Irritable Bowel Syndrome patients exhibit depressive and anxiety scores in the subsyndromal range

Irritable bowel syndrome (IBS) patients frequently experience affective disorders and psychiatric outpatients frequently meet criteria for IBS. The exact nature of this co-morbidity is not clear. 34 patients with Rome-II diagnosed IBS were recruited from a Gastroenterology clinic. Patients with social anxiety disorder (10 SSRI-remitted and 7 untreated subjects) were used as a psychiatric comparison, 28 normal subjects from our register were included as a fourth group (Volunteers). Depressive and anxiety symptoms were measured by the Beck Depression Inventory (BDI) and Spielberger Trait Anxiety Inventory (STAI), respectively. Personality traits were measured with the Swedish universities Scales of Personality (SSP). IBS subjects had BDI and STAI scores intermediate between those of volunteers and patients, despite their lack of a co-morbid psychiatric diagnosis. A principle component factor analysis of the SSP dataset corresponded closely to the solution published with other samples. ANOVA revealed significant between-group differences for 7 of the 13 SSP variables

Optimising outcomes of exercise and corticosteroid injection in patients with subacromial pain (impingement) syndrome: a factorial randomised trial

Objectives: To compare the clinical effectiveness of (1) physiotherapist-led exercise versus an exercise leaflet, and (2) ultrasound-guided subacromial corticosteroid injection versus unguided injection for pain and function in subacromial pain (formerly impingement) syndrome (SAPS).Methods: This was a single-blind 2×2 factorial randomised trial. Adults with SAPS were randomised equally to one of four treatment groups: (1) ultrasound-guided corticosteroid injection and physiotherapist-led exercise, (2) ultrasound-guided corticosteroid injection and an exercise leaflet, (3) unguided corticosteroid injection and physiotherapist-led exercise and (4) unguided corticosteroid injection and an exercise leaflet. The primary outcome was the Shoulder Pain and Disability Index (SPADI), collected at 6 weeks, 6 and 12 months and compared at 6 weeks for the injection interventions and 6 months for the exercise interventions by intention to treat.Results: We recruited 256 participants (64 treatment per group). Response rates for the primary outcome were 94% at 6 weeks, 88% at 6 months and 80% at 12 months. Greater improvement in total SPADI score was seen with physiotherapist-led exercise than with the exercise leaflet at 6 months (adjusted mean difference -8.23; 95% CI -14.14 to -2.32). There were no significant differences between the injection groups at 6 weeks (-2.04; -7.29 to 3.22), 6 months (-2.36; -8.16 to 3.44) or 12 months (1.59; -5.54 to 8.72).Conclusions: In patients with SAPS, physiotherapist-led exercise leads to greater improvements in pain and function than an exercise leaflet. Ultrasound guidance confers no additional benefit over unguided corticosteroid injection

57. Development and Validation of a Musculoskeletal Patient Reported Outcome Measure

Background: The UK government has called for clinical services to gather data from patients to evaluate quality of healthcare and monitor progress over time. However, practical, brief clinical tools for this purpose are lacking. We aimed to develop and validate a musculoskeletal patient reported outcome measure (MSK-PROM) suitable for evaluating care and also monitoring patient progress within community musculoskeletal services.Methods: In Phase 1 we developed the MSK-PROM through two consensus workshops (to identify and prioritize the key domains for inclusion in the tool), an online consultation survey with relevant stakeholders, and two face validity workshops to test the readability and comprehension of the draft tool. In Phase 2 we tested the reliability and sensitivity to change of the draft tool with a prospective cohort of adults attending musculoskeletal physiotherapy services in the West Midlands region, and discussed acceptability and feasibility with samples of participating patients and clinicians.Results: Eleven key domains were prioritized for inclusion in the MSK-PROM: independence, physical function, severity of the worst symptom, pain severity, work interference, difficulty with activities and roles, quality of life, understanding how to deal with symptoms, anxiety/depression, and overall impact. For five of the identified health domains (function, anxiety, mood, pain and quality of life) questions from the existing validated and recommended quality of life measure (EQ-5D-5L) were used to avoid duplication in clinical practice. The MSK-PROM therefore includes six new single items in addition to five from the EQ-5D-5L. 425 physiotherapy consulters with musculoskeletal problems completed the MSK-PROM at every treatment visit (88% had a completed MSK-PROM for at least 1 follow-up, and 225 (53%) responded to a three month follow-up questionnaire. Completion rates for the MSK-PROM items were high (>97%) with scores Normally distributed (mean = 28, S.D. = 6.5, 10 of the 11 items are scored giving a scale range 10–50, with the work item excluded as for over a third of patients this item was not applicable). Data from stable patients with unchanged symptoms at visit 2 confirmed the MSK-PROM’s reliability (ICC 0.98 (95% CI 0.96, 0.98) and demonstrated its superior sensitivity to change compared with the EQ-5D-5L weighted score (MSK-PROM: standardized response mean (SRM) = 0.66, AUC 0.81 vs EQ-5D-5L: SRM 0.44, AUC 0.74). The MSK-PROM was found to be acceptable and feasible to use in community physiotherapy services, with minor modifications to improve the wording of the tool.Conclusion: A new patient reported outcome measure (MSK-PROM) has been developed using domains that matter the most to musculoskeletal patients, clinicians and service managers, and has been shown to be feasible, valid and reliable for use in clinical practice. The tool will be made freely available for clinical use