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Northgraves M, Cohen J, Harvey J, Huang C, Palmieri C, Pinder S, Roy P, Reynia S, Soares M, Cain H. A randomised controlled trial of Pre-Operative Oncotype DX testing in early-stage breast cancer (PRE-DX study) - Study protocol. PLoS One 2024; 19:e0300339. [PMID: 38489298 PMCID: PMC10942020 DOI: 10.1371/journal.pone.0300339] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/21/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND The Oncotype DX® Breast Recurrence Score assay can guide recommendations made to patients with oestrogen receptor positive (ER+), human epidermal growth factor receptor 2 negative (HER2-) breast cancer regarding post-surgery adjuvant therapy. Standard practice is to order the test in the post-operative setting on a specimen from the excised invasive carcinoma. However, it has been shown to be technically possible to perform the test on the diagnostic core biopsy. By testing the diagnostic core biopsy in the pre-operative setting, the wait for excised invasive carcinoma Recurrence Score results could be reduced allowing patients to be more accurately counselled regarding their treatment pathway sooner with any adjuvant treatment recommendations expedited. This would allow for more efficient streaming of follow up appointments. The aim of this study is to compare the impact on the patient treatment pathway of performing the Oncotype DX® test on the diagnostic core biopsy pre-operatively (intervention) as opposed to the excised invasive carcinoma (control). METHODS AND ANALYSIS This parallel group randomised controlled trial aims to recruit 330 newly diagnosed patients with grade 2 or grade 3, ER+, HER2-, invasive intermediate risk early-stage breast cancer. Participants will be randomised 2:1 to the preoperative testing of the diagnostic core biopsy compared to the post-operative testing of the excision specimen. The primary endpoint is number of clinical touchpoints between treating team and patient from initial approach until offer and prescription of the first adjuvant treatment. Secondary endpoints include time from diagnosis to offer and prescription of the first adjuvant treatment, patient-reported anxiety scores and health cost impact analysis collected at baseline, following the post-operative clinic and following the offer of adjuvant treatment, and number of alterations in treatment sequence from original planned surgical treatment to neoadjuvant therapy. TRIAL REGISTRATION The study was registered on ISRCTN (ISRCTN14337451) on the 16th August 2022.
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Affiliation(s)
| | - Judith Cohen
- Hull Health Trials Unit, University of Hull, Hull, United Kingdom
| | - James Harvey
- Nightingale Breast Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Chao Huang
- Hull Health Trials Unit, University of Hull, Hull, United Kingdom
- Institute for Clinical and Applied Health Research (ICAHR), University of Hull, Hull, United Kingdom
| | - Carlo Palmieri
- Institute of Systems, Molecular and Integrative Biology, Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Sarah Pinder
- School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
- Department of Cellular Pathology, Guy’s and St Thomas NHS Foundation Trust, London, United Kingdom
| | - Pankaj Roy
- Department of Breast Surgery, Oxford University Hospitals NHS Foundation Trust, Oxfordshire, United Kingdom
| | | | - Marta Soares
- Centre for Health Economics, University of York, York, United Kingdom
| | - Henry Cain
- Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
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Hutchinson A, Allgar V, Cohen J, Currow D, Griffin S, Hart S, Hodge A, Mason S, Northgraves M, Reeve J, Swan F, Johnson M. OP08 A feasibility cluster randomised controlled trial of a paramedic-administered breathlessness management intervention for acute-on-chronic breathlessness (BREATHE): study findings. J Accid Emerg Med 2022. [DOI: 10.1136/emermed-2022-999.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundOne-fifth of conveyances to the emergency department (ED) are due to acute-on-chronic breathlessness. Paramedic breathlessness management may ease distress quicker and/or reduce ED conveyances. We evaluated the feasibility of a full trial of a paramedic delivered intervention to reduce avoidable conveyances (recruitment, randomisation, consent, training and intervention acceptability, adherence, data quality, best primary outcome, sample size estimation). The intervention comprised evidence-based non-drug techniques and a self-management booklet.MethodsThis mixed-methods feasibility cluster randomised controlled trial (ISRCTN80330546) with embedded qualitative study about trial processes, training and intervention delivery, randomised paramedics to usual care or to intervention+usual care. Retrospective patient consent to use call-out data and prospective patient/carer consent for follow-up was sought. Potential primary outcomes were breathlessness intensity (numerical rating scale) and ED conveyance. Follow-up included an interview for patients/carers and questionnaires at 14 days, 1 and 6 months and paramedic focus groups and survey.ResultsRecruitment was during the COVID-19 pandemic, leading to high demands on paramedics and fewer call-outs by eligible patients. We enrolled 29 paramedics; 9 withdrew. Randomisation/trial procedures were acceptable. Paramedics recruited 13 patients; 8 were followed up. Data quality was good. The intervention did not extend call-out time, was delivered with fidelity and no contamination and was acceptable to patients, carers, and paramedics. There were no repeat call-outs < 48 hours. Recruitment stop-go criteria were not met. We had insufficient data for sample size estimation.ConclusionsA full trial in the same circumstances is not feasible. However, valuable information was gained on recruitment, attrition, consent, training and intervention acceptability and adherence, and patient-reported data collection.
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Hutchinson A, Allgar V, Cohen J, Currow DC, Griffin S, Hart S, Hird K, Hodge A, Mason S, Northgraves M, Reeve J, Swan F, Johnson MJ. Mixed-methods feasibility cluster randomised controlled trial of a paramedic-administered breathlessness management intervention for acute-on-chronic breathlessness (BREATHE): Study findings. ERJ Open Res 2022; 8:00257-2022. [DOI: 10.1183/23120541.00257-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/11/2022] [Indexed: 11/05/2022] Open
Abstract
IntroductionOne-fifth of emergency department presentations by ambulance are due to acute-on-chronic breathlessness. We explored the feasibility of an evaluation-phase, cluster randomised controlled trial (cRCT) of the effectiveness and cost-effectiveness of a paramedic-administered, non-pharmacological breathlessness intervention for people with acute-on-chronic breathlessness at ambulance call-out (BREATHE) regarding breathlessness intensity and conveyance to hospital.MethodsThis mixed-methods, feasibility cRCT (ISRCTN80330546), randomised paramedics to usual care or intervention plus usual care. Retrospective patient consent to use call-out data (primary endpoint) and prospective patient/carer consent for follow-up was sought. Potential primary outcomes included breathlessness intensity (numerical rating scale) and conveyance. Follow-up included: interviews with patients/carers and questionnaires at 14 days, 1 and 6 months; paramedic focus groups and surveys.ResultsRecruitment was during COVID-19, with high demands on paramedics and fewer call-outs by eligible patients. We enrolled 29 paramedics; nine withdrew. Randomisation/trial procedures were acceptable.Paramedics recruited thirteen patients, not meeting recruitment target (n=36); eight patients and three carers were followed up. Data quality was good but insufficient for future sample size estimation.The intervention did not extend call-out time, was delivered with fidelity and was acceptable to patients, carers and paramedics. There were no repeat call-outs within 48 h. All trained paramedics strongly recommended BREATHE as a highly relevant, simple intervention.ConclusionPatient recruitment to target was not feasible during the pandemic. Training and intervention were acceptable and delivered with fidelity. Results include valuable information on recruitment, consent, attrition, and data collection that will inform the design and delivery of a definitive trial.
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Northgraves M, Allsup D, Cohen J, Huang C, Turgoose J, Ali S. A prospective registry-based cohort study of the diagnosis and management of acute leukaemia in pregnancy: Study protocol. PLoS One 2022; 17:e0263195. [PMID: 35130292 PMCID: PMC8820608 DOI: 10.1371/journal.pone.0263195] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/07/2021] [Indexed: 11/26/2022] Open
Abstract
Background Acute leukaemias (AL) are aggressive but potentially curable blood cancers that can potentially affect women of childbearing age. When a pregnancy is complicated by a diagnosis of AL, clinicians face a complex dilemma: to balance risking the mother’s survival through delayed AL treatment, against the potential harm to the foetus through exposure to anti-cancer drugs. Up until now, all guidance and advice regarding the management of AL in pregnancy, have been based on expert opinion and small case studies. There is a pressing need for more studies in the subject to address this evidence gap. Methods and analysis This study is a registry-based observational cohort study which aims to monitor and record the treatment outcomes of patients diagnosed with AL during pregnancy. Additionally, the study aims to assess pregnancy outcomes in patients who become pregnant following successful treatment. Prospective and historical cases from August 2009 onwards will be identified from AL treating haematology units within the UK. Details of diagnosis, AL treatment delivered, antenatal and postnatal outcomes for mother and neonate will be collected. This study will establish a new research database for Leukaemia in Pregnancy. Trial registration The study was registered on Clinicaltrials.gov (NCT04182074) on the 2nd December 2019.
