Best Practice & Research. Clinical Rheumatology[JOURNAL]
Sun
200 papers
Guidelines and algorithms: a call for evaluation of their use and effects.
Schumacher HR
J Clin Rheumatol · 2012 Dec · PMID 23211584 · Publisher ↗
Abstract loading — click title to view on PubMed.
Are patients meeting the updated physical activity guidelines? Physical activity participation, recommendation, and preferences among inner-city adults with rheumatic diseases.
Manning VL, Hurley MV, Scott DL … +1 more , Bearne LM
J Clin Rheumatol · 2012 Dec · PMID 23188205 · Publisher ↗
BACKGROUND: Physical activity (PA) improves the health of people with rheumatic diseases. Revised guidelines (published in the United States in 2008 and in the United Kingdom in 2011) recommend that adults complete 150 o...
BACKGROUND: Physical activity (PA) improves the health of people with rheumatic diseases. Revised guidelines (published in the United States in 2008 and in the United Kingdom in 2011) recommend that adults complete 150 or more minutes of moderate-intensity PA or 75 or more minutes of vigorous-intensity PA (or equivalent) in bouts of 10 or minutes per week, yet whether people with rheumatic diseases meet these guidelines is unknown. OBJECTIVES: This study evaluates the PA levels of adults with rheumatic diseases attending an inner-city hospital against the updated PA guidelines. It assesses respondents' PA preferences and the proportion who report ever receiving PA advice from a healthcare professional (HCP). METHODS: Five hundred and eight patients (46% response rate) attending the general rheumatology clinics of an inner-city UK hospital completed the self-report International Physical Activity Questionnaire and 3 additional questions: "Has a doctor or other HCP ever suggested PA or exercise to help your arthritis or joint symptoms?" "Would you like help from your doctor or health service to become more physically active?" and "Which physical activities do you enjoy?" RESULTS: Overall, 61% of respondents met the updated PA guidelines, and 39% did not meet the guidelines. Forty-three percent of respondents reported ever receiving PA advice from an HCP, and 50% reported that they would "like help" to become more physically active. Walking was the most preferred PA (65%). CONCLUSIONS: Almost two-thirds of our respondents met the updated PA guidelines; however, many were entirely inactive. Recommending regular PA should be integral to rheumatic disease management, and walking offers a potentially accessible, inexpensive, and acceptable PA intervention.
The role of patient organisations in musculoskeletal care.
Opava CH, Carlsson A
Best Pract Res Clin Rheumatol · 2012 Jun · PMID 22867934 · Publisher ↗
Better integration of patient organisations with health-care has been called for in policy statements by for example, the World Health Organization. Our aim was to describe the role of patient organisations in musculoske...
Better integration of patient organisations with health-care has been called for in policy statements by for example, the World Health Organization. Our aim was to describe the role of patient organisations in musculoskeletal care. We suggest that their work could be divided into three different fields of activities, that is, member benefits to satisfy individual needs, raised awareness to create better conditions for people with disability and the promotion of research to improve prevention, care and find a definite cure. Some scientific work exists to support that people with musculoskeletal conditions perceive a delay in information about patient organisations, that simple leaflets are effective in promoting such contacts and that they result in improved health behaviours. Furthermore, patient organisations may assist in improving health-care providers' education and skills training, and also support advocacy in political and societal issues with consequences for health-care practice. Mutual support and collaboration are thus encouraged.
Aquatic exercise & balneotherapy in musculoskeletal conditions.
Verhagen AP, Cardoso JR, Bierma-Zeinstra SM
Best Pract Res Clin Rheumatol · 2012 Jun · PMID 22867930 · Publisher ↗
This is a best-evidence synthesis providing an evidence-based summary on the effectiveness of aquatic exercises and balneotherapy in the treatment of musculoskeletal conditions. The most prevalent musculoskeletal conditi...
