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Jones CA, Jessiman-Perreault G, Kania-Richmond A(A, Metcalfe A, Hart DA, Beaupre LA. The effect of geographic location and payor type on provincial-wide delivery of the GLA:D program for hip and knee osteoarthritis in Alberta, Canada. OSTEOARTHRITIS AND CARTILAGE OPEN 2023; 5:100398. [PMID: 37649533 PMCID: PMC10463251 DOI: 10.1016/j.ocarto.2023.100398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 09/01/2023] Open
Abstract
Objective The Good Life with osteoArthritis: Denmark (GLA:D™) program for knee and hip osteoarthritis has been shown to be effective, but evaluations have yet to explore whether effectiveness differs by program context. The present study explores whether there are differences in effectiveness of the GLA:D™ program for treatment of hip and knee osteoarthritis across program location (i.e., rural, urban, metro) and program payor (i.e., public, private) within Alberta, Canada. Design The study population was adults with hip or knee osteoarthritis attending the 8-week GLA:D™ supervised exercise and education programme in Alberta between Sep 2017-Mar 2020. Outcomes of interest were joint-related pain and quality of life (HOOS/KOOS), health quality of life (EQ-5D-5L), and performance-based functional (30-s chair stand test; 40-m walk test) measures. Minimally clinically important changes were calculated for each outcome and ANOVA and chi-square tests were used to determine statistical significance by program location or payor. Results Of the 1321 eligible participants, 974 (73.7%) completed the baseline questionnaire, about 50% of participants participated in a metro area and 60% paid privately for the program. There were no statistically significant differences in improvements of joint-related pain, joint-related quality of life, health-related quality of life, or performance-based functional measures by program location or program payor, except for participants who received the program in a publicly covered primary care clinic who experienced significantly larger improvements in joint-related pain. Conclusion The implementation of the GLA:D™ program for the treatment of knee and hip osteoarthritis in Alberta is effective across a range of contexts.
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Affiliation(s)
- C. Allyson Jones
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Ania (Anna) Kania-Richmond
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Amy Metcalfe
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - David A. Hart
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lauren A. Beaupre
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - the Bone and Joint Health SCN
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Suh TH, Avetisian H, Speechley J, Palmer JL, Bailey JD. Rare Reconstruction of Four Metatarsals Using Kirschner Wires After a Severe Crushing Injury: Surgical Decision Making and Prognosis. Cureus 2023; 15:e49318. [PMID: 38146548 PMCID: PMC10749425 DOI: 10.7759/cureus.49318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2023] [Indexed: 12/27/2023] Open
Abstract
Metatarsal fractures are one of the most common injuries after foot trauma. It is debilitating, as the metatarsals are one of the most crucial bones for any weight-bearing movement. This report demonstrates the beneficial outcome of using Kirschner wires (K-wires) in a trauma setting and the complicated healing process. A 56-year-old gentleman was brought into the emergency department after a reinforced cement pipe fell onto the patient's steel-toe boots, striking his left foot immediately proximal to the steel portion of the boot. The patient had sustained displaced comminuted fractures of the left second, third, fourth, and fifth metatarsals with an extensive open wound (Gustilo type II open fracture). Open reduction with internal fixation (ORIF) was performed using K-wires to restore and preserve the anatomical and functional integrity of the foot. Following the surgery, the patient developed a hammer toe of the left fifth metatarsophalangeal (MTP) joint two months after the ORIF; we performed resection arthroplasty to relieve discomfort and further aid the recovery process. Following the resection arthroplasty, eschar had formed at the surgical site, extending from the lateral aspect of the left foot to the plantar surface, for which we had performed a skin graft after excisional debridement of the necrotic tissue. After one year of close follow-ups with rigorous physical therapy exercises, the patient had a fair recovery process and is now able to ambulate without any assistive devices. As such, using K-wires remains a viable option for reducing misaligned metatarsal fractures and providing fairly good outcomes even in the setting of severe foot trauma.
