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  • #46
    Predictors of persistent pain after breast cancer surgery: a systematic review and meta-analysis of observational studies

    http://www.cmaj.ca/content/early/2016/07/11/cmaj.151276

    Abstract

    Background: Persistent pain after breast cancer surgery affects up to 60% of patients. Early identification of those at higher risk could help inform optimal management. We conducted a systematic review and meta-analysis of observational studies to explore factors associated with persistent pain among women who have undergone surgery for breast cancer.

    Methods: We searched the MEDLINE, Embase, CINAHL and PsycINFO databases from inception to Mar. 12, 2015, to identify cohort or case-control studies that explored the association between risk factors and persistent pain (lasting ≥ 2 mo) after breast cancer surgery. We pooled estimates of association using random-effects models, when possible, for all independent variables reported by more than 1 study. We reported relative measures of association as pooled odds ratios (ORs) and absolute measures of association as the absolute risk increase.

    Results: Thirty studies, involving a total of 19 813 patients, reported the association of 77 independent variables with persistent pain. High-quality evidence showed increased odds of persistent pain with younger age (OR for every 10-yr decrement 1.36, 95% confidence interval [CI] 1.24-1.48), radiotherapy (OR 1.35, 95% CI 1.16-1.57), axillary lymph node dissection (OR 2.41, 95% CI 1.73-3.35) and greater acute postoperative pain (OR for every 1 cm on a 10-cm visual analogue scale 1.16, 95% CI 1.03-1.30). Moderate-quality evidence suggested an association with the presence of preoperative pain (OR 1.29, 95% CI 1.01-1.64). Given the 30% risk of pain in the absence of risk factors, the absolute risk increase corresponding to these ORs ranged from 3% (acute postoperative pain) to 21% (axillary lymph node dissection). High-quality evidence showed no association with body mass index, type of breast surgery, chemotherapy or endocrine therapy.

    Interpretation: Development of persistent pain after breast cancer surgery was associated with younger age, radiotherapy, axillary lymph node dissection, greater acute postoperative pain and preoperative pain. Axillary lymph node dissection provides the only high-yield target for a modifiable risk factor to prevent the development of persistent pain after breast cancer surgery.
    Jo Bowyer
    Chartered Physiotherapist Registered Osteopath.
    "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

    Comment


    • #47
      We need to talk about the bad science being funded

      https://theconversation.com/we-need-...g-funded-61916

      Spectacular failures to replicate key scientific findings have been documented of late, particularly in biology, psychology and medicine.

      A report on the issue, published in Nature this May, found that about 90% of some 1,576 researchers surveyed now believe there is a reproducibility crisis in science.

      While this rightly tarnishes the public belief in science, it also has serious consequences for governments and philanthropic agencies that fund research, as well as the pharmaceutical and biotechnology sectors. It means they could be wasting billions of dollars on research each year.

      One contributing factor is easily identified. It is the high rate of so-called false discoveries in the literature. They are false-positive findings and lead to the erroneous perception that a definitive scientific discovery has been made.

      This high rate occurs because the studies that are published often have low statistical power to identify a genuine discovery when it is there, and the effects being sought are often small.

      Further, dubious scientific practices boost the chance of finding a statistically significant result, usually at a probability of less than one in 20. In fact, our probability threshold for acceptance of a discovery should be more stringent, just as it is for discoveries of new particles in physics.

      The English mathematician and the father of computing Charles Babbage noted the problem in his 1830 book Reflections on the Decline of Science in England, and on Some of Its Causes. He formally split these practices into “hoaxing, forging, trimming and cooking”.
      Jo Bowyer
      Chartered Physiotherapist Registered Osteopath.
      "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

      Comment


      • #48
        Proposed Training to Meet Challenges of Large-Scale Data in Neuroscience

        http://journal.frontiersin.org/artic...016.00028/full

        Introduction
        Large-scale brain genomics has already made a significant impact on neuroscience (Insel et al., 2004), and big data have the potential to change the process of discovery in neuroscience as it has in mathematics, astronomy, and genetics (Nielsen, 2011). Although data in neuroscience is being produced at ever larger scales, the promise of this large-scale data can only be realized by having a workforce adequately trained to meet its challenges. The scale of data being considered by current initiatives creates challenges that outstrip conventional ways of handling, considering, and analyzing data (see Priorities for Accelerating Neuroscience Research Through Enhanced Communication, Coordination, and Collaboration3). Large-scale neuroscience projects emerging around the world—such as the European Commission Human Brain Project4 and the White House BRAIN Initiative5—demand big data neuroinformatics approaches. These approaches include multi-scale integration of the dynamic activity and structure of the brain, brain simulation, quantitative theory and modeling of brain function, neurotechnology and research infrastructure, neuromorphic computing, theoretical neuroscience, and large-scale brain activity maps (Insel et al., 2013).

