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  • #31
    OpenTrials: what, why and how?

    http://blogs.biomedcentral.com/on-me...ource=Teradata

    The messy world of clinical trials

    You might find it surprising that such a thing doesn’t already exist. But the world of clinical trials is currently in something of a mess, as is increasingly recognized, especially when it comes to knowledge management.

    Whole trials are routinely left unpublished, which exposes the medical literature to avoidable bias and exaggeration. When trials are published, the results are often misreported in academic journal articles.

    You can find the same trials reporting different results in different places, and the information in journal articles has been shown to be less complete than – and discrepant with – other sources like clinical study reports.

    Furthermore, key documents such as Case Report Forms and Ethics Committee paperwork are often left inaccessible, even though we know they can contain important information.


    OpenTrials: towards a collaborative open database of all available information on all clinical trials
    http://trialsjournal.biomedcentral.c...063-016-1290-8

    Abstract

    OpenTrials is a collaborative and open database for all available structured data and documents on all clinical trials, threaded together by individual trial. With a versatile and expandable data schema, it is initially designed to host and match the following documents and data for each trial: registry entries; links, abstracts, or texts of academic journal papers; portions of regulatory documents describing individual trials; structured data on methods and results extracted by systematic reviewers or other researchers; clinical study reports; and additional documents such as blank consent forms, blank case report forms, and protocols. The intention is to create an open, freely re-usable index of all such information and to increase discoverability, facilitate research, identify inconsistent data, enable audits on the availability and completeness of this information, support advocacy for better data and drive up standards around open data in evidence-based medicine. The project has phase I funding. This will allow us to create a practical data schema and populate the database initially through web-scraping, basic record linkage techniques, crowd-sourced curation around selected drug areas, and import of existing sources of structured and documents. It will also allow us to create user-friendly web interfaces onto the data and conduct user engagement workshops to optimise the database and interface designs. Where other projects have set out to manually and perfectly curate a narrow range of information on a smaller number of trials, we aim to use a broader range of techniques and attempt to match a very large quantity of information on all trials. We are currently seeking feedback and additional sources of structured data.

    Background

    Trials are used to inform decision making, but there are several ongoing problems with information management on clinical trials, including publication bias, selective outcome reporting, lack of information on methodological flaws, and duplication of effort for search and extraction of data, which have a negative impact on patient care. Randomised trials are used to detect differences between treatments because they are less vulnerable to confounding, and because biases can be minimised within the trial itself. The broader structural problems external to each individual trial result in additional biases, which can exaggerate or attenuate the apparent benefits of treatments.

    To take the example of publication bias, the results of trials are commonly and legally withheld from doctors, researchers and patients, more so when they have unwelcome results [1, 2], and there are no clear data on how much is missing for each treatment, sponsor, research site, or investigator [3], which undermines efforts at audit and accountability. Information that is publicly available in strict legal terms can still be difficult to identify and access if, for example, it is contained in a poorly indexed regulatory document or a results portal that is not commonly accessed [4, 5]. In addition to this, different reports on the same trial can often describe inconsistent results because of, for example, diverse analytic approaches to the same data in different reports or undisclosed primary outcome switching and other forms of misreporting [4, 6]. There is also considerable inefficiency and duplication of effort around extracting structured data from trial reports to conduct systematic reviews, for example, and around indexing these data to make it more discoverable and more used. Lastly, although large collections of structured “open data” on clinical trials would be valuable for research and clinical activity, including linkage to datasets other than those on trials, there is little available and it can be hard to search or access.


    Retraction Watch

    What leads to bias in the scientific literature? New study tries to answer

    http://retractionwatch.com/2017/03/2...-tries-answer/

    Update 04/04/2017


    Want to analyze millions of scientific papers all at once? Here’s the best way to do it

    http://www.sciencemag.org/news/2017/...et_cid=1452935

    With more than a million scientific papers produced each year, keeping on top of the latest research is becoming an impossible task. That’s why a growing number of scientists are having computers trawl through thousands of research papers at once for raw data and text. Now, in one of the largest text and data mining exercises ever conducted, scientists say they have identified the best way to do such searches, which could improve the hunt for everything from new drug targets to genes that have not been studied in detail.