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Affiliation(s)
- Thomas H Suh
- College of Medicine, Kirksville College of Osteopathic Medicine, Andrew Taylor Still University (A.T. Still University), Kirksville, USA
| | - Henry Avetisian
- College of Medicine, Jacobs School of Medicine and Biomedical Sciences at the University of Buffalo, Buffalo, USA
| | - Jacob Speechley
- College of Medicine, Kirksville College of Osteopathic Medicine, Andrew Taylor Still University (A.T. Still University), Kirksville, USA
| | - Jordan L Palmer
- College of Medicine, Kirksville College of Osteopathic Medicine, Andrew Taylor Still University (A.T. Still University), Kirksville, USA
| | - John D Bailey
- Orthopedic Surgery, Northeast Regional Medical Center, Mid America Orthopedics & Spine, Kirksville, USA
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Hernández-Lázaro H, Mingo-Gómez MT, Jiménez-Del-Barrio S, Rodríguez-Fernández AI, Areso-Bóveda PB, Ceballos-Laita L. Validation of the International Classification of Functioning, Disability, and Health (ICF) core set for post-acute musculoskeletal conditions in a primary care physiotherapy setting from the perspective of patients using focus groups. Disabil Rehabil 2023:1-8. [PMID: 37667886 DOI: 10.1080/09638288.2023.2251392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/15/2023] [Accepted: 08/18/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE To validate the comprehensive ICF core set for post-acute musculoskeletal conditions from the perspective of patients in a primary care physiotherapy setting. MATERIALS AND METHODS A qualitative study was conducted with patients suffering from musculoskeletal problems. A phenomenological approach based on focus groups was used to identify the most relevant aspects related to physical therapy care in their condition. The data were analyzed using a meaning condensation procedure, identifying relevant themes and concepts. The identified concepts were linked to the ICF and compared to the ICF core set for post-acute musculoskeletal conditions. RESULTS Forty-three patients were included in eight focus groups. A total of 1281 relevant concepts were extracted and related to 156 ICF second-level entities. Entities in the ICF core set for post-acute musculoskeletal conditions were 95.7% confirmed. Eighty-nine additional second-level ICF entities were identified. CONCLUSIONS Entities in the ICF core set for post-acute musculoskeletal conditions are relevant to patients seen in primary care physical therapy units. However, there are areas of functioning related to community health care not covered by this ICF-based tool.IMPLICATIONS OF REHABILITATIONAn ICF-based framework is feasible for the assessment of musculoskeletal conditions.Post-acute musculoskeletal ICF core set was confirmed in patient focus groups.Additional ICF categories emerged for a primary care physical therapy setting.Community features of functioning could be addressed by a tailored ICF core set.
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Affiliation(s)
- Héctor Hernández-Lázaro
- Ólvega Primary Care Physiotherapy Unit, Soria Health Care Management, Regional Health Administration of Castilla y León (SACYL), Ólvega, Spain
- Faculty of Health Sciences, University of Valladolid, Soria, Spain
| | - Maria Teresa Mingo-Gómez
- Faculty of Health Sciences, University of Valladolid, Soria, Spain
- Clinical Research in Health Sciences Group, University of Valladolid, Soria, Spain
| | - Sandra Jiménez-Del-Barrio
- Faculty of Health Sciences, University of Valladolid, Soria, Spain
- Clinical Research in Health Sciences Group, University of Valladolid, Soria, Spain
| | - Ana Isabel Rodríguez-Fernández
- Cervera de Pisuerga Primary Care Physiotherapy Unit, Palencia Health Care Management, Regional Health Administration of Castilla y León (SACYL), Cervera de Pisuerga, Spain
| | - Paula Begoña Areso-Bóveda
- Burgos Centro Primary Care Physiotherapy Unit, Burgos Primary Health Care Management, Regional Health Administration of Castilla y León (SACYL), Burgos, Spain
| | - Luis Ceballos-Laita
- Faculty of Health Sciences, University of Valladolid, Soria, Spain
- Clinical Research in Health Sciences Group, University of Valladolid, Soria, Spain