        Big data projects create significant computational challenges and require the development and deployment of new methods, algorithms, and tools for visualization, analysis, and data mining. Further, big data entails sharing and amalgamating data, which requires ontogenies, standards, and ontologies to link, describe, and maintain data in usable fashions. The field of neuroscience faces particular challenges due to the multi-scale nature of the data and the need to integrate across many sub-domains and species. Integration and indexing data across scales and complex data repositories is essential to identify meaningful patterns and to enable researchers to build efficiently upon prior work. At present, there are few programs worldwide that are geared toward properly training students to meet these challenges.

        The next generation workforce will be dealing with this large-scale data and therefore needs the appropriate skills and knowledge to fulfill these roles. Key players such as the National Science Foundation (NSF) and International Neuroinformatics Coordinating Facility (INCF) see workforce development as an essential element in realizing the exciting potential of big data in neuroscience.

        Inspired by the efforts and priorities of the European Commission Human Brain Project and the White House BRAIN Initiative, an NSF-sponsored workshop, called iNeuro Project, with more than 35 participants was convened in Arlington, VA, USA, November 13–14, 2014 to address the need for training in this aspect of neuroinformatics. This workshop brought together purveyors of large-scale data resources, individuals involved with bioinformatics training, library and information scientists, computer scientists, neuroscience educators, INCF and NSF officers, and other scientific collaborators focused on dealing with the human capital needs posed by large-scale data in neuroscience. Here we report on the discussions of this workshop both to inform the community and as a call to action to develop programs to educate and train the workforce needed to fulfill the potential of big data.

        This workshop was designed to: (1) obtain a statement of the problem from various perspectives; (2) discern where we are now in terms of training this future workforce; (3) decide what desired skill sets will be needed in the future; (4) discern the curricular mix needed to impart the desired skill sets; (5) discuss whether existing training programs can serve as models for the desired training or whether these programs would have to be developed de novo; (6) discuss the strengths and weaknesses of those proposed training programs; and (7) plan for next steps. The full workshop report is available from iNeuro Project2.


        Science has outgrown the human mind and its limited capacities

        https://aeon.co/ideas/science-has-ou...f0226-69418129



        Cometh the man; Francis Bacon's insight was that the process of discovery was inherently algorithmic.

        The duty of man who investigates the writings of scientists, if learning the truth is his goal, is to make himself an enemy of all that he reads and … attack it from every side. He should also suspect himself as he performs his critical examination of it, so that he may avoid falling into either prejudice or leniency.

        – Ibn al-Haytham (965-1040 CE)
        Science is in the midst of a data crisis. Last year, there were more than 1.2 million new papers published in the biomedical sciences alone, bringing the total number of peer-reviewed biomedical papers to over 26 million. However, the average scientist reads only about 250 papers a year. Meanwhile, the quality of the scientific literature has been in decline. Some recent studies found that the majority of biomedical papers were irreproducible.

        The twin challenges of too much quantity and too little quality are rooted in the finite neurological capacity of the human mind. Scientists are deriving hypotheses from a smaller and smaller fraction of our collective knowledge and consequently, more and more, asking the wrong questions, or asking ones that have already been answered. Also, human creativity seems to depend increasingly on the stochasticity of previous experiences – particular life events that allow a researcher to notice something others do not. Although chance has always been a factor in scientific discovery, it is currently playing a much larger role than it should.