    There is long-standing debate among text and data miners: whether sifting through full research papers, rather than much shorter and simpler research summaries, or abstracts, is worth the extra effort. Though it may seem obvious that full papers would give better results, some researchers say that a lot of information they contain is redundant, and that abstracts contain all that’s needed. Given the challenges of obtaining and formatting full papers for mining, stick with abstracts, they say.

    In an attempt to settle the debate, Søren Brunak, a bioinformatician at the Technical University of Denmark in Kongens Lyngby, and colleagues analyzed more than 15 million scientific articles published in English from 1823 to 2016. After creating two databases of those articles—one of full-text and one of abstracts—the researchers directly compared the results of mining either. The full texts were obtained from publishers Elsevier and Springer, as well as the open-access section of online repository PubMed Central. The abstracts from the same papers were collected from MEDLINE, a resource that like PubMed Central receives funding from the U.S. National Institutes of Health.

    Text mining full research articles gave consistently better results than text mining abstracts, the team reports this month on the preprint server bioRxiv (which was not mined). In one example test, the authors identified far more associations between genes and a variety of diseases from the full-text articles than the abstracts—potentially creating a treasure trove of ideas for future research targets.
    Update 24/07/2017
    Last edited by Jo Bowyer; 24-07-2017, 02:38 PM.
    Jo Bowyer
    Chartered Physiotherapist Registered Osteopath.
    "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

    Comment


    • #32
      Number needed to understand

      https://noijam.com/2016/06/09/number...to-understand/

      The Number Needed to Treat (NNT) is a commonly used measure to communicate the effectiveness of a health care intervention. It really is a beautiful thing – just a single number, no distracting percentage, no associated Greek symbol and a simple “the lower the better” rule.

      But.

      What does it really mean?

      Tran Quang Hung has written a wonderful, plain language post at students4bestevidence.com:
      Jo Bowyer
      Chartered Physiotherapist Registered Osteopath.
      "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

      Comment


      • #33
        Implementation interventions to improve the management of non-specific low back pain: a systematic review

        http://bmcmusculoskeletdisord.biomed...891-016-1110-z

        Abstract

        Background
        Recommendations in clinical practice guidelines for non-specific low back pain (NSLBP) are not necessarily translated into practice. Multiple studies have investigated different interventions to implement best evidence into clinical practice yet no synthesis of these studies has been carried out to date.

        The aim of this study was to systematically review available studies to determine whether implementation interventions in this field have been effective and to identify which strategies have been most successful in changing healthcare practitioner behaviours and improving patient outcomes.

        Methods
        A systematic review was undertaken, searching electronic databases until end of December 2012 plus hand searching, writing to key authors and using prior knowledge of the field to identify papers. Included studies evaluated an implementation intervention to improve the management of NSLBP in clinical practice, measured key outcomes regarding change in practitioner behaviour and/or patient outcomes and subjected their data to statistical analysis. The Cochrane Effective Practice and Organisation of Care (EPOC) recommendations about systematic review conduct were followed. Study inclusion, data extraction and study risk of bias assessments were conducted independently by two review authors.

        Results
        Of 7654 potentially eligible citations, 17 papers reporting on 14 studies were included. Risk of bias of included studies was highly variable with 7 of 17 papers rated at high risk. Single intervention or one-off implementation efforts were consistently ineffective in changing clinical practice. Increasing the frequency and duration of implementation interventions led to greater success with those continuously ongoing over time the most successful in improving clinical practice in line with best evidence recommendations.

        Conclusions
        Single intervention or one-off implementation interventions may seem attractive but are largely unsuccessful in effecting meaningful change in clinical practice for NSLBP. Increasing frequency and duration of implementation interventions seems to lead to greater success and the most successful implementation interventions used consistently sustained strategies.
        Keywords

        Non-specific low back pain Implementation Best practice guidelines
        Jo Bowyer
        Chartered Physiotherapist Registered Osteopath.
        "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

        Comment


        • #34
          Perceived quality of physiotherapist-led orthopaedic triage compared with standard practice in primary care: a randomised controlled trial

          http://bmcmusculoskeletdisord.biomed...891-016-1112-x

          Abstract
          Background
          Physiotherapist-led orthopaedic triage, where physiotherapists diagnose and determine management plans, aims to enhance effectiveness and provide the best care. However, scientific evidence for the effectiveness of this model of care remains limited, and there are few studies reporting on patients’ perceptions of the care provided. The purpose of this study was to evaluate patients’ perceived quality of care in a physiotherapist-led orthopaedic triage in primary care, compared with standard practice.