This is a best-evidence synthesis providing an evidence-based summary on the effectiveness of aquatic exercises and balneotherapy in the treatment of musculoskeletal conditions. The most prevalent musculoskeletal conditions addressed in this review include: low back pain, osteoarthritis, fibromyalgia and rheumatoid arthritis. Over 30 years of research demonstrates that exercises in general, and specifically aquatic exercises, are beneficial for reducing pain and disability in many musculoskeletal conditions demonstrating small to moderate effect sizes ranging between 0.19 and 0.32. Balneotherapy might be beneficial, but the evidence is yet insufficient to make a definitive statement about its use. High-quality trials are needed on balneotherapy and aquatic exercises research especially in specific patient categories that might benefit most.
Lifestyle- and behaviour-change interventions in musculoskeletal conditions.
Knittle K, De Gucht V, Maes S
Best Pract Res Clin Rheumatol · 2012 Jun · PMID 22867927 · Publisher ↗
This review discusses several health behaviours associated with the progression and impact of osteoarthritis (OA) and rheumatoid arthritis (RA), including weight management, physical activity, medication adherence and sm...
This review discusses several health behaviours associated with the progression and impact of osteoarthritis (OA) and rheumatoid arthritis (RA), including weight management, physical activity, medication adherence and smoking. An overview of current theories of behaviour-change is provided in terms of principles that can guide medical practice. Finally, evaluation studies of interventions targeting weight loss, physical activity and medication adherence in patients with OA or RA are presented and discussed. Of existing behaviour-change interventions in this population, few have taken a comprehensive theory-based approach to behaviour-change. Practitioners who provide lifestyle or behavioural advice to patients would do well to adopt a less prescriptive and more patient-centred approach in which they, or other health professionals to whom they refer the patient, assist the patient in formulating personal change goals, in translating good intentions into specific action plans and in closely monitoring their progress towards self-chosen goals.
Taking advances from bench to bedside during the last decade.
Kok MR, Tak PP
Best Pract Res Clin Rheumatol · 2012 Apr · PMID 22794095 · Publisher ↗
The remarkable advances in understanding the pathogenesis and therapeutic options for rheumatoid arthritis over the last 10 years are a leap forward in the treatment of this disease. This has led to a shift in focus from...
The remarkable advances in understanding the pathogenesis and therapeutic options for rheumatoid arthritis over the last 10 years are a leap forward in the treatment of this disease. This has led to a shift in focus from established disease to early identification and treatment. Actualisation of treatment guidelines aiming for remission, and a vastly growing arsenal of new synthetic and biological agents have been major achievements. An area of ongoing research is the discovery and development of additional and improved biomarkers for (early) disease with the goal of designing a more personalised treatment regimen to prevent structural tissue damage. Developing valid tools to predict response and outcome for the individual patient remains, however, a great challenge. We will herein summarise some of the major achievements in diagnostic and therapeutic discoveries in rheumatoid arthritis of the past decade.
Osteoarthritis.
Hunter DJ
Best Pract Res Clin Rheumatol · 2011 Dec · PMID 22265262 · Publisher ↗
The pathogenesis of osteoarthritis (OA) appears to be the result of a complex interplay between mechanical, cellular and biochemical forces. Obesity is the strongest risk factor for disease onset in the knee, and mechani...
The pathogenesis of osteoarthritis (OA) appears to be the result of a complex interplay between mechanical, cellular and biochemical forces. Obesity is the strongest risk factor for disease onset in the knee, and mechanical factors dominate the risk for disease progression. OA is a highly prevalent and disabling disease. The current pre-eminent focus in OA research and clinical practice is on persons with established radiographic symptomatic disease. This is the very end-stage of disease genesis, and modern therapies hence are largely palliative. In an effort to mitigate the rising tide of increasing OA prevalence and disease impact, we need to focus more on preventing the onset of disease and modifying the structural progression of OA. Greater therapeutic attention to the important role of mechanical factors, joint injury and obesity in OA etiopathogenesis, is required if we are to find ways of reducing the public health impact of this condition.
Joint appendages: the structures which have historically been overlooked in arthritis research and therapy development.