        One promising strategy to overcome the current crisis is to integrate machines and artificial intelligence in the scientific process. Machines have greater memory and higher computational capacity than the human brain. Automation of the scientific process could greatly increase the rate of discovery. It could even begin another scientific revolution. That huge possibility hinges on an equally huge question: can scientific discovery really be automated?
        Update 24/04/2017
        Last edited by Jo Bowyer; 24-04-2017, 01:54 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


        • #49
          I'd Do Anything for Research, But I Won't Do That: Interest in Pharmacological Interventions in Older Adults Enrolled in a Longitudinal Aging Study

          http://journals.plos.org/plosone/art...l.pone.0159664

          Abstract

          Alzheimer’s disease (AD) ranks as the 6th leading cause of death in the United States, yet unlike other diseases in this category, there are no disease-modifying medications for AD. Currently there is significant interest in exploring the benefits of pharmacological treatment before the onset of dementia (e.g., in those with mild cognitive impairment); however, recruitment for such studies is challenging. The current study examined interest in pharmacological intervention trials relative to other types of clinical interventions. A total of 67 non-demented older adults enrolled in a longitudinal cognitive aging study completed a questionnaire assessing interest in participating in a variety of hypothetical research study designs. Consistent with past research, results showed that the opportunities for participants to advance science, receive feedback about their current health, and help themselves or others, were associated with increased interest in clinical trial participation. Some factors were not associated with change in interest (e.g., a doctor not recommending participation) while others were associated with decreased interest (e.g., having to come in for multiple visits each week). Relative to other types of interventions, pharmacological intervention trials were associated with the least interest in participation, despite pharmacological interventions being rated as more likely to result in AD treatment. Decreased interest was not predicted by subjective memory concerns, number of current medications, cardiovascular risk, or beliefs about the likely success of pharmacological treatments. These results highlight the challenges faced by researchers investigating pharmacological treatments in non-demented older individuals, and suggest future research could contribute to more effective ways of recruiting participants in AD-related clinical trials.
          Jo Bowyer
          Chartered Physiotherapist Registered Osteopath.
          "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

          Comment


          • #50
            Development and validation of a novel questionnaire for self-determination of the range of motion of wrist and elbow

            http://bmcmusculoskeletdisord.biomed...891-016-1171-z

            Abstract

            Background
            The aim of this study was to develop and validate a novel self-administered questionnaire for assessing the patient’s own range of motion (ROM) of the wrist and the elbow.

            Methods
            In a prospective clinical study from January 2015 to June 2015, 101 consecutive patients were evaluated with a novel, self-administered, diagram-based, wrist motion assessment score (W-MAS) and elbow motion assessment score (E-MAS). The questionnaire was statistically evaluated for test-retest reliability, patient-physician agreement, comparison with healthy population, and influence of covariates (age, gender, affected side and involvement in workers’ compensation cases).

            Results
            Assessment of patient-physician agreement demonstrated almost perfect agreement (k > 0.80) with regard to six out of eight items. There was substantial agreement with regard to two items: elbow extension (k = 0.76) and pronation (k = 0.75). The assessment of the test-retest reliability revealed at least substantial agreement (k = 0.70). The questionnaire revealed a high discriminative power when comparing the healthy population with the study group (p = 0.007 or lower for every item). Age, gender, affected side and involvement in workers’ compensation cases did not in general significantly influence the patient-physician agreement for the questionnaire.

            Conclusion
            The W-MAS and E-MAS are valid and reliable self-administered questionnaires that provide a high level of patient-physician agreement for the assessments of wrist and elbow ROM.
            Level of evidence: Diagnostic study, Level II

            Keywords

            Self-assessment Measurement tool Validity Reliability Range of motion Wrist Elbow Questionnaire
            Jo Bowyer
            Chartered Physiotherapist Registered Osteopath.
            "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

            Comment


            • #51
              Study protocol for a multicentre randomized controlled trial on effectiveness of an outpatient multimodal rehabilitation program for adolescents with chronic musculoskeletal pain (2B Active)

              http://bmcmusculoskeletdisord.biomed...891-016-1178-5

              Abstract

              Background
              Chronic musculoskeletal pain (CMP) in adolescents can influence functioning and well-being, and has negative consequences for families and society as well. According to the Fear Avoidance Model, fear of movement and pain catastrophizing can influence the occurrence and maintenance of chronic pain complaints and functional disability. Primary objective is to evaluate the effectiveness of a multimodal rehabilitation program in reducing functional disability for adolescents with CMP compared with care as usual.

