1
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Bagg MK, Hince DA, Travers MJ, Truter P, Orange GM, Wand BM. Care Should be Taken to Ensure Qualitative Process Evaluations Conducted Alongside Clinical Trials do not Complicate the Interpretation of the Original Trial. J Pain 2024; 25:104441. [PMID: 38679452 DOI: 10.1016/j.jpain.2023.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 11/24/2023] [Accepted: 11/29/2023] [Indexed: 05/01/2024]
Affiliation(s)
- Matthew K Bagg
- School of Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia; Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, Australia; Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia; Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
| | - Dana A Hince
- The Institute of Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Mervyn J Travers
- School of Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Piers Truter
- School of Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia; Fiona Stanley Hospital, Physiotherapy Department, Murdoch, Western Australia, Australia; Rockingham General Hospital, Physiotherapy Department, Coolongup, Western Australia, Australia
| | - Gemma M Orange
- School of Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Benedict M Wand
- School of Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
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2
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Antonic-Baker A, Auvrez C, Tao G, Bagg MK, Gadowski A, McKimmie A, Hicks AJ, Hill R, Romero L, Ponsford JL, Lannin NA, Gabbe BJ, Cameron PA, Cooper DJ, Rushworth N, Fitzgerald M, O'Brien TJ. The Australian Traumatic Brain Injury Initiative: Systematic Review and Consensus Process to Determine the Predictive Value of Pre-existing Health Conditions for People with Moderate-Severe Traumatic Brain Injury. J Neurotrauma 2024. [PMID: 38450564 DOI: 10.1089/neu.2023.0462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024] Open
Abstract
The first aim of the Australian Traumatic Brain Injury Initiative (AUS-TBI) encompasses development of a set of measures that comprehensively predict outcomes for people with moderate-severe TBI across Australia. This process engaged diverse stakeholders and information sources across six areas: social, health, and clinical factors; biological markers; treatments; and longer-term outcomes. Here, we report the systematic review of pre-existing health conditions as predictors of outcome for people with moderate-severe TBI. Standardized searches were implemented across databases until March 31, 2022. English-language reports of studies evaluating association between pre-existing health conditions and clinical outcome in at least 10 patients with moderate-severe TBI were included. A predefined algorithm was used to assign a judgement of predictive value to each observed association. The list of identified pre-existing health conditions was then discussed with key stakeholders during a consensus meeting to determine the feasibility of incorporating them into standard care. The searches retrieved 22,217 records, of which 47 articles were included. The process led to identification of 88 unique health predictors (homologized to 21 predictor categories) of 55 outcomes (homologized to 19 outcome categories). Only pre-existing health conditions with high and moderate predictive values were discussed during the consensus meeting. Following the consensus meeting, 5 out of 11 were included (migraine, mental health conditions, ≥4 pre-existing health conditions, osteoporosis, and body mass index [BMI]) as common data elements in the AUS-TBI data dictionary. Upon further discussion, 3 additional pre-existing health conditions were included. These are pre-existing heart disease, frailty score, and previous incidence of TBI.
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Affiliation(s)
- Ana Antonic-Baker
- Department of Neuroscience, Central Clinical School, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Clarissa Auvrez
- Department of Neuroscience, Central Clinical School, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Gerard Tao
- Department of Neuroscience, Central Clinical School, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Alfred Health, Melbourne, VIC, Australia
| | - Matthew K Bagg
- Curtin Health Innovation Research Institute, School of Medicine, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
| | - Adelle Gadowski
- School of Public Health and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Ancelin McKimmie
- School of Public Health and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Amelia J Hicks
- Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, VIC, Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | | | | | - Jennie L Ponsford
- Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, VIC, Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Natasha A Lannin
- Department of Neuroscience, Central Clinical School, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Alfred Health, Melbourne, VIC, Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Health Data Research UK, Swansea University Medical School, Swansea University, Singleton Park, United Kingdom
| | - Peter A Cameron
- School of Public Health and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- National Trauma Research Institute, Melbourne, VIC, Australia
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
| | - D Jamie Cooper
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, Australia
| | | | - Melinda Fitzgerald
- Curtin Health Innovation Research Institute, School of Medicine, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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3
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Ponsford JL, Hicks AJ, Bagg MK, Phyland R, Carrier S, James AC, Lannin NA, Rushworth N, O'Brien TJ, Cameron PA, Cooper DJ, Hill R, Gabbe BJ, Fitzgerald M. The Australian Traumatic Brain Injury Initiative: Review and Recommendations for Outcome Measures for Use With Adults and Children After Moderate-to-Severe Traumatic Brain Injury. Neurotrauma Rep 2024; 5:387-408. [PMID: 38655112 PMCID: PMC11035854 DOI: 10.1089/neur.2023.0127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
The Australian Traumatic Brain Injury Initiative (AUS-TBI) aims to select a set of measures to comprehensively predict and assess outcomes following moderate-to-severe traumatic brain injury (TBI) across Australia. The aim of this article was to report on the implementation and findings of an evidence-based consensus approach to develop AUS-TBI recommendations for outcome measures following adult and pediatric moderate-to-severe TBI. Following consultation with a panel of expert clinicians, Aboriginal and Torres Strait Islander representatives and a Living Experience group, and preliminary literature searches with a broader focus, a decision was made to focus on measures of mortality, everyday functional outcomes, and quality of life. Standardized searches of bibliographic databases were conducted through March 2022. Characteristics of 75 outcome measures were extracted from 1485 primary studies. Consensus meetings among the AUS-TBI Steering Committee, an expert panel of clinicians and researchers and a group of individuals with lived experience of TBI resulted in the production of a final list of 11 core outcome measures: the Functional Independence Measure (FIM); Glasgow Outcome Scale-Extended (GOS-E); Satisfaction With Life Scale (SWLS) (adult); mortality; EuroQol-5 Dimensions (EQ5D); Mayo-Portland Adaptability Inventory (MPAI); Return to Work /Study (adult and pediatric); Functional Independence Measure for Children (WEEFIM); Glasgow Outcome Scale Modified for Children (GOS-E PEDS); Paediatric Quality of Life Scale (PEDS-QL); and Strengths and Difficulties Questionnaire (pediatric). These 11 outcome measures will be included as common data elements in the AUS-TBI data dictionary. Review Registration PROSPERO (CRD42022290954).
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Affiliation(s)
- Jennie L. Ponsford
- Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Victoria, Australia
- School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Amelia J. Hicks
- Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Victoria, Australia
- School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Matthew K. Bagg
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney New South Wales, Australia
| | - Ruby Phyland
- Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Victoria, Australia
- School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Sarah Carrier
- Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Victoria, Australia
- School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Amelia C. James
- Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Victoria, Australia
- School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Natasha A. Lannin
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Nick Rushworth
- Brain Injury Australia, Sydney, New South Wales, Australia
| | - Terence J. O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Peter A. Cameron
- Alfred Health, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne VIC 3004, Australia
| | - D. Jamie Cooper
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne VIC 3004, Australia
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne Victoria, Australia
| | - Regina Hill
- Regina Hill Effective Philanthropy Pty Ltd., Melbourne, Victoria, Australia
| | - Belinda J Gabbe
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne VIC 3004, Australia
- Health Data Research UK, Swansea University Medical School, Swansea University, Singleton Park, United Kingdom
| | - Melinda Fitzgerald
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, Australia
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4
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Bagg MK, Hicks AJ, Hellewell SC, Ponsford JL, Lannin NA, O'Brien TJ, Cameron PA, Cooper DJ, Rushworth N, Gabbe BJ, Fitzgerald M. The Australian Traumatic Brain Injury Initiative: Statement of Working Principles and Rapid Review of Methods to Define Data Dictionaries for Neurological Conditions. Neurotrauma Rep 2024; 5:424-447. [PMID: 38660461 PMCID: PMC11040195 DOI: 10.1089/neur.2023.0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
The Australian Traumatic Brain Injury Initiative (AUS-TBI) aims to develop a health informatics approach to collect data predictive of outcomes for persons with moderate-severe TBI across Australia. Central to this approach is a data dictionary; however, no systematic reviews of methods to define and develop data dictionaries exist to-date. This rapid systematic review aimed to identify and characterize methods for designing data dictionaries to collect outcomes or variables in persons with neurological conditions. Database searches were conducted from inception through October 2021. Records were screened in two stages against set criteria to identify methods to define data dictionaries for neurological conditions (International Classification of Diseases, 11th Revision: 08, 22, and 23). Standardized data were extracted. Processes were checked at each stage by independent review of a random 25% of records. Consensus was reached through discussion where necessary. Thirty-nine initiatives were identified across 29 neurological conditions. No single established or recommended method for defining a data dictionary was identified. Nine initiatives conducted systematic reviews to collate information before implementing a consensus process. Thirty-seven initiatives consulted with end-users. Methods of consultation were "roundtable" discussion (n = 30); with facilitation (n = 16); that was iterative (n = 27); and frequently conducted in-person (n = 27). Researcher stakeholders were involved in all initiatives and clinicians in 25. Importantly, only six initiatives involved persons with lived experience of TBI and four involved carers. Methods for defining data dictionaries were variable and reporting is sparse. Our findings are instructive for AUS-TBI and can be used to further development of methods for defining data dictionaries.
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Affiliation(s)
- Matthew K. Bagg
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Health Sciences, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Amelia J. Hicks
- School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
- Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Victoria, Australia
| | - Sarah C. Hellewell
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, Australia
| | - Jennie L. Ponsford
- School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
- Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Victoria, Australia
| | - Natasha A. Lannin
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Terence J. O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Peter A. Cameron
- National Trauma Research Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - D. Jamie Cooper
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Nick Rushworth
- Brain Injury Australia, Sydney, New South Wales, Australia
| | - Belinda J. Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Health Data Research UK, Swansea University Medical School, Swansea University, Singleton Park, United Kingdom
| | - Melinda Fitzgerald
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, Australia
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5
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Keeves J, Gadowski A, McKimmie A, Bagg MK, Antonic-Baker A, Hicks AJ, Clarke N, Brown A, McNamara R, Reeder S, Roman C, Jeffcote T, Romero L, Hill R, Ponsford JL, Lannin NA, O'Brien TJ, Cameron PA, Rushworth N, Fitzgerald M, Gabbe BJ, Cooper DJ. The Australian Traumatic Brain Injury Initiative: Systematic Review of the Effect of Acute Interventions on Outcome for People With Moderate-Severe Traumatic Brain Injury. J Neurotrauma 2024. [PMID: 38279797 DOI: 10.1089/neu.2023.0465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024] Open
Abstract
The Australian Traumatic Brain Injury Initiative (AUS-TBI) is developing a data resource to enable improved outcome prediction for people with moderate-severe TBI (msTBI) across Australia. Fundamental to this resource is the collaboratively designed data dictionary. This systematic review and consultation aimed to identify acute interventions with potential to modify clinical outcomes for people after msTBI, for inclusion in a data dictionary. Standardized searches were implemented across bibliographic databases from inception through April 2022. English-language reports of randomized controlled trials (RCTs) evaluating any association between any acute intervention and clinical outcome in at least 100 patients with msTBI, were included. A predefined algorithm was used to assign a value to each observed association. Consultation with AUS-TBI clinicians and researchers formed the consensus process for interventions to be included in a single data dictionary. Searches retrieved 14,455 records, of which 124 full-length RCTs were screened, with 35 studies included. These studies evaluated 26 unique acute interventions across 21 unique clinical outcomes. Only 4 interventions were considered to have medium modifying value for any outcome from the review, with an additional 8 interventions agreed upon through the consensus process. The interventions with medium value were tranexamic acid and phenytoin, which had a positive effect on an outcome; and decompressive craniectomy surgery and hypothermia, which negatively affected outcomes. From the systematic review and consensus process, 12 interventions were identified as potential modifiers to be included in the AUS-TBI national data resource.
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Affiliation(s)
- Jemma Keeves
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, Western Australlia, Australia
- School of Public Health and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Adelle Gadowski
- School of Public Health and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ancelin McKimmie
- School of Public Health and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Matthew K Bagg
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, Western Australlia, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Health Sciences and Physiotherapy, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Ana Antonic-Baker
- Department of Neuroscience, Central Clinical School, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Amelia J Hicks
- Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Victoria, Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Nyssa Clarke
- School of Public Health and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alastair Brown
- Department of Critical Care Medicine, St Vincent's Hospital, Melbourne, Victoria, Australia
- Department of Intensive Care Medicine, Austin Hospital, Melbourne, Victoria, Australia
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, Victoria, Australia
| | - Rob McNamara
- School of Medicine, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Department of Intensive Care Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Sandy Reeder
- School of Public Health and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Neuroscience, Central Clinical School, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | | - Toby Jeffcote
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, Victoria, Australia
| | | | - Regina Hill
- Regina Hill Effective Consulting Pty. Ltd., Melbourne, Victoria, Australia
| | - Jennie L Ponsford
- Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Victoria, Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Natasha A Lannin
- Department of Neuroscience, Central Clinical School, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Peter A Cameron
- School of Public Health and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- National Trauma Research Institute, Melbourne, Victoria, Australia
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Nick Rushworth
- Brain Injury Australia, Sydney, New South Wales, Australia
| | - Melinda Fitzgerald
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, Western Australlia, Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Health Data Research UK, Swansea University Medical School, Swansea University, Singleton Park, United Kingdom
| | - D Jamie Cooper
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, Victoria, Australia
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6
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Fitzgerald M, Ponsford JL, Hill R, Rushworth N, Kendall E, Armstrong E, Gilroy J, Bullen J, Keeves J, Bagg MK, Hellewell SC, Lannin NA, O'Brien TJ, Cameron PA, Cooper DJ, Gabbe BJ. The Australian Traumatic Brain Injury Initiative: Single Data Dictionary to Predict Outcome for People With Moderate-Severe Traumatic Brain Injury. J Neurotrauma 2024. [PMID: 38117144 DOI: 10.1089/neu.2023.0467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
In this series of eight articles, the Australian Traumatic Brain Injury Initiative (AUS-TBI) consortium describes the Australian approach used to select the common data elements collected acutely that have been shown to predict outcome following moderate-severe traumatic brain injury (TBI) across the lifespan. This article presents the unified single data dictionary, together with additional measures chosen to facilitate comparative effectiveness research and data linkage. Consultations with the AUS-TBI Lived Experience Expert Group provided insights on the merits and considerations regarding data elements for some of the study areas, as well as more general principles to guide the collection of data and the selection of meaningful measures. These are presented as a series of guiding principles and themes. The AUS-TBI Aboriginal and Torres Strait Islander Advisory Group identified a number of key points and considerations for the project approach specific to Aboriginal and Torres Strait Islander peoples, including key issues of data sovereignty and community involvement. These are outlined in the form of principles to guide selection of appropriate methodologies, data management, and governance. Implementation of the AUS-TBI approach aims to maximize ongoing data collection and linkage, to facilitate personalization of care and improved outcomes for people who experience moderate-severe TBI.
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Affiliation(s)
- Melinda Fitzgerald
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, Australia
| | - Jennie L Ponsford
- School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
- Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Victoria, Australia
| | - Regina Hill
- Regina Hill Effective Consulting Pty. Ltd., Melbourne, Victoria, Australia
| | - Nick Rushworth
- Brain Injury Australia, Sydney, New South Wales, Australia
| | - Elizabeth Kendall
- The Hopkins Centre, Griffith University, Brisbane, Queensland, Australia
| | - Elizabeth Armstrong
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - John Gilroy
- Aboriginal and Torres Strait Islander Research, Faculty of Medicine and Health, The University of Sydney, Sydney New South Wales, Australia
| | - Jonathan Bullen
- Office of DVCA, Curtin University, Bentley, Western Australia, Australia
- Telethon Kids Institute, West Perth, Western Australia, Australia
| | - Jemma Keeves
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Matthew K Bagg
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Health Sciences, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Sarah C Hellewell
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, Australia
| | - Natasha A Lannin
- Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Terence J O'Brien
- Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
| | - Peter A Cameron
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- National Trauma Research Institute, Melbourne, Victoria, Australia
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - D Jamie Cooper
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Health Data Research UK, Swansea University Medical School, Swansea University, Singleton Park, United Kingdom
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7
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Gabbe BJ, Keeves J, McKimmie A, Gadowski AM, Holland AJ, Semple BD, Young JT, Crowe L, Ownsworth T, Bagg MK, Antonic-Baker A, Hicks AJ, Hill R, Curtis K, Romero L, Ponsford JL, Lannin NA, O'Brien TJ, Cameron PA, Cooper DJ, Rushworth N, Fitzgerald M. The Australian Traumatic Brain Injury Initiative: Systematic Review and Consensus Process to Determine the Predictive Value of Demographic, Injury Event, and Social Characteristics on Outcomes for People With Moderate-Severe Traumatic Brain Injury. J Neurotrauma 2024. [PMID: 38115598 DOI: 10.1089/neu.2023.0461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
The objective of the Australian Traumatic Brain Injury (AUS-TBI) Initiative is to develop a data dictionary to inform data collection and facilitate prediction of outcomes of people who experience moderate-severe TBI in Australia. The aim of this systematic review was to summarize the evidence of the association between demographic, injury event, and social characteristics with outcomes, in people with moderate-severe TBI, to identify potentially predictive indicators. Standardized searches were implemented across bibliographic databases to March 31, 2022. English-language reports, excluding case series, which evaluated the association between demographic, injury event, and social characteristics, and any clinical outcome in at least 10 patients with moderate-severe TBI were included. Abstracts and full text records were independently screened by at least two reviewers in Covidence. A pre-defined algorithm was used to assign a judgement of predictive value to each observed association. The review findings were discussed with an expert panel to determine the feasibility of incorporation of routine measurement into standard care. The search strategy retrieved 16,685 records; 867 full-length records were screened, and 111 studies included. Twenty-two predictors of 32 different outcomes were identified; 7 were classified as high-level (age, sex, ethnicity, employment, insurance, education, and living situation at the time of injury). After discussion with an expert consensus group, 15 were recommended for inclusion in the data dictionary. This review identified numerous predictors capable of enabling early identification of those at risk for poor outcomes and improved personalization of care through inclusion in routine data collection.
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Affiliation(s)
- Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Health Data Research UK, Swansea University Medical School, Swansea University, Singleton Park, United Kingdom
| | - Jemma Keeves
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin School of Population Health, Curtin University, Bentley, WA, Australia
| | - Ancelin McKimmie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Adelle M Gadowski
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Andrew J Holland
- The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney School of Medicine, Westmead, Australia
| | - Bridgette D Semple
- Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, VIC, Australia
| | - Jesse T Young
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
- Clinical Sciences Murdoch Children's Research Institute, Parkville, VIC, Australia
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
- Justice Health Group, Curtin School of Population Health, Curtin University, Bentley, WA, Australia
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Louise Crowe
- Clinical Sciences Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Tamara Ownsworth
- School of Applied Psychology and the Hopkins Centre, Griffith University, Brisbane, Australia
| | - Matthew K Bagg
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin School of Population Health, Curtin University, Bentley, WA, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
- School of Health Sciences, University of Notre Dame Australia, Fremantle, WA, Australia
| | - Ana Antonic-Baker
- Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, VIC, Australia
| | - Amelia J Hicks
- Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, VIC, Australia
- School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Regina Hill
- Regina Hill Effective Consulting Pty. Ltd., Melbourne, VIC, Australia
| | - Kate Curtis
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- Illawarra Shoalhaven LHD, Wollongong, NSW, Australia
- George Institute for Global Health, Newtown, NSW, Australia
| | | | - Jennie L Ponsford
- Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, VIC, Australia
- School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Natasha A Lannin
- Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, VIC, Australia
- Alfred Health, Melbourne, VIC, Australia
| | - Terence J O'Brien
- Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, VIC, Australia
| | - Peter A Cameron
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- National Trauma Research Institute, Melbourne, VIC, Australia
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
| | - D Jamie Cooper
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, Australia
| | | | - Melinda Fitzgerald
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin School of Population Health, Curtin University, Bentley, WA, Australia
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Bagg MK, Hellewell SC, Keeves J, Antonic-Baker A, McKimmie A, Hicks AJ, Gadowski A, Newcombe VFJ, Barlow KM, Balogh ZJ, Ross JP, Law M, Caeyenberghs K, Parizel PM, Thorne J, Papini M, Gill G, Jefferson A, Ponsford JL, Lannin NA, O'Brien TJ, Cameron PA, Cooper DJ, Rushworth N, Gabbe BJ, Fitzgerald M. The Australian Traumatic Brain Injury Initiative: Systematic Review of Predictive Value of Biological Markers for People With Moderate-Severe Traumatic Brain Injury. J Neurotrauma 2024. [PMID: 38115587 DOI: 10.1089/neu.2023.0464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
The Australian Traumatic Brain Injury Initiative (AUS-TBI) aims to co-design a data resource to predict outcomes for people with moderate-severe traumatic brain injury (TBI) across Australia. Fundamental to this resource is the data dictionary, which is an ontology of data items. Here, we report the systematic review and consensus process for inclusion of biological markers in the data dictionary. Standardized database searches were implemented from inception through April 2022. English-language studies evaluating association between a fluid, tissue, or imaging marker and any clinical outcome in at least 10 patients with moderate-severe TBI were included. Records were screened using a prioritization algorithm and saturation threshold in Research Screener. Full-length records were then screened in Covidence. A pre-defined algorithm was used to assign a judgement of predictive value to each observed association, and high-value predictors were discussed in a consensus process. Searches retrieved 106,593 records; 1,417 full-length records were screened, resulting in 546 included records. Two hundred thirty-nine individual markers were extracted, evaluated against 101 outcomes. Forty-one markers were judged to be high-value predictors of 15 outcomes. Fluid markers retained following the consensus process included ubiquitin C-terminal hydrolase L1 (UCH-L1), S100, and glial fibrillary acidic protein (GFAP). Imaging markers included computed tomography (CT) scores (e.g., Marshall scores), pathological observations (e.g., hemorrhage, midline shift), and magnetic resonance imaging (MRI) classification (e.g., diffuse axonal injury). Clinical context and time of sampling of potential predictive indicators are important considerations for utility. This systematic review and consensus process has identified fluid and imaging biomarkers with high predictive value of clinical and long-term outcomes following moderate-severe TBI.
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Affiliation(s)
- Matthew K Bagg
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
- School of Health Sciences, University of Notre Dame Australia, Fremantle, WA, Australia
| | - Sarah C Hellewell
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- School of Medicine, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
| | - Jemma Keeves
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Ana Antonic-Baker
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Ancelin McKimmie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Amelia J Hicks
- Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, VIC, Australia
- School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Adelle Gadowski
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Virginia F J Newcombe
- PACE Section, Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Karen M Barlow
- Acquired Brain Injury in Children Research Program, Queensland Children's Hospital, Brisbane, QLD, Australia
- Centre for Children's Health Research, University of Queensland, Brisbane, QLD, Australia
| | - Zsolt J Balogh
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia
| | - Jason P Ross
- Molecular Diagnostic Solutions, Health and Biosecurity, CSIRO, Australia
| | - Meng Law
- Alzheimer's Disease Research Center, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Department of Neuroscience and Radiology, Monash University, Alfred Health, Melbourne, VIC, Australia
| | - Karen Caeyenberghs
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia
| | - Paul M Parizel
- University of Antwerp, Edegem, Belgium
- Department of Radiology, Royal Perth Hospital and University of Western Australia, Perth, WA, Australia
- West Australian National Imaging Facility Node, Nedlands, WA, Australia
| | - Jacinta Thorne
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
| | - Melissa Papini
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
| | - Geena Gill
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
| | - Amanda Jefferson
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
| | - Jennie L Ponsford
- Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, VIC, Australia
- School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Natasha A Lannin
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Alfred Health, Melbourne, VIC, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Peter A Cameron
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- National Trauma Research Institute, Melbourne, VIC, Australia
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
| | - D Jamie Cooper
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, Australia
| | | | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Health Data Research UK, Swansea University Medical School, Swansea University, Singleton Park, United Kingdom
| | - Melinda Fitzgerald
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
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Cashin AG, Lee H, Wand BM, Bagg MK, O'Hagan ET, Rizzo RRN, Stanton TR, Moseley GL, McAuley JH. Mechanisms of education and graded sensorimotor retraining in people with chronic low back pain: a mediation analysis. Pain 2023; 164:2792-2800. [PMID: 37366598 DOI: 10.1097/j.pain.0000000000002978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 04/14/2023] [Indexed: 06/28/2023]
Abstract
ABSTRACT An improved understanding of the biopsychosocial influences that contribute to and maintain pain has promoted the development of new efficacious treatments for chronic low back pain (CLBP). This study aimed to investigate the mechanisms of a new treatment-education and graded sensorimotor retraining-on pain and disability. We conducted a preplanned causal mediation analysis of a randomized clinical trial which allocated 276 participants with CLBP to 12 weekly clinical sessions of education and graded sensorimotor retraining (n = 138) or a sham and attention control (n = 138). Outcomes were pain intensity and disability, both assessed at 18 weeks. Hypothesized mediators included tactile acuity, motor coordination, back self-perception, beliefs about the consequences of back pain, kinesiophobia, pain self-efficacy, and pain catastrophizing, all assessed at the end of treatment (12 weeks). Four of 7 mechanisms (57%) mediated the intervention effect on pain; the largest mediated effects were for beliefs about back pain consequences (-0.96 [-1.47 to -0.64]), pain catastrophizing (-0.49 [-0.61 to -0.24]), and pain self-efficacy (-0.37 [-0.66 to -0.22]). Five of 7 mechanisms (71%) mediated the intervention effect on disability; the largest mediated effects were for beliefs about back pain consequences (-1.66 [-2.62 to -0.87]), pain catastrophizing (-1.06 [-1.79 to -0.53]), and pain self-efficacy (-0.84 [-1.89 to -0.45]). When all 7 mechanisms were considered simultaneously, the joint mediation effect explained most of the intervention effect for both pain and disability. Optimizing interventions to target beliefs about the consequences of back pain, pain catastrophizing, and pain self-efficacy is likely to lead to improved outcomes for people with CLBP.
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Affiliation(s)
- Aidan G Cashin
- Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia
- School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Hopin Lee
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Benedict M Wand
- Faculty of Medicine, Nursing and Midwifery and Health Sciences, The University of Notre Dame Australia, Fremantle, Australia
| | - Matthew K Bagg
- Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
- Perron Institute for Neurological and Translational Science, Perth, Australia
| | - Edel T O'Hagan
- Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia
- Westmead Applied Research Centre, The University of Sydney, Sydney, Australia
| | - Rodrigo R N Rizzo
- Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia
- School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Tasha R Stanton
- IIMPACT (Innovation, IMPlementation And Clinical Translation) in Health, University of South Australia, Kaurna Country, Adelaide, Australia
| | - G Lorimer Moseley
- IIMPACT (Innovation, IMPlementation And Clinical Translation) in Health, University of South Australia, Kaurna Country, Adelaide, Australia
| | - James H McAuley
- Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia
- School of Health Sciences, University of New South Wales, Sydney, Australia
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Ishaq I, Mehta P, Skinner IW, Bagg MK, Bier J, Verhagen AP. Treatment classifications and interventions for neck pain: a scoping review. J Clin Epidemiol 2023; 159:1-9. [PMID: 37142167 DOI: 10.1016/j.jclinepi.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 04/09/2023] [Accepted: 04/25/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVES Our aim is to provide an overview of how neck pain is classified in the literature, define and group conservative interventions into 'nodes', and develop draft networks of interventions in preparation for a network meta-analysis (NMA). STUDY DESIGN AND SETTINGS We performed a scoping review. For feasibility reasons, we searched for randomized clinical trials (RCTs) via neck pain clinical practice guidelines (CPGs) published from 2014. We used standardized data extraction forms to extract data about classification of neck pain and interventions evaluated in the included RCTs. We calculated frequencies of neck pain classifications and grouped interventions into nodes based on the definitions used in Cochrane reviews. Draft network graphs comparing interventions were constructed using the online Shiny R application CINEMA. RESULTS We included 242 RCTs from seven CPGs, evaluating 28,581 patients. We found three different classification systems of which The Neck Pain Task Force classification was used most often. We defined and grouped all interventions into 19 discrete potential nodes. CONCLUSION We found a wide variation in neck pain classifications and conservative interventions. Grouping the interventions was challenging and needs further evaluation before conducting a final NMA.
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Affiliation(s)
- Iqra Ishaq
- Graduate School of Health, Discipline of Physiotherapy, University of Technology Sydney, Sydney, Australia
| | - Poonam Mehta
- Graduate School of Health, Discipline of Physiotherapy, University of Technology Sydney, Sydney, Australia
| | - Ian W Skinner
- Graduate School of Health, Discipline of Physiotherapy, University of Technology Sydney, Sydney, Australia; School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Port Macquarie, Australia
| | - Matthew K Bagg
- Faculty of Health Sciences, Curtin Health Innovation Research Institute, Curtin University, Perth, Australia; Perron Institute for Neurological and Translational Science, Perth, Australia; Neuroscience Research Australia, Sydney, Australia
| | - Jasper Bier
- Department of General Practice, Erasmus University of Rotterdam, Rotterdam, The Netherlands
| | - Arianne P Verhagen
- Graduate School of Health, Discipline of Physiotherapy, University of Technology Sydney, Sydney, Australia.
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11
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O'Hagan ET, Cashin AG, Rizzo RRN, Leake HB, Zahara P, Bagg MK, Wand BM, McAuley JH. Development of a booster intervention for graded sensorimotor retraining (RESOLVE) in people with persistent low back pain: A nested, randomised, feasibility trial. Musculoskeletal Care 2023; 21:444-452. [PMID: 36433897 PMCID: PMC10946532 DOI: 10.1002/msc.1715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Low back pain contributes to an increasing global health burden exacerbated by unsustained improvements from current treatments. There is a need to develop, and test interventions to maintain initial improvements from low back pain treatments. One option is to implement a booster intervention. This study aimed to develop and test the feasibility of implementing a booster intervention delivered remotely to supplement the benefits from a complex intervention for chronic low back pain. METHOD This study was nested in the RESOLVE trial. The booster intervention was developed by an expert group, including a clinical psychologist, exercise physiologist and physiotherapists, and based on a motivational interviewing framework. We developed a conversational flow chart to support the clinician to guide participants towards achieving their pre-specified personal goals and future low back pain self-management. Participants with chronic low back pain who were aged over 18 years and fluent in English were recruited. The booster intervention was delivered in one session, remotely, by telephone. The intervention was considered feasible if: participants were able to be contacted or <3 contacts were necessary to arrange the booster session; there were sufficient willing participants (<15% of sample unwilling to participate); and participants and research clinicians reported a perceived benefit of >7/10. RESULTS Fifty participants with chronic non-specific low back pain were recruited to test the feasibility of implementing the booster intervention. Less than three contact attempts were necessary to arrange the booster session, only one participant declined to participate. Participants perceived the session to be beneficial; on a 0 to 10 scale of perceived benefit, the average score recorded was 8.3 (SD 2.0). Clinicians also reported a moderate perceived benefit to the participant; the average score recorded by clinicians was 6.3 (SD 1.6). CONCLUSION We developed a step by step, simple booster intervention that was perceived to be beneficial to participants with chronic low back pain. The booster can feasibly be delivered remotely following a complex intervention.
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Affiliation(s)
- Edel T. O'Hagan
- Centre for Pain IMPACTNeuroscience Research AustraliaSydneyNew South WalesAustralia
- Prince of Wales Clinical SchoolUniversity of New South WalesSydneyNew South WalesAustralia
- Westmead Applied Research CentreThe University of SydneySydneyNew South WalesAustralia
| | - Aidan G. Cashin
- Centre for Pain IMPACTNeuroscience Research AustraliaSydneyNew South WalesAustralia
- School of Health SciencesFaculty of Medicine and HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Rodrigo R. N. Rizzo
- Centre for Pain IMPACTNeuroscience Research AustraliaSydneyNew South WalesAustralia
- School of Health SciencesFaculty of Medicine and HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Hayley B. Leake
- Centre for Pain IMPACTNeuroscience Research AustraliaSydneyNew South WalesAustralia
- IIMPACT in HealthAllied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - Pauline Zahara
- Centre for Pain IMPACTNeuroscience Research AustraliaSydneyNew South WalesAustralia
| | - Matthew K. Bagg
- Centre for Pain IMPACTNeuroscience Research AustraliaSydneyNew South WalesAustralia
- Curtin Health Innovation Research InstituteFaculty of Health SciencesCurtin UniversityPerthWestern AustraliaAustralia
- Perron Institute for Neurological and Translational SciencePerthWestern AustraliaAustralia
| | - Benedict M. Wand
- Faculty of Medicine, Nursing and Midwifery and Health SciencesThe University of Notre Dame AustraliaFremantleWestern AustraliaAustralia
| | - James H. McAuley
- Centre for Pain IMPACTNeuroscience Research AustraliaSydneyNew South WalesAustralia
- School of Health SciencesFaculty of Medicine and HealthUniversity of New South WalesSydneyNew South WalesAustralia
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12
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Rizzo RRN, Wand BM, Leake HB, O'Hagan ET, Bagg MK, Bunzli S, Traeger AC, Gustin SM, Moseley GL, Sharma S, Cashin AG, McAuley JH. "My Back is Fit for Movement": A Qualitative Study Alongside a Randomized Controlled Trial for Chronic Low Back Pain. J Pain 2023; 24:824-839. [PMID: 36577460 DOI: 10.1016/j.jpain.2022.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/14/2022] [Accepted: 12/18/2022] [Indexed: 12/27/2022]
Abstract
A new wave of treatments has emerged to target nervous system alterations and maladaptive conceptualizations about pain for chronic low back pain. The acceptability of these treatments is still uncertain. We conducted a qualitative study alongside a randomized controlled trial to identify perceptions of facilitators or barriers to participation in a non-pharmacological intervention that resulted in clinically meaningful reductions across 12 months for disability compared to a sham intervention. We conducted semi-structured interviews with participants from the trial's active arm after they completed the 12-week program. We included a purposeful sample (baseline and clinical characteristics) (n = 20). We used reflexive thematic analysis informed by the Theoretical Framework of Acceptability for health care interventions. We identified positive and negative emotional/cognitive responses associated with treatment acceptability and potential efficacy, including emotional support, cognitive empowerment, readiness for self-management, and acceptance of face-to-face and online components designed to target the brain. These findings suggest the importance of psychoeducation and behavior change techniques to create a positive attitude towards movement and increase the perception of pain control; systematic approaches to monitor and target misconceptions about the interventions during treatment; and psychoeducation and behavior change techniques to maintain the improvements after the cessation of formal care. PERSPECTIVE: This article presents the experiences of people with chronic low back pain participating in a new non-pharmacological brain-targeted treatment that includes face-to-face and self-directed approaches. The facilitators and barriers of the interventions could potentially inform adaptations and optimization of treatments designed to target the brain to treat chronic low back pain.
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Affiliation(s)
- Rodrigo R N Rizzo
- School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia.
| | - Benedict M Wand
- School of Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, Australia
| | - Hayley B Leake
- Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia; IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia
| | - Edel T O'Hagan
- Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, Australia
| | - Matthew K Bagg
- Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia; Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia. Perron Institute for Neurological and Translational Science, Perth, Australia
| | - Samantha Bunzli
- School of Health Sciences and Social Work, Griffith University, Nathan Campus, Queensland, Australia; Physiotherapy Department, Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Adrian C Traeger
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Sylvia M Gustin
- Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia; NeuroRecovery Research Hub, School of Psychology, University of New South Wales, Sydney, Australia
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia
| | - Saurab Sharma
- School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia
| | - Aidan G Cashin
- School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia
| | - James H McAuley
- School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia
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13
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Cashin AG, Wand BM, O'Connell NE, Lee H, Rizzo RR, Bagg MK, O'Hagan E, Maher CG, Furlan AD, van Tulder MW, McAuley JH. Pharmacological treatments for low back pain in adults: an overview of Cochrane Reviews. Cochrane Database Syst Rev 2023; 4:CD013815. [PMID: 37014979 PMCID: PMC10072849 DOI: 10.1002/14651858.cd013815.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
BACKGROUND Pharmacological interventions are the most used treatment for low back pain (LBP). Use of evidence from systematic reviews of the effects of pharmacological interventions for LBP published in the Cochrane Library, is limited by lack of a comprehensive overview. OBJECTIVES To summarise the evidence from Cochrane Reviews of the efficacy, effectiveness, and safety of systemic pharmacological interventions for adults with non-specific LBP. METHODS The Cochrane Database of Systematic Reviews was searched from inception to 3 June 2021, to identify reviews of randomised controlled trials (RCTs) that investigated systemic pharmacological interventions for adults with non-specific LBP. Two authors independently assessed eligibility, extracted data, and assessed the quality of the reviews and certainty of the evidence using the AMSTAR 2 and GRADE tools. The review focused on placebo comparisons and the main outcomes were pain intensity, function, and safety. MAIN RESULTS Seven Cochrane Reviews that included 103 studies (22,238 participants) were included. There is high confidence in the findings of five reviews, moderate confidence in one, and low confidence in the findings of another. The reviews reported data on six medicines or medicine classes: paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, benzodiazepines, opioids, and antidepressants. Three reviews included participants with acute or sub-acute LBP and five reviews included participants with chronic LBP. Acute LBP Paracetamol There was high-certainty evidence for no evidence of difference between paracetamol and placebo for reducing pain intensity (MD 0.49 on a 0 to 100 scale (higher scores indicate worse pain), 95% CI -1.99 to 2.97), reducing disability (MD 0.05 on a 0 to 24 scale (higher scores indicate worse disability), 95% CI -0.50 to 0.60), and increasing the risk of adverse events (RR 1.07, 95% CI 0.86 to 1.33). NSAIDs There was moderate-certainty evidence for a small between-group difference favouring NSAIDs compared to placebo at reducing pain intensity (MD -7.29 on a 0 to 100 scale (higher scores indicate worse pain), 95% CI -10.98 to -3.61), high-certainty evidence for a small between-group difference for reducing disability (MD -2.02 on a 0-24 scale (higher scores indicate worse disability), 95% CI -2.89 to -1.15), and very low-certainty evidence for no evidence of an increased risk of adverse events (RR 0.86, 95% CI 0. 63 to 1.18). Muscle relaxants and benzodiazepines There was moderate-certainty evidence for a small between-group difference favouring muscle relaxants compared to placebo for a higher chance of pain relief (RR 0.58, 95% CI 0.45 to 0.76), and higher chance of improving physical function (RR 0.55, 95% CI 0.40 to 0.77), and increased risk of adverse events (RR 1.50, 95% CI 1. 14 to 1.98). Opioids None of the included Cochrane Reviews aimed to identify evidence for acute LBP. Antidepressants No evidence was identified by the included reviews for acute LBP. Chronic LBP Paracetamol No evidence was identified by the included reviews for chronic LBP. NSAIDs There was low-certainty evidence for a small between-group difference favouring NSAIDs compared to placebo for reducing pain intensity (MD -6.97 on a 0 to 100 scale (higher scores indicate worse pain), 95% CI -10.74 to -3.19), reducing disability (MD -0.85 on a 0-24 scale (higher scores indicate worse disability), 95% CI -1.30 to -0.40), and no evidence of an increased risk of adverse events (RR 1.04, 95% CI -0.92 to 1.17), all at intermediate-term follow-up (> 3 months and ≤ 12 months postintervention). Muscle relaxants and benzodiazepines There was low-certainty evidence for a small between-group difference favouring benzodiazepines compared to placebo for a higher chance of pain relief (RR 0.71, 95% CI 0.54 to 0.93), and low-certainty evidence for no evidence of difference between muscle relaxants and placebo in the risk of adverse events (RR 1.02, 95% CI 0.67 to 1.57). Opioids There was high-certainty evidence for a small between-group difference favouring tapentadol compared to placebo at reducing pain intensity (MD -8.00 on a 0 to 100 scale (higher scores indicate worse pain), 95% CI -1.22 to -0.38), moderate-certainty evidence for a small between-group difference favouring strong opioids for reducing pain intensity (SMD -0.43, 95% CI -0.52 to -0.33), low-certainty evidence for a medium between-group difference favouring tramadol for reducing pain intensity (SMD -0.55, 95% CI -0.66 to -0.44) and very low-certainty evidence for a small between-group difference favouring buprenorphine for reducing pain intensity (SMD -0.41, 95% CI -0.57 to -0.26). There was moderate-certainty evidence for a small between-group difference favouring strong opioids compared to placebo for reducing disability (SMD -0.26, 95% CI -0.37 to -0.15), moderate-certainty evidence for a small between-group difference favouring tramadol for reducing disability (SMD -0.18, 95% CI -0.29 to -0.07), and low-certainty evidence for a small between-group difference favouring buprenorphine for reducing disability (SMD -0.14, 95% CI -0.53 to -0.25). There was low-certainty evidence for a small between-group difference for an increased risk of adverse events for opioids (all types) compared to placebo; nausea (RD 0.10, 95% CI 0.07 to 0.14), headaches (RD 0.03, 95% CI 0.01 to 0.05), constipation (RD 0.07, 95% CI 0.04 to 0.11), and dizziness (RD 0.08, 95% CI 0.05 to 0.11). Antidepressants There was low-certainty evidence for no evidence of difference for antidepressants (all types) compared to placebo for reducing pain intensity (SMD -0.04, 95% CI -0.25 to 0.17) and reducing disability (SMD -0.06, 95% CI -0.40 to 0.29). AUTHORS' CONCLUSIONS We found no high- or moderate-certainty evidence that any investigated pharmacological intervention provided a large or medium effect on pain intensity for acute or chronic LBP compared to placebo. For acute LBP, we found moderate-certainty evidence that NSAIDs and muscle relaxants may provide a small effect on pain, and high-certainty evidence for no evidence of difference between paracetamol and placebo. For safety, we found very low- and high-certainty evidence for no evidence of difference with NSAIDs and paracetamol compared to placebo for the risk of adverse events, and moderate-certainty evidence that muscle relaxants may increase the risk of adverse events. For chronic LBP, we found low-certainty evidence that NSAIDs and very low- to high-certainty evidence that opioids may provide a small effect on pain. For safety, we found low-certainty evidence for no evidence of difference between NSAIDs and placebo for the risk of adverse events, and low-certainty evidence that opioids may increase the risk of adverse events.
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Affiliation(s)
- Aidan G Cashin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
- School of Health Sciences, Faculty of Medicine & Health, University of New South Wales, Sydney, Australia
| | - Benedict M Wand
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Australia
| | - Neil E O'Connell
- Department of Health Sciences, Centre for Health and Wellbeing Across the Lifecourse, Brunel University London, Uxbridge, UK
| | - Hopin Lee
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Rodrigo Rn Rizzo
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
- School of Health Sciences, Faculty of Medicine & Health, University of New South Wales, Sydney, Australia
| | - Matthew K Bagg
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
- Prince of Wales Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, Australia
- New College Village, University of New South Wales, Sydney, Australia
| | - Edel O'Hagan
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
- Prince of Wales Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, Australia
| | - Christopher G Maher
- Sydney Musculoskeletal Health, The University of Sydney, Sydney, Australia
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
| | | | - Maurits W van Tulder
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, Netherlands
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
- School of Health Sciences, Faculty of Medicine & Health, University of New South Wales, Sydney, Australia
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14
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Wewege MA, Bagg MK, Jones MD, Ferraro MC, Cashin AG, Rizzo RR, Leake HB, Hagstrom AD, Sharma S, McLachlan AJ, Maher CG, Day R, Wand BM, O'Connell NE, Nikolakopolou A, Schabrun S, Gustin SM, McAuley JH. Comparative effectiveness and safety of analgesic medicines for adults with acute non-specific low back pain: systematic review and network meta-analysis. BMJ 2023; 380:e072962. [PMID: 36948512 PMCID: PMC10540836 DOI: 10.1136/bmj-2022-072962] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 03/24/2023]
Abstract
OBJECTIVE To evaluate the comparative effectiveness and safety of analgesic medicines for acute non-specific low back pain. DESIGN Systematic review and network meta-analysis. DATA SOURCES Medline, PubMed, Embase, CINAHL, CENTRAL, ClinicalTrials.gov, clinicialtrialsregister.eu, and World Health Organization's International Clinical Trials Registry Platform from database inception to 20 February 2022. ELIGIBILITY CRITERIA FOR STUDY SELECTION Randomised controlled trials of analgesic medicines (eg, non-steroidal anti-inflammatory drugs, paracetamol, opioids, anti-convulsant drugs, skeletal muscle relaxants, or corticosteroids) compared with another analgesic medicine, placebo, or no treatment. Adults (≥18 years) who reported acute non-specific low back pain (for less than six weeks). DATA EXTRACTION AND SYNTHESIS Primary outcomes were low back pain intensity (0-100 scale) at end of treatment and safety (number of participants who reported any adverse event during treatment). Secondary outcomes were low back specific function, serious adverse events, and discontinuation from treatment. Two reviewers independently identified studies, extracted data, and assessed risk of bias. A random effects network meta-analysis was done and confidence was evaluated by the Confidence in Network Meta-Analysis method. RESULTS 98 randomised controlled trials (15 134 participants, 49% women) included 69 different medicines or combinations. Low or very low confidence was noted in evidence for reduced pain intensity after treatment with tolperisone (mean difference -26.1 (95% confidence intervals -34.0 to -18.2)), aceclofenac plus tizanidine (-26.1 (-38.5 to -13.6)), pregabalin (-24.7 (-34.6 to -14.7)), and 14 other medicines compared with placebo. Low or very low confidence was noted for no difference between the effects of several of these medicines. Increased adverse events had moderate to very low confidence with tramadol (risk ratio 2.6 (95% confidence interval 1.5 to 4.5)), paracetamol plus sustained release tramadol (2.4 (1.5 to 3.8)), baclofen (2.3 (1.5 to 3.4)), and paracetamol plus tramadol (2.1 (1.3 to 3.4)) compared with placebo. These medicines could increase the risk of adverse events compared with other medicines with moderate to low confidence. Moderate to low confidence was also noted for secondary outcomes and secondary analysis of medicine classes. CONCLUSIONS The comparative effectiveness and safety of analgesic medicines for acute non-specific low back pain are uncertain. Until higher quality randomised controlled trials of head-to-head comparisons are published, clinicians and patients are recommended to take a cautious approach to manage acute non-specific low back pain with analgesic medicines. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019145257.
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Affiliation(s)
- Michael A Wewege
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
| | - Matthew K Bagg
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
- Perron Institute for Neurological and Translational Science, Perth, WA, Australia
| | - Matthew D Jones
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
| | - Michael C Ferraro
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
| | - Aidan G Cashin
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
| | - Rodrigo Rn Rizzo
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
| | - Hayley B Leake
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia
| | - Amanda D Hagstrom
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Saurab Sharma
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
| | - Andrew J McLachlan
- Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, Gadigal Country, Sydney, NSW, Australia
| | - Christopher G Maher
- Sydney Musculoskeletal Health, University of Sydney, Gadigal Country, Sydney, NSW, Australia
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, NSW, Australia
| | - Richard Day
- Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, NSW, Australia
- St Vincent's Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Benedict M Wand
- Faculty of Medicine, Nursing and Midwifery and Health Sciences, University of Notre Dame Australia, Fremantle, WA, Australia
| | - Neil E O'Connell
- Department of Health Sciences, Centre for Health and Wellbeing Across the Lifecourse, Brunel University London, Uxbridge, UK
| | - Adriani Nikolakopolou
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Centre, University of Freiburg, Freiburg, Germany
| | - Siobhan Schabrun
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
- School of Physical Therapy, University of Western Ontario, London, ON, Canada
- The Gray Centre for Mobility and Activity, Parkwood Institute, London, ON, Canada
| | - Sylvia M Gustin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
- NeuroRecovery Research Hub, School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - James H McAuley
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
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15
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Hansford HJ, Cashin AG, Bagg MK, Wewege MA, Ferraro MC, Kianersi S, Mayo-Wilson E, Grant SP, Toomey E, Skinner IW, McAuley JH, Lee H, Jones MD. Feasibility of an Audit and Feedback Intervention to Facilitate Journal Policy Change Towards Greater Promotion of Transparency and Openness in Sports Science Research. Sports Med - Open 2022; 8:101. [PMID: 35932429 PMCID: PMC9357245 DOI: 10.1186/s40798-022-00496-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 07/21/2022] [Indexed: 11/10/2022]
Abstract
Objectives To evaluate (1) the feasibility of an audit-feedback intervention to facilitate sports science journal policy change, (2) the reliability of the Transparency of Research Underpinning Social Intervention Tiers (TRUST) policy evaluation form, and (3) the extent to which policies of sports science journals support transparent and open research practices. Methods We conducted a cross-sectional, audit-feedback, feasibility study of transparency and openness standards of the top 38 sports science journals by impact factor. The TRUST form was used to evaluate journal policies support for transparent and open research practices. Feedback was provided to journal editors in the format of a tailored letter. Inter-rater reliability and agreement of the TRUST form was assessed using intraclass correlation coefficients and the standard error of measurement, respectively. Time-based criteria, fidelity of intervention delivery and qualitative feedback were used to determine feasibility. Results The audit-feedback intervention was feasible based on the time taken to rate journals and provide tailored feedback. The mean (SD) score on the TRUST form (range 0–27) was 2.05 (1.99), reflecting low engagement with transparent and open practices. Inter-rater reliability of the overall score of the TRUST form was moderate [ICC (2,1) = 0.68 (95% CI 0.55–0.79)], with standard error of measurement of 1.17. However, some individual items had poor reliability. Conclusion Policies of the top 38 sports science journals have potential for improved support for transparent and open research practices. The feasible audit-feedback intervention developed here warrants large-scale evaluation as a means to facilitate change in journal policies. Registration: OSF (https://osf.io/d2t4s/).
Supplementary Information The online version contains supplementary material available at 10.1186/s40798-022-00496-x.
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16
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Wand BM, Cashin AG, McAuley JH, Bagg MK, Orange GM, Moseley GL. The Fit-for-Purpose Model: Conceptualizing and Managing Chronic Nonspecific Low Back Pain as an Information Problem. Phys Ther 2022; 103:6785992. [PMID: 36317747 DOI: 10.1093/ptj/pzac151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/06/2022] [Accepted: 08/20/2022] [Indexed: 11/05/2022]
Abstract
Chronic nonspecific low back pain (CNSLBP) is a complex and multifaceted problem. The following Perspective Piece tries to help make sense of this complexity by describing a model for the development and maintenance of persistent low back pain that integrates modifiable factors across the biopsychosocial spectrum. The Fit-for-Purpose model (FFPM) posits the view that chronic nonspecific low back pain represents a state in which the person in pain holds strong and relatively intransient internal models of an immutably damaged, fragile, and unhealthy back, and information that supports these models is more available and trustworthy than information that counters them. This Perspective proposes a corresponding treatment framework for persistent pain that aims to shift internal models of a fragile, damaged, unhealthy, and unchangeable self toward the formulation of the back as healthy, strong, adaptable and fit-for-purpose and to provide the system with precise and trustworthy evidence that supports this supposition while minimizing information that works against it.
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Affiliation(s)
- Benedict M Wand
- Faculty of Medicine, Nursing & Midwifery and Health Sciences, The University of Notre Dame Australia, Fremantle, Australia
| | - Aidan G Cashin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia.,School of Health Sciences, Faculty of Medicine & Health, University of New South Wales, Sydney, Australia
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia.,School of Health Sciences, Faculty of Medicine & Health, University of New South Wales, Sydney, Australia
| | - Matthew K Bagg
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia.,Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia.,Perron Institute for Neurological and Translational Science, Perth, Australia
| | - Gemma M Orange
- Faculty of Medicine, Nursing & Midwifery and Health Sciences, The University of Notre Dame Australia, Fremantle, Australia
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia
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17
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Bagg MK, Wand BM, Cashin AG, Lee H, Hübscher M, Stanton TR, O’Connell NE, O’Hagan ET, Rizzo RRN, Wewege MA, Rabey M, Goodall S, Saing S, Lo SN, Luomajoki H, Herbert RD, Maher CG, Moseley GL, McAuley JH. Effect of Graded Sensorimotor Retraining on Pain Intensity in Patients With Chronic Low Back Pain: A Randomized Clinical Trial. JAMA 2022; 328:430-439. [PMID: 35916848 PMCID: PMC9346551 DOI: 10.1001/jama.2022.9930] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
IMPORTANCE The effects of altered neural processing, defined as altering neural networks responsible for perceptions of pain and function, on chronic pain remains unclear. OBJECTIVE To estimate the effect of a graded sensorimotor retraining intervention (RESOLVE) on pain intensity in people with chronic low back pain. DESIGN, SETTING, AND PARTICIPANTS This parallel, 2-group, randomized clinical trial recruited participants with chronic (>3 months) nonspecific low back pain from primary care and community settings. A total of 276 adults were randomized (in a 1:1 ratio) to the intervention or sham procedure and attention control groups delivered by clinicians at a medical research institute in Sydney, Australia. The first participant was randomized on December 10, 2015, and the last was randomized on July 25, 2019. Follow-up was completed on February 3, 2020. INTERVENTIONS Participants randomized to the intervention group (n = 138) were asked to participate in 12 weekly clinical sessions and home training designed to educate them about and assist them with movement and physical activity while experiencing lower back pain. Participants randomized to the control group (n = 138) were asked to participate in 12 weekly clinical sessions and home training that required similar time as the intervention but did not focus on education, movement, and physical activity. The control group included sham laser and shortwave diathermy applied to the back and sham noninvasive brain stimulation. MAIN OUTCOMES AND MEASURES The primary outcome was pain intensity at 18 weeks, measured on an 11-point numerical rating scale (range, 0 [no pain] to 10 [worst pain imaginable]) for which the between-group minimum clinically important difference is 1.0 point. RESULTS Among 276 randomized patients (mean [SD] age, 46 [14.3] years; 138 [50%] women), 261 (95%) completed follow-up at 18 weeks. The mean pain intensity was 5.6 at baseline and 3.1 at 18 weeks in the intervention group and 5.8 at baseline and 4.0 at 18 weeks in the control group, with an estimated between-group mean difference at 18 weeks of -1.0 point ([95% CI, -1.5 to -0.4]; P = .001), favoring the intervention group. CONCLUSIONS AND RELEVANCE In this randomized clinical trial conducted at a single center among patients with chronic low back pain, graded sensorimotor retraining, compared with a sham procedure and attention control, significantly improved pain intensity at 18 weeks. The improvements in pain intensity were small, and further research is needed to understand the generalizability of the findings. TRIAL REGISTRATION ANZCTR Identifier: ACTRN12615000610538.
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Affiliation(s)
- Matthew K. Bagg
- Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
- Perron Institute for Neurological and Translational Science, Perth, Australia
| | - Benedict M. Wand
- Faculty of Medicine, Nursing and Midwifery and Health Sciences, The University of Notre Dame Australia, Fremantle, Australia
| | - Aidan G. Cashin
- Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia
- School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Hopin Lee
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Markus Hübscher
- Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia
| | - Tasha R. Stanton
- IIMPACT (Innovation, IMPlementation And Clinical Translation) in Health, University of South Australia, Kaurna Country, Adelaide, Australia
| | - Neil E. O’Connell
- Department of Health Sciences, Centre for Health and Wellbeing Across the Lifecourse, Brunel University London, Uxbridge, United Kingdom
| | - Edel T. O’Hagan
- Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Rodrigo R. N. Rizzo
- Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia
- School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Michael A. Wewege
- Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia
- School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Martin Rabey
- Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia
| | - Stephen Goodall
- Centre for Health Economics Research and Evaluation, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Sopany Saing
- Centre for Health Economics Research and Evaluation, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Serigne N. Lo
- Melanoma Institute Australia, University of Sydney, Sydney, Australia
- Institute for Research and Medical Consultations, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hannu Luomajoki
- School of Health Professions, Zurich University of Applied Sciences, Institute of Physiotherapy, Winterthur, Switzerland
| | | | - Chris G. Maher
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
| | - G. Lorimer Moseley
- IIMPACT (Innovation, IMPlementation And Clinical Translation) in Health, University of South Australia, Kaurna Country, Adelaide, Australia
| | - James H. McAuley
- Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia
- School of Health Sciences, University of New South Wales, Sydney, Australia
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18
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Rizzo RRN, Cashin AG, Bagg MK, Gustin SM, Lee H, McAuley JH. A Systematic Review of the Reporting Quality of Observational Studies That Use Mediation Analyses. Prev Sci 2022; 23:1041-1052. [PMID: 35167030 PMCID: PMC9343342 DOI: 10.1007/s11121-022-01349-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2022] [Indexed: 11/26/2022]
Abstract
Mediation analysis is a common statistical method used to investigate mechanisms of health exposure and interventions. The reporting quality of mediation studies used in randomised controlled trials has been considered heterogeneous and incomplete. The reporting quality of mediation analysis in observational studies is unknown. We conducted a systematic review to describe the reporting standards of recently published observational studies that used mediation analysis to understand the mechanism of health exposures. We searched for studies published between June 2017 and June 2019 indexed in EMBASE, MEDLINE and PsycINFO. Two reviewers screened articles and selected a random sample of 50 eligible studies for inclusion. We included studies across 13 healthcare fields and ten different health conditions. Most studies (74%) collected data on healthy individuals to assess their risk of developing a health disorder. Psychosocial and behavioural factors (self-control, self-esteem, alcohol consumption, pain) were the most prevalent exposures (n = 30, 60%), outcomes (n = 23, 46%) and mediators (n = 29, 58%). Most studies used a cross-sectional design (64%, n = 32), and a few studies reported sample size calculations (4%, n = 8). In 20% (n = 10) of the studies, adjustment for confounders was reported. Only 10% (n = 5) of studies reported the assumptions underlying the mediation analysis, and 14% (n = 7) of studies conducted some sensitivity analysis to assess the degree which unmeasured confounders would affect the estimate of the mediation effect. Mediation analysis is a common method used to investigate mechanisms in prevention research. The reporting of mediation analysis in observational studies is incomplete and may impact reproducibility, evidence synthesis and implementation.
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Affiliation(s)
- Rodrigo R N Rizzo
- School of Health Sciences, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Aidan G Cashin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Matthew K Bagg
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
- New College Village, University of New South Wales, Sydney, Australia
| | - Sylvia M Gustin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Hopin Lee
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK.
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.
| | - James H McAuley
- School of Health Sciences, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
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19
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Cashin AG, Bagg MK, Richards GC, Toomey E, McAuley JH, Lee H. Limited engagement with transparent and open science standards in the policies of pain journals: a cross-sectional evaluation. BMJ Evid Based Med 2021; 26:313-319. [PMID: 31980469 DOI: 10.1136/bmjebm-2019-111296] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/06/2020] [Indexed: 11/04/2022]
Abstract
Scientific progress requires transparency and openness. The ability to critique, replicate and implement scientific findings depends on the transparency of the study design and methods, and the open availability of study materials, data and code. Journals are key stakeholders in supporting transparency and openness. This study aimed to evaluate 10 highest ranked pain journals' authorship policies with respect to their support for transparent and open research practices. Two independent authors evaluated the journal policies (as at 27 May 2019) using three tools: the self-developed Transparency and Openness Evaluation Tool, the Centre for Open Science (COS) Transparency Factor and the International Committee of Medical Journal Editors (ICMJE) requirements for disclosure of conflicts of interest. We found that the journal policies had an overall low level of engagement with research transparency and openness standards. The median COS Transparency Factor score was 3.5 (IQR 2.8) of 29 possible points, and only 7 of 10 journals' stated requirements for disclosure of conflicts of interest aligned fully with the ICMJE recommendations. Improved transparency and openness of pain research has the potential to benefit all that are involved in generating and using research findings. Journal policies that endorse and facilitate transparent and open research practices will ultimately improve the evidence base that informs the care provided for people with pain.
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Affiliation(s)
- Aidan G Cashin
- Prince of Wales Clinical School, University of New South Wales Faculty of Medicine, Randwick, New South Wales, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Matthew K Bagg
- Prince of Wales Clinical School, University of New South Wales Faculty of Medicine, Randwick, New South Wales, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Georgia C Richards
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Elaine Toomey
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, Randwick, New South Wales, Australia
| | - Hopin Lee
- Centre for Statistics in Medicine & Rehabilitation Research in Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, Oxfordshire, UK
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
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20
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Hayden JA, Ellis J, Ogilvie R, Stewart SA, Bagg MK, Stanojevic S, Yamato TP, Saragiotto BT. Some types of exercise are more effective than others in people with chronic low back pain: a network meta-analysis. J Physiother 2021; 67:252-262. [PMID: 34538747 DOI: 10.1016/j.jphys.2021.09.004] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/06/2021] [Indexed: 12/29/2022] Open
Abstract
QUESTION What are the effects of specific types of exercise treatments on pain intensity and functional limitation outcomes for adults with chronic low back pain? DESIGN Systematic review with network meta-analysis of randomised controlled trials. PARTICIPANTS Adults with non-specific low back pain for ≥ 12 weeks. INTERVENTION Exercise treatments prescribed or planned by a health professional that involved conducting specific activities, postures and/or movements with a goal to improve low back pain outcomes. OUTCOME MEASURES Pain intensity (eg, visual analogue scale or numerical rating scale) and back-related functional limitations (eg, Roland Morris Disability Questionnaire or Oswestry Disability Index), each standardised to range from 0 to 100. RESULTS This review included 217 randomised controlled trials with 20,969 participants and 507 treatment groups. Most exercise types were more effective than minimal treatment for pain and functional limitation outcomes. Network meta-analysis results were compatible with moderate to clinically important treatment effects for Pilates, McKenzie therapy, and functional restoration (pain only) and flexibility exercises (function only) compared with minimal treatment, other effective treatments and other exercise types. The estimated mean differences for these exercise types compared with minimal treatment ranged from -15 to -19 for pain and from -10 to -12 for functional limitation. CONCLUSION This review found evidence that Pilates, McKenzie therapy and functional restoration were more effective than other types of exercise treatment for reducing pain intensity and functional limitations. Nevertheless, people with chronic low back pain should be encouraged to perform the exercise that they enjoy to promote adherence. REGISTRATION DOI:10.1002/14651858.CD009790.
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Affiliation(s)
- Jill A Hayden
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada.
| | - Jenna Ellis
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada
| | - Rachel Ogilvie
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada
| | - Samuel A Stewart
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada
| | - Matthew K Bagg
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia; WA SportsMed Physiotherapy, Perth, Australia
| | - Sanja Stanojevic
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada
| | - Tiê P Yamato
- Musculoskeletal Health Sydney, School of Public Health, University of Sydney, Sydney, Australia; Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Bruno T Saragiotto
- Musculoskeletal Health Sydney, School of Public Health, University of Sydney, Sydney, Australia; Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
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21
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Cashin AG, Rizzo RRN, Wand BM, O'Connell NE, Lee H, Bagg MK, O'Hagan E, Maher CG, Furlan AD, van Tulder MW, McAuley JH. Non-pharmacological and non-surgical treatments for low back pain in adults: an overview of Cochrane Reviews. Hippokratia 2021. [DOI: 10.1002/14651858.cd014691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Aidan G Cashin
- Prince of Wales Clinical School, Faculty of Medicine; The University of New South Wales; Sydney Australia
- Centre for Pain IMPACT; Neuroscience Research Australia; Sydney Australia
| | - Rodrigo RN Rizzo
- Centre for Pain IMPACT; Neuroscience Research Australia; Sydney Australia
- School of Health Sciences, Faculty of Medicine and Health; The University of New South Wales; Sydney Australia
| | - Benedict M Wand
- School of Physiotherapy; The University of Notre Dame Australia; Fremantle Australia
| | - Neil E O'Connell
- Department of Health Sciences, Centre for Health and Wellbeing Across the Lifecourse; Brunel University London; Uxbridge UK
| | - Hopin Lee
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS); University of Oxford; Oxford UK
- School of Medicine and Public Health; The University of Newcastle; Newcastle Australia
| | - Matthew K Bagg
- Centre for Pain IMPACT; Neuroscience Research Australia; Sydney Australia
| | - Edel O'Hagan
- Prince of Wales Clinical School, Faculty of Medicine; The University of New South Wales; Sydney Australia
- Centre for Pain IMPACT; Neuroscience Research Australia; Sydney Australia
| | - Christopher G Maher
- Sydney School of Public Health; The University of Sydney; Sydney Australia
- Institute for Musculoskeletal Health; The University of Sydney and Sydney Local Health District; Sydney Australia
| | | | - Maurits W van Tulder
- Department of Health Sciences, Faculty of Earth and Life Sciences; VU University Amsterdam; Amsterdam Netherlands
| | - James H McAuley
- Centre for Pain IMPACT; Neuroscience Research Australia; Sydney Australia
- School of Health Sciences, Faculty of Medicine and Health; The University of New South Wales; Sydney Australia
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22
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Cashin AG, Folly T, Bagg MK, Wewege MA, Jones MD, Ferraro MC, Leake HB, Rizzo RRN, Schabrun SM, Gustin SM, Day R, Williams CM, McAuley JH. Efficacy, acceptability, and safety of muscle relaxants for adults with non-specific low back pain: systematic review and meta-analysis. BMJ 2021; 374:n1446. [PMID: 34233900 PMCID: PMC8262447 DOI: 10.1136/bmj.n1446] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To investigate the efficacy, acceptability, and safety of muscle relaxants for low back pain. DESIGN Systematic review and meta-analysis of randomised controlled trials. DATA SOURCES Medline, Embase, CINAHL, CENTRAL, ClinicalTrials.gov, clinicialtrialsregister.eu, and WHO ICTRP from inception to 23 February 2021. ELIGIBILITY CRITERIA FOR STUDY SELECTION Randomised controlled trials of muscle relaxants compared with placebo, usual care, waiting list, or no treatment in adults (≥18 years) reporting non-specific low back pain. DATA EXTRACTION AND SYNTHESIS Two reviewers independently identified studies, extracted data, and assessed the risk of bias and certainty of the evidence using the Cochrane risk-of-bias tool and Grading of Recommendations, Assessment, Development and Evaluations, respectively. Random effects meta-analytical models through restricted maximum likelihood estimation were used to estimate pooled effects and corresponding 95% confidence intervals. Outcomes included pain intensity (measured on a 0-100 point scale), disability (0-100 point scale), acceptability (discontinuation of the drug for any reason during treatment), and safety (adverse events, serious adverse events, and number of participants who withdrew from the trial because of an adverse event). RESULTS 49 trials were included in the review, of which 31, sampling 6505 participants, were quantitatively analysed. For acute low back pain, very low certainty evidence showed that at two weeks or less non-benzodiazepine antispasmodics were associated with a reduction in pain intensity compared with control (mean difference -7.7, 95% confidence interval-12.1 to-3.3) but not a reduction in disability (-3.3, -7.3 to 0.7). Low and very low certainty evidence showed that non-benzodiazepine antispasmodics might increase the risk of an adverse event (relative risk 1.6, 1.2 to 2.0) and might have little to no effect on acceptability (0.8, 0.6 to 1.1) compared with control for acute low back pain, respectively. The number of trials investigating other muscle relaxants and different durations of low back pain were small and the certainty of evidence was reduced because most trials were at high risk of bias. CONCLUSIONS Considerable uncertainty exists about the clinical efficacy and safety of muscle relaxants. Very low and low certainty evidence shows that non-benzodiazepine antispasmodics might provide small but not clinically important reductions in pain intensity at or before two weeks and might increase the risk of an adverse event in acute low back pain, respectively. Large, high quality, placebo controlled trials are urgently needed to resolve uncertainty. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019126820 and Open Science Framework https://osf.io/mu2f5/.
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Affiliation(s)
- Aidan G Cashin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Thiago Folly
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
| | - Matthew K Bagg
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
- New College Village, University of New South Wales, Sydney, NSW, Australia
| | - Michael A Wewege
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
- School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Matthew D Jones
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
- School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Michael C Ferraro
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
- School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Hayley B Leake
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia
| | - Rodrigo R N Rizzo
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
- School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Siobhan M Schabrun
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
| | - Sylvia M Gustin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, NSW, Australia
| | - Richard Day
- Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, NSW, Australia
- St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Christopher M Williams
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Population Health, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
- School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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23
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Cashin AG, Lee H, Bagg MK, Wand BM, O'Hagan E, Rizzo RRN, Stanton TR, Moseley GL, McAuley JH. Investigating the Mechanisms of Graded Sensorimotor Precision Training in Adults With Chronic Nonspecific Low Back Pain: Protocol for a Causal Mediation Analysis of the RESOLVE Trial. JMIR Res Protoc 2021; 10:e26053. [PMID: 34255720 PMCID: PMC8285749 DOI: 10.2196/26053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 05/13/2021] [Accepted: 05/13/2021] [Indexed: 11/13/2022] Open
Abstract
Background Chronic low back pain (CLBP) is a global health problem associated with an increasing burden on individuals, health care systems, and society. Common treatments for people with CLBP produce, on average, small short-term improvements in pain and function compared with minimal care. The RESOLVE trial randomly allocated 276 people with CLBP to a new complex treatment strategy, pain education integrated with graded sensorimotor precision training (RESOLVE), or a sham control. The RESOLVE treatment was developed within a theoretical framework to target possible treatment mechanisms associated with CLBP development and persistence. Objective This protocol describes the planned evaluation of these proposed treatment mechanisms. Improved understanding of the mechanisms underpinning the RESOLVE treatment may guide its refinement and implementation. Methods We will use causal mediation analysis to evaluate the proposed treatment mechanisms, including pain self-efficacy, back beliefs, pain catastrophizing, kinesiophobia, back perception, tactile acuity, and movement coordination. The primary outcomes are pain intensity and function at 18 weeks following allocation. Data were collected blind to allocation and hypotheses at baseline (mediators, outcomes, confounders), end of treatment (mediators), and at 18 weeks following allocation (outcomes). We will test the robustness of our findings by conducting planned sensitivity analyses. Results Ethical approval was granted by the University of New South Wales Human Research Ethics Committee (HC15357). A total of 276 participants have been recruited from primary care practices and the community in Sydney, Australia. Conclusions The RESOLVE treatment constitutes a new paradigm for CLBP management with potentially wide-reaching implications. This mechanistic evaluation will provide evidence for the hypothesized treatment mechanisms and help explain why the treatment strategy did or did not have an effect on patient-reported outcomes. These results will help guide the treatment refinement and implementation. Trial Registration Australian and New Zealand Clinical Trials Registry ACTRN12615000610538; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368619&isReview=true International Registered Report Identifier (IRRID) DERR1-10.2196/26053
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Affiliation(s)
- Aidan G Cashin
- Prince of Wales Clinical School, University of New South Wales, Randwick, Australia.,Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Hopin Lee
- Oxford Clinical Trials Research Unit and Centre for Statistics in Medicine, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom.,School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Matthew K Bagg
- Prince of Wales Clinical School, University of New South Wales, Randwick, Australia.,Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Benedict M Wand
- School of Physiotherapy, The University of Notre Dame, Fremantle, Australia
| | - Edel O'Hagan
- Prince of Wales Clinical School, University of New South Wales, Randwick, Australia.,Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Rodrigo R N Rizzo
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia.,School of Health Sciences, University of New South Wales, Randwick, Australia
| | - Tasha R Stanton
- IIMPACT in Health, University of South Australia, Adelaide, Australia
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Adelaide, Australia
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia.,School of Health Sciences, University of New South Wales, Randwick, Australia
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24
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Mathieson S, Bagg MK, Schoene M, Maher CG. Nonpharmacologic and Pharmacologic Management of Acute Pain From Non-Low Back, Musculoskeletal Injuries in Adults. Ann Intern Med 2021; 174:732-733. [PMID: 33999672 DOI: 10.7326/l21-0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Stephanie Mathieson
- Institute for Musculoskeletal Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Matthew K Bagg
- Neuroscience Research Australia, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Schoene
- The BackLetter, Lippincott Williams & Wilkins, Philadelphia, Pennsylvania
| | - Christopher G Maher
- Institute for Musculoskeletal Health, University of Sydney, Camperdown, New South Wales, Australia
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25
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Ferraro MC, Bagg MK, Wewege MA, Cashin AG, Leake HB, Rizzo RRN, Jones MD, Gustin SM, Day R, Loo CK, McAuley JH. Efficacy, acceptability, and safety of antidepressants for low back pain: a systematic review and meta-analysis. Syst Rev 2021; 10:62. [PMID: 33627178 PMCID: PMC7905649 DOI: 10.1186/s13643-021-01599-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/26/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Antidepressant medicines are used to manage symptoms of low back pain. The efficacy, acceptability, and safety of antidepressant medicines for low back pain (LBP) are not clear. We aimed to evaluate the efficacy, acceptability, and safety of antidepressant medicines for LBP. METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, ClinicalTrials.gov , the EU Clinical Trials Register, and the WHO International Clinical Trial Registry Platform from inception to May 2020. We included published and trial registry reports of RCTs that allocated adult participants with LBP to receive an antidepressant medicine or a placebo medicine. Pairs of authors independently extracted data in duplicate. We extracted participant characteristics, study sample size, outcome values, and measures of variance for each outcome. We data using random-effects meta-analysis models and calculated estimates of effects and heterogeneity for each outcome. We formed judgments of confidence in the evidence in accordance with GRADE. We report our findings in accordance with the PRISMA statement. We prespecified all outcomes in a prospectively registered protocol. The primary outcomes were pain intensity and acceptability. We measured pain intensity at end-of-treatment on a 0-100 point scale and considered 10 points the minimal clinically important difference. We defined acceptability as the odds of stopping treatment for any reason. RESULTS We included 23 RCTs in this review. Data were available for pain in 17 trials and acceptability in 14 trials. Treatment with antidepressants decreased pain intensity by 4.33 points (95% CI - 6.15 to - 2.50) on a 0-100 scale, compared to placebo. Treatment with antidepressants increased the odds of stopping treatment for any reason (OR 1.27 [95% CI 1.03 to 1.56]), compared to placebo. CONCLUSIONS Treatment of LBP with antidepressants is associated with small reductions in pain intensity and increased odds of stopping treatment for any reason, compared to placebo. The effect on pain is not clinically important. The effect on acceptability warrants consideration. These findings provide Level I evidence to guide clinicians in their use of antidepressants to treat LBP. TRIAL REGISTRATION We prospectively registered the protocol for this systematic review on PROSPERO ( CRD42020149275 ).
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Affiliation(s)
- Michael C Ferraro
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia.,School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Matthew K Bagg
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia. .,Prince of Wales Clinical School, University of New South Wales, Sydney, Australia. .,New College Village, University of New South Wales, Sydney, Australia.
| | - Michael A Wewege
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia.,School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Aidan G Cashin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Hayley B Leake
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia.,IIMPACT in Health, University of South Australia, Adelaide, Australia
| | - Rodrigo R N Rizzo
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia.,School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Matthew D Jones
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia.,School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Sylvia M Gustin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia.,School of Psychology, University of New South Wales, Sydney, Australia
| | - Richard Day
- Clinical Pharmacology & Toxicology, St. Vincent's Hospital, Sydney, Australia.,St. Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Colleen K Loo
- School of Psychiatry, University of New South Wales, Sydney, Australia.,Black Dog Institute, Sydney, Australia
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia.,School of Health Sciences, University of New South Wales, Sydney, Australia
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26
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Wun A, Kollias P, Jeong H, Rizzo RR, Cashin AG, Bagg MK, McAuley JH, Jones MD. Why is exercise prescribed for people with chronic low back pain? A review of the mechanisms of benefit proposed by clinical trialists. Musculoskelet Sci Pract 2021; 51:102307. [PMID: 33254007 DOI: 10.1016/j.msksp.2020.102307] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/19/2020] [Accepted: 11/21/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Exercise is recommended for the management of chronic low back pain (CLBP). Trialists have proposed numerous mechanisms to explain why exercise improves pain and function in people with CLBP, but these are yet to be synthesised. OBJECTIVE To synthesise the proposed mechanisms of benefit for exercise in people with CLBP. DESIGN Review. METHODS The Physiotherapy Evidence Database (PEDro) was searched from inception to July 2019. Randomised controlled trials of adults with CLBP, indexed in PEDro as 'fitness training', were included. Two reviewers independently screened and extracted data from each study. Data were analysed quantitatively and qualitatively using thematic analysis. RESULTS 186 studies were identified and 110 were included in the analysis. Thirty-six studies (33%) did not provide a mechanism of benefit for exercise in people with CLBP. Of the remaining studies, most provided more than one mechanism, from which 33 unique mechanisms were identified. These were grouped into five themes which, from most to least common, were: neuromuscular (n = 105 (44%)); psychosocial (n = 87 (36%)); neurophysiological (n = 22 (9%)); cardiometabolic (n = 15 (6%)); and tissue healing (n = 12 (5%)). The effects of these proposed mechanisms on outcomes for people with CLBP were seldom examined. CONCLUSIONS This review identified a variety of mechanisms proposed in clinical trials to explain why 'fitness training' works for people with CLBP, but these mechanisms were seldom tested. Randomised controlled trials investigating the mediating effects of these mechanisms may be warranted to better understand why exercise works for CLBP.
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Affiliation(s)
- Annika Wun
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Paul Kollias
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Harry Jeong
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Rodrigo Rn Rizzo
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Aidan G Cashin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia; Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Matthew K Bagg
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia; Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia; New College Village, University of New South Wales, Sydney, Australia
| | - James H McAuley
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Matthew D Jones
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia.
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27
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Cashin AG, Wand BM, O'Connell NE, Lee H, Bagg MK, O'Hagan E, Maher CG, Furlan AD, van Tulder MW, McAuley JH. Pharmacological treatments for low back pain in adults: an overview of Cochrane Reviews. Hippokratia 2020. [DOI: 10.1002/14651858.cd013815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Aidan G Cashin
- Prince of Wales Clinical School, Faculty of Medicine; The University of New South Wales; Sydney Australia
- Centre for Pain IMPACT; Neuroscience Research Australia; Sydney Australia
| | - Benedict M Wand
- School of Physiotherapy; The University of Notre Dame Australia; Fremantle Australia
| | - Neil E O'Connell
- Health Economics Research Group, Institute of Environment, Health and Societies, Department of Clinical Sciences; Brunel University London; Uxbridge UK
| | - Hopin Lee
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS); University of Oxford; Oxford UK
- School of Medicine and Public Health; University of Newcastle; Newcastle Australia
| | - Matthew K Bagg
- Prince of Wales Clinical School, Faculty of Medicine; The University of New South Wales; Sydney Australia
- Centre for Pain IMPACT; Neuroscience Research Australia; Sydney Australia
- New College Village; University of New South Wales; Sydney Australia
| | - Edel O'Hagan
- Prince of Wales Clinical School, Faculty of Medicine; The University of New South Wales; Sydney Australia
- Centre for Pain IMPACT; Neuroscience Research Australia; Sydney Australia
| | - Christopher G Maher
- Sydney School of Public Health; The University of Sydney; Sydney Australia
- Institute for Musculoskeletal Health; The University of Sydney and Sydney Local Health District; Sydney Australia
| | | | - Maurits W van Tulder
- Department of Health Sciences, Faculty of Earth and Life Sciences; VU University Amsterdam; Amsterdam Netherlands
| | - James H McAuley
- Centre for Pain IMPACT; Neuroscience Research Australia; Sydney Australia
- School of Medical Sciences, Faculty of Medicine; University of New South Wales; Sydney Australia
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28
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Bagg MK, O'Hagan E, Zahara P, Wand BM, Hübscher M, Moseley GL, McAuley JH. Response to letter from Chou regarding "Systematic reviews that include only published data may overestimate the effectiveness of analgesic medicines for low back pain". J Clin Epidemiol 2020; 131:162-163. [PMID: 33166645 DOI: 10.1016/j.jclinepi.2020.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 11/01/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Matthew K Bagg
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales 2031, Australia; Prince of Wales Clinical School, University of New South Wales, Kensington, New South Wales 2052, Australia; New College Village, University of New South Wales, Kensington, New South Wales 2052, Australia.
| | - Edel O'Hagan
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales 2031, Australia; Prince of Wales Clinical School, University of New South Wales, Kensington, New South Wales 2052, Australia
| | - Pauline Zahara
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales 2031, Australia
| | - Benedict M Wand
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia 6959, Australia
| | - Markus Hübscher
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales 2031, Australia
| | - G Lorimer Moseley
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales 2031, Australia; IIMPACT in Health, University of South Australia, South Australia 5001, Australia
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales 2031, Australia; School of Medical Sciences, University of New South Wales, Kensington, New South Wales 2052, Australia
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29
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Wewege MA, Bagg MK, Jones MD, McAuley JH. Analgesic medicines for adults with low back pain: protocol for a systematic review and network meta-analysis. Syst Rev 2020; 9:255. [PMID: 33148322 PMCID: PMC7643321 DOI: 10.1186/s13643-020-01506-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 10/19/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND There is limited evidence for the comparative effectiveness of analgesic medicines for adults with low back pain. This systematic review and network meta-analysis aims to determine the analgesic effect, safety, acceptability, effect on function, and relative rank according to analgesic effect, safety, acceptability, and effect on function of a single course of [an] analgesic medicine(s) or combination of these medicines for people with low back pain. METHODS We will include published and unpublished randomised trials written in any language that compare an analgesic medicine to either another medicine, placebo/sham, or no intervention in adults with low back pain, grouped according to pain duration: acute (fewer than 6 weeks), sub-acute (6 to 12 weeks), and chronic (greater than 12 weeks). The co-primary outcomes are pain intensity following treatment and safety (adverse events). The secondary outcomes are function and acceptability (all-cause dropouts). We will perform a network meta-analysis to compare and rank analgesic medicines. We will form judgements of confidence in the results using the Confidence in Network Meta-Analysis (CINeMA) methodology. DISCUSSION This network meta-analysis will establish which medicine, or combination of medicines, is most effective for reducing pain and safest for adults with low back pain. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019145257.
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Affiliation(s)
- Michael A. Wewege
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Matthew K. Bagg
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW 2052 Australia
- New College Village, University of New South Wales, Sydney, Australia
| | - Matthew D. Jones
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - James H. McAuley
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
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Bagg MK, O'Hagan E, Zahara P, Wand BM, Hübscher M, Moseley GL, McAuley JH. Systematic reviews that include only published data may overestimate the effectiveness of analgesic medicines for low back pain: a systematic review and meta-analysis. J Clin Epidemiol 2020; 124:149-159. [PMID: 31816418 DOI: 10.1016/j.jclinepi.2019.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/28/2019] [Accepted: 12/04/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Systematic reviews of analgesics for low back pain generally include published data only. Obtaining data from unpublished trials is potentially important because they may impact effect sizes in meta-analyses. We determined whether including unpublished data from trial registries changes the effect sizes in meta-analyses of analgesics for low back pain. STUDY DESIGN AND SETTING Trial registries were searched for unpublished data that conformed to the inclusion criteria of n = 5 individual source systematic reviews. We reproduced the meta-analyses using data available from the original reviews and then reran the same analyses with the addition of new unpublished data. RESULTS Sixteen completed, unpublished, trials were eligible for inclusion in four of the source reviews. Data were available for five trials. We updated the analyses for two of the source reviews. The addition of data from two trials reduced the effect size of muscle relaxants, compared with sham, for recent-onset low back pain from -21.71 (95% CI: -28.23 to -15.19) to -2.34 (95% CI: -3.34 to -1.34) on a 0-100 scale for pain intensity. The addition of data from three trials (one enriched design) reduced the effect size of opioid analgesics, compared with sham, for chronic low back pain from -10.10 (95% CI: -12.81 to -7.39) to -9.31 (95% CI: -11.51 to -7.11). The effect reduced in the subgroup of enriched design studies, from -12.40 (95% CI: -16.90 to -7.91) to -11.34 (95% CI: -15.36 to -7.32), and in the subgroup of nonenriched design studies, from -7.27 (95% CI: -9.97 to -4.57) to -7.19 (95% CI: -9.24 to -5.14). CONCLUSION Systematic reviews should include reports of unpublished trials. The result for muscle relaxants conflicts with the conclusion of the published review and recent international guidelines. Adding unpublished data strengthens the evidence that opioid analgesics have small effects on persistent low back pain and more clearly suggests these effects may not be clinically meaningful.
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Affiliation(s)
- Matthew K Bagg
- Neuroscience Research Australia, Randwick, NSW 2031, Australia; Prince of Wales Clinical School, University of New South Wales, Kensington, NSW 2052, Australia; New College Village, University of New South Wales, Kensington, NSW 2052, Australia.
| | - Edel O'Hagan
- Neuroscience Research Australia, Randwick, NSW 2031, Australia; Prince of Wales Clinical School, University of New South Wales, Kensington, NSW 2052, Australia
| | - Pauline Zahara
- Neuroscience Research Australia, Randwick, NSW 2031, Australia
| | - Benedict M Wand
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, WA 6959, Australia
| | - Markus Hübscher
- Neuroscience Research Australia, Randwick, NSW 2031, Australia
| | - G Lorimer Moseley
- Neuroscience Research Australia, Randwick, NSW 2031, Australia; IIMPACT in Health, University of South Australia, SA 5000, Australia
| | - James H McAuley
- Neuroscience Research Australia, Randwick, NSW 2031, Australia; School of Medical Sciences, University of New South Wales, Kensington, NSW 2052, Australia
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31
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Bagg MK, Lo S, Cashin AG, Herbert RD, O'Connell NE, Lee H, Hübscher M, Wand BM, O'Hagan E, Rizzo RRN, Moseley GL, Stanton TR, Maher CG, Goodall S, Saing S, McAuley JH. The RESOLVE Trial for people with chronic low back pain: statistical analysis plan. Braz J Phys Ther 2020; 25:103-111. [PMID: 32811786 DOI: 10.1016/j.bjpt.2020.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/12/2020] [Accepted: 06/03/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Statistical analysis plans describe the planned data management and analysis for clinical trials. This supports transparent reporting and interpretation of clinical trial results. This paper reports the statistical analysis plan for the RESOLVE clinical trial. The RESOLVE trial assigned participants with chronic low back pain to graded sensory-motor precision training or sham-control. RESULTS We report the planned data management and analysis for the primary and secondary outcomes. The primary outcome is pain intensity at 18-weeks post randomization. We will use mixed-effects models to analyze the primary and secondary outcomes by intention-to-treat. We will report adverse effects in full. We also describe analyses if there is non-adherence to the interventions, data management procedures, and our planned reporting of results. CONCLUSION This statistical analysis plan will minimize the potential for bias in the analysis and reporting of results from the RESOLVE trial. TRIAL REGISTRATION ACTRN12615000610538 (https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368619).
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Affiliation(s)
- Matthew K Bagg
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia; Prince of Wales Clinical School, University of New South Wales, Prince of Wales Hospital Campus, Sydney, Australia; New College Village, University of New South Wales, Sydney, Australia.
| | - Serigne Lo
- Melanoma Institute Australia, University of Sydney, Sydney, Australia
| | - Aidan G Cashin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia; Prince of Wales Clinical School, University of New South Wales, Prince of Wales Hospital Campus, Sydney, Australia
| | - Rob D Herbert
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Neil E O'Connell
- Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, Kingston Lane, Uxbridge, United Kingdom
| | - Hopin Lee
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia; Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Headington, United Kingdom; School of Medicine and Public Health, University of Newcastle, University Drive, Newcastle, Australia
| | - Markus Hübscher
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Benedict M Wand
- School of Physiotherapy, The University of Notre Dame Australia Fremantle, Perth, Australia
| | - Edel O'Hagan
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia; Prince of Wales Clinical School, University of New South Wales, Prince of Wales Hospital Campus, Sydney, Australia
| | - Rodrigo R N Rizzo
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia; School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - G Lorimer Moseley
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia; IIMPACT in Health, University of South Australia, City East Campus, Australia
| | - Tasha R Stanton
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia; IIMPACT in Health, University of South Australia, City East Campus, Australia
| | - Christopher G Maher
- Institute for Musculoskeletal Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Stephen Goodall
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia
| | - Sopany Saing
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia; School of Medical Sciences, University of New South Wales, Sydney, Australia
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Palsson TS, Gibson W, Darlow B, Bunzli S, Lehman G, Rabey M, Moloney N, Vaegter HB, Bagg MK, Travers M. Author Response to Cibulka. Phys Ther 2020; 100:pzaa047. [PMID: 32242632 DOI: 10.1093/ptj/pzaa047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Thorvaldur S Palsson
- Department of Health Science and Technology, SMI, Aalborg University, Frederik Bajers Vej 7A-205, Aalborg 9220, Denmark
| | - William Gibson
- School of Physiotherapy, The University of Notre Dame, Fremantle, Australia
| | - Ben Darlow
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Samantha Bunzli
- Department of Surgery, University of Melbourne, Melbourne, Australia
| | | | | | - Niamh Moloney
- Thrive Physiotherapy; and Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Henrik B Vaegter
- Pain Research Group, Pain Center South, Odense University Hospital, Odense, Denmark; and Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Matthew K Bagg
- Neuroscience Research Australia, Sydney, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia; and New College Village, University of New South Wales
| | - Mervyn Travers
- School of Physiotherapy, The University of Notre Dame; and School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
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33
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Maher CG, Hayden JA, Saragiotto BT, Yamato TP, Bagg MK. Letter in response to: 'Which specific modes of exercise training are most effective for treating low back pain? Network meta-analysis' by Owen et al. Br J Sports Med 2020; 55:285-286. [PMID: 32024645 DOI: 10.1136/bjsports-2019-101812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Chris G Maher
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jill A Hayden
- CH&E, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Bruno T Saragiotto
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Tie P Yamato
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de Sao Paulo, Sao Paulo, Brazil
| | - Matthew K Bagg
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia.,Prince of Wales Clinical School, University of New South Wales, Randwick, New South Wales, Australia
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34
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Travers MJ, Murphy MC, Debenham JR, Chivers P, Bulsara MK, Bagg MK, Palsson TS, Gibson W. Should this systematic review and meta-analysis change my practice? Part 2: exploring the role of the comparator, diversity, risk of bias and confidence. Br J Sports Med 2019; 53:1493-1497. [PMID: 30962181 DOI: 10.1136/bjsports-2018-099959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 03/08/2019] [Accepted: 03/18/2019] [Indexed: 02/01/2023]
Affiliation(s)
- Mervyn J Travers
- School of Physiotherapy, University of Notre Dame Australia, Fremantle, Western Australia, Australia
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Myles Calder Murphy
- School of Physiotherapy, University of Notre Dame Australia, Fremantle, Western Australia, Australia
- Sports Science Sports Medicine Department, Western Australian Cricket Association, Perth, Western Australia, Australia
| | - James Robert Debenham
- School of Physiotherapy, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Paola Chivers
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Max K Bulsara
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Matthew K Bagg
- Pain Research, Education and Management Program, Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia
- UNSW Prince of Wales Clinical School, Randwick, New South Wales, Australia
| | - Thorvaldur Skulli Palsson
- Laboratory for Musculoskeletal Pain and Motor Control, Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - William Gibson
- School of Physiotherapy, University of Notre Dame Australia, Fremantle, Western Australia, Australia
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35
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Travers MJ, Murphy MC, Debenham JR, Chivers P, Bulsara MK, Bagg MK, Palsson TS, Gibson W. Should this systematic review and meta-analysis change my practice? Part 1: exploring treatment effect and trustworthiness. Br J Sports Med 2019; 53:1488-1492. [PMID: 30962182 DOI: 10.1136/bjsports-2018-099958] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Mervyn J Travers
- School of Physiotherapy, University of Notre Dame Australia, Fremantle, Western Australia, Australia
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Myles Calder Murphy
- School of Physiotherapy, University of Notre Dame Australia, Fremantle, Western Australia, Australia
- Sports Science Sports Medicine Department, Western Australian Cricket Association, Perth, Western Australia, Australia
| | - James Robert Debenham
- School of Physiotherapy, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Paola Chivers
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Max K Bulsara
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Matthew K Bagg
- Pain Research, Education and Management Program, Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia
- UNSW Prince of Wales Clinical School, Sydney, New South Wales, Australia
| | - Thorvaldur Skulli Palsson
- Laboratory for Musculoskeletal Pain and Motor Control, Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - William Gibson
- School of Physiotherapy, University of Notre Dame Australia, Fremantle, Western Australia, Australia
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36
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Palsson TS, Gibson W, Darlow B, Bunzli S, Lehman G, Rabey M, Moloney N, Vaegter HB, Bagg MK, Travers M. Changing the Narrative in Diagnosis and Management of Pain in the Sacroiliac Joint Area. Phys Ther 2019; 99:1511-1519. [PMID: 31355883 DOI: 10.1093/ptj/pzz108] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 12/18/2018] [Accepted: 03/10/2019] [Indexed: 02/09/2023]
Abstract
The sacroiliac joint (SIJ) is often considered to be involved when people present for care with low back pain where SIJ is located. However, determining why the pain has arisen can be challenging, especially in the absence of a specific cause such as pregnancy, disease, or trauma, when the SIJ might be identified as a source of symptoms with the help of manual clinical tests. Nonspecific SIJ-related pain is commonly suggested to be causally associated with movement problems in the SIJ(s)-a diagnosis traditionally derived from manual assessment of movements of the SIJ complex. Management choices often consist of patient education, manual treatment, and exercise. Although some elements of management are consistent with guidelines, this Perspective article argues that the assumptions on which these diagnoses and treatments are based are problematic, particularly if they reinforce unhelpful, pathoanatomical beliefs. This article reviews the evidence regarding the clinical detection and diagnosis of SIJ movement dysfunction. In particular, it questions the continued use of assessing movement dysfunction despite mounting evidence undermining the biological plausibility and subsequent treatment paradigms based on such diagnoses. Clinicians are encouraged to align their assessment methods and explanatory models with contemporary science to reduce the risk of their diagnoses and choice of intervention negatively affecting clinical outcomes.
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Affiliation(s)
- Thorvaldur S Palsson
- Department of Health Science and Technology, SMI, Aalborg University, Frederik Bajers Vej 7A-205, Aalborg 9220, Denmark
| | - William Gibson
- School of Physiotherapy, The University of Notre Dame, Fremantle, Australia
| | - Ben Darlow
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Samantha Bunzli
- Department of Surgery, University of Melbourne, Melbourne, Australia
| | | | | | - Niamh Moloney
- Thrive Physiotherapy; and Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Henrik B Vaegter
- Pain Research Group, Pain Center South, Odense University Hospital, Odense, Denmark; and Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Matthew K Bagg
- Neuroscience Research Australia, Sydney, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia; and New College Village, University of New South Wales
| | - Mervyn Travers
- School of Physiotherapy, The University of Notre Dame; and School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
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37
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Skinner IW, Cashin AG, Bagg MK. Clarification of Reporting of Outcome Measures and Protocol Deviations in Report of a Randomized Clinical Trial. JAMA Neurol 2019; 76:371-372. [PMID: 30667457 DOI: 10.1001/jamaneurol.2018.3595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ian William Skinner
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Aidan G Cashin
- Neuroscience Research Australia, Sydney, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Matthew K Bagg
- Neuroscience Research Australia, Sydney, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.,New College Village, University of New South Wales, Sydney, Australia
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38
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Bagg MK, McLachlan AJ, Maher CG, Kamper SJ, Williams CM, Henschke N, Wand BM, Moseley GL, Hübscher M, O'Connell NE, van Tulder MW, Nikolakopoulou A, McAuley JH. Paracetamol, NSAIDS and opioid analgesics for chronic low back pain: a network meta-analysis. Cochrane Database Syst Rev 2018. [DOI: 10.1002/14651858.cd013045] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Matthew K Bagg
- Neuroscience Research Australia; Sydney NSW Australia
- University of New South Wales; Prince of Wales Clinical School; Sydney NSW Australia
- University of New South Wales; New College Village; Sydney NSW Australia
| | - Andrew J McLachlan
- University of Sydney; Faculty of Pharmacy; A15 - Pharmacy Room N405 Sydney NSW Australia 2006
- Concord Repatriation General Hospital; Centre for Education and Research on Ageing; Sydney NSW Australia
| | - Christopher G Maher
- University of Sydney; Sydney School of Public Health; Level 10 North, King George V Building, Missenden Road, Camperdown Sydney NSW Australia 2050
| | - Steven J Kamper
- University of Sydney; Sydney School of Public Health; Level 10 North, King George V Building, Missenden Road, Camperdown Sydney NSW Australia 2050
| | - Christopher M Williams
- University of Newcastle; School of Medicine and Public Health; Longworth Ave Callaghan New South Wales (NSW) Australia 2308
- Hunter Medical Research Institute; New Lambton NSW Australia 2305
| | | | - Benedict M Wand
- The University of Notre Dame Australia Fremantle; School of Physiotherapy; 19 Mouat Street (PO Box 1225) Perth West Australia Australia 6959
| | - G L Moseley
- Neuroscience Research Australia; Sydney NSW Australia
- University of South Australia; Sansom Institute for Health Research; Adelaide Australia
| | | | - Neil E O'Connell
- Brunel University London; Health Economics Research Group, Institute of Environment, Health and Societies, Department of Clinical Sciences; Kingston Lane Uxbridge Middlesex UK UB8 3PH
| | - Maurits W van Tulder
- Vrije Universiteit; Department of Health Sciences, Faculty of Science and Amsterdam Movement Science institute; Amsterdam Netherlands
| | - Adriani Nikolakopoulou
- University of Bern; Institute of Social and Preventive Medicine (ISPM); Bern Switzerland
| | - James H McAuley
- Neuroscience Research Australia; Sydney NSW Australia
- University of New South Wales; School of Medical Sciences; Sydney NSW Australia
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39
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Affiliation(s)
- Matthew K Bagg
- Neuroscience Research Australia; Prince of Wales Clinical School, University of New South Wales; New College Village, University of New South Wales
| | - James H McAuley
- Neuroscience Research Australia; School of Medical Sciences, University of New South Wales, Sydney, Australia
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40
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Bagg MK, Salanti G, McAuley JH. Comparing interventions with network meta-analysis. J Physiother 2018; 64:128-132. [PMID: 29661376 DOI: 10.1016/j.jphys.2018.02.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 02/12/2018] [Accepted: 02/18/2018] [Indexed: 12/30/2022] Open
Affiliation(s)
- Matthew K Bagg
- Neuroscience Research Australia; Prince of Wales Clinical School & New College Village, University of New South Wales, Sydney, Australia
| | - Georgia Salanti
- Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - James H McAuley
- Neuroscience Research Australia; School of Medical Sciences, University of New South Wales, Sydney, Australia
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41
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Travers MJ, Bagg MK, Gibson W, O'Sullivan K, Palsson TS. Better than what? Comparisons in low back pain clinical trials. Br J Sports Med 2018; 53:847-848. [PMID: 29420237 DOI: 10.1136/bjsports-2017-098130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2017] [Indexed: 11/03/2022]
Affiliation(s)
- Mervyn J Travers
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia.,School of Physiotherapy and Exercise Science, Curtin University, Bentley, Western Australia, Australia
| | - Matthew K Bagg
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,New College Village, University of New South Wales, Sydney, New South Wales, Australia
| | - William Gibson
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Kieran O'Sullivan
- Department of Sports Spine Centre, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Department of Clinical Therapies, University of Limerick, Limerick, Ireland
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42
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Bagg MK, McAuley JH, Moseley GL, Wand BM. Recent data from radiofrequency denervation trials further emphasise that treating nociception is not the same as treating pain. Br J Sports Med 2018; 53:841-842. [PMID: 29351958 DOI: 10.1136/bjsports-2017-098510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Matthew K Bagg
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,New College Village, University of New South Wales, Sydney, New South Wales, Australia
| | - James H McAuley
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - G Lorimer Moseley
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia.,Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Benedict Martin Wand
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
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43
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Bagg MK, McAuley JH. Comment: A Comparison of the Efficacy and Tolerability of the Treatments for Sciatica: A Network Meta-Analysis. Ann Pharmacother 2017; 52:97-98. [PMID: 28948841 DOI: 10.1177/1060028017733480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Bagg MK, Hübscher M, Rabey M, Wand BM, O'Hagan E, Moseley GL, Stanton TR, Maher CG, Goodall S, Saing S, O'Connell NE, Luomajoki H, McAuley JH. The RESOLVE Trial for people with chronic low back pain: protocol for a randomised clinical trial. J Physiother 2017; 63:47-48. [PMID: 27939089 DOI: 10.1016/j.jphys.2016.11.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 10/16/2016] [Accepted: 11/03/2016] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Low back pain is the leading worldwide cause of disability, and results in significant personal hardship. Most available treatments, when tested in high-quality randomised, controlled trials, achieve only modest improvements in pain, at best. Recently, treatments that target central nervous system function have been developed and tested in small studies. Combining treatments that target central nervous system function with traditional treatments directed towards functioning of the back is a promising approach that has yet to be tested in adequately powered, prospectively registered, clinical trials. The RESOLVE trial will be the first high-quality assessment of two treatment programs that combine central nervous system-directed and traditional interventions in order to improve chronic low back pain. AIM To compare the effectiveness of two treatment programs that combine central nervous system-directed and traditional interventions at reducing pain intensity at 18 weeks post randomisation in a randomised clinical trial of people with chronic low back pain. DESIGN Two-group, randomised, clinical trial with blinding of participants and assessors. PARTICIPANTS AND SETTING Two hundred and seventy-five participants with chronic low back pain that has persisted longer than 3 months and no specific spinal pathology will be recruited from the community and primary care in Sydney, Australia. INTERVENTIONS Both of the interventions contain treatments that target central nervous system function combined with treatments directed towards functioning of the back. Adherence to the intervention will be monitored using an individual treatment diary and adverse events recorded through passive capture. Participants are informed prior to providing informed consent that some of the treatments are not active. Blinding is maintained by not disclosing any further information. Complete disclosure of the contents of the intervention has been made with the UNSW HREC (HC15357) and an embargoed project registration has been made on the Open Science Framework to meet the Declaration of Helsinki requirement for transparent reporting of trial methods a priori. INTERVENTION A Participants randomised to Intervention A will receive a 12-session treatment program delivered as 60-minute sessions, scheduled approximately weekly, over a period of 12 to 18 weeks. All treatment sessions are one-on-one. The program includes a home treatment component of 30minutes, five times per week. The intervention comprises discussion of the participant's low back pain experience, graded sensory training, graded motor imagery training and graded, precision-focused and feedback-enriched, functional movement training. Treatment progression is determined by participant proficiency, with mandatory advancement at set time points with respect to a standard protocol. INTERVENTION B Participants randomised to Intervention B will receive a 12-session treatment program of the same duration and structure as Intervention A. The intervention comprises discussion of the participant's low back pain experience, transcranial direct current stimulation to the motor and pre-frontal cortices, cranial electrical stimulation, and low-intensity laser therapy and pulsed electromagnetic energy to the area of greatest pain. Treatment is delivered according to published recommendations and progressed with respect to a standard protocol. MEASUREMENTS The primary outcome is pain intensity at 18 weeks post randomisation. Secondary outcomes will include disability, depression, pain catastrophising, kinesiophobia, beliefs about back pain, pain self-efficacy, quality of life, healthcare resource use, and treatment credibility. Assessment will occur at baseline and at 18, 26 and 52 weeks after randomisation. Treatment credibility will be assessed at baseline and 2 weeks after randomisation only. ANALYSIS A statistician blinded to group status will analyse the data by intention-to-treat using linear mixed models with random intercepts. Linear contrasts will be constructed to compare the adjusted mean change (continuous variables) in outcome from baseline to each time point between intervention A and intervention B. This will provide effect estimates and 95% confidence intervals for any difference between the interventions. SIGNIFICANCE Preliminary data suggest that combining treatments that target central nervous system function with traditional interventions is a promising approach to chronic low back pain treatment. In the context of modest effects on pain intensity from most available treatments, this approach may lead to improved clinical outcomes for people with chronic low back pain. The trial will determine which, if either, of two treatment programs that combine central nervous system-directed and traditional interventions is more effective at reducing pain intensity in a chronic low back pain cohort. Central nervous system-directed interventions constitute a completely new treatment paradigm for chronic low back pain management. The results have the potential to be far reaching and change current physiotherapy management of chronic low back pain in Australia and internationally.
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Affiliation(s)
- Matthew K Bagg
- Neuroscience Research Australia, Sydney, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Markus Hübscher
- Neuroscience Research Australia, Sydney, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Martin Rabey
- Neuroscience Research Australia, Sydney, Australia
| | - Benedict M Wand
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Australia
| | - Edel O'Hagan
- Neuroscience Research Australia, Sydney, Australia
| | - G Lorimer Moseley
- Neuroscience Research Australia, Sydney, Australia; Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Tasha R Stanton
- Neuroscience Research Australia, Sydney, Australia; Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Chris G Maher
- The George Institute for Global Health, University of Sydney, Sydney, Australia
| | - Stephen Goodall
- Centre for Health Economics Research and Evaluation, UTS Business School, University of Technology Sydney, Sydney, Australia
| | - Sopany Saing
- Centre for Health Economics Research and Evaluation, UTS Business School, University of Technology Sydney, Sydney, Australia
| | - Neil E O'Connell
- Department of Clinical Sciences, Health Economics Research Group, Institute of Environment, Health and Societies, Brunel University London, Uxbridge, United Kingdom
| | - Hannu Luomajoki
- School of Health Professions, Zurich University of Applied Sciences, Institute of Physiotherapy, Winterthur, Switzerland
| | - James H McAuley
- Neuroscience Research Australia, Sydney, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
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