a relatively high number of disc pathologies. The MRI findings did not influence the GP’s decision to refer a patient to a specialist or the prognosis regarding recovery. From a clinical perspective, these results raise a number of questions about the usefulness of lumbar MRI in general practice. In order to establish whether MRI of the lumbar spine should be used as diagnostic instrument in primary care or restricted to secondary care, a well-designed randomized trial of diagnostic accuracy and cost-effectiveness is required. Until then, GPs are advised to follow the recommendations of the relevant Dutch College of General Practitioner’s guideline, which advises against diagnostic imaging in primary care

Genetic association studies in lumbar disc degeneration: a systematic review

E-Poater: no. P00