          Methods
          In a randomised controlled trial, patients of working age referred for orthopaedic consultation at a primary healthcare clinic in Sweden received either physiotherapist-led triage (n = 102) or standard practice (orthopaedic surgeon assessment) (n = 101). Neither subjects nor clinicians were blinded.

          The questionnaire Quality from the Patient's Perspective (QPP) was used to evaluate perceived quality of care focusing on the caregivers’ medical-technical competence and identity-orientated approach. Also, to what extent patients’ expectations were met, and their intention to follow advice was evaluated.

          Results
          For this study, 163 patients (80 %) were analysed (physiotherapist-led triage (n = 83), standard practice (n = 80)). Participants perceived significantly higher quality of care with the triage than with the standard practice in regards to receiving best possible examination and treatment (medical-technical competence) (p < 0.001). This was also found in regards to receiving information about examination and treatment (p < 0.001), results (p < 0.001), and self-care (p < 0.001), the caregiver’s understanding (p < 0.001), respect (p < 0.001) and commitment (p < 0.001) as well as the opportunity to participate in decision-making (p = 0.01) (identity-orientated approach). Participants in the physiotherapist-led triage group reported to a significantly higher extent that their expectations of the treatment were met (p < 0.001), as well as the intent to follow the advice and instructions received (p = 0.019).

          Conclusions
          This paper reports on patients’ perceptions of quality of care in a physiotherapist-led orthopaedic triage compared with standard practice. Patients in both groups reported that they perceived good quality of care, with the patients in the physiotherapist-led triage reporting significantly higher perceived quality of care than those in the standard practice group. This model of care seems to meet patients’ expectations and result in a greater intention to follow advice and instructions for self-management.

          Our findings are in line with existing literature that this model of care provides an opportunity to shape patient-centered care that can improve access and offer care on the most appropriate level, with maintained good quality of care.
          Trial registration
          Clinical Trials NCT02265172. Registered 10 June 2014

          Keywords

          Advanced practice physiotherapy Physical therapy Quality of care Patient perception Sweden Expectations
          Jo Bowyer
          Chartered Physiotherapist Registered Osteopath.
          "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

          Comment


          • #35
            The Potential for Postrandomization Confounding in Randomized Clinical Trials

            http://jama.jamanetwork.com/article....icleid=2526647

            In this Viewpoint, JoAnn Manson and colleagues discuss the risk of postrandomization “confounding,” a bias that can be introduced in long-duration trials of sustained interventions, using statin initiation after randomization in Women’s Health Initiative trials as an example.

            Randomized clinical trials (RCTs) are considered the “gold standard” for evaluating an intervention’s efficacy and safety.1 Although large-scale RCTs are nearly always free of baseline confounding because randomization balances the distribution of measured and unmeasured risk factors across treatment groups, biases may emerge after randomization because of differential use of nonstudy medication or treatments, imbalanced rates of disease screening, differential loss to follow-up, and other differences between treatment groups. Such postrandomization “confounding” is more likely to occur in long-term trials or pragmatic trials taking place in typical patient care settings. Because community-based long-duration pragmatic trials are increasingly being used to evaluate sustained interventions, it is important for researchers to use available methodological approaches to assess the presence of such biases1 and for clinicians to be aware of potential sources of confounding when interpreting results of RCTs.
            via @hopinlee
            Jo Bowyer
            Chartered Physiotherapist Registered Osteopath.
            "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

            Comment


            • #36
              Does the addition of hip strengthening exercises improve outcomes following total knee arthroplasty? A study protocol for a randomized trial

              http://bmcmusculoskeletdisord.biomed...891-016-1104-x

              Abstract

              Background
              Total knee arthroplasty (TKA) is effective in reducing pain and improving function for end-stage knee osteoarthritis. However, muscle weakness and functional limitations persist despite assistance from post-operative rehabilitation programs that traditionally focus on quadriceps strengthening and range of movement exercises. Hip abductor muscle weakness is evident in knee osteoarthritis and hip muscle strengthening reduces knee pain in this group. Following TKA, people with weak hip abductor strength perform more poorly on measures of physical function. However, very little is known of the effectiveness of including hip abductor strengthening exercises in post-operative rehabilitation. The aim of this trial is to compare the effects of targeted hip abductor strengthening to those of traditional care in a TKA rehabilitation program on muscle strength, patient reported outcomes and functional performance measures.