Ash Z, McGonagle D
Best Pract Res Clin Rheumatol · 2011 Dec · PMID 22265260 · Publisher ↗
Rheumatologists have largely conceptualised joint disease in inflammatory and degenerative arthritis in terms of bone, cartilage and the synovial lining, but have tended to overlook other integral components of the joint...
Rheumatologists have largely conceptualised joint disease in inflammatory and degenerative arthritis in terms of bone, cartilage and the synovial lining, but have tended to overlook other integral components of the joints which are attached close to joint margins. We discuss these structures under the umbrella term of 'appendages'. These structures include ligaments, tendons, entheses or joint insertions, regional fibrocartilages, bursae and other peri-articular joint structures including fat pads and nails. In this review, we highlight how these structures play key pathophysiological roles in inflammatory arthritis and we emphasise how an understanding of these structures is collectively important for both clinical practice and future rheumatological research.
B-cell therapies in established rheumatoid arthritis.
Leandro MJ, Becerra-Fernandez E
Best Pract Res Clin Rheumatol · 2011 Aug · PMID 22137923 · Publisher ↗
B-cell depletion therapy based on rituximab is effective and relatively safe in established rheumatoid arthritis. Rituximab is licensed for the treatment of rheumatoid arthritis in combination with methotrexate and in pa...
B-cell depletion therapy based on rituximab is effective and relatively safe in established rheumatoid arthritis. Rituximab is licensed for the treatment of rheumatoid arthritis in combination with methotrexate and in patients who did not respond or cannot tolerate tumour necrosis factor antagonists. Sustained control of disease activity can be achieved by repeated courses of treatment. The optimal dose and schedule of retreatment are still not established. Nevertheless, data are now available that provide a good base for current clinical practice and a good starting point for further research. In general, rituximab has a good safety profile with most studies showing similar incidences of serious adverse events and infections to placebo. However, reasonable and well-funded doubts remain over the safety of long-term strategies of treatment of rheumatoid arthritis with rituximab, in particular, in relation to the risk of secondary hypogammaglobulinaemia and potential increased risk of infections.
Established rheumatoid arthritis: rationale for best practice: physicians' perspective of how to realise tight control in clinical practice.
Horton SC, Walsh CA, Emery P
Best Pract Res Clin Rheumatol · 2011 Aug · PMID 22137921 · Publisher ↗
Developments in the understanding of the pathogenesis of rheumatoid arthritis (RA) and the introduction of targeted biologic therapies have greatly advanced the management of RA in clinical practice. The management of RA...
Developments in the understanding of the pathogenesis of rheumatoid arthritis (RA) and the introduction of targeted biologic therapies have greatly advanced the management of RA in clinical practice. The management of RA is now aimed at achieving remission, to prevent joint damage and disability. In particular, a critical period early in disease is recognised, in which early aggressive treatment with disease-modifying therapy is advocated. Although a state of remission is the ideal, this chapter discusses the difficulties which may arise in achieving this goal in patients with established disease. The evidence for best management, aimed at achieving clinical remission in established disease, is reviewed. The consequences of incomplete control of chronic inflammation in established disease, including pain, disability and co-morbidities (such as cardiovascular disease and osteoporosis), also pose a significant clinical challenge. The rationale for a multidisciplinary team approach in reducing the associated morbidity and mortality of the disease are examined.
Assessment of control of rheumatoid arthritis disease activity.
Salomon-Escoto KI, Gravallese EM, Kay J
Best Pract Res Clin Rheumatol · 2011 Aug · PMID 22137920 · Publisher ↗
As very effective targeted biological therapies have become available to treat rheumatoid arthritis (RA), remission is now the goal of treatment. Since 1981, efforts have been undertaken to develop criteria for clinical...
