Osteoarthritis subpopulations and implications for clinical trial design

Treatment guidelines for osteoarthritis have stressed the need for research on clinical predictors of response to different treatments. However, identifying such clinical predictors of response is less easy than it seems, and there is not a given classification of osteoarthritis subpopulations. This review article highlights the key methodical issues when analyzing and designing clinical studies to detect important subgroups with respect to treatment effect. In addition, we discuss the main osteoarthritis subpopulations and give examples of how specific treatment effects in these subpopulations have been assessed

Identifying a core set of outcome domains to measure in clinical trials for shoulder disorders:a modified Delphi study

Objective: To achieve consensus on the most important outcome domains to measure across all clinical trials for shoulder disorders. Methods: We performed an online modified Delphi study with an international, multidisciplinary and multistakeholder panel. A literature review and the OMERACT Filter 2.0 framework was used to generate a list of potential core domains, which were presented to patients, clinicians and researchers in two Delphi rounds. Participants were asked to judge the importance of each potential core domain and provide a rationale for their response. A core domain was defined a priori as a domain that at least 67% of participants considered core. Results: In both rounds, 335 individuals were invited to participate (268 clinicians/researchers and 67 patients); response rates were 27% (n=91) and 29% (n=96), respectively. From a list of 41 potential core domains, four domains met our criteria for inclusion: 'pain', 'physical functioning', 'global assessment of treatment success' and 'health-related quality of life'. Two additional domains, 'sleep functioning' and 'psychological functioning', met the criteria for inclusion by some, but not all stakeholder groups. There was consensus that 'number of deaths' was not a core domain, but insufficient agreement on whether or not several other domains, including 'range of motion' and 'muscle strength', were core domains. Conclusions: Based on international consensus from patients, clinicians and researchers, 'pain', 'physical functioning', 'global assessment of treatment success' and 'health-related quality of life' were considered core outcome domains for shoulder disorder trials. The value of several other domains needs further consideration

Outcome Reporting in Randomized Trials for Shoulder Disorders: Literature Review to Inform the Development of a Core Outcome Set

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141827/1/acr23254_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/141827/2/acr23254.pd

The efficacy of Tai Chi Chuan in older adults: a systematic review

OBJECTIVES: The purpose of this study was to assess the effect of Tai Chi Chuan (TCC) on fall prevention, balance and cardiorespiratory functions in the elderly. METHODS: A systematic review was carried out according to the Cochrane standards. A computerized literature search was carried out. Studies were selected when they had an experimental design; the age of the study population was >50; one of the interventions was a form of TCC; and when falls, balance or cardiorespiratory functions were used as an outcome measure. A total of seven studies were included, with in total 505 participants, of whom all but 27 were healthy seniors, age between 53 and 96 years. RESULTS: In most studies, the intervention of TCC is a modified Yang style, varying from 10 to 24 forms. The intensity of TCC varies from 1 h weekly for 10 weeks to 1 h every morning for 1 year. One study used falls as outcome measure and reported a beneficial effect of 47% in the TCC group. All studies mention a beneficial effect of TCC, but in most studies this

Differences in Patient Characteristics, Number of Treatments, and Recovery Rates Between Referred and Self-referred Patients With Nonspecific Neck Pain in Manual Therapy:A Secondary Analysis

Objective: In various countries, patients can visit a physiotherapist via self-referral. The aims of this study were to evaluate whether there are differences between individuals with nonspecific neck pain who consult a manual therapist via self-referral and those who do so via referral by a physician concerning patient characteristics, number of treatments, and recovery; and whether (self-)referral is associated with recovery. Methods: This study is part of a prospective cohort study with posttreatment and 12-month follow-up in a Dutch manual-therapy setting. Adult patients with nonspecific neck pain were eligible for participation. Baseline measurements included demographic data and data concerning neck pain. At follow-up, number of treatments, recovery, and satisfaction were assessed. To evaluate differences between the groups, we used the χ2 test and the independent t test. A logistic regression analysis was used to evaluate the association between referral status and recovery. Results: In total, 272 manual therapists participated and 1311 patients were included. Of 831 patients whose referral data are available, about half patients consulted a manual therapist by self-referral. The mean number of treatments was 5.4, which did not differ between the 2 groups. We found no differences between the groups concerning age, sex, pain intensity at baseline, or recovery rate. Patients in the self-referral group experienced acute neck pain more frequently, had recurrent complaints more often, and reported less disability compared to the referred group. Referral status was not associated with recovery. Conclusion: We found several small differences between self-referred and referred patients

The influence of drug use on fall incidents among nursing home residents: A systematic review

Background: Falls are a major health problem among the elderly, particularly in nursing homes. Abnormalities of balance and gait, psychoactive drug use, and dementia have been shown to contribute to fall risk. Methods: We conducted a systematic review of the literature to investigate which psychoactive drugs increase fall risk and what is known about the influence of these drugs on gait in nursing home residents with dementia. We included studies with a prospective cohort design on psychoactive drug use in nursing homes with dementia residents and with falls as an outcome measure. Results: Seventeen studies were included in the review. Pooled risk estimates were not calculated because there was no homogeneity across studies. We assessed the strength of evidence for psychoactive drugs as a prognostic factor for falls by defining four levels of evidence: strong, moderate, limited or inconclusive. Strong evidence was defined as consistent findings (≥80%) in at least two high quality cohorts. We found strong evidence that the use of multiple drugs (3/3 cohorts, effect sizes 1.30-1xs0.30), antidepressants (10/12 cohorts, effect sizes 1.10-7.60), and anti-anxiety drugs (2/2 cohorts, effect sizes 1.22-1.32) is associated with increased fall risk. The evidence for the association of other psychoactive drug classes with fall risk was limited or inconclusive. Conclusions: Research on the contribution of psychoactive drugs to fall risk in nursing home residents with dementia is limited. The scarce evidence shows, however, that multiple drugs, antidepressants and anti-anxiety drugs increase fall risk in nursing home populations with residents with dementia

Do neurosurgeons subscribe to the guideline lumbosacral radicular syndrome?

Background: This study presents a survey of the opinion of neurosurgeons on the multidisciplinary clinical guideline 'lumbosacral radicular syndrome'. The aim was to describe to what extent neurosurgeons in the Netherlands endorse the content of this guideline. The guideline was issued in 1996 by the Netherlands Institute of Quality Health Care and this is the first attempt to evaluate the implementation of this guideline. Methods: All active neurosurgeons (n=92) in the Netherlands were invited to complete a questionnaire investigating to what extent they agree with the 26 recommendations in the guideline 'lumbosacral radicular syndrome'. The results are represented in frequencies (%) in order to express the magnitude of their consent or dissent with the recommendations. Results: Overall, 75% of the neurosurgeons responded and, of these, 94% agreed (at least partially) with the content of the guideline. Of the 26 recommendations in the guideline, seven were not fully endorsed by the neurosurgeons. Three of these seven recommendations may need revision based on newly published data. Conclusion: This survey shows that almost all neurosurgeons subscribed (at least partially) to the multidisciplinary LRS guideline. Therefore, one important aspect of the implementation process has been fulfilled, i.e. acceptance of the content of the guideline