              Methods/design
              This protocol describes a single-blinded randomized controlled trial, where 104 participants referred for inpatient rehabilitation following TKA will be recruited. Participants will be randomized using computer-generated numbers to one of two groups: usual care or usual care with additional hip strengthening exercises. Participants will attend physiotherapy daily during their inpatient length of stay, and will then attend between six and eight physiotherapy sessions as an outpatient. Primary outcomes are isometric hip abductor strength and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Secondary outcomes are stair climb test, 6 min walk test, timed up and go, 40 m fast-paced walk test, 30 second chair stand test, isometric quadriceps strength, Lower Extremity Functional Scale (LEFS) and SF-12. Outcome measures will be recorded at baseline (admission to inpatient rehabilitation), and then 3 weeks, 6 weeks and 6 months post admission to rehabilitation.

              Discussion
              The findings of this study will determine whether the addition of targeted hip strengthening to usual care rehabilitation improves physical performance and patient reported outcomes following TKA when compared to usual care rehabilitation. This will then determine whether targeted hip strengthening exercises should be included in traditional rehabilitation programs to improve the outcomes following total knee arthroplasty.
              Jo Bowyer
              Chartered Physiotherapist Registered Osteopath.
              "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

              Comment


              • #37
                Threats to traditional systematic reviews

                For many years systematic reviews have been placed on a pedestal, relatively free from critical scrutiny. Frequently seen as being at the top of the ‘evidence pyramid’ they have been adopted as the main way of assessing the worth of an individual intervention.

                More recently threats to the pre-eminence of systematic reviews have come from multiple areas. Some authors, including myself, have been critical of groups such as Cochrane for creating methods that are so costly in terms of finance and time that too few are done and the majority are not being kept up to date.

                The rise of the ‘rapid review’ is another ‘threat’ to traditional systematic reviews, as increasingly these are being seen as viable alternatives. And, as the rapid review methods mature, they will surely win prominence by their ability to deliver robust results in a fraction of the time of traditional systematic reviews, at a lower cost and be better able to be kept up to date.

                However, an increasingly obvious threat is that of reporting bias. Reporting bias, the selective reporting or suppression of information, is increasingly apparent and the evidence mounts as to the effects. There are numerous problems associated with this, for instance:

                AllTrials reports that over 30% of trials are unpublished, and when unpublished trials are used in evidence synthesis it can profoundly alter the results of the systematic review. The problem is that the vast majority of systematic reviews do not include all or any of the unpublished studies.
                The basis for most systematic reviews is the journal article, and therefore these summaries of the trial miss lots of important information such as side effects and outcome switching.
                The net result is that, for systematic reviews based on journal articles, the results simply cannot be trusted as being an accurate reflection of an interventions ‘worth’.[1] [2] [3] Being generous we could describe them as supplying a ‘ball park’ estimate; synthesis of the published evidence alone doesn’t support more than that. While some systematic reviews might be accurate, we have no real way of knowing which are accurate and which aren’t. So, if the evidence synthesis is based on published journal articles (the overwhelming majority) – beware.

                But this brings us nicely back to the role of rapid reviews. There are a few studies comparing rapid and systematic reviews (based on journal articles) and these have consistently reported very little difference in results.[4] [5] It appears that a sample of published journal articles gives roughly the same results as all the journal articles found in a systematic review (is this really surprising given that sampling is a widely accepted part of biomedical trials?). So, if all you need is a ball park estimate, do it quickly and at low cost. However, if you want an accurate result you really need to go beyond published journal articles. Systematic reviews (based on published journal articles) are caught between two stools, they are not quick enough and they’re not robust enough.

                This realisation will surely help us move towards a more nuanced approach to evidence synthesis, one not rooted in attempts to capture all journal articles. This new approach must better articulate why the evidence synthesis is required and build from there. And, the new approach(es) must be based on evidence, not faith.