As very effective targeted biological therapies have become available to treat rheumatoid arthritis (RA), remission is now the goal of treatment. Since 1981, efforts have been undertaken to develop criteria for clinical remission in RA. Although several different measures of disease activity have been proposed, many issues remain unresolved. Active joint inflammation, even if involving only a few joints, negatively impacts a patient's quality of life and may ultimately result in structural damage. Thus, a low disease activity state (LDAS), which has been adopted as the target in clinical trials of 'treat to target', may not be the optimal treatment target in clinical practice. Similarly, the definitions of remission used in clinical trials may not be appropriate for use in daily clinical practice because some allow for the presence of several tender and swollen joints. Measures of disease activity do not necessarily correlate with structural remission, which implies halting progression of radiographic evidence of damage over time. Because no single measure of RA disease activity fully quantifies the global burden of disease, rheumatologists must follow multiple parameters to assess disease activity thoroughly and to adjust treatment optimally.
An audit of the variability of diagnosis and management of gout in the rheumatology setting: the gout evaluation and management study.
Perez-Ruiz F, Carmona L, Yébenes MJ … +5 more , Pascual E, de Miguel E, Ureña I, González-Gay MA, GEMA Study Group, Sociedad Española de Reumatología
J Clin Rheumatol · 2011 Oct · PMID 21946457 · Publisher ↗
OBJECTIVE: The objectives of the study were to evaluate the rate of variability in diagnosis and treatment of the patients with gout in the rheumatology setting and to estimate the rate of adjustment to the European Leag...
OBJECTIVE: The objectives of the study were to evaluate the rate of variability in diagnosis and treatment of the patients with gout in the rheumatology setting and to estimate the rate of adjustment to the European League Against Rheumatism recommendations as a key step to improve the quality of care in gout. METHODS: The GEMA (Gout Evaluation and MAnagement) study is a cross-sectional audit in which 803 files of patients with an International Classification of Diseases code of gout were randomly chosen from 41 rheumatology units. The data collected regarded the clinical management of gout. Indicators based on the European League Against Rheumatism recommendations were created, and information on the fulfillment of the recommendations was retrieved. The mean adjustment and 95% confidence interval (CI) were estimated for each recommendation. RESULTS: Patients from whose files information was retrieved were very representative of gout (94% were men, with a mean age of 60 years, 43% obese, 62% hypertensive, more than 25% with tophaceous gout, 61% hyperlipidemic). A diagnosis based on the observation of monosodium urate crystals on the microscope had been made in only 26%; thus, the adjustment to diagnostic recommendations was low, 26.0% (95% CI, 18.9%-33.1%). The adjustment to the recommendations on evaluating comorbidity was 50.6% (95% CI, 46.6%-54.5%). Mean adjustment to recommendations on management, in general, was better, especially those regarding acute flares (100%), and lifestyle changes, with 71.4% (95% CI, 63.7%-79.1%) with treatment using urate-lowering drugs could be improved (mean adjustment, 52.1% [95% CI, 43.1-61.1]). CONCLUSIONS: Overall, implementation of clinical care in gout should be put on further attention to diagnosis, time-consuming evaluation of comorbidities, and long-term control of serum urate levels.
Evaluating factors influencing screening for pulmonary hypertension in systemic sclerosis: does disparity between available guidelines influence clinical practice?
Pauling JD, McHugh NJ
Clin Rheumatol · 2012 Feb · PMID 21912881 · Publisher ↗
Pulmonary arterial hypertension (PAH) is one of the leading causes of mortality in systemic sclerosis (SSc). We audited adherence with available recommendations regarding cardiopulmonary screening for PAH in SSc and expl...