              Methods/Design
              Pragmatic multicentre parallel group randomized controlled trial. Randomization by minimization (ratio 1:1) and treatment allocation will be concealed, computer-generated and performed by an independent organization. After randomization, data collection and researchers remain blinded. Inclusion of 124 adolescents and their parents is intended. This sample size is based on a 25 % difference in group mean on the primary outcome, with α = 5 %, β = 80 % and expected 15 % loss to follow up. Study population are adolescents (12–21 years) with CMP with an indication for outpatient rehabilitation treatment in the Netherlands.

              The intervention group receives a Multimodal Rehabilitation Program (MRP), a multidisciplinary outpatient individual rehabilitation program. MRP consists of 2 different treatment approaches: A graded exposure module or a combination module of graded exposure and physical training. Selection of a module depends on the needs of the patient. To both modules a parent module is added. The control group receives care as usual, which is the care currently provided in Dutch rehabilitation centres. Treatment duration varies between 7 and 16 weeks, depending on treatment allocation.

              Self-reported measurements are at baseline, and at 2, 4, 10 and 12 months after start of treatment. Intention to treat analysis for between group differences on all outcome variables will be performed. Primary outcome is functional disability (Functional Disability Inventory). Secondary outcome variables are fear of pain, catastrophizing, perceived harmfulness, pain intensity, depressive symptoms, and quality of life. Total direct and indirect costs and health related quality of life will be measured. Process evaluation focuses on protocol adherence, patient centeredness and treatment expectations.

              Discussion
              A pragmatic approach was chosen, to ensure that results obtained are most applicable to daily practice.
              Trial registration
              Clinicaltrials.gov ID: NCT02181725 (7 February 2014).

              Funded by Fonds Nuts Ohra, Stichting Vooruit, and Adelante.

              Keywords

              Chronic pain adolescent Graded Exposure Therapy RCT Pragmatic Economic evaluation Rehabilitation
              Jo Bowyer
              Chartered Physiotherapist Registered Osteopath.
              "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

              Comment


              • #52
                Mission Drift in Qualitative Research, or Moving Toward a Systematic Review of Qualitative Studies, Moving Back to a More Systematic Narrative Review

                http://www.nova.edu/ssss/QR/QR9-1/jones.pdf

                The paper argues that the systematic review of qualitative research is best served by reliance upon qualitative methods themselves. A case is made for strengthening the narrative literature review and using narrative itself as a method of review. A technique is proposed that builds upon recent developments in qualitative systematic review by the use of a narrative inductive method of analysis. The essence of qualitative work is described. The natural ability for issues of ethnicity and diversity to be investigated through a qualitative approach is elaborated. Recent developments in systematic review are delineated, including the Delphi and Signal and Noise techniques, inclusion of grey literature, scoping studies and meta-ethnography. A narrative inductive interpretive method to review qualitative research is proposed, using reflective teams to analyse documents. Narrative is suggested as a knowledge-generating method and its underlying hermeneutic approach is defended as providing validity and theoretical structure. Finally, qualities that distinguish qualitative research from more quantitative investigations are delineated. Starting points for reflecting on qualitative studies and their usefulness are listed.
                Key words: Qualitative Systematic Review, Evidence-Based Policy, Grey Literature, Scoping Studies, Delphi, ‘Signal and Noise’, Meta-ethnography, Narrative Review, Narrative Method, and Reflective Teams
                Jo Bowyer
                Chartered Physiotherapist Registered Osteopath.
                "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                Comment


                • #53
                  Effectiveness and Economic Evaluation of Chiropractic Care for the Treatment of Low Back Pain: A Systematic Review of Pragmatic Studies

                  http://journals.plos.org/plosone/art...l.pone.0160037

                  Abstract

                  Background Context

                  Low back pain (LBP) is one of the leading causes of disability worldwide and among the most common reasons for seeking primary sector care. Chiropractors, physical therapists and general practitioners are among those providers that treat LBP patients, but there is only limited evidence regarding the effectiveness and economic evaluation of care offered by these provider groups.

                  Purpose

                  To estimate the clinical effectiveness and to systematically review the literature of full economic evaluation of chiropractic care compared to other commonly used care approaches among adult patients with non-specific LBP.

                  Study Design

                  Systematic reviews of interventions and economic evaluations.