                Jon Brassey is the founder and director of the EBM search engine the Trip Database. In addition to this he works as lead for knowledge mobilisation at Public Health Wales, is an honorary fellow at the Centre for Evidence-Based Medicine, Oxford and recently started the Rapid-Reviews.info website.
                He will be on the panel for a discussion of “Improving the Evidence for Systematic Reviews” on Wednesday 22nd June at Evidence Live 2016
                Jo Bowyer
                Chartered Physiotherapist Registered Osteopath.
                "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                Comment


                • #38
                  Why Most Clinical Research Is Not Useful

                  http://journals.plos.org/plosmedicin...l.pmed.1002049

                  Summary Points

                  Blue-sky research cannot be easily judged on the basis of practical impact, but clinical research is different and should be useful. It should make a difference for health and disease outcomes or should be undertaken with that as a realistic prospect.

                  Many of the features that make clinical research useful can be identified, including those relating to problem base, context placement, information gain, pragmatism, patient centeredness, value for money, feasibility, and transparency.

                  Many studies, even in the major general medical journals, do not satisfy these features, and very few studies satisfy most or all of them. Most clinical research therefore fails to be useful not because of its findings but because of its design.

                  The forces driving the production and dissemination of nonuseful clinical research are largely identifiable and modifiable.

                  Reform is needed. Altering our approach could easily produce more clinical research that is useful, at the same or even at a massively reduced cost.
                  via Mick Thacker @dibbygibby
                  Jo Bowyer
                  Chartered Physiotherapist Registered Osteopath.
                  "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                  Comment


                  • #39
                    Clinical Research – About Us or The Patient?

                    http://www.evidenceinmotion.com/blog...us-or-patient/

                    It is worth a look at the comments section on this one.
                    Jo Bowyer
                    Chartered Physiotherapist Registered Osteopath.
                    "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                    Comment


                    • #40
                      Whither the randomised controlled trial?

                      https://www.sciencebasedmedicine.org...linical-trial/

                      One of the most frequent complaints about evidence-based medicine (EBM), in contrast to science-based medicine (SBM), is its elevation of the randomized clinical trial as the be-all and end-all for clinical evidence for an intervention for a particular disease or condition. Unknown but enormous quantities of “digital ink” have been spilled explaining this distinction right here on this blog, beginning with our founder’s very first post, continuing with Kimball Atwood’s series of posts explaining the shortcomings of EBM’s reliance on clinical trials über alles using homeopathy as his example, to my referring to this aspect of EBM as “methodolatry,” defined as profane worship of the randomized controlled clinical trial (RCT) as the only valid method of clinical investigation. The problem, of course, with methodolatry, is that it completely ignores prior plausibility, and when that prior plausibility is as close to zero as you can imagine (e.g., for clinical trials of homeopathy), then the only positive results that you see in such trials can reasonably be concluded to be due to noise, shortcomings in trial design, and bias. Unfortunately, a failure to realize this has led to many pointless clinical trials and contributed to the rise of a whole new “specialty” known as integrative medicine, dedicated to “integrating” quackery and pseudoscience into science-based medicine.

                      So we know that practitioners of “complementary and alternative medicine” (CAM), now referred to more frequently as integrative medicine, don’t like RCTs. They love pragmatic trials, because such trials are usually unblinded, often not randomized, and generally face a lower bar of evidence. That pragmatic trials are intended to test the “real world” use of medical and surgical interventions that have already been shown to be safe and effective in RCTs and that the vast majority of CAM nostrums have not met that standard appears not to concern them in the least. However, CAM practitioners are not the only ones critical of RCTs, as I learned when, via Steve Novella, I came across an article in The New England Journal of Medicine entitled “Assessing the Gold Standard — Lessons from the History of RCTs” by Bothwell et al. Given that the article is two weeks old, I wonder how I missed it. Be that as it may, although Bothwell et al make some good points, I tend to agree with Steve that the overall gist of the article is overly critical, to the point of, as Steve put it, portraying the RCT as broken rather than flawed and advocating revolution rather than reform.
                      Jo Bowyer
                      Chartered Physiotherapist Registered Osteopath.
                      "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                      Comment


                      • #41
                        Spinal mobilization vs conventional physiotherapy in the management of chronic low back pain due to spinal disk degeneration: a randomized controlled trial

                        http://www.tandfonline.com/eprint/6P...euWIidAj5/full

                        Abstract
                        Objectives: The aim of the study was to examine the efficacy of spinal mobilization in subjects with low back pain (LBP) and associated spinal disk degeneration.
                        Methods: Seventy-five subjects suffering from chronic LBP (>3 months) were randomly allocated into 3 groups of 25 subjects each. Each group received five treatment sessions with the first group receiving manual therapy (MT) (spinal mobilization), the second a sham treatment, and the third conventional physiotherapy (CP) (stretching exercises, transcutaneous electrical nerve stimulation, and massage). Subjects were assessed for their pain intensity using the numerical pain rating scale and for their self-reported disability using the Oswestry and Roland-Morris Questionnaire at baseline and after the completion of the five treatment sessions.
                        Results: Paired t-tests showed a significant improvement for all outcome measures in the MT and CP group (p < 0.05). Analysis of covariance revealed that the MT group had significant improvement in all outcome measures in comparison with the sham and CP group (p < 0.05), whereas no significant difference was observed between the sham and CP group (p > 0.05).
                        Discussion: MT is preferable to CP in order to reduce the pain intensity and disability in subjects with chronic LBP and associated disk degeneration. The findings of this study may lead to the establishment of spinal mobilization as one of the most preferable approaches for the management of LBP due to disk degeneration.
                        via Colette Ridehalgh @CR19Colette
                        Jo Bowyer
                        Chartered Physiotherapist Registered Osteopath.
                        "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                        Comment


                        • #42
                          How Well Do Randomized Controlled Trials Reflect Standard Care: A Comparison between Scientific Research Data and Standard Care Data in Patients with Intermittent Claudication.....

                          http://journals.plos.org/plosone/art...l.pone.0157921

                          Abstract

                          Objective

                          The aim of the present study was to assess the degree and impact of patient selection of patients with intermittent claudication undergoing supervised exercise therapy in Randomized Controlled Trials (RCTs) by describing commonly used exclusion criteria, and by comparing baseline characteristics and treatment response measured as improvement in maximum walking distance of patients included in RCTs and patients treated in standard care.

                          Methods

                          We compared data from RCTs with unselected standard care data. First, we systematically reviewed RCTs that investigated the effect of supervised exercise therapy in patients with intermittent claudication. For each of the RCTs, we extracted and categorized the eligibility criteria and their justifications. To assess whether people in RCTs (n = 1,440) differed from patients treated in daily practice (n = 3,513), in terms of demographics, comorbidity and walking capacity, we assessed between group-differences using t-tests. To assess differences in treatment response, we compared walking distances at three and six months between groups using t-tests. Differences of ≥15% were set as a marker for a clinically relevant difference.

                          Results

                          All 20 included RCTs excluded large segments of patients with intermittent claudication. One-third of the RCTs eligibility criteria were justified. Despite, the numerous eligibility criteria, we found that baseline characteristics were largely comparable. A statistically significant and (borderline) clinically relevant difference in treatment response after three and six months between trial participants and standard care patients was found. Improvements in maximum walking distance after three and six months were significantly and clinically less in trial participants.

                          Conclusions

                          The finding that baseline characteristics of patients included in RCTs and patients treated in standard care were comparable, may indicate that RCT eligibility criteria are used implicitly by professionals when referring patients to standard physiotherapy care. The larger treatment response reported in standard physiotherapy care compared to clinical trials, might suggest that scientific studies underestimate the benefits of supervised exercise therapy in patients with intermittent claudication.
                          Jo Bowyer
                          Chartered Physiotherapist Registered Osteopath.
                          "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                          Comment


                          • #43
                            Arthritis Research UK Musculoskeletal Health Questionnaire (MSK-HQ)

                            http://www.arthritisresearchuk.org/p...tionnaire.aspx

                            What is the MSK-HQ?

                            The MSK-HQ is a short questionnaire that allows people with musculoskeletal conditions (such as arthritis or back pain) to report their symptoms and quality of life in a standardised way.

                            It was developed jointly by the Arthritis Research UK Primary Care Sciences Research Centre at Keele University and the University of Oxford, co-produced with active participation and feedback from people with arthritis and musculoskeletal conditions, clinicians and academics.