Pulmonary arterial hypertension (PAH) is one of the leading causes of mortality in systemic sclerosis (SSc). We audited adherence with available recommendations regarding cardiopulmonary screening for PAH in SSc and explored potential factors influencing clinical practice. A retrospective case note review of 108 patients with SSc who had attended outpatient clinic over the previous year was undertaken. Records were scrutinised for evidence of previous assessment with trans-thoracic echocardiography (TTE) and pulmonary function tests (PFT), along with information regarding clinical phenotype and serological subset. The proportion of patients for whom screening had been undertaken within the previous 12 months was low, with significantly fewer having TTE compared with PFT assessment (34.7% vs. 53.1%, p = 0.014). The majority of patients had undergone TTE and PFT assessment within the previous 2 years, but a lower proportion had undergone TTE compared with PFT (69.4% vs. 82.7%, p = 0.044). There were strong trends for more frequent PFT assessment in younger patients, limited cutaneous SSc and worse previous PFT results. In contrast, the frequency of TTE assessment was not associated with previous investigation results or disease subtype. Serological profile did not influence the frequency of either TTE or PFT assessments. Disparity between available published guidelines may influence both the frequency and preference of PAH screening in SSc in clinical practice. The higher frequency of PFT assessment might reflect a perceived superiority amongst clinicians of PFT over TTE in the early identification of SSc-PAH. SSc-specific guidelines, possibly incorporating additional independent risk factors, may improve the cost-effectiveness and clinical efficacy of screening recommendations designed to ensure the early identification of PAH in patients with SSc.
Defining high risk of osteoporotic fracture: a cross talk between clinical experience and guidelines recommendations.
Casado E, Malouf J, Caamaño MM … +4 more , Salas E, Sánchez-Bursón JM, Rentero ML, Herrero-Beaumont G
J Clin Rheumatol · 2011 Aug · PMID 23640502 · Publisher ↗
BACKGROUND: : There is no universally accepted definition for patients at high risk of osteoporotic fracture. OBJECTIVES: : This study aimed to survey Spanish rheumatologists; to obtain opinions about risk factors, and a...
BACKGROUND: : There is no universally accepted definition for patients at high risk of osteoporotic fracture. OBJECTIVES: : This study aimed to survey Spanish rheumatologists; to obtain opinions about risk factors, and an acceptable definition for patients at high risk of osteoporotic fracture; and to compare daily practice patterns with current osteoporosis guidelines. METHODS: : A total of 174 rheumatologists from throughout Spain completed an online survey about various risk factors for fragility fracture and about the management of patients with osteoporosis in clinical practice. Results were reviewed by a coordinating committee of osteoporosis experts and were compared with published national and international guideline recommendations. RESULTS: : Almost all rheumatologists who completed the survey (99%) consider that a group of patients exists with a high risk of osteoporotic fracture and that this group should be managed appropriately. Previous fracture is considered the most important risk factor, particularly in cases of multiple fracture, severe vertebral fracture, hip fracture, or fracture despite osteoporosis treatment. However, in osteoporosis guidelines, age, bone mineral density, and previous fragility fracture are the most important risk factors for new fracture. Furthermore, Spanish rheumatologists tend to treat patients at high risk of fracture with anabolic therapy (e.g., teriparatide), whereas guidelines make no such recommendation. CONCLUSIONS: : In osteoporosis, a large gap exists between implementation of guideline recommendations and actual clinical practice; this may be due, in part, to heterogeneity among existing guidelines. Thus, inclusion in guidelines of a practical definition of high risk of osteoporotic fracture may provide significant opportunities to improve patient care and prevent future fragility fractures.
Foot health needs in people with systemic sclerosis: an audit of foot health care provision.
Alcacer-Pitarch B, Siddle HJ, Buch MH … +3 more , Emery P, Hashmi F, Redmond AC
Clin Rheumatol · 2011 Dec · PMID 21660438 · Publisher ↗
The vascular and cutaneous alterations evident in systemic sclerosis/scleroderma (SSc) place the foot at risk of ulceration. The UK Podiatry Rheumatic Care Association (PRCA)/Arthritis and Musculoskeletal Alliance standa...
