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Abstract
A multidisciplinary approach for the management of patients with chronic pain is now well-established in many countries, especially in situations involving a complex disease process in the sense of a biopsychosocial model. Both the efficacy and cost-effectiveness of multidisciplinary pain treatment programs and their superiority compared to unimodal therapy has been documented in a number of studies, reviews and meta-analyses, in particular for patients suffering from chronic low back pain. Nevertheless, there are still major shortcomings concerning the definition of multimodal and multidisciplinary treatment and the quality of structures and processes, compared for example to the standards defined by the German Pain Society (Deutsche Schmerzgesellschaft). Furthermore, there is still no consensus on specific therapeutic approaches, the differentiation between responders and non-responders as well as on the tools required for measurement. All these questions will have to be answered by concerted efforts in a multicenter setting.
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Affiliation(s)
- U Kaiser
- UniversitätsSchmerzCentrum, Universitätsklinikum Carl Gustav Carus, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - R Sabatowski
- UniversitätsSchmerzCentrum, Universitätsklinikum Carl Gustav Carus, Fetscherstr. 74, 01307, Dresden, Deutschland. .,Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland.
| | - S C Azad
- Klinik für Anaesthesiologie, Interdisziplinäre Schmerzambulanz und Tagesklinik, Ludwig-Maximilians-Universität München, München, Deutschland
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Lange T, Rataj E, Kopkow C, Lützner J, Günther KP, Schmitt J. Outcome Assessment in Total Knee Arthroplasty: A Systematic Review and Critical Appraisal. J Arthroplasty 2017; 32:653-665.e1. [PMID: 28341034 DOI: 10.1016/j.arth.2016.09.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 09/05/2016] [Accepted: 09/13/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The Outcome Measures in Rheumatology (OMERACT) initiative developed a core outcome set (COS) of domains to assess effectiveness of interventions for knee osteoarthritis. These domains (pain, physical function, patient global assessment, imaging at 1 year) should be assessed in every trial to make research evidence meaningful and comparable. We systematically evaluated and critically appraised the use of measurement instruments and outcome domains in prospective studies evaluating patients with knee osteoarthritis undergoing total knee arthroplasty (TKA) and assessed their accordance with the OMERACT COS. METHODS Literature search was performed until August 26, 2014, in Medline and Embase. Clinical trials and prospective observational studies with ≥50 participants and a follow-up of ≥1 year were included. We collected general study characteristics, comprehensive information on measurement instruments, and corresponding domains used. RESULTS This systematic review identified low accordance of used outcome domains with the OMERACT COS of domains published in 1997. Only 4 of 100 included studies included all recommended core domains. Pain (85% of studies) and physical function (86%) were assessed frequently, whereas patient global assessment (21%) and joint imaging (≥1 year; 27%) were rarely assessed. There was substantial heterogeneity in the use of measurement instruments (n = 111) investigating TKA. CONCLUSION More efforts are required to implement the existing COS. In addition, a more consistent use of adequate measurement instruments is important to make research evidence on TKA more relevant, better comparable, and thus more useful for guideline developers and clinical decision makers.
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Affiliation(s)
- Toni Lange
- Center for Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany; University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - Elisabeth Rataj
- Center for Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany; University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - Christian Kopkow
- Center for Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Jörg Lützner
- University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - Klaus-Peter Günther
- University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - Jochen Schmitt
- Center for Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
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Egloff N, Wegmann B, Juon B, Stauber S, von Känel R, Vögelin E. The impact of anxiety and depressive symptoms on chronic pain in conservatively and operatively treated hand surgery patients. J Pain Res 2017; 10:259-263. [PMID: 28203103 PMCID: PMC5293357 DOI: 10.2147/jpr.s116674] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The aim of this prospective study was to examine to what extent anxiety and depressive symptoms predict the level of pain at 4-month follow-up in hand surgery patients. A total of 132 consecutive patients (mean age: 51.5±17.1 years, 51.9% female) of a tertiary center for hand surgery participated in this study. The patients underwent conservative or operative treatment, depending on the nature of their hand problem. The initial pain assessment included psychometric testing with the hospital anxiety and depression scale. Ninety-nine patients underwent operative treatment and 33 patients were conservatively treated. At 4-month follow-up, the amount of pain was measured with a visual analog scale (0–10). After controlling for age, sex, and pre-surgical pain intensity, depressive symptoms were a significant predictor for increased pain levels at follow-up in conservatively treated patients. In operatively treated patients, anxiety symptoms showed a trend for being a predictor of pain level at follow-up. The findings support the assumption that psychological factors may have an impact on pain outcome in patients presenting to hand surgery clinics.