                            The purpose of the work was to develop holistic indicators that reflect how well services improve quality of life for people with musculoskeletal conditions, such as arthritis or back pain. The MSK-HQ instrument is designed to be used across different musculoskeletal care pathways in different healthcare settings.
                            via @hopinlee
                            Jo Bowyer
                            Chartered Physiotherapist Registered Osteopath.
                            "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                            Comment


                            • #44
                              Impact of biomedical and biopsychosocial training sessions on the attitudes, beliefs, and recommendations of health care providers about low back pain: a randomised clinical trial.

                              https://www.somasimple.com/forums/ne...ote=1&p=220505

                              Abstract
                              The beliefs and attitudes of health care providers may contribute to chronic low back pain (LBP) disability, influencing the recommendations that they provide to their patients. An excessively biomedical style of undergraduate training can increase negative beliefs and attitudes about LBP, whereas instruction following a biopsychosocial model could possibly lessen these negative beliefs in health care professionals. The objectives of this study were to determine the effectiveness of 2 brief educational modules with different orientations (biomedical or biopsychosocial) on changing the beliefs and attitudes of physical therapy students and the recommendations that they give to patients. The intervention in the experimental group was based on the general biopsychosocial model, whereas the sessions in the control group dealt with the basics of the biomechanics of back pain. The participants completed the Fear-Avoidance Beliefs Questionnaire (FABQ), Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS), and Rainville et al. Clinical Cases questionnaire before and after the interventions. The participants attending the biopsychosocial session displayed a reduction in fear-avoidance beliefs (P<.001) and Pain-Impairement beliefs (P<.001), which was strongly correlated with an improvement in clinicians' activity and work recommendations. However, the students assigned to the biomechanics sessions increased their fear-avoidance scores (P<.01), and their recommendations for activity levels worsened significantly (P<.001). Our results confirm the possibility of modifying the behaviour of students through the modification of their beliefs and attitudes. We also conclude that a strictly biomedical education exacerbates maladaptive beliefs, and consequently results in inadequate activity recommendations. The implications of this study are important for both the development of continuing medical education and the design of the training curriculum for undergraduate students.
                              via @DavidRHerdman
                              Jo Bowyer
                              Chartered Physiotherapist Registered Osteopath.
                              "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                              Comment


                              • #45
                                Transparent reporting for reproducible science

                                http://onlinelibrary.wiley.com/enhan...b90812fbcc3fa3

                                The inability to reproduce key scientific results is a growing concern among scientists, funding agencies, academic journals and the public (Begley and Ellis 2012; Prinz et al. 2011). Studies examining research practices in neuroscience and other fields have highlighted problems with study design (Button et al. 2013), inadequate reporting of methods and results (Baker et al. 2014), and errors in statistical analyses (Lazic 2010; Strasak et al. 2007) and data visualization (Weissgerber et al. 2015). Each of these factors may contribute to irreproducibility. These observations have sparked discussion about the respective roles and responsibilities of authors, peer reviewers and journals in improving the quality of scientific literature (Nature Editorial, 2013; Nature Medicine Editorial, 2016; Collins and Tabak 2014; Landis et al. 2012).

                                In principle, one can distinguish between efforts to improve the quality of the research itself and initiatives aimed at improving the quality of scientific reporting. In practice, however, these two factors are often intertwined. Initiatives and guidelines designed to improve the quality of research often contain recommendations for investigators at all stages of the research process, including preparing manuscripts for publication. Without following these recommendations, authors might inadvertently omit critical details when describing their methods and results, which could render even an excellent study to appear as low quality.

                                The Journal of Neuroscience Research is introducing new policies, which are designed to ensure that papers contain essential information that reviewers and readers need to evaluate published studies. By having authors report complete, accurate and transparent scientific methods and statistical results; this policy will reduce inadequacies in experimental reporting and improve reproducibility and replication. These policy changes are in line with the National Institutes of Health Principles and Guidelines for Reporting Preclinical Research (NIHPG). This editorial provides an overview of these policies and highlights other resources that may help scientists to improve the quality of research and scientific data reporting.
                                Jo Bowyer
                                Chartered Physiotherapist Registered Osteopath.
                                "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                                Comment

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