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Hernandez-Lazaro H, Mingo-Gómez MT, Ceballos-Laita L, Medrano-de-la-Fuente R, Jimenez-Del Barrio S. Validation of the international classification of functioning, disability, and health (ICF) core sets for musculoskeletal conditions in a primary health care setting from physiotherapists' perspective using the Delphi method. Disabil Rehabil 2022:1-11. [PMID: 35830343 DOI: 10.1080/09638288.2022.2096128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To analyze the possibilities of using ICF core sets for musculoskeletal conditions in primary care physiotherapy units of the Health Service of "Castilla y León" (Spain). METHODS A three-round Delphi study was conducted by physiotherapists working in a primary care setting. The data obtained were linked to second-level ICF categories and their relevance was assessed by the participants. The most relevant categories were compared with those present in the existing ICF core sets for musculoskeletal conditions. RESULTS Eighty-four physiotherapists participated in the survey. The consensus was reached for 45 ICF categories and 5 personal factors after the survey. Thirty-five of these categories were present in the Comprehensive Core Set for post-acute Musculoskeletal Conditions. In addition, 35 categories present in the core set were not considered relevant from the participants' perspective. CONCLUSIONS Physiotherapists mainly considered movement-related categories as relevant. The ICF core set for post-acute musculoskeletal conditions comprises many of these categories and can therefore be taken as a basis for the adoption of ICF in the clinical context. RELEVANCE Primary care physiotherapists should be aware of the advantages of using ICF in their clinical settings.Implications for RehabilitationThis study shows which body functions and structures, activities and participation, environmental factors, and personal characteristics are relevant from primary care physiotherapists' perspective assessing persons with musculoskeletal conditions.The Comprehensive ICF Core Set for Subacute Musculoskeletal Conditions includes most of the categories identified in this study, but they need to be refined to fully represent the primary care physiotherapists' perspective.The results of this study support the use of the Comprehensive ICF Core Set for Subacute Musculoskeletal Conditions as a basis for operationalizing ICF in this clinical setting.
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Affiliation(s)
- Hector Hernandez-Lazaro
- Ólvega Primary Care Health Center. Surgery, Ophthalmology, Otorhinolaryngology and Physical Therapy Department, University of Valladolid, Valladolid, Spain.,Castille and Leon Health Service, Soria, Spain
| | - Maria Teresa Mingo-Gómez
- Clinical Research in Health Sciences Group. Department of Surgery, Ophthalmology, Otorhinolaryngology and Physical Therapy, University of Valladolid, Valladolid, Spain
| | - Luis Ceballos-Laita
- Clinical Research in Health Sciences Group. Department of Surgery, Ophthalmology, Otorhinolaryngology and Physical Therapy, University of Valladolid, Valladolid, Spain
| | - Ricardo Medrano-de-la-Fuente
- Clinical Research in Health Sciences Group. Department of Surgery, Ophthalmology, Otorhinolaryngology and Physical Therapy, University of Valladolid, Valladolid, Spain
| | - Sandra Jimenez-Del Barrio
- Clinical Research in Health Sciences Group. Department of Surgery, Ophthalmology, Otorhinolaryngology and Physical Therapy, University of Valladolid, Valladolid, Spain
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Nicol R, Yu H, Selb M, Prodinger B, Hartvigsen J, Côté P. How Does the Measurement of Disability in Low Back Pain Map Unto the International Classification of Functioning, Disability and Health?: A Scoping Review of the Manual Medicine Literature. Am J Phys Med Rehabil 2021; 100:367-395. [PMID: 33141774 DOI: 10.1097/phm.0000000000001636] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT The objective of this study was to catalog items from instruments used to measure functioning, disability, and contextual factors in patients with low back pain treated with manual medicine (manipulation and mobilization) according to the International Classification of Functioning, Disability and Health. This catalog will be used to inform the development of an International Classification of Functioning, Disability and Health-based assessment schedule for low back pain patients treated with manual medicine. In this scoping review, we systematically searched MEDLINE, Embase, PsycINFO, and CINAHL. We identified instruments (questionnaires, clinical tests, single questions) used to measure functioning, disability, and contextual factors, extracted the relevant items, and then linked these items to the International Classification of Functioning, Disability and Health. We included 95 articles and identified 1510 meaningful concepts. All but 70 items were linked to the International Classification of Functioning, Disability and Health. Of the concepts linked to the International Classification of Functioning, Disability and Health, body functions accounted for 34.7%, body structures accounted for 0%, activities and participation accounted for 41%, environmental factors accounted for 3.6%, and personal factors accounted for 16%. Most items used to measure functioning and disability in low back pain patient treated with manual medicine focus on body functions, as well as activities and participation. The lack of measures that address environmental factors warrants further investigation.
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Affiliation(s)
- Richard Nicol
- From the ELiB (et liv i bevegelse), Oslo, Norway (RN); UOIT-CMCC Centre for Disability Prevention and Rehabilitation, University of Ontario Institute of Technology, Oshawa, Ontario, Canada (HY, PC); ICF Research Branch, Nottwil, Switzerland (MS); Swiss Paraplegic Research, Nottwil, Switzerland (MS); Department of Applied Health and Social Sciences, University of Applied Sciences Rosenheim, Rosenheim, Germany (BP); Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark (JH); Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark (JH); and Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada (PC)
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Lawson A, Naylor J, Buchbinder R, Ivers R, Balogh Z, Smith P, Mittal R, Xuan W, Howard K, Vafa A, Yates P, Rieger B, Smith G, Elkinson I, Kim W, Sungaran J, Latendresse K, Wong J, Viswanathan S, Landale K, Drobetz H, Tran P, Page R, Hau R, Mulford J, Incoll I, Kale M, Schick B, Higgs A, Oppy A, Perriman D, Harris I. A Combined Randomised and Observational Study of Surgery for Fractures In the distal Radius in the Elderly (CROSSFIRE): a statistical analyses plan. Trials 2020; 21:651. [PMID: 32669121 PMCID: PMC7364640 DOI: 10.1186/s13063-020-4228-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/03/2020] [Indexed: 01/21/2023] Open
Abstract
Background We are performing a combined randomised and observational study comparing internal fixation to non-surgical management for common wrist fractures in older patients. This paper describes the statistical analysis plan. Methods/design A Combined Randomised and Observational Study of Surgery for Fractures In the distal Radius in the Elderly (CROSSFIRE) is a randomised controlled trial comparing two types of usual care for treating wrist fractures in older patients, surgical fixation using volar locking plates and non-surgical treatment using closed reduction and plaster immobilisation. The primary aim of this comparative-effectiveness study is to determine whether surgery is superior to non-surgical treatment with respect to patient-reported wrist function at 12 months post treatment. The secondary outcomes include radiographic outcomes, complication rates and patient-reported outcomes including quality of life, pain, treatment success and cosmesis. Primary analysis will use a two-sample t test and an intention-to-treat analysis using the randomised arm of the study. Statistical analyses will be two-tailed and significance will be determined by p < 0.05. Sensitivity analyses will be conducted to assess for differences in intention-to-treat, per-protocol and as-treated analyses. Sensitivity analyses will also be conducted to assess selection bias by evaluating differences in participants between the randomised and observational study arms, and for bias relating to any missing data. An economic analysis will be conducted separately if surgery is shown to provide superior outcomes to a level of clinical significance. Discussion This statistical analysis plan describes the analysis of the CROSSFIRE study which aims to provide evidence to aid clinical decision-making in the treatment of distal radius fractures in older patients. Trial registration CROSSFIRE was approved by The Hunter New England Human Research Ethics Committee (HNEHREC Reference No: 16/02/17/3.04). Registered on 22 July 2016 with The Australian and New Zealand Clinical Trials Registry (ANZCTR Number; ACTRN12616000969460). This manuscript is based on v.11 of the statistical analysis plan. A copy of v.11, signed by the chief investigator and the senior statistician is kept at the administering institution.
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Affiliation(s)
- Andrew Lawson
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia. .,South Western Sydney Clinical School, UNSW, Sydney, NSW, Australia.
| | - Justine Naylor
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.,South Western Sydney Clinical School, UNSW, Sydney, NSW, Australia
| | - Rachelle Buchbinder
- Monash University, Melbourne, VIC, Australia.,Cabrini Institute, Melbourne, VIC, Australia
| | - Rebecca Ivers
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, NSW, Australia
| | | | - Paul Smith
- Canberra Hospital, Canberra, ACT, Australia
| | - Rajat Mittal
- South Western Sydney Clinical School, UNSW, Sydney, NSW, Australia
| | - Wei Xuan
- Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
| | - Kirsten Howard
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Arezoo Vafa
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
| | - Piers Yates
- Fiona Stanley Hospital, Perth, WA, Australia
| | | | - Geoff Smith
- St George and Sutherland Hospitals, Sydney, NSW, Australia
| | | | - Woosung Kim
- Wellington Hospital, Wellington, New Zealand
| | | | - Kim Latendresse
- Nambour Hospital and Sunshine Coast University Hospital, Nambour, QLD, Australia
| | - James Wong
- Westmead Hospital, Sydney, NSW, Australia
| | | | | | | | - Phong Tran
- Western Health, Melbourne, VIC, Australia
| | - Richard Page
- University Hospital Geelong, Barwon Health, Geelong, NSW, Australia.,School of Medicine, Deakin University, Geelong, VIC, Australia
| | | | | | - Ian Incoll
- Gosford and Wyong Hospitals, Gosford, NSW, Australia
| | - Michael Kale
- Gosford and Wyong Hospitals, Gosford, NSW, Australia
| | | | | | - Andrew Oppy
- Royal Melbourne Hospital, Melbourne, VIC, Australia
| | | | - Ian Harris
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.,South Western Sydney Clinical School, UNSW, Sydney, NSW, Australia.,Liverpool Hospital, Sydney, NSW, Australia
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Clinimetrics: The EuroQol-5 Dimension (EQ-5D). J Physiother 2020; 66:133. [PMID: 32291225 DOI: 10.1016/j.jphys.2020.02.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/23/2020] [Accepted: 02/19/2020] [Indexed: 10/24/2022] Open
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Changes in health-related quality of life (EQ-5D) dimensions associated with community-based musculoskeletal physiotherapy: a multi-centre analysis. Qual Life Res 2018; 27:2373-2382. [PMID: 29948600 PMCID: PMC6133001 DOI: 10.1007/s11136-018-1883-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2018] [Indexed: 11/17/2022]
Abstract
Purpose To determine the changes in each of the five dimensions of the EuroQol 5-dimension index associated with community-based physiotherapy. Methods Four thousand one hundred and thirty-six patients that received community-based musculoskeletal physiotherapy across five NHS centres completed the EQ-5D on entry into the service and upon discharge. Patients were categorised on symptom location and response to treatment based on their EQ-5D index improving by at least 0.1 (“EQ-5D responders”). For each symptom location, and for responders and non-responders to treatment, the mean (± SD) were calculated for each dimension pre- and post-treatment as well as the size of effect. Results The mobility dimension improved (p < 0.05) in all symptom locations for EQ-5D responders (d = 0.26–1.58) and in ankle, knee, hip and lumbar symptoms for EQ-5D non-responders (d = 0.17–0.45). The self-care dimension improved (p < 0.05) in all symptom locations for EQ-5D responders (d = 0.49–1.16). The usual activities dimension improved (p < 0.05) across all symptom locations for EQ-5D responders (d = 1.00–1.75) and EQ-5D non-responders (d = 0.14–0.60). Despite the pain/discomfort dimension improving (p < 0.05) across all symptom locations for both EQ-5D responders (d = 1.07–1.43) and EQ-5D non-responders (d = 0.29–0.66), the anxiety/depression dimension improved (p < 0.05) from higher starting levels in EQ-5D responders (d = 0.76–1.05) with no change seen for EQ-5D non-responders (d = − 0.16 to 0.06). Conclusions Clinicians should not assume that a patient presenting with pain but expressing high anxiety/depression is unlikely to respond to treatment, as they may show the best HRQoL outcomes. For patients presenting with pain/discomfort and low levels of anxiety/depression, the EQ-5D index is perhaps not a suitable tool for sole use in patient management and service evaluation.
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