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Affiliation(s)
| | - David Allsup
- Centre for Atherothrombosis and Metabolic Disease, Hull York Medical School, Hull, United Kingdom
| | - Judith Cohen
- Hull Health Trials Unit, University of Hull, Hull, United Kingdom
- Institute for Clinical and Applied Health Research (ICAHR), University of Hull, Hull, United Kingdom
| | - Chao Huang
- Hull Health Trials Unit, University of Hull, Hull, United Kingdom
- Institute for Clinical and Applied Health Research (ICAHR), University of Hull, Hull, United Kingdom
| | - John Turgoose
- Hull Health Trials Unit, University of Hull, Hull, United Kingdom
| | - Sahra Ali
- King’s College Hospital NHS Foundation Trust, Denmark Hill, London, United Kingdom
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Mitchell AS, Cook L, Dean A, Fairhurst C, Northgraves M, Torgerson DJ, Reed M. An embedded randomised controlled retention trial of personalised text messages compared to non-personalised text messages in an orthopaedic setting. F1000Res 2021; 9:591. [PMID: 35600143 PMCID: PMC9091807 DOI: 10.12688/f1000research.24244.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Several studies have investigated whether personalising trial documentation can aid recruitment and retention. We did a ‘study within a trial’ (SWAT) evaluating the effectiveness of a personalised text message compared to a non-personalised text message, on the retention rate in a large orthopaedic trial. Methods: The SWAT was embedded in the Knee Replacement Bandaging Study (KReBS) trial. The primary outcome was the proportion of 12-month questionnaires returned. Secondary outcomes were the proportion of questionnaires completed and time to questionnaire return. Binary data were analysed using logistic regression and time to return using Cox proportional hazards regression. Odds ratios (OR) and hazard ratios (HR) are presented, with associated 95% confidence intervals (CI) and p-values. Results: In total, 1465 participants were included in the SWAT. In the personalised group, 644/723 (89.1%) of participants returned a questionnaire, compared to 654/742 (88.1%) in the non-personalised group. The absolute difference in return rate was 0.9% (95% CI: -2.3% to 4.2%; p=0.57). There was no evidence of a difference between the groups in the likelihood of returning a questionnaire (OR 1.09; 95% CI: 0.79 to 1.51; p=0.61), the likelihood of returning a complete questionnaire (OR 1.11; 95% CI: 0.82 to 1.51; p=0.50) nor in time to return (HR 1.05; 95% CI: 0.94 to 1.17; p=0.40). Conclusion: This SWAT adds to the growing evidence base for whether personalised text messages are effective. Registration: ISRCTN87127065 (20/02/2017); SWAT 35 (01/12/2015)
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Affiliation(s)
- Alex S. Mitchell
- Department of Health Sciences, University of York, UK, York, Y010 5DD, UK
| | - Liz Cook
- Department of Health Sciences, University of York, UK, York, Y010 5DD, UK
| | - Alexandra Dean
- Department of Health Sciences, University of York, UK, York, Y010 5DD, UK
| | - Caroline Fairhurst
- Department of Health Sciences, University of York, UK, York, Y010 5DD, UK
| | | | - David J. Torgerson
- Department of Health Sciences, University of York, UK, York, Y010 5DD, UK
| | - Mike Reed
- Department of Health Sciences, University of York, UK, York, Y010 5DD, UK
- North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, Tyne and Wear, NE29 8NH, UK
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Dias J, Brealey S, Cook L, Fairhurst C, Hinde S, Leighton P, Choudhary S, Costa M, Hewitt C, Hodgson S, Jefferson L, Jeyapalan K, Keding A, Northgraves M, Palmer J, Rangan A, Richardson G, Taub N, Tew G, Thompson J, Torgerson D. Surgical fixation compared with cast immobilisation for adults with a bicortical fracture of the scaphoid waist: the SWIFFT RCT. Health Technol Assess 2021; 24:1-234. [PMID: 33109331 DOI: 10.3310/hta24520] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 11/22/2022] Open
Abstract
BACKGROUND Scaphoid fractures account for 90% of carpal fractures and occur predominantly in young men. Immediate surgical fixation of this fracture has increased. OBJECTIVE To compare the clinical effectiveness and cost-effectiveness of surgical fixation with cast treatment and early fixation in adults with scaphoid waist fractures that fail to unite. DESIGN Multicentre, pragmatic, open-label, parallel two-arm randomised controlled trial with an economic evaluation and a nested qualitative study. SETTING Orthopaedic departments of 31 hospitals in England and Wales recruited from July 2013, with final follow-up in September 2017. PARTICIPANTS Adults (aged ≥ 16 years) presenting within 2 weeks of injury with a clear, bicortical fracture of the scaphoid waist on plain radiographs. INTERVENTIONS Early surgical fixation using Conformité Européenne-marked headless compression screws. Below-elbow cast immobilisation for 6-10 weeks and urgent fixation of confirmed non-union. MAIN OUTCOME MEASURES The primary outcome and end point was the Patient-Rated Wrist Evaluation total score at 52 weeks, with a clinically relevant difference of 6 points. Secondary outcomes included Patient-Rated Wrist Evaluation pain and function subscales, Short Form questionnaire 12-items, bone union, range of movement, grip strength, complications and return to work. RESULTS The mean age of 439 participants was 33 years; 363 participants were male (83%) and 269 participants had an undisplaced fracture (61%). The primary analysis was on 408 participants with valid Patient-Rated Wrist Evaluation outcome data for at least one post-randomisation time point (surgery, n = 203 of 219; cast, n = 205 of 220). There was no clinically relevant difference in the Patient-Rated Wrist Evaluation total score at 52 weeks: the mean score in the cast group was 14.0 (95% confidence interval 11.3 to 16.6) and in the surgery group was 11.9 (95% confidence interval 9.2 to 14.5), with an adjusted mean difference of -2.1 in favour of surgery (95% confidence interval -5.8 to 1.6; p = 0.27). The non-union rate was low (surgery group, n = 1; cast group, n = 4). Eight participants in the surgery group had a total of 11 reoperations and one participant in the cast group required a reoperation for non-union. The base-case economic analysis at 52 weeks found that surgery cost £1295 per patient more (95% confidence interval £1084 to £1504) than cast treatment. The base-case analysis of a lifetime-extrapolated model confirmed that the cast treatment pathway was more cost-effective. The nested qualitative study identified patients' desire to have a 'sense of recovering', which surgeons should address at the outset. LIMITATION There were 17 participants who had initial cast treatment and surgery for confirmed non-union, which in 14 cases was within 6 months from randomisation and in three cases was after 6 months. Three of the four participants in the cast group who had a non-union at 52 weeks were not offered surgery. CONCLUSIONS Adult patients with an undisplaced or minimally displaced scaphoid waist fracture should have cast immobilisation and suspected non-unions immediately confirmed and urgently fixed. Patients should be followed up at 5 years to investigate the effect of partial union, degenerative arthritis, malunion and screw problems on their quality of life. TRIAL REGISTRATION Current Controlled Trials ISRCTN67901257. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 52. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Joseph Dias
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Stephen Brealey
- Alcuin Research Resource Centre Building, Department of Health Sciences, University of York, York, UK
| | - Liz Cook
- Alcuin Research Resource Centre Building, Department of Health Sciences, University of York, York, UK
| | - Caroline Fairhurst
- Alcuin Research Resource Centre Building, Department of Health Sciences, University of York, York, UK
| | | | - Paul Leighton
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Surabhi Choudhary
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Matthew Costa
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Kadoorie Centre, John Radcliffe Hospital, Oxford, UK
| | - Catherine Hewitt
- Alcuin Research Resource Centre Building, Department of Health Sciences, University of York, York, UK
| | - Stephen Hodgson
- Department of Orthopaedic Surgery, Bolton NHS Foundation Trust, Royal Bolton Hospital, Bolton, UK
| | - Laura Jefferson
- Alcuin Research Resource Centre Building, Department of Health Sciences, University of York, York, UK.,Department of Health Sciences, University of York, York, UK
| | | | - Ada Keding
- Alcuin Research Resource Centre Building, Department of Health Sciences, University of York, York, UK
| | - Matthew Northgraves
- Alcuin Research Resource Centre Building, Department of Health Sciences, University of York, York, UK
| | - Jared Palmer
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Amar Rangan
- Alcuin Research Resource Centre Building, Department of Health Sciences, University of York, York, UK.,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | - Nicholas Taub
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Garry Tew
- Alcuin Research Resource Centre Building, Department of Health Sciences, University of York, York, UK.,Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - John Thompson
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - David Torgerson
- Alcuin Research Resource Centre Building, Department of Health Sciences, University of York, York, UK
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Srikesavan C, Toye F, Brealey S, Goodchild L, Northgraves M, Charalambous CP, Rangan A, Lamb S. Experiences and perceptions of trial participants and healthcare professionals in the UK Frozen Shoulder Trial (UK FROST): a nested qualitative study. BMJ Open 2021; 11:e040829. [PMID: 34117042 PMCID: PMC8202103 DOI: 10.1136/bmjopen-2020-040829] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To explore the experiences and perceptions of trial participants and healthcare professionals in the UK Frozen Shoulder Trial (UK FROST), a multicentre randomised controlled trial that compared manipulation under anaesthesia (MUA), arthroscopic capsular release (ACR) with a 12-week early structured physiotherapy programme (ESP) in people with unilateral frozen shoulder referred to secondary care. DESIGN Nested qualitative study with semistructured interviews. We used constant comparison method to develop our themes. SETTING This qualitative study was nested within the UK FROST. PARTICIPANTS 44 trial participants (ESP: 14; MUA: 15; ACR: 15), and 8 surgeons and 8 physiotherapists who delivered the treatments in the trial. RESULTS Trial participants found UK FROST treatments acceptable and satisfactory in terms of content, delivery and treatment benefits. Participants in all arms experienced improvements in pain, shoulder movements, and function. Participants said they would choose the same treatment that they received in the trial.Surgeons and physiotherapists felt that the content and delivery of UK FROST treatments was not significantly different to their routine practice except for the additional number of physiotherapy sessions offered in the trial. They had mixed feelings about the effectiveness of UK FROST treatments. Both stressed the value of including hydrodilatation as a comparator of other treatment options. Physiotherapists raised concerns about the capacity to deliver the number of UK FROST physiotherapy sessions in routine clinical settings.Shared perceptions of trial participants, surgeons and physiotherapists were: (1) Pain relief and return of shoulder movements and function are important outcomes and (2) Adherence to exercises leads to better outcomes. CONCLUSION In general, our findings indicated that trial participants, and surgeons and physiotherapists who delivered the treatments had positive experiences and perceptions in the UK FROST. Early qualitative investigations to explore the feasibility of delivering treatments in real-world settings are suggested in future trials in the frozen shoulder. TRIAL REGISTRATION NUMBER International Standard Randomised Controlled Trial Register, ID: ISRCTN48804508. Registered on 25 July 2014; Results.