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Affiliation(s)
- Niklaus Egloff
- Division of Psychosomatic Medicine, Department of General Internal Medicine, Inselspital Bern University Hospital; Department of Clinical Research, University of Bern
| | - Barbara Wegmann
- Division of Psychosomatic Medicine, Department of General Internal Medicine, Inselspital Bern University Hospital
| | - Bettina Juon
- Department of Plastic and Hand Surgery, Inselspital Bern University Hospital, Bern
| | - Stefanie Stauber
- Division of Psychosomatic Medicine, Department of General Internal Medicine, Inselspital Bern University Hospital
| | - Roland von Känel
- Department of Clinical Research, University of Bern; Department of Psychosomatic Medicine, Clinic Barmelweid, Barmelweid, Switzerland
| | - Esther Vögelin
- Department of Plastic and Hand Surgery, Inselspital Bern University Hospital, Bern
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Thoomes EJ. Effectiveness of manual therapy for cervical radiculopathy, a review. Chiropr Man Therap 2016; 24:45. [PMID: 27980724 PMCID: PMC5146882 DOI: 10.1186/s12998-016-0126-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 10/11/2016] [Indexed: 12/16/2022] Open
Abstract
Manual therapy is often used for patients with neck pain with or without radicular symptoms. There is sparse evidence on the effectiveness in cervical radiculopathy. The aim of this study was to assess current levels of evidence on the effectiveness of manual therapy interventions for patients with cervical radiculopathy. Electronic data bases were systematically searched for clinical guidelines, reviews and randomised clinical trials (RCTs) reporting on the effectiveness of manual therapy for patients with cervical radiculopathy. Eight relevant reviews, two guidelines and two recent RCTs, that had not yet been included in either, were retrieved. The overall quality of the evidence of included studies was evaluated using the GRADE method. Most interventions were only studied in one single RCT. There is low level evidence that cervical manipulation and mobilisation as unimodal interventions are effective on pain and range of motion at the immediate follow up, but no evidence on the effectiveness of thoracic manipulation or mobilisation as unimodal interventions. There is low level evidence that a combination of spinal mobilisation and motor control exercises is more effective on pain and activity limitations than separate interventions or a wait-and-see policy. There is low level evidence of the effectiveness of cervical mobilisation with a neurodynamical intent as unimodal intervention, on the effectiveness of a multimodal intervention with neurodynamic intent on pain activity limitations and global perceived effect compared to a wait-and-see policy. There is also low level evidence that a multimodal intervention consisting of spinal and neurodynamic mobilisations and specific exercises is effective on pain in patients with CR. There is low level evidence that traction is no more effective than placebo traction.
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Affiliation(s)
- E. J. Thoomes
- Fysio-Experts Physical Therapy Clinic, Hazerswoude, The Netherlands
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Kaiser U, Deckert S, Kopkow C, Trautmann F, Schmitt J, Sabatowski R. Response to Ruan et al., EJP 2016. Eur J Pain 2016; 20:1545-6. [PMID: 27633812 DOI: 10.1002/ejp.900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2016] [Indexed: 11/06/2022]
Affiliation(s)
- U Kaiser
- Center for Evidence-based Healthcare & Comprehensive Pain Center, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Germany
| | - S Deckert
- Center for Evidence-based Healthcare & Comprehensive Pain Center, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Germany.
| | - C Kopkow
- Center for Evidence-based Healthcare & Comprehensive Pain Center, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Germany
| | - F Trautmann
- Center for Evidence-based Healthcare & Comprehensive Pain Center, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Germany
| | - J Schmitt
- Center for Evidence-based Healthcare & Comprehensive Pain Center, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Germany
| | - R Sabatowski
- Center for Evidence-based Healthcare & Comprehensive Pain Center, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Germany
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Ruan X, Urman R, Kaye A. Comment on Deckert et al.: A systematic review of the outcomes reported in multimodal pain therapy for chronic pain. Eur J Pain 2016; 20:1542-4. [DOI: 10.1002/ejp.930] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2016] [Indexed: 12/29/2022]
Affiliation(s)
- X. Ruan
- Department of Anesthesiology; Louisiana State University Health Science Center; New Orleans LA USA
| | - R.D. Urman
- Department of Anesthesiology; Harvard Medical School; Brigham and Women's Hospital; Boston MA USA
| | - A.D Kaye
- Department of Anesthesiology; Louisiana State University Health Science Center; New Orleans LA USA
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Kaiser U, Neustadt K, Kopkow C, Schmitt J, Sabatowski R. Core Outcome Sets and Multidimensional Assessment Tools for Harmonizing Outcome Measure in Chronic Pain and Back Pain. Healthcare (Basel) 2016; 4:E63. [PMID: 27589816 PMCID: PMC5041064 DOI: 10.3390/healthcare4030063] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 08/15/2016] [Accepted: 08/17/2016] [Indexed: 12/28/2022] Open
Abstract
Core Outcome Sets (COSs) are a set of domains and measurement instruments recommended for application in any clinical trial to ensure comparable outcome assessment (both domains and instruments). COSs are not exclusively recommended for clinical trials, but also for daily record keeping in routine care. There are several COS recommendations considering clinical trials as well as multidimensional assessment tools to support daily record keeping in low back pain. In this article, relevant initiatives will be described, and implications for research in COS development in chronic pain and back pain will be discussed.
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Affiliation(s)
- Ulrike Kaiser
- Comprehensive Pain Center, University Hospital "Carl Gustav Carus", Technical University Dresden, Dresden 01307, Germany.
| | - Katrin Neustadt
- Comprehensive Pain Center, University Hospital "Carl Gustav Carus", Technical University Dresden, Dresden 01307, Germany.
| | - Christian Kopkow
- Center for Evidence-Based Healthcare, Medical Faculty, Technical University Dresden, Dresden 01307, Germany.
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare, Medical Faculty, Technical University Dresden, Dresden 01307, Germany.
| | - Rainer Sabatowski
- Comprehensive Pain Center, University Hospital "Carl Gustav Carus", Technical University Dresden, Dresden 01307, Germany.
- Department of Anesthesiology and Intensive Care, University Hospital "Carl Gustav Carus",Technical University Dresden, Dresden 01307, Germany.
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Schmidt SG. Recognizing potential barriers to setting and achieving effective rehabilitation goals for patients with persistent pain. Physiother Theory Pract 2016; 32:415-26. [DOI: 10.1080/09593985.2016.1194664] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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