23 research outputs found
The clinical course of low back pain: a meta-analysis comparing outcomes in randomised clinical trials (RCTs) and observational studies.
BACKGROUND: Evidence suggests that the course of low back pain (LBP) symptoms in randomised clinical trials (RCTs) follows a pattern of large improvement regardless of the type of treatment. A similar pattern was independently observed in observational studies. However, there is an assumption that the clinical course of symptoms is particularly influenced in RCTs by mere participation in the trials. To test this assumption, the aim of our study was to compare the course of LBP in RCTs and observational studies. METHODS: Source of studies CENTRAL database for RCTs and MEDLINE, CINAHL, EMBASE and hand search of systematic reviews for cohort studies. Studies include individuals aged 18 or over, and concern non-specific LBP. Trials had to concern primary care treatments. Data were extracted on pain intensity. Meta-regression analysis was used to compare the pooled within-group change in pain in RCTs with that in cohort studies calculated as the standardised mean change (SMC). RESULTS: 70 RCTs and 19 cohort studies were included, out of 1134 and 653 identified respectively. LBP symptoms followed a similar course in RCTs and cohort studies: a rapid improvement in the first 6 weeks followed by a smaller further improvement until 52 weeks. There was no statistically significant difference in pooled SMC between RCTs and cohort studies at any time point:- 6 weeks: RCTs: SMC 1.0 (95% CI 0.9 to 1.0) and cohorts 1.2 (0.7to 1.7); 13 weeks: RCTs 1.2 (1.1 to 1.3) and cohorts 1.0 (0.8 to 1.3); 27 weeks: RCTs 1.1 (1.0 to 1.2) and cohorts 1.2 (0.8 to 1.7); 52 weeks: RCTs 0.9 (0.8 to 1.0) and cohorts 1.1 (0.8 to 1.6). CONCLUSIONS: The clinical course of LBP symptoms followed a pattern that was similar in RCTs and cohort observational studies. In addition to a shared 'natural history', enrolment of LBP patients in clinical studies is likely to provoke responses that reflect the nonspecific effects of seeking and receiving care, independent of the study design
Quantifying the Ancillary Benefits of the Representative Concentration Pathways on Air Quality in Europe
âLate lessons from early warningsâ â uncertainty and precaution in policy approaches to Arctic climate change impacts
Human Development in the New Arctic
In the decades ahead global change will have major consequences for the Arctic natural environment and human populations. In this chapter we reflect on the state of human development in the new Arctic and some of the key components of human wellbeing, including the basic sources of change. We address the importance of data and monitoring as ways forward to track changes in human development. The speed of Arctic change, its complexity, and the uncertainty about future directions, makes it increasingly important to understand how human development is changing, and precisely what and how individual aspects are changing. Rapid change in the Arctic has increased the emphasis placed on devising indicators for monitoring and measuring change in human development and quality of life. The Arctic Social Indicators (ASI) framework and method for monitoring and tracking change in human development is briefly discussed, and an application to the case of Nunavut, Canada, is presented