                  Methods

                  A comprehensive search strategy was conducted to identify 1) pragmatic randomized controlled trials (RCTs) and/or 2) full economic evaluations of chiropractic care for low back pain compared to standard care delivered by other healthcare providers. Studies published between 1990 and 4th June 2015 were considered. Primary outcomes included pain, functional status and global improvement. Study selection, critical quality appraisal and data extraction were conducted by two independent reviewers. Data from RCTs with low risk of bias were included in a meta-analysis to determine effect estimates. Cost estimates of full economic evaluations were converted to 2015 USD and results summarized using Slavin’s qualitative best-evidence synthesis.

                  Results

                  Six RCTs and three full economic evaluations were scientifically admissible. Five RCTs with low risk of bias compared chiropractic care to exercise therapy (n = 1), physical therapy (n = 3) and medical care (n = 1). Overall, we found similar effects for chiropractic care and the other types of care and no reports of serious adverse events. Three low to high quality full economic evaluations studies (one cost-effectiveness, one cost-minimization and one cost-benefit) compared chiropractic to medical care. Given the divergent conclusions (favours chiropractic, favours medical care, equivalent options), mixed-evidence was found for economic evaluations of chiropractic care compared to medical care.

                  Conclusion

                  Moderate evidence suggests that chiropractic care for LBP appears to be equally effective as physical therapy. Limited evidence suggests the same conclusion when chiropractic care is compared to exercise therapy and medical care although no firm conclusion can be reached at this time. No serious adverse events were reported for any type of care. Our review was also unable to clarify whether chiropractic or medical care is more cost-effective. Given the limited available evidence, the decision to seek or to refer patients for chiropractic care should be based on patient preference and values. Future studies are likely to have an important impact on our estimates as these were based on only a few admissible studies.


                  Unfortunately, very few studies met our inclusion criteria and all our effect estimates regarding primary and secondary outcomes came from one or two studies.
                  They started off with 4,095 articles !!!!!!!!!!!
                  Jo Bowyer
                  Chartered Physiotherapist Registered Osteopath.
                  "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                  Comment


                  • #54
                    The Association between the Cross-Sectional Area of the Dural Sac and Low Back Pain in a Large Population: The Wakayama Spine Study

                    http://journals.plos.org/plosone/art...l.pone.0160002

                    Abstract

                    Objective

                    The purpose of this study was to evaluate the relations between the degree of encroachment, measured as the cross-sectional area of the dural sac, and low back pain in a large population.

                    Methods

                    In this cross-sectional study, data from 802 participants (247 men, 555 women; mean age, 63.5 years) were analyzed. The measurement of the cross-sectional area of the dural sac from the level of L1/2 to L4/5 was taken using axial T2-weighted images. The minimum cross-sectional area was defined as the cross-sectional area of the dural sac at the most constricted level in the examined spine. Participants were divided into three groups according to minimum cross-sectional area measurement quartiles (less than the first quartile, between the first and third quartiles, and greater than the third quartile). A multivariate logistic regression analysis was used to estimate the association between the minimum cross-sectional area and the prevalence of low back pain.

                    Results

                    The mean minimum cross-sectional area was 117.3 mm2 (men: 114.4 mm2; women: 118.6 mm2). A logistic regression analysis adjusted for age, sex, body mass index, and other confounding factors, including disc degeneration, showed that a narrow minimum cross-sectional area (smaller than the first quartile) was significantly associated with low back pain (odds ratio, 1.78; 95% confidence interval, 1.13–2.80 compared to the wide minimum cross-sectional area group: minimum cross-sectional area greater than the third quartile measured).

                    Conclusion

                    This study showed that a narrow dural sac cross-sectional area was significantly associated with the presence of low back pain after adjustment for age, sex, and body mass index. Further investigations that include additional radiographic findings and psychological factors will continue to elucidate the causes of low back pain.

                    Introduction
                    Low back pain (LBP) is a multifactorial symptom, a common cause of morbidity and disability, and was reported to have a prevalence of 28.5% in a recent study [1,2]. There are many causes of chronic LBP, one of which is lumbar spinal stenosis (LSS) [3]. According to the Evidence-Based Clinical Guidelines for Multidisciplinary Spine Care developed by The North American Spine Society [4], degenerative LSS describes a condition in which there is diminished space available for the neural and vascular elements in the lumbar spine secondary to degenerative changes in the spinal canal. When symptomatic, this condition causes a variable clinical syndrome of gluteal and/or lower-extremity pain and/or fatigue, which may occur with or without back pain. In reality, however, 67.5%–95% of patients with LSS experience LBP [5–7].