The vascular and cutaneous alterations evident in systemic sclerosis/scleroderma (SSc) place the foot at risk of ulceration. The UK Podiatry Rheumatic Care Association (PRCA)/Arthritis and Musculoskeletal Alliance standards of care recommend that all people with SSc should receive at least basic information about their foot health, and that those with foot problems should have access to self-management advice and care where needed. The aim of this study was to evaluate foot health services offered in Leeds (UK) for people with SSc, against nationally agreed standards of care. Ninety-one consecutive patients with SSc were selected from either the connective tissue disease outpatient clinic (n = 70) or the specialist rheumatology foot health clinic (n = 21) at Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust. All the patients completed a disease-specific audit tool developed by the UK PRCA that evaluates provision of foot health care for patients with SSc. Sixty-one patients (67%) reported having had foot problems at some point in time and 54 (59%) had current foot problems. Of these 54 patients, 17 (32%) had not received any foot care. Only 36 (39%) of the 91 patients had received any foot health information. This audit demonstrates that patients with SSc have a relatively high prevalence of self-reported foot problems. Foot health care and information are inadequate for people with SSc and foot problems, and preventative information is almost non-existent. Improved foot health information will better empower patients to self-manage low risk problems, and help identify high risk problems which require specialist care.
Soluble and tissue biomarkers in ankylosing spondylitis.
de Vlam K
Best Pract Res Clin Rheumatol · 2010 Oct · PMID 21035087 · Publisher ↗
The study of biomarkers has become a very important field of research in spondyloarthropathy. Biomarkers are useful for different aspects of the disease such as diagnosis, assessment of disease activity and outcome, incl...
The study of biomarkers has become a very important field of research in spondyloarthropathy. Biomarkers are useful for different aspects of the disease such as diagnosis, assessment of disease activity and outcome, including damage. The most commonly used biomarkers in spondyloarthropathies are HLA-B27 for diagnosis and erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) for disease activity. HLA-B27 is very sensitive but has a low specificity. ESR and CRP have both low sensitivity and specificity. The introduction of new and very expensive therapies is another reason for analysis of biomarkers. Clinicians need tools to predict more accurately disease activity, disease progression and response to therapy. This article focusses on the several known and new biomarkers of promise, including markers for cartilage and bone damage, and discusses some of the problems encountered during the search and development of new biomarkers. Biomarkers, soluble and tissue-related, reflecting structural damage and disease activity, constitute a high priority for the drug discovery process and the understanding of the pathogenesis of a particular disease. The identification of relevant tools to evaluate the natural course, disease activity, treatment response and outcome of ankylosing spondylitis is of increasing relevance since the raised awareness and development of new therapeutic options. Until now these different aspects are monitored by artificial patient-centred or physician-centred constructs. Very often, their approach is indirect and is not free from disease-unrelated influences. The Outcome Measures in Rheumatology Soluble Biomarker Working Group has taken several major steps towards the development and implementation of such assessment methods. The major drawback is that these tools do not directly reflect biological and pathological processes. Serological biomarkers objectively measure different aspects of the biological and pathological process and may contribute to a major advance in the assessments of patients. The ultimate goal is the use of biomarkers in a personalised approach for disease management in clinical practice.
Measurement: function and mobility (focussing on the ICF framework).
Boonen A, Maksymowych WP
Best Pract Res Clin Rheumatol · 2010 Oct · PMID 21035083 · Publisher ↗
While several instruments and measures are available to assess function and mobility, there was no exhaustive list of impairments, limitations and restrictions that are the consequence of ankylosing spondylitis (AS). The...
While several instruments and measures are available to assess function and mobility, there was no exhaustive list of impairments, limitations and restrictions that are the consequence of ankylosing spondylitis (AS). The International Classification of Functioning, Disability and Health (ICF) facilitates agreement on a comprehensive description of aspects of functioning that are relevant and typical for a specific disease by using ICF categories. The Comprehensive ICF Core Set for AS is the selection of 80 ICF categories that are typical and relevant for AS. Physical functioning and mobility have an essential but partial role in the broad view of functioning and health in AS. Consistent with the bio-psycho-social model, the ICF Core Set for AS also recognises the role of contextual factors, either environmental or personal, when understanding functioning. This new reference for functioning is now available for clinical practice and research. It can help to increase insight into the complexity of functioning and can serve as the starting point for the development of new instruments that address either global functioning or aspects of functioning.