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Affiliation(s)
- Cynthia Srikesavan
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Francine Toye
- Physiotherapy Research Unit, Oxford University Hospitals NHS Foundation Trust Nuffield Orthopaedic Centre, Oxford, UK
| | - Stephen Brealey
- York Trials Unit, ARRC Building, Department of Health Sciences, University of York, York, UK
| | - Lorna Goodchild
- The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | | | - Charalambos P Charalambous
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
- School of Medicine, University of Central Lancashire, Preston, UK
| | - Amar Rangan
- York Trials Unit, ARRC Building, Department of Health Sciences, University of York, York, UK
| | - Sarah Lamb
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- College of Medicine and Health, University of Exeter, Exeter, UK
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Northgraves M, Cohen J, Allgar V, Currow D, Hart S, Hird K, Hodge A, Johnson M, Mason S, Swan F, Hutchinson A. A feasibility cluster randomised controlled trial of a paramedic-administered breathlessness management intervention for acute-on-chronic breathlessness (BREATHE). ERJ Open Res 2021; 7:00955-2020. [PMID: 33816602 PMCID: PMC8005684 DOI: 10.1183/23120541.00955-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/07/2021] [Indexed: 11/19/2022] Open
Abstract
Chronic breathlessness, persistent and disabling despite optimal treatment of underlying causes, is a prevalent and frightening symptom and is associated with many emergency presentations and admission to hospital. Breathlessness management techniques used by paramedics may reduce the need for conveyance to hospital. The Breathlessness RElief AT HomE study (BREATHE) aims to explore the feasibility of conducting a definitive cluster randomised controlled trial (cRCT) for people with acute-on-chronic breathlessness who have called an ambulance, to evaluate the effectiveness and cost-effectiveness of a paramedic-administered non-pharmacological breathlessness intervention. The trial is a mixed-methods feasibility cRCT. Eight paramedics will be randomised 1:1 to deliver either the BREATHE intervention in addition to usual care or usual care alone at call-outs for acute-on-chronic breathlessness. Sixty participants will be recruited to provide access to routine data relating to the index call-out with optional follow-up questionnaires at 14 days, 1 month and 6 months. An in-depth interview will be conducted with a subgroup. Feasibility outcomes relating to recruitment, data quality (especially candidate primary outcomes), and intervention acceptability and fidelity will be collected as well as providing data to estimate a sample size for a definitive trial. Yorkshire and The Humber–Sheffield Research Ethics Committee approved the trial protocol (19/YH/0314). The study results will inform progression to, or not, and design of a main trial according to predetermined stop-go criteria. Findings will be disseminated to relevant stakeholders and submitted for publication in a peer-reviewed journal. Acute-on-chronic breathlessness initiates many emergency presentations. The BREATHE protocol describes a feasibility, cluster randomised controlled trial of a paramedic breathlessness management intervention.https://bit.ly/2LZg72w
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Affiliation(s)
| | - Judith Cohen
- Hull Health Trials Unit, University of Hull, Hull, UK
| | - Victoria Allgar
- Hull York Medical School / Health Sciences, University of York, York, UK
| | - David Currow
- Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Simon Hart
- Respiratory Research Group, Hull York Medical School, Cottingham, UK
| | - Kelly Hird
- Yorkshire Ambulance Service NHS Trust, Wakefield, UK
| | - Andrew Hodge
- Yorkshire Ambulance Service NHS Trust, Wakefield, UK
| | - Miriam Johnson
- Wolfson Palliative Care Research Group, Hull York Medical School, Hull, UK
| | - Suzanne Mason
- CURE group, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Flavia Swan
- Wolfson Palliative Care Research Group, Hull York Medical School, Hull, UK
| | - Ann Hutchinson
- Wolfson Palliative Care Research Group, Hull York Medical School, Hull, UK
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Flett L, Adamson J, Barron E, Brealey S, Corbacho B, Costa ML, Gedney G, Giotakis N, Hewitt C, Hugill-Jones J, Hukins D, Keding A, McDaid C, Mitchell A, Northgraves M, O'Carroll G, Parker A, Scantlebury A, Stobbart L, Torgerson D, Turner E, Welch C, Sharma H. A multicentre, randomized, parallel group, superiority study to compare the clinical effectiveness and cost-effectiveness of external frame versus internal locking plate for complete articular pilon fracture fixation in adults. Bone Jt Open 2021; 2:150-163. [PMID: 33663229 PMCID: PMC8009896 DOI: 10.1302/2633-1462.23.bjo-2020-0178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Indexed: 11/05/2022] Open
Abstract
AIMS A pilon fracture is a severe ankle joint injury caused by high-energy trauma, typically affecting men of working age. Although relatively uncommon (5% to 7% of all tibial fractures), this injury causes among the worst functional and health outcomes of any skeletal injury, with a high risk of serious complications and long-term disability, and with devastating consequences on patients' quality of life and financial prospects. Robust evidence to guide treatment is currently lacking. This study aims to evaluate the clinical and cost-effectiveness of two surgical interventions that are most commonly used to treat pilon fractures. METHODS A randomized controlled trial (RCT) of 334 adult patients diagnosed with a closed type C pilon fracture will be conducted. Internal locking plate fixation will be compared with external frame fixation. The primary outcome and endpoint will be the Disability Rating Index (a patient self-reported assessment of physical disability) at 12 months. This will also be measured at baseline, three, six, and 24 months after randomization. Secondary outcomes include the Olerud and Molander Ankle Score (OMAS), the five-level EuroQol five-dimenison score (EQ-5D-5L), complications (including bone healing), resource use, work impact, and patient treatment preference. The acceptability of the treatments and study design to patients and health care professionals will be explored through qualitative methods. DISCUSSION The two treatments being compared are the most commonly used for this injury, however there is uncertainty over which is most clinically and cost-effective. The Articular Pilon Fracture (ACTIVE) Trial is a sufficiently powered and rigorously designed study to inform clinical decisions for the treatment of adults with this injury. Cite this article: Bone Jt Open 2021;2(3):150-163.
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Affiliation(s)
- Lydia Flett
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Joy Adamson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Elizabeth Barron
- Department of Trauma and Orthopaedics, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Stephen Brealey
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Belen Corbacho
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Matthew L Costa
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Graham Gedney
- Patient Experience Team, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Nikolaos Giotakis
- Department of Trauma and Orthopaedics, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | | | - Deborah Hukins
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Ada Keding
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Catriona McDaid
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Alex Mitchell
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Matthew Northgraves
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Grace O'Carroll
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Adwoa Parker
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | | | - Lynne Stobbart
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - David Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Emma Turner
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Charlie Welch
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Hemant Sharma
- Department of Trauma and Orthopaedics, Hull University Teaching Hospitals NHS Trust, Hull, UK.,Hull York Medical School, University of Hull, Hull, UK
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10
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Pickering K, Wane S, Speake H, Crank H, Anderson A, Cain H, Copeland R, Lee D, Gray J, McNally R, Hargreaves J, Cohen J, Northgraves M, Wilson C, Saxton J. Abstract PS8-26: The new normal; adjusting to remote ways of providing bespoke weight management support to breast cancer survivors during the COVID-19 global pandemic. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps8-26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
PurposeNEWDAY-ABC (North England Women’s Diet and ActivitY After Breast Cancer) trial is a bespoke weight management and behaviour change intervention for women treated for early-stage estrogen-receptor positive breast cancer (BC) with a body mass index (BMI) of ≥25 kg/m2. Many women are overweight or report further weight gain during and after BC-treatment. Due to the complex nature of weight management, NEWDAY-ABC was co-designed with BC-survivors and health care professionals (HCPs) prior to the COVID-19 outbreak. However, because of the COVID-19 pandemic, refinements had to be made to the intervention to enable remote (virtual) delivery options, allowing the trial to proceed while adhering to government social distancing and shielding guidance.
MethodsPrior to the COVID-19 outbreak, initial focus groups (FG) were conducted with n=16 BC-survivors and n=21 HCPs. Framework analysis was used to categorise what BC-survivors want from a weight management intervention. Participants (n=9) subsequently attended a two-stage successive interactive co-design workshop. Workshop 1 explored: i) techniques to motivate change; ii) approaches to overcome challenges to intervention adherence; iii) core components of the intervention. Workshop 2 explored: i) language and graphics used for the support and educational materials; ii) delivery mechanisms; iii) refinement of workshop 1 ideas.
Results / findingsCo-design revealed the intervention should address: i) self-confidence and self-esteem; ii) reassurance of safe physical activity (PA) and dietary guidance for BC-survivors; iii) knowledge about what happens to the body after treatment. In terms of intervention delivery: i) self-monitoring of weight should be optional; ii) content should be as visual as possible iii) emotional needs are as important to address as PA and dietary recommendations; iv) one-to-one facilitator support is as important as group peer-support.
To integrate all these elements, the NEWDAY-ABC intervention included face-to-face group support sessions. However, due to the COVID-19 pandemic, remote delivery options had to be embedded into the intervention design to enable this support to be provided via means that are accessible to all eligible participants, whilst adhering to the guidance on social distancing and shielding of vulnerable populations.
Key considerations include:•Participant and session leader’s ability to access and engage with remote delivery•Creating a peer supportive environment remotely•Remote platform security•Effectiveness of remote delivery in achieving clinically meaningful weight loss
ConclusionsThe COVID-19 pandemic has forced cancer care to quickly adapt to ways of providing remote support to meet the needs of cancer patients and survivors. While this presents many challenges, including issues of accessibility, privacy and accessing peer support, use of virtual delivery platforms and new technologies means that BC-survivors can still access this bespoke weight management intervention during an extended period of post-pandemic social distancing. The effectiveness of the NEWDAY-ABC intervention in providing the required level of peer support, guidance and self-confidence needed for clinically meaningful weight loss with virtual delivery options will be tested in a randomised controlled trial.
Citation Format: Katie Pickering, Sarah Wane, Helen Speake, Helen Crank, Annie Anderson, Henry Cain, Rob Copeland, Daniela Lee, Joanne Gray, Richard McNally, Jackie Hargreaves, Judith Cohen, Matthew Northgraves, Caroline Wilson, John Saxton. The new normal; adjusting to remote ways of providing bespoke weight management support to breast cancer survivors during the COVID-19 global pandemic [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS8-26.
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Affiliation(s)
| | - Sarah Wane
- 2Northumbria University, Newcastle, United Kingdom
| | - Helen Speake
- 1Sheffield Hallam University, Sheffield, United Kingdom
| | - Helen Crank
- 1Sheffield Hallam University, Sheffield, United Kingdom
| | | | - Henry Cain
- 4Newcastle Upon Tyne NHS Trust, Newcastle, United Kingdom
| | - Rob Copeland
- 1Sheffield Hallam University, Sheffield, United Kingdom
| | - Daniela Lee
- 4Newcastle Upon Tyne NHS Trust, Newcastle, United Kingdom
| | - Joanne Gray
- 2Northumbria University, Newcastle, United Kingdom
| | | | | | - Judith Cohen
- 7Hull Clinical Trials Unit, Hull, United Kingdom
| | | | - Caroline Wilson
- 8University of Sheffield, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - John Saxton
- 2Northumbria University, Newcastle, United Kingdom
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11
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Brealey S, Northgraves M, Kottam L, Keding A, Corbacho B, Goodchild L, Srikesavan C, Rex S, Charalambous CP, Hanchard N, Armstrong A, Brooksbank A, Carr A, Cooper C, Dias J, Donnelly I, Hewitt C, Lamb SE, McDaid C, Richardson G, Rodgers S, Sharp E, Spencer S, Torgerson D, Toye F, Rangan A. Surgical treatments compared with early structured physiotherapy in secondary care for adults with primary frozen shoulder: the UK FROST three-arm RCT. Health Technol Assess 2020; 24:1-162. [PMID: 33292924 DOI: 10.3310/hta24710] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 12/26/2022] Open
Abstract
BACKGROUND Frozen shoulder causes pain and stiffness. It affects around 10% of people in their fifties and is slightly more common in women. Costly and invasive surgical interventions are used, without high-quality evidence that these are effective. OBJECTIVES To compare the clinical effectiveness and cost-effectiveness of three treatments in secondary care for adults with frozen shoulder; to qualitatively explore the acceptability of these treatments to patients and health-care professionals; and to update a systematic review to explore the trial findings in the context of existing evidence for the three treatments. DESIGN This was a pragmatic, parallel-group, multicentre, open-label, three-arm, randomised superiority trial with unequal allocation (2 : 2 : 1). An economic evaluation and a nested qualitative study were also carried out. SETTING The orthopaedic departments of 35 hospitals across the UK were recruited from April 2015, with final follow-up in December 2018. PARTICIPANTS Participants were adults (aged ≥ 18 years) with unilateral frozen shoulder, characterised by restriction of passive external rotation in the affected shoulder to < 50% of the opposite shoulder, and with plain radiographs excluding other pathology. INTERVENTIONS The inventions were early structured physiotherapy with a steroid injection, manipulation under anaesthesia with a steroid injection and arthroscopic capsular release followed by manipulation. Both of the surgical interventions were followed with post-procedural physiotherapy. MAIN OUTCOME MEASURES The primary outcome and end point was the Oxford Shoulder Score at 12 months post randomisation. A difference of 5 points between early structured physiotherapy and manipulation under anaesthesia or arthroscopic capsular release or of 4 points between manipulation under anaesthesia and arthroscopic capsular release was judged clinically important. RESULTS The mean age of the 503 participants was 54 years; 319 were female (63%) and 150 had diabetes (30%). The primary analyses comprised 473 participants (94%). At the primary end point of 12 months, participants randomised to arthroscopic capsular release had, on average, a statistically significantly higher (better) Oxford Shoulder Score than those randomised to manipulation under anaesthesia (2.01 points, 95% confidence interval 0.10 to 3.91 points; p = 0.04) or early structured physiotherapy (3.06 points, 95% confidence interval 0.71 to 5.41 points; p = 0.01). Manipulation under anaesthesia did not result in statistically significantly better Oxford Shoulder Score than early structured physiotherapy (1.05 points, 95% confidence interval -1.28 to 3.39 points; p = 0.38). No differences were deemed of clinical importance. Serious adverse events were rare but occurred in participants randomised to surgery (arthroscopic capsular release,n = 8; manipulation under anaesthesia,n = 2). There was, however, one serious adverse event in a participant who received non-trial physiotherapy. The base-case economic analysis showed that manipulation under anaesthesia was more expensive than early structured physiotherapy, with slightly better utilities. The incremental cost-effectiveness ratio for manipulation under anaesthesia was £6984 per additional quality-adjusted life-year, and this intervention was probably 86% cost-effective at the threshold of £20,000 per quality-adjusted life-year. Arthroscopic capsular release was more costly than early structured physiotherapy and manipulation under anaesthesia, with no statistically significant benefit in utilities. Participants in the qualitative study wanted early medical help and a quicker pathway to resolve their shoulder problem. Nine studies were identified from the updated systematic review, including UK FROST, of which only two could be pooled, and found that arthroscopic capsular release was more effective than physiotherapy in the long-term shoulder functioning of patients, but not to the clinically important magnitude used in UK FROST. LIMITATIONS Implementing physiotherapy to the trial standard in clinical practice might prove challenging but could avoid theatre use and post-procedural physiotherapy. There are potential confounding effects of waiting times in the trial. CONCLUSIONS None of the three interventions was clearly superior. Early structured physiotherapy with a steroid injection is an accessible and low-cost option. Manipulation under anaesthesia is the most cost-effective option. Arthroscopic capsular release carries higher risks and higher costs. FUTURE WORK Evaluation in a randomised controlled trial is recommended to address the increasing popularity of hydrodilatation despite the paucity of high-quality evidence. TRIAL REGISTRATION Current Controlled Trials ISRCTN48804508. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 71. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Stephen Brealey
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Matthew Northgraves
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Lucksy Kottam
- The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Ada Keding
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Belen Corbacho
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | | | - Cynthia Srikesavan
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Saleema Rex
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Charalambos P Charalambous
- Department of Orthopaedics, Blackpool Victoria Hospital, Blackpool, UK.,School of Medicine, University of Central Lancashire, Preston, UK
| | - Nigel Hanchard
- School of Health & Life Sciences, Teesside University, Middlesbrough, UK
| | | | | | - Andrew Carr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Cushla Cooper
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Joseph Dias
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Sarah E Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Catriona McDaid
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | | | - Sara Rodgers
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | | | - Sally Spencer
- Postgraduate Medical Institute, Edge Hill University, Ormskirk, UK
| | - David Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Francine Toye
- Physiotherapy Research Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Amar Rangan
- York Trials Unit, Department of Health Sciences, University of York, York, UK.,The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK.,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
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12
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Rangan A, Brealey SD, Keding A, Corbacho B, Northgraves M, Kottam L, Goodchild L, Srikesavan C, Rex S, Charalambous CP, Hanchard N, Armstrong A, Brooksbank A, Carr A, Cooper C, Dias JJ, Donnelly I, Hewitt C, Lamb SE, McDaid C, Richardson G, Rodgers S, Sharp E, Spencer S, Torgerson D, Toye F. Management of adults with primary frozen shoulder in secondary care (UK FROST): a multicentre, pragmatic, three-arm, superiority randomised clinical trial. Lancet 2020; 396:977-989. [PMID: 33010843 DOI: 10.1016/s0140-6736(20)31965-6] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [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] [Received: 04/06/2020] [Revised: 06/26/2020] [Accepted: 07/08/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Manipulation under anaesthesia and arthroscopic capsular release are costly and invasive treatments for frozen shoulder, but their effectiveness remains uncertain. We compared these two surgical interventions with early structured physiotherapy plus steroid injection. METHODS In this multicentre, pragmatic, three-arm, superiority randomised trial, patients referred to secondary care for treatment of primary frozen shoulder were recruited from 35 hospital sites in the UK. Participants were adults (≥18 years) with unilateral frozen shoulder, characterised by restriction of passive external rotation (≥50%) in the affected shoulder. Participants were randomly assigned (2:2:1) to receive manipulation under anaesthesia, arthroscopic capsular release, or early structured physiotherapy. In manipulation under anaesthesia, the surgeon manipulated the affected shoulder to stretch and tear the tight capsule while the participant was under general anaesthesia, supplemented by a steroid injection. Arthroscopic capsular release, also done under general anaesthesia, involved surgically dividing the contracted anterior capsule in the rotator interval, followed by manipulation, with optional steroid injection. Both forms of surgery were followed by postprocedural physiotherapy. Early structured physiotherapy involved mobilisation techniques and a graduated home exercise programme supplemented by a steroid injection. Both early structured physiotherapy and postprocedural physiotherapy involved 12 sessions during up to 12 weeks. The primary outcome was the Oxford Shoulder Score (OSS; 0-48) at 12 months after randomisation, analysed by initial randomisation group. We sought a target difference of 5 OSS points between physiotherapy and either form of surgery, or 4 points between manipulation and capsular release. The trial registration is ISRCTN48804508. FINDINGS Between April 1, 2015, and Dec 31, 2017, we screened 914 patients, of whom 503 (55%) were randomly assigned. At 12 months, OSS data were available for 189 (94%) of 201 participants assigned to manipulation (mean estimate 38·3 points, 95% CI 36·9 to 39·7), 191 (94%) of 203 participants assigned to capsular release (40·3 points, 38·9 to 41·7), and 93 (94%) of 99 participants assigned to physiotherapy (37·2 points, 35·3 to 39·2). The mean group differences were 2·01 points (0·10 to 3·91) between the capsular release and manipulation groups, 3·06 points (0·71 to 5·41) between capsular release and physiotherapy, and 1·05 points (-1·28 to 3·39) between manipulation and physiotherapy. Eight serious adverse events were reported with capsular release and two with manipulation. At a willingness-to-pay threshold of £20 000 per quality-adjusted life-year, manipulation under anaesthesia had the highest probability of being cost-effective (0·8632, compared with 0·1366 for physiotherapy and 0·0002 for capsular release). INTERPRETATION All mean differences on the assessment of shoulder pain and function (OSS) at the primary endpoint of 12 months were less than the target differences. Therefore, none of the three interventions were clinically superior. Arthoscopic capsular release carried higher risks, and manipulation under anaesthesia was the most cost-effective. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Amar Rangan
- York Trials Unit, Department of Health Sciences, University of York, York, UK; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK; The James Cook University Hospital, South Tees Hospitals National Health Service (NHS) Foundation Trust, Middlesbrough, UK.
| | - Stephen D Brealey
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Ada Keding
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Belen Corbacho
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Matthew Northgraves
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Lucksy Kottam
- The James Cook University Hospital, South Tees Hospitals National Health Service (NHS) Foundation Trust, Middlesbrough, UK
| | - Lorna Goodchild
- The James Cook University Hospital, South Tees Hospitals National Health Service (NHS) Foundation Trust, Middlesbrough, UK
| | - Cynthia Srikesavan
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Saleema Rex
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Charalambos P Charalambous
- Department of Orthopaedics, Blackpool Victoria Hospital, Blackpool, UK; School of Medicine, University of Central Lancashire, Preston, UK
| | - Nigel Hanchard
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | | | | | - Andrew Carr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Cushla Cooper
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Joseph J Dias
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Sarah E Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Catriona McDaid
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | | | - Sara Rodgers
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | | | - Sally Spencer
- Postgraduate Medical Institute, Edge Hill University, Ormskirk, UK
| | - David Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Francine Toye
- Physiotherapy Research Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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13
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Dias JJ, Brealey SD, Fairhurst C, Amirfeyz R, Bhowal B, Blewitt N, Brewster M, Brown D, Choudhary S, Coapes C, Cook L, Costa M, Davis T, Di Mascio L, Giddins G, Hedley H, Hewitt C, Hinde S, Hobby J, Hodgson S, Jefferson L, Jeyapalan K, Johnston P, Jones J, Keding A, Leighton P, Logan A, Mason W, McAndrew A, McNab I, Muir L, Nicholl J, Northgraves M, Palmer J, Poulter R, Rahimtoola Z, Rangan A, Richards S, Richardson G, Stuart P, Taub N, Tavakkolizadeh A, Tew G, Thompson J, Torgerson D, Warwick D. Surgery versus cast immobilisation for adults with a bicortical fracture of the scaphoid waist (SWIFFT): a pragmatic, multicentre, open-label, randomised superiority trial. Lancet 2020; 396:390-401. [PMID: 32771106 DOI: 10.1016/s0140-6736(20)30931-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [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] [Received: 02/10/2020] [Revised: 04/02/2020] [Accepted: 04/16/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Scaphoid fractures account for 90% of carpal fractures and occur predominantly in young men. The use of immediate surgical fixation to manage this type of fracture has increased, despite insufficient evidence of improved outcomes over non-surgical management. The SWIFFT trial compared the clinical effectiveness of surgical fixation with cast immobilisation and early fixation of fractures that fail to unite in adults with scaphoid waist fractures displaced by 2 mm or less. METHODS This pragmatic, parallel-group, multicentre, open-label, two-arm, randomised superiority trial included adults (aged 16 years or older) who presented to orthopaedic departments of 31 hospitals in England and Wales with a clear bicortical fracture of the scaphoid waist on radiographs. An independent remote randomisation service used a computer-generated allocation sequence with randomly varying block sizes to randomly assign participants (1:1) to receive either early surgical fixation (surgery group) or below-elbow cast immobilisation followed by immediate fixation if non-union of the fracture was confirmed (cast immobilisation group). Randomisation was stratified by whether or not there was displacement of either a step or a gap of 1-2 mm inclusive on any radiographic view. The primary outcome was the total patient-rated wrist evaluation (PRWE) score at 52 weeks after randomisation, and it was analysed on an available case intention-to-treat basis. This trial is registered with the ISRCTN registry, ISRCTN67901257, and is no longer recruiting, but long-term follow-up is ongoing. FINDINGS Between July 23, 2013, and July 26, 2016, 439 (42%) of 1047 assessed patients (mean age 33 years; 363 [83%] men) were randomly assigned to the surgery group (n=219) or to the cast immobilisation group (n=220). Of these, 408 (93%) participants were included in the primary analysis (203 participants in the surgery group and 205 participants in the cast immobilisation group). 16 participants in the surgery group and 15 participants in the cast immobilisation group were excluded because of either withdrawal, no response, or no follow-up data at 6, 12, 26, or 52 weeks. There was no significant difference in mean PRWE scores at 52 weeks between the surgery group (adjusted mean 11·9 [95% CI 9·2-14·5]) and the cast immobilisation group (14·0 [11·3 to 16·6]; adjusted mean difference -2·1 [95% CI -5·8 to 1·6], p=0·27). More participants in the surgery group (31 [14%] of 219 participants) had a potentially serious complication from surgery than in the cast immobilisation group (three [1%] of 220 participants), but fewer participants in the surgery group (five [2%]) had cast-related complications than in the cast immobilisation group (40 [18%]). The number of participants who had a medical complication was similar between the two groups (four [2%] in the surgery group and five [2%] in the cast immobilisation group). INTERPRETATION Adult patients with scaphoid waist fractures displaced by 2 mm or less should have initial cast immobilisation, and any suspected non-unions should be confirmed and immediately fixed with surgery. This treatment strategy will help to avoid the risks of surgery and mostly limit the use of surgery to fixing fractures that fail to unite. FUNDING National Institute for Health Research Health Technology Assessment Programme.
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Affiliation(s)
- Joseph J Dias
- Leicester General Hospital, University Hospitals of Leicester National Health Service (NHS) Trust, Leicester, UK.
| | - Stephen D Brealey
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Caroline Fairhurst
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Rouin Amirfeyz
- University Hospitals Bristol NHS Foundation Trust, Bristol Royal Infirmary, Bristol, UK
| | - Bhaskar Bhowal
- Leicester General Hospital, University Hospitals of Leicester National Health Service (NHS) Trust, Leicester, UK
| | - Neil Blewitt
- North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Mark Brewster
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Daniel Brown
- The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Royal Liverpool University Hospital, Liverpool, UK
| | - Surabhi Choudhary
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Christopher Coapes
- South Tees Hospitals NHS Foundation Trust, The James Cook University Hospital, Middlesbrough, UK
| | - Liz Cook
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Matthew Costa
- The Kadoorie Centre, John Radcliffe Hospital, Oxford, UK; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Oxford, UK
| | - Tim Davis
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre Campus, Nottingham, UK
| | - Livio Di Mascio
- Barts Health NHS Trust, The Royal London Hospital, London, UK
| | - Grey Giddins
- Royal United Hospital Bath NHS Trust, Royal United Hospital, Bath, UK
| | - Helen Hedley
- University Hospitals Coventry and Warwickshire NHS Trust, University Hospital, Coventry, UK
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | | | - Jonathan Hobby
- Hampshire Hospitals NHS Foundation Trust, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Stephen Hodgson
- Bolton NHS Foundation Trust, Royal Bolton Hospital, Bolton, UK
| | | | - Kanagaratnam Jeyapalan
- Leicester General Hospital, University Hospitals of Leicester National Health Service (NHS) Trust, Leicester, UK
| | - Phillip Johnston
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - Jonathon Jones
- Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough City Hospital, Peterborough, UK
| | - Ada Keding
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Paul Leighton
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Andrew Logan
- Cardiff and Vale University of Health Board, University Hospital of Wales, Cardiff, UK
| | - Will Mason
- Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire Royal Hospital, Gloucester, UK
| | - Andrew McAndrew
- Royal Berkshire NHS Foundation Trust, Royal Berkshire Hospital, Reading, UK
| | - Ian McNab
- Oxford University Hospitals NHS Trust, Nuffield Orthopaedic Centre, Oxford, UK
| | - Lindsay Muir
- Salford Royal Hospital NHS Foundation Trust, Salford, UK
| | - James Nicholl
- Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells, Kent, UK
| | | | - Jared Palmer
- Leicester General Hospital, University Hospitals of Leicester National Health Service (NHS) Trust, Leicester, UK
| | - Rob Poulter
- Royal Cornwall Hospitals NHS Trust, Royal Cornwall Hospital, Truro, Cornwall, UK
| | - Zulfi Rahimtoola
- Royal Berkshire NHS Foundation Trust, Royal Berkshire Hospital, Reading, UK
| | - Amar Rangan
- York Trials Unit, Department of Health Sciences, University of York, York, UK; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Oxford, UK
| | | | | | - Paul Stuart
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Nicholas Taub
- Department of Health Sciences, University of Leicester, George Davies Centre, Leicester, UK
| | - Adel Tavakkolizadeh
- King's College Hospital NHS Foundation Trust, King's College Hospital, Brixton, London, UK
| | - Garry Tew
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - John Thompson
- Department of Health Sciences, University of Leicester, George Davies Centre, Leicester, UK
| | - David Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - David Warwick
- University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, UK
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Mitchell AS, Cook L, Dean A, Fairhurst C, Northgraves M, Torgerson DJ, Reed M. An embedded randomised controlled retention trial of personalised text messages compared to non-personalised text messages in an orthopaedic setting. F1000Res 2020; 9:591. [PMID: 35600143 PMCID: PMC9091807 DOI: 10.12688/f1000research.24244.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 07/22/2023] Open
Abstract
Background: Several studies have investigated whether personalising trial documentation can aid recruitment and retention. We did a 'study within a trial' (SWAT) evaluating the effectiveness of a personalised text message compared to a non-personalised text message, on the retention rate in a large orthopaedic trial. Methods: The SWAT was embedded in the Knee Replacement Bandaging Study (KReBS) trial. The primary outcome was the proportion of 12-month questionnaires returned. Secondary outcomes were the proportion of questionnaires completed and time to questionnaire return. Binary data were analysed using logistic regression and time to return using Cox proportional hazards regression. Odds ratios (OR) and hazard ratios (HR) are presented, with associated 95% confidence intervals (CI) and p-values. Results: In total, 1465 participants were included in the SWAT. In the personalised group, 644/723 (89.1%) of participants returned a questionnaire, compared to 654/742 (88.1%) in the non-personalised group. The absolute difference in return rate was 0.9% (95% CI: -2.3% to 4.2%; p=0.57). There was no evidence of a difference between the groups in the likelihood of returning a questionnaire (OR 1.09; 95% CI: 0.79 to 1.51; p=0.61), the likelihood of returning a complete questionnaire (OR 1.11; 95% CI: 0.82 to 1.51; p=0.50) nor in time to return (HR 1.05; 95% CI: 0.94 to 1.17; p=0.40). Conclusion: This SWAT adds to the growing evidence base for whether personalised text messages are effective. Registration: ISRCTN87127065 (20/02/2017); SWAT 35 (01/12/2015).
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Affiliation(s)
- Alex S. Mitchell
- Department of Health Sciences, University of York, UK, York, Y010 5DD, UK
| | - Liz Cook
- Department of Health Sciences, University of York, UK, York, Y010 5DD, UK
| | - Alexandra Dean
- Department of Health Sciences, University of York, UK, York, Y010 5DD, UK
| | - Caroline Fairhurst
- Department of Health Sciences, University of York, UK, York, Y010 5DD, UK
| | | | - David J. Torgerson
- Department of Health Sciences, University of York, UK, York, Y010 5DD, UK
| | - Mike Reed
- Department of Health Sciences, University of York, UK, York, Y010 5DD, UK
- North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, Tyne and Wear, NE29 8NH, UK
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Partha Sarathy P, Kottam L, Parker A, Brealey S, Coleman E, Keding A, Mitchell A, Northgraves M, Torgerson D, Rangan A. Timing of electronic reminders did not improve trial participant questionnaire response: a randomized trial and meta-analyses. J Clin Epidemiol 2020; 122:70-77. [PMID: 32151697 DOI: 10.1016/j.jclinepi.2020.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/18/2020] [Accepted: 03/03/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The objective of this study was to assess whether timing of short messaging service (SMS) reminders improved postal questionnaire return rates from participants in a randomized controlled trial (RCT). STUDY DESIGN AND SETTING A Study Within A Trial (SWAT) embedded in a multicenter RCT evaluating three treatments for the frozen shoulder. Participants who provided a mobile telephone number were randomized to either prenotification SMS on the day of the questionnaire mail-out or postnotification SMS 4 days after questionnaire mail-out for the 3-month follow-up. The primary outcome was the proportion of participants who returned a valid questionnaire. A systematic review was undertaken to identify other embedded trials to perform a meta-analysis. RESULTS Of the 269 participants, 122/135 (90.4%) returned a valid questionnaire in the prenotification arm and 119/134 (88.8%) in the postnotification arm (difference of -1.6%; 95% CI of difference: -8.9%, 5.7%). There was no difference in time to response (HR = 1.04; 95% CI: 0.80 to 1.34) or need for additional reminders (OR = 0.71; 95% CI: 0.43 to 1.17). Meta-analysis of two RCTs showed no difference in response rates between prenotification and postnotification reminders (OR = 0.78 95% CI: 0.42 to 1.45). CONCLUSION Timing of SMS reminders did not improve response rates and time to response or affect the need for additional reminders.
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Affiliation(s)
- Prasanna Partha Sarathy
- York Trials Unit, Department of Health Sciences, University of York, Heslington, York YO10 5DD, UK
| | - Lucksy Kottam
- STRIVE, The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Marton Road, Middlesbrough, TS4 3BW, UK
| | - Adwoa Parker
- York Trials Unit, Department of Health Sciences, University of York, Heslington, York YO10 5DD, UK
| | - Stephen Brealey
- York Trials Unit, Department of Health Sciences, University of York, Heslington, York YO10 5DD, UK.
| | - Elizabeth Coleman
- York Trials Unit, Department of Health Sciences, University of York, Heslington, York YO10 5DD, UK
| | - Ada Keding
- York Trials Unit, Department of Health Sciences, University of York, Heslington, York YO10 5DD, UK
| | - Alex Mitchell
- York Trials Unit, Department of Health Sciences, University of York, Heslington, York YO10 5DD, UK
| | - Matthew Northgraves
- York Trials Unit, Department of Health Sciences, University of York, Heslington, York YO10 5DD, UK
| | - David Torgerson
- York Trials Unit, Department of Health Sciences, University of York, Heslington, York YO10 5DD, UK
| | - Amar Rangan
- York Trials Unit, Department of Health Sciences, University of York, Heslington, York YO10 5DD, UK; STRIVE, The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Marton Road, Middlesbrough, TS4 3BW, UK
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16
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Arundel C, James S, Northgraves M, Booth A. Study reporting guidelines: How valid are they? Contemp Clin Trials Commun 2019; 14:100343. [PMID: 30923775 PMCID: PMC6421355 DOI: 10.1016/j.conctc.2019.100343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 02/27/2019] [Accepted: 03/05/2019] [Indexed: 10/28/2022] Open
Abstract
Reporting guidelines help improve the reporting of specific study designs, and clear guidance on the best approaches for developing guidelines is available. The methodological strength, or validation of guidelines is however unclear. This article explores what validation of reporting guidelines might involve, and whether this has been conducted for key reporting guidelines.
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Affiliation(s)
- Catherine Arundel
- York Trials Unit, Department of Health Sciences, University of York, York, UK
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17
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Booth A, Ingoe HMA, Northgraves M, Coleman E, Harden M, Kassam J, Kwok I, Hilton C, Bates P, McDaid C. Effectiveness of surgical fixation for lateral compression type one (LC-1) fragility fractures of the pelvis: a systematic review. BMJ Open 2019; 9:e024737. [PMID: 31110085 PMCID: PMC6530388 DOI: 10.1136/bmjopen-2018-024737] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To undertake a systematic review of the evidence base for the effectiveness of surgical fixation of lateral compression (LC-1) fragility fractures of the pelvis compared with non-surgical approaches. SEARCHES MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and two international trials registers were searched up to January 2017 (MEDLINE to February 2019) for studies of internal or external fixation of fragility fractures of the pelvis. PARTICIPANTS Patients with lateral compression pelvic fractures, sustained as the result of a low-energy mechanism, defined as a fall from standing height or less. INTERVENTIONS Surgery using either external or internal fixation devices. Conservative non-surgical treatment was the defined comparator. OUTCOME MEASURES Outcomes of interest were patient mobility and function, pain, quality of life, fracture union, mortality, hospital length of stay and complications (additional operative procedures, number and type of adverse events and serious adverse events). QUALITY ASSESSMENT AND SYNTHESIS The Joanna Briggs Institute Checklist for Case Series was used to assess the included studies. Results were presented in a narrative synthesis. RESULTS Of 3421 records identified, four retrospective case series met the inclusion criteria. Fixation types were not consistent between studies or within studies and most patients had more than one type of pelvic fixation. Where reported, mobility and function improved post-surgery, and a reduction in pain was recorded. Length of hospital stay ranged from 4 days to 54 days for surgical fixation of any type. Reported complications and adverse outcomes included: infections, implant loosening, pneumonia and thrombosis. Use of analgesia was not reported. CONCLUSIONS There is insufficient evidence to support guidance on the most effective treatment for patients who fail to mobilise after sustaining an LC-1 fragility fracture. TRIAL REGISTRATION NUMBER CRD42017055872.
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Affiliation(s)
- Alison Booth
- Department of Health Sciences, University of York, York, UK
| | - Helen Margaret Ann Ingoe
- Department of Health Sciences, University of York, York, UK
- Trauma and Orthopaedics, The James Cook University Hospital, Middlesbrough, UK
| | | | | | - Melissa Harden
- Centre for Reviews and Dissemination, University of York, York, UK
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18
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Dakin SG, Rangan A, Martinez F, Brealey S, Northgraves M, Kottam L, Cooper C, Buckley CD, Carr AJ. Tissue inflammation signatures point towards resolution in adhesive capsulitis. Rheumatology (Oxford) 2019; 58:1109-1111. [DOI: 10.1093/rheumatology/kez007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Stephanie Georgina Dakin
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Amar Rangan
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Department of Health Sciences, University of York, York, UK
| | - Fernando Martinez
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | | | | | - Lucksy Kottam
- Department of Trauma & Orthopaedics, The James Cook University Hospital, Middlesbrough, UK
| | - Cushla Cooper
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Christopher Dominic Buckley
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Andrew Jonathan Carr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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19
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Jefferson L, Fairhurst C, Brealey S, Coleman E, Cook L, Hewitt C, Keding A, Northgraves M, Rangan A, Tew GA, Torgerson DJ, Dias J. Remote or on-site visits were feasible for the initial setup meetings with hospitals in a multicenter surgical trial: an embedded randomized trial. J Clin Epidemiol 2018; 100:13-21. [PMID: 29679748 DOI: 10.1016/j.jclinepi.2018.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 04/07/2018] [Accepted: 04/11/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To investigate the effects, costs, and feasibility of providing on-site compared with remote meetings to set up hospital sites in a multicenter, surgical randomized controlled trial. STUDY DESIGN AND SETTING Hospitals were randomized to receive the initial trial setup meetings on-site (i.e., face-to-face) or remotely (i.e., via teleconference). Data were collected on site setup, recruitment, follow-up, and costs for the two methods. The hospital staff experience of trial setup was also surveyed. RESULTS Thirty-nine sites were randomized and 33 sites set up to recruit (19 on-site and 14 remote). For sites randomized to an on-site meeting compared with remote meeting respectively, the time from first contact to the first recruit was a median of 246 days (interquartile range [IQR] 196-346] vs. 212 days (IQR 154-266), mean recruitment was 10 participants (median 10, IQR 2-17) vs. 11 participants (median 6, IQR 5-23), and participant follow-up at 12 months was 81% vs. 82%. Sites allocated to an initial on-site visit cost on average £289.83 more to setup. CONCLUSION Remote or on-site visits are feasible for the initial setup meetings with hospitals in a multicenter surgical trial. This embedded trial should be replicated to improve generalizability and increase statistical power using meta-analysis. ISRCTN78899574.
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Affiliation(s)
- Laura Jefferson
- Department of Health Sciences, University of York, Area 4, Seebohm Rowntree Building, Heslington, York YO10 5DD, United Kingdom
| | - Caroline Fairhurst
- Department of Health Sciences, University of York, York Trials Unit, Lower Ground Floor, ARRC Building, Heslington, York YO10 5DD, United Kingdom
| | - Stephen Brealey
- Department of Health Sciences, University of York, York Trials Unit, Lower Ground Floor, ARRC Building, Heslington, York YO10 5DD, United Kingdom.
| | - Elizabeth Coleman
- Department of Health Sciences, University of York, York Trials Unit, Lower Ground Floor, ARRC Building, Heslington, York YO10 5DD, United Kingdom
| | - Liz Cook
- Department of Health Sciences, University of York, York Trials Unit, Lower Ground Floor, ARRC Building, Heslington, York YO10 5DD, United Kingdom
| | - Catherine Hewitt
- Department of Health Sciences, University of York, York Trials Unit, Lower Ground Floor, ARRC Building, Heslington, York YO10 5DD, United Kingdom
| | - Ada Keding
- Department of Health Sciences, University of York, York Trials Unit, Lower Ground Floor, ARRC Building, Heslington, York YO10 5DD, United Kingdom
| | - Matthew Northgraves
- Department of Health Sciences, University of York, York Trials Unit, Lower Ground Floor, ARRC Building, Heslington, York YO10 5DD, United Kingdom
| | - Amar Rangan
- Department of Health Sciences, University of York, York Trials Unit, Lower Ground Floor, ARRC Building, Heslington, York YO10 5DD, United Kingdom
| | - Garry A Tew
- Department of Health Sciences, University of York, York Trials Unit, Lower Ground Floor, ARRC Building, Heslington, York YO10 5DD, United Kingdom
| | - David J Torgerson
- Department of Health Sciences, University of York, York Trials Unit, Lower Ground Floor, ARRC Building, Heslington, York YO10 5DD, United Kingdom
| | - Joseph Dias
- AToMS-Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Undercroft (nr Ward 28), Gwendolen Road, Leicester LE5 4PW, United Kingdom
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20
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Brealey S, Armstrong AL, Brooksbank A, Carr AJ, Charalambous CP, Cooper C, Corbacho B, Dias J, Donnelly I, Goodchild L, Hewitt C, Keding A, Kottam L, Lamb SE, McDaid C, Northgraves M, Richardson G, Rodgers S, Shah S, Sharp E, Spencer S, Torgerson D, Toye F, Rangan A. United Kingdom Frozen Shoulder Trial (UK FROST), multi-centre, randomised, 12 month, parallel group, superiority study to compare the clinical and cost-effectiveness of Early Structured Physiotherapy versus manipulation under anaesthesia versus arthroscopic capsular release for patients referred to secondary care with a primary frozen shoulder: study protocol for a randomised controlled trial. Trials 2017; 18:614. [PMID: 29273079 PMCID: PMC5741880 DOI: 10.1186/s13063-017-2352-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 11/24/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Frozen shoulder (also known as adhesive capsulitis) occurs when the capsule, or the soft tissue envelope around the ball and socket shoulder joint, becomes scarred and contracted, making the shoulder tight, painful and stiff. It affects around 1 in 12 men and 1 in 10 women of working age. Although this condition can settle with time (typically taking 1 to 3 years), for some people it causes severe symptoms and needs referral to hospital. Our aim is to evaluate the clinical and cost-effectiveness of two invasive and costly surgical interventions that are commonly used in secondary care in the National Health Service (NHS) compared with a non-surgical comparator of Early Structured Physiotherapy. METHODS We will conduct a randomised controlled trial (RCT) of 500 adult patients with a clinical diagnosis of frozen shoulder, and who have radiographs that exclude other pathology. Early Structured Physiotherapy with an intra-articular steroid injection will be compared with manipulation under anaesthesia with a steroid injection or arthroscopic (keyhole) capsular release followed by manipulation. Both surgical interventions will be followed with a programme of post-procedural physiotherapy. These treatments will be undertaken in NHS hospitals across the United Kingdom. The primary outcome and endpoint will be the Oxford Shoulder Score (a patient self-reported assessment of shoulder function) at 12 months. This will also be measured at baseline, 3 and 6 months after randomisation; and on the day that treatment starts and 6 months later. Secondary outcomes include the Disabilities of Arm Shoulder and Hand (QuickDASH) score, the EQ-5D-5 L score, pain, extent of recovery and complications. We will explore the acceptability of the different treatments to patients and health care professionals using qualitative methods. DISCUSSION The three treatments being compared are the most frequently used in secondary care in the NHS, but there is uncertainty about which one works best and at what cost. UK FROST is a rigorously designed and adequately powered study to inform clinical decisions for the treatment of this common condition in adults. TRIAL REGISTRATION International Standard Randomised Controlled Trial Register, ID: ISRCTN48804508 . Registered on 25 July 2014.
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Affiliation(s)
- Stephen Brealey
- York Trials Unit, Department of Health Sciences, Faculty of Sciences, University of York, ARRC Building, York, YO10 5DD, UK
| | - Alison L Armstrong
- University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK
| | | | - Andrew Jonathan Carr
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Windmill Road, Oxford, OX3 7LD, UK
| | - Charalambos P Charalambous
- Blackpool Victoria Hospital and Blackpool and School of Medicine University of Central Lancashire, Preston, PR1 2HE, UK
| | - Cushla Cooper
- Nuffield Department of Orthopaedics, University of Oxford, Botnar Research Centre, Headington, Oxford, OX3 7LD, UK
| | - Belen Corbacho
- York Trials Unit, Department of Health Sciences, Faculty of Sciences, University of York, ARRC Building, York, YO10 5DD, UK
| | - Joseph Dias
- University Hospitals of Leicester NHS Trust, Gwendolen Road, Leicester, LE5 4PW, UK
| | - Iona Donnelly
- University of Glasgow, Glasgow Royal Infirmary Orthopaedic Research Unit, Gatehouse Building, 84 Castle Street, Glasgow, G4 0SF, UK
| | - Lorna Goodchild
- James Cook University Hospital, South Tees Hospitals NHS Trust, Marton Road, Middlesbrough, TS4 3BW, UK
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, Faculty of Sciences, University of York, ARRC Building, York, YO10 5DD, UK
| | - Ada Keding
- York Trials Unit, Department of Health Sciences, Faculty of Sciences, University of York, ARRC Building, York, YO10 5DD, UK
| | - Lucksy Kottam
- Department of Trauma and Orthopaedics, South Tees Institute of Learning Research and Innovation, The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Marton Road, Middlesbrough, TS4 3BW, UK
| | - Sarah E Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculo-skeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, Ox4 7AL, UK
| | - Catriona McDaid
- York Trials Unit, Department of Health Sciences, Faculty of Sciences, University of York, ARRC Building, York, YO10 5DD, UK
| | - Matthew Northgraves
- York Trials Unit, Department of Health Sciences, Faculty of Sciences, University of York, ARRC Building, York, YO10 5DD, UK
| | - Gerry Richardson
- Centre for Health Economics, University of York, York, YO10 5DD, UK
| | - Sara Rodgers
- York Trials Unit, Department of Health Sciences, Faculty of Sciences, University of York, ARRC Building, York, YO10 5DD, UK
| | - Sarwat Shah
- Department of Health Sciences, Faculty of Sciences, University of York, Seebohm Rowntree Building, York, YO10 5DD, UK
| | - Emma Sharp
- Orthopaedic Department, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK
| | - Sally Spencer
- Edge Hill University, St. Helens Road, Ormskirk, Lancashire, L39 4QP, UK
| | - David Torgerson
- York Trials Unit, Department of Health Sciences, Faculty of Sciences, University of York, ARRC Building, York, YO10 5DD, UK
| | - Francine Toye
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Road, Headington, Oxford, OX3 7HE, UK
| | - Amar Rangan
- Department of Health Sciences, University of York, York, YO10 5DD, UK. .,Faculty of Medical Sciences and NDORMS, University of Oxford, Oxford, OX3 7LD, UK.
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Stamuli E, Torgerson D, Northgraves M, Ronaldson S, Cherry L. Identifying the primary outcome for a randomised controlled trial in rheumatoid arthritis: the role of a discrete choice experiment. J Foot Ankle Res 2017; 10:57. [PMID: 29270231 PMCID: PMC5732456 DOI: 10.1186/s13047-017-0240-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 07/25/2017] [Accepted: 11/28/2017] [Indexed: 11/29/2022] Open
Abstract
Background This study sought to establish the preferences of people with Rheumatoid Arthritis (RA) about the best outcome measure for a health and fitness intervention randomised controlled trial (RCT). The results of this study were used to inform the choice of the trial primary and secondary outcome measure. Methods A discrete choice experiment (DCE) was used to assess people’s preferences regarding a number of outcomes (foot and ankle pain, fatigue, mobility, ability to perform daily activities, choice of footwear) as well as different schedules and frequency of delivery for the health and fitness intervention. The outcomes were chosen based on literature review, clinician recommendation and patients’ focus groups. The DCE was constructed in SAS software using the D-efficiency criteria. It compared hypothetical scenarios with varying levels of outcomes severity and intervention schedule. Preference weights were estimated using appropriate econometric models. The partial log-likelihood method was used to assess the attribute importance. Results One hundred people with RA completed 18 choice sets. Overall, people selected foot and ankle pain as the most important outcome, with mobility being nearly as important. There was no evidence of differential preference between intervention schedules or frequency of delivery. Conclusions Foot and ankle pain can be considered the patient choice for primary outcome of an RCT relating to a health and fitness intervention. This study demonstrated that, by using the DCE method, it is possible to incorporate patients’ preferences at the design stage of a RCT. This approach ensures patient involvement at early stages of health care design. Electronic supplementary material The online version of this article (10.1186/s13047-017-0240-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eugena Stamuli
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD UK
| | - David Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD UK
| | - Matthew Northgraves
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD UK
| | - Sarah Ronaldson
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD UK
| | - Lindsey Cherry
- Solent NHS Trust & University of Southampton, Faculty of Health Sciences, B45, Southampton, SO17 1BJ UK
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