                    LBP in patients with LSS is also multifactorial. Patients with LSS often have facet arthrosis and degenerative discs. These pathologies may explain their back pain. Earlier findings from preoperative imaging studies of patients with central spinal stenosis have suggested that the cross-sectional area (CSA) of the dural sac was closely related to preoperative walking ability, health-related quality of life, leg pain, and LBP [8–10]. Recent studies have also reported the possibility of improving LBP following decompression surgery [11,12]. Thus, it is possible that constriction of the dural sac is also the cause of LBP in LSS patients.
                    Jo Bowyer
                    Chartered Physiotherapist Registered Osteopath.
                    "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                    Comment


                    • #55
                      Frontiers reviewer told: don’t be strict, endorse paper, reports Giulia Liberati

                      https://forbetterscience.wordpress.c...ulia-liberati/

                      Journal peer review is a mysterious black box all scientists fear. The task of the reviewers is to help authors to improve their manuscripts scientifically and to help journal editors to weed out scientifically substandard and inappropriate works. That’s the theory anyway, in practice there are good reasons why the peer review process is traditionally something to be hidden by all means from the readers of published papers. Probably to avoid occasional shock, disgust and repulsion, similar to how the supermarket customers should by no means be made aware of the true origins of industrially raised meat. In a kind of a vicious circle, this peer review secrecy is a direct invitation to rig it even more. Editors tend to assign friendly reviewers according to authors’ eminence, while peer reviewer conflicts of interests are routinely disregarded, since no one will ever find out anyway. In the same vein, scientists who made themselves some powerful enemies will see their manuscripts destroyed by unreasonable and aggressive peer review. They often naively hope the editor was decent enough not to invite those same adversaries whom the authors specifically asked to be excluded.

                      There is even good money to be made from gaming the peer review process. The subscription publisher Taylor & Francis offers manuscript authors premium peer review services: 300€ per page for rapid peer review, with 5-6 weeks “submission to acceptance” and €635 per page for “fast track”, which basically guarantees you to publish your paper in only 3 weeks latest. Now imagine if you paid Taylor & Francis €2000 for a 3-page manuscript, only to get rejected in fast track process- would this make any sense at all? The system can obviously only work to everyone’s satisfaction if all pay-per-peer-review papers are accepted without any hustle or demand for extra experiments in the prepaid time.
                      Jo Bowyer
                      Chartered Physiotherapist Registered Osteopath.
                      "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                      Comment


                      • #56
                        "I Just Don't Believe Those Results.

                        http://blogs.discovermagazine.com/ne.../#.V6iKHFQrIdV

                        Are some scientific results so unexpected that we should just reject them?

                        This is something I’ve been wondering recently. It’s one thing to disbelieve a study because there are problems with the methods used. But is it scientifically valid to judge a study by its results alone, even if you don’t know of any methodological flaws?
                        Jo Bowyer
                        Chartered Physiotherapist Registered Osteopath.
                        "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                        Comment


                        • #57
                          Is One Trial Sufficient to Obtain Excellent Pressure Pain Threshold Reliability in the Low Back of Asymptomatic Individuals? A Test-Retest Study

                          http://journals.plos.org/plosone/art...l.pone.0160866

                          Abstract

                          The assessment of pressure pain threshold (PPT) provides a quantitative value related to the mechanical sensitivity to pain of deep structures. Although excellent reliability of PPT has been reported in numerous anatomical locations, its absolute and relative reliability in the lower back region remains to be determined. Because of the high prevalence of low back pain in the general population and because low back pain is one of the leading causes of disability in industrialized countries, assessing pressure pain thresholds over the low back is particularly of interest. The purpose of this study study was (1) to evaluate the intra- and inter- absolute and relative reliability of PPT within 14 locations covering the low back region of asymptomatic individuals and (2) to determine the number of trial required to ensure reliable PPT measurements. Fifteen asymptomatic subjects were included in this study. PPTs were assessed among 14 anatomical locations in the low back region over two sessions separated by one hour interval. For the two sessions, three PPT assessments were performed on each location. Reliability was assessed computing intraclass correlation coefficients (ICC), standard error of measurement (SEM) and minimum detectable change (MDC) for all possible combinations between trials and sessions. Bland-Altman plots were also generated to assess potential bias in the dataset. Relative reliability for both intra- and inter- session was almost perfect with ICC ranged from 0.85 to 0.99. With respect to the intra-session, no statistical difference was reported for ICCs and SEM regardless of the conducted comparisons between trials. Conversely, for inter-session, ICCs and SEM values were significantly larger when two consecutive PPT measurements were used for data analysis. No significant difference was observed for the comparison between two consecutive measurements and three measurements. Excellent relative and absolute reliabilities were reported for both intra- and inter-session. Reliable measurements can be equally achieved when using the mean of two or three consecutive PPT measurements, as usually proposed in the literature, or with only the first one. Although reliability was almost perfect regardless of the conducted comparison between PPT assessments, our results suggest using two consecutive measurements to obtain higher short term absolute reliability.
                          Jo Bowyer
                          Chartered Physiotherapist Registered Osteopath.
                          "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                          Comment