Treating early rheumatoid arthritis intensively: current UK practice does not reflect guidelines.
Garrood T, Shattles W, Scott DL
Clin Rheumatol · 2011 Jan · PMID 20683739 · Publisher ↗
Recent guidance published in the UK by the National Institute for Health and Clinical Excellence has recommended that patients with early rheumatoid arthritis (RA) are treated with combination disease-modifying anti-rheu...
Recent guidance published in the UK by the National Institute for Health and Clinical Excellence has recommended that patients with early rheumatoid arthritis (RA) are treated with combination disease-modifying anti-rheumatic drugs (DMARDs). It is unclear to what extent this reflects current UK practice. UK rheumatologists were asked to complete a web-based questionnaire asking about their treatment preferences in early RA and to indicate their attitudes to combination DMARD therapy. Although the majority was using step-up combination DMARDs, only 50% of the 258 respondents were using initial combination therapy in any patients with newly diagnosed RA despite scoring it highly for efficacy and safety. Concerns were expressed about side effects, increased monitoring requirements, and acceptability to patients. Current UK practice does not reflect the recently published guidelines. Uncertainties remain as to which patients need combination therapy and the optimal regimes to use. Further research is required to elucidate attitudes to aggressive therapy in early disease.
Contemporary low back pain research - and implications for practice.
Pransky G, Buchbinder R, Hayden J
Best Pract Res Clin Rheumatol · 2010 Apr · PMID 20227649 · Publisher ↗
Each month, several journals contain reports on new ways of looking at low back pain-related risk and prognostic factors, new clinical interventions and suggestions for improved care. This is because back pain continues...
Each month, several journals contain reports on new ways of looking at low back pain-related risk and prognostic factors, new clinical interventions and suggestions for improved care. This is because back pain continues to be a vexing condition to manage. It often defies evaluation, diagnosis and treatment, and is associated with considerable individual suffering and negative societal impact. Although reviewing new and promising strategies is always interesting and gratifying for the reader, it is sobering to reconsider similar efforts over the past decades. Most new ideas for low back pain care have not proven to be effective when subjected to repeated rigorous and independent evaluation. New developments in epidemiologic and clinical understanding, and innovative approaches to non-medical management now appear to provide the best opportunities for improving outcomes. In this article, we review new perspectives and research studies that show promise, and suggest alternatives to current clinical and research paradigms.
Challenges in using evidence to inform your clinical practice in low back pain.
Ostelo R, Croft P, van der Weijden T … +1 more , van Tulder M
Best Pract Res Clin Rheumatol · 2010 Apr · PMID 20227648 · Publisher ↗
The aim of evidence-based medicine (EBM) from its early days was to provide the appropriate means for making effective clinical decisions, not only for avoiding habitual practice but also for enhancing clinical performan...
The aim of evidence-based medicine (EBM) from its early days was to provide the appropriate means for making effective clinical decisions, not only for avoiding habitual practice but also for enhancing clinical performance. It is, however, unrealistic to simply assume that the results of research will soon evolve into practice. In this article, when aiming to translate results from research into practice, we focus on certain challenges, which can be broadly categorised into two: how the evidence is generated, and how the evidence is implemented. When focussing on generating evidence, a major barrier to the rapid passage of research into clinical practice is that the 'practice' in trials or research settings could be a long way from the setting, circumstances, patient groups and resources available in the daily practice of many clinicians. This is the consequence of the several choices that researchers have to make in designing a trial regarding population, measurement tools and interventions. For implementing the evidence, clinical guidelines appear to be one of the most promising and effective tools for improving the quality of care. Although the importance of implementing clinical guidelines is widely recognised, little is known about the optimal implementation strategy. We present two examples of implementing low back pain guidelines, illustrating that it remains difficult to develop effective implementation strategies. Finally, we discuss some future directions that have been proposed for EBM, which aim to overcome the essential tension between internal validity and external validity (generalisability), specifically in fields where complex syndromes and complex interventions are the focus of attention.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe