The impact of non-traumatic hip and knee disorders on health-related quality of life as measured with the SF-36 or SF-12: a systematic review

OBJECTIVES: The purpose of this review is to summarize the available evidence on the impact of non-traumatic hip or knee disorders on health-related quality of life (HRQL), as measured with the Short Form 36 Health Survey (SF-36) or Short Form 12 Health Survey (SF-12), by comparing this with data from reference populations. METHODS: Studies were identified by an electronic search of the MEDLINE, PsychInfo and Cinahl databases. Studies with the following features were included: study population included patients with non-traumatic hip or knee disorders, the SF-36 or SF-12 was used as an outcome measure and mean scores on these HRQL measures were presented. Using mean HRQL scores from the selected studies and scores from reference populations, z-scores were computed. Pooled estimates were computed for subgroups of studies with similar patients in similar settings. RESULTS: A total of 40 studies met the inclusion criteria. Patients with non-traumatic hip and knee disorders scored up to 2.5 standard deviations (SDs) below reference population values, especially on the physical aspects of HRQL. Social and mental aspects were up to 1 SD below reference population values, especially in patients in clinical settings. CONCLUSIONS: The impact of non-traumatic hip or knee disorders on HRQL is substantial, especially on the physical aspects of HRQ

Should treatment of (sub)acute low back pain be aimed at psychosocial prognostic factors? Cluster randomised clinical trial in general practice

OBJECTIVE: To compare the effects of a minimal intervention strategy aimed at assessment and modification of psychosocial prognostic factors and usual care for treatment of (sub)acute low back pain in general practice. DESIGN: Cluster randomised clinical trial. SETTING: 60 general practitioners in 41 general practices. PARTICIPANTS: 314 patients with non-specific low back pain of less than 12 weeks' duration, recruited by their general practitioner. INTERVENTIONS: In the minimal intervention strategy group the general practitioner explored the presence of psychosocial prognostic factors, discussed these factors, set specific goals for reactivation, and provided an educational booklet. The consultation took about 20 minutes. Usual care was not standardised. MAIN OUTCOME MEASURES: Functional disability (Roland-Morris disability questionnaire), perceived recovery, and sick leave because of low back pain assessed at baseline and after 6, 13, 26, and 52 weeks. RESULTS: The dropout rate was 8% in the minimal intervention strategy group and 9% in the usual care group. Multilevel analyses showed no significant differences between the groups on any outcome measure during 12 months of follow-up in the whole group or in relevant subgroups (patients with high scores on psychosocial measures at baseline or a history of frequent or prolonged low back pain). CONCLUSION: This study provides no evidence that (Dutch) general practitioners should adopt our new treatment strategy aimed at psychosocial prognostic factors in patients with (sub)acute low back pain. Further research should examine why our new strategy was not more effective than usual car

Course and prognosis of knee complaints in general practice

OBJECTIVE: Patients frequently present with knee complaints in general practice. Information about the course and prognosis of knee complaints is needed to inform patients and facilitate decisions on referral and treatment. The objective of the study was to assess the course of knee complaints and to identify predictors of outcome in patients visiting their general practitioner with a new episode of knee complaints. METHODS: Data were collected by means of self-administered questionnaires. After 3 and 12 months of followup, the following outcomes were assessed: perceived recovery, change in pain, and change in physical functioning. As potential predictors of outcome, several sociodemographic variables, characteristics of the symptom, baseline scores of the outcome measures, and intra- and extra-individual variables were analyzed using multiple regression analyses. RESULTS: We included 251 patients with a new episode of knee complaints presented in general practice. Only 25% reported recovery after 3 months, increasing to 44% after 12 months. A history of knee complaints, a longer duration of the current episode of knee complaints, other coexisting musculoskeletal complaints, and a higher level of distress were associated with a worse prognosis. In the linear regression models, 41-53% of the variance in pain reduction and improvement in functioning could be explained by the predictors. The area under the receiver operating characteristic curves, estimating the predictive accuracy of the Cox regression models concerning perceived recovery, was 0.77 after 3 months and 0.72 after 12 months. CONCLUSION: Many patients did not recover after 12 months. Distress was found to be strongly associated with less pain reduction and less improvement in functionin

Data from a study of effectiveness suggested potential prognostic factors related to the patterns of shoulder pain

60 years). For the remaining patients, who had steady improvement in pain severity during the 52 weeks, there were still large between-patient variations in the rate of reaching recovery; this was influenced by treatment types: corticosteroid injections were associated with a faster relief of the pain. CONCLUSION: Age and gender might be the two important prognostic factors associated with persistent-recurrent problems. The effect of corticosteroid injections seems to be tempora

Practical aspects of conducting a pragmatic randomised trial in primary care: patient recruitment and outcome assessment.

BACKGROUND: Conducting a pragmatic randomised trial in primary care is often accompanied by practical problems. Such problems are seldom reported and may constitute useful lessons for researchers planning future trials. AIM: To address the difficulties involved in patient recruitment and to present measures to minimise bias during outcome assessment. METHOD: A recently conducted trial comparing the effects of corticosteroid injections and physiotherapy for painful stiff shoulder was used to illustrate problems related to patient recruitment and outcome assessment. RESULTS: Recruitment of patients was not without difficulties despite careful preparation. Recruitment was discontinued after 20 months, when 109 of the intended 120 patients had been admitted to the trial. The shoulder trial mainly included patient-oriented subjective outcome measures. Subgroup analyses demonstrated that patient preferences might have had some influence on outcome. CONCLUSIONS: General practitioners might be willing or unwilling to participate in research for many reasons. The researcher should take these motivations into account when inviting physicians to take part in research. Strategies to enhance enrolment should be prepared before the start of the trial. When blinding of patients is problematic, patient preferences should be assessed before randomisation and their influence on the outcome studied. Although involving a blinded independent observer enables a more objective assessment of outcome, the success of blinding should be clearly evaluated