                          • #58
                            The Qualification of Outcome after Cervical Spine Surgery by Patients Compared to the Neck Disability Index

                            http://journals.plos.org/plosone/art...l.pone.0161593

                            Abstract

                            Objective

                            The Neck Disability Index (NDI) is a patient self-assessed outcome measurement tool to assess disability, and that is frequently used to evaluate the effects of the treatment of neck-related problems. In individualized medicine it is mandatory that patients can interpret data in order to choose a treatment. A change of NDI or an absolute NDI is generally meaningless to a patient. Therefore, a correlation between the qualification of the clinical situation rated by the patient and the NDI score was evaluated.

                            Methods

                            Patients who completed an NDI after anterior surgery because of symptomatic single level degenerative cervical disc disease were asked one month after completion of the NDI to qualify their clinical situation of a 5-item Likert scale varying from excellent to bad. Since a clear distinction between the categories was not possible based on the total NDI score, a ROC-curve was built, and the AUC computed in order to estimate best dichotomization in qualification of the clinical situation. The best corresponding cut-off point for the NDI total score was found by studying sensitivity and specificity for all possible cut-off points.

                            Results

                            102 patients were included. The highest AUC was obtained by dichotomizing the qualification into a group with good outcome and less-good outcome. The highest sensitivity and specificity for the dichotomized qualification as good outcome corresponded to a NDI ≤ 7. Sensitivity was 81.08% and specificity was 78.57%.

                            Conclusion

                            This is the first study that correlated the qualification of the situation by the patients themselves and NDI. An NDI ≤ 7 corresponded to a good outcome according to the patients. This is valuable information to inform patients in their decision for any treatment.
                            Jo Bowyer
                            Chartered Physiotherapist Registered Osteopath.
                            "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                            Comment


                            • #59
                              Evaluation of a risk-stratification strategy to improve primary care for low back pain: the MATCH cluster randomized trial protocol

                              http://bmcmusculoskeletdisord.biomed...891-016-1219-0

                              Abstract

                              Background
                              Despite numerous options for treating back pain and the increasing healthcare resources devoted to this problem, the prevalence and impact of back pain-related disability has not improved. It is now recognized that psychosocial factors, as well as physical factors, are important predictors of poor outcomes for back pain. A promising new approach that matches treatments to the physical and psychosocial obstacles to recovery, the STarT Back risk stratification approach, improved patients’ physical function while reducing costs of care in the United Kingdom (UK). This trial evaluates implementation of this strategy in a United States (US) healthcare setting.

                              Methods
                              Six large primary care clinics in an integrated healthcare system in Washington State were block-randomized, three to receive an intensive quality improvement intervention for back pain and three to serve as controls for secular trends. The intervention included 6 one-hour training sessions for physicians, 5 days of training for physical therapists, individualized and group coaching of clinicians, and integration of the STarT Back tool into the electronic health record. This prognostic tool uses 9 questions to categorize patients at low, medium or high risk of persistent disabling pain with recommendations about evidence-based treatment options appropriate for each subgroup. Patients at least 18 years of age, receiving primary care for non-specific low back pain, were invited to provide data 1–3 weeks after their primary care visit and follow-up data 2 months and 6 months (primary endpoint) later. The primary outcomes are back-related physical function and pain severity. Using an intention to treat approach, intervention effects on patient outcomes will be estimated by comparing mean changes at the 2 and 6 month follow-up between the pre- and post-implementation periods. The inclusion of control clinics permits adjustment for secular trends. Differences in change scores by intervention group and time period will be estimated using linear mixed models with random effects. Secondary outcomes include healthcare utilization and adherence to clinical guidelines.

                              Discussion
                              This trial will provide the first randomized trial evidence of the clinical effectiveness of implementing risk stratification with matched treatment options for low back pain in a United States health care delivery system.



                              Restriction in lateral bending range of motion, lumbar lordosis, and hamstring flexibility predicts the development of low back pain: a systematic review of prospective cohort studies

                              https://bmcmusculoskeletdisord.biome...891-017-1534-0

                              Background
                              Low back pain (LBP) is an increasingly common condition worldwide with significant costs associated with its management. Identification of musculoskeletal risk factors that can be treated clinically before the development of LBP could reduce costs and improve the quality of life of individuals. Therefore the aim was to systematically review prospective cohort studies investigating lower back and / or lower limb musculoskeletal risk factors in the development of LBP.

                              Methods
                              MEDLINE, EMBASE, AMED, CINAHL, SPORTDiscus, and the Cochrane Library were searched from inception to February 2016. No age, gender or occupational restrictions of participants were applied. Articles had to be published in English and have a 12 month follow-up period. Musculoskeletal risk factors were defined as any osseous, ligamentous, or muscular structure that was quantifiably measured at baseline. Studies were excluded if participants were pregnant, diagnosed with cancer, or had previous low back surgery. Two authors independently reviewed and selected relevant articles. Methodological quality was evaluated independently by two reviewers using a generic tool for observational studies.

                              Results
                              Twelve articles which evaluated musculoskeletal risk factors for the development of low back pain in 5459 participants were included. Individual meta-analyses were conducted based on risk factors common between studies. Meta-analysis revealed that reduced lateral flexion range of motion (OR = 0.41, 95% CI 0.24-0.73, p = 0.002), limited lumbar lordosis (OR = 0.73, 95% CI 0.55-0.98, p = 0.034), and restricted hamstring range of motion (OR = 0.96, 95% CI 0.94-0.98, p = 0.001) were significantly associated with the development of low back pain. Meta-analyses on lumbar extension range of motion, quadriceps flexibility, fingertip to floor distance, lumbar flexion range of motion, back muscle strength, back muscle endurance, abdominal strength, erector spinae cross sectional area, and quadratus lumborum cross sectional area showed non-significant results.

                              Conclusion
                              In summary, we found that a restriction in lateral flexion and hamstring range of motion as well as limited lumbar lordosis were associated with an increased risk of developing LBP. Future research should aim to measure additional lower limb musculoskeletal risk factors, have follow up periods of 6-12 months, adopt a standardised definition of LBP, and only include participants who have no history of LBP.
                              Keywords

                              Low back pain Systematic review Risk factors Prospective cohort studies Meta-analysis

                              Update 06/05/2017
                              Last edited by Jo Bowyer; 06-05-2017, 11:33 AM.
                              Jo Bowyer
                              Chartered Physiotherapist Registered Osteopath.
                              "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                              Comment


                              • #60
                                Originally posted by Jo Bowyer View Post
                                http://blogs.discovermagazine.com/ne.../#.V6iKHFQrIdV

                                Are some scientific results so unexpected that we should just reject them?

                                This is something I’ve been wondering recently. It’s one thing to disbelieve a study because there are problems with the methods used. But is it scientifically valid to judge a study by its results alone, even if you don’t know of any methodological flaws?
                                Thanks for sharing Jo!
                                IMO unexpected results should make us think, hard, they shouldn't be rejected nor ignored. They can be valuable in that way; by helping us come up with other possible explanations or help us update our prior explanations to better fit reallity.

                                To answer your question. I'm not sure if I think it's valid to judge a study by it's results alone, but we should be critical to apply it's results, because of Bayes (which the author mentions). Bayes is the reason we should be critical of study results contradicting multiple earlier studies. One study is just one part of the total evidence base, which should be what makes up my priors.

                                With that said, it doesn't seem like many of us use it this way. We don't apply Bayes, we judge, ignore or disbelieve study results that doesn't fit our biases. That's certainly not valid!
                                Last edited by mortene; 04-09-2016, 09:26 AM. Reason: spelling
